Those who boast of the certainty and perspicacity of instinct - those who wish that man, in imitation of animals, followed only his appetites in health and disease ; have never
reflected on the daily and often fatal errors of the appetites uncontrolled. It will suffice to give them some examples to unprejudice their minds, and convince the reader, that the lights of experience are less faulty than our instinctive tastes, especially among the sick.
1. Let a traveler, after a long walk under an ardent sun, covered with dust and sweat, and dying of thirst, come to the side of a cool and limpid spring; instinct would lead him to take long, deep draughts of its waters; but woe to him if he does not resist the temptation. It is not necessary in this place, to recall the example of Alexander the Great, arrested in the midst of his triumphant career, for having yielded to a similar temptation, to bathe in the waves of the Cydnus. No one reaches the years of discretion, without knowing, either by personal experience, or the hearsay of others, how dangerous such conduct is. and how fatal it has been in many instances.
2. A miserable shipwrecked sailor, who has endured the torment of hunger for many days, is finally rescued by a vessel fully provisioned. Do you suppose that the commander of that ship, would allow him to eat and drink to full satisfaction ? No, certainly, for it would cause the speedy death of the unfortunate sufferer ; the blind and imperious cravings of his appetite, would permit only a partial gratification.
3. A woman in labor, is attacked either with hemorrhage, or convulsions, or her child has a bad presentation. Would you abandon this accouchement entirely to the resources of nature ? There is much reason to fear, that under such circumstances, the mother or the child, or even both would succumb, if Art comes not to their relief ; but by a simple and painless maneuver, the skillful accoucheur will, in most cases, save the lives of both.
4. Let an individual be attacked with an intermittent fever ; instinct suggests to him to employ much covering, during the cold stage, and cast it off during the fever ; and quench his burning thirst with copious draughts of water. The paroxysm passed, he resumes his ordinary life without any precaution, because he is sensible of no change in his condition, except a slight diminution of strength and appetite. During each paroxysm, his instinct suggests only a repetition of the same acts. Now what will be the result ?
If the attack is mild, the climate healthy, and the patient have a "good constitution, he will recover by the efforts of nature alone, after a few repetitions of the paroxysm ; but in most cases, one or more of these favorable conditions are wanting, then the scene is changed, and the results are very different. Sometimes the subject succumbs in a few days ; at others, the fever assumes a remitting type, and goes on indefinitely, producing at length, visceral congestions, chronic inflammations, and incurable degeneration of organs; in fine, in cases less severe, the subject has a slow convalescence, and is for a long time, incapable of active labor. Thanks to the progress of science, these sort of affections, formerly so common and disastrous, are now rarer, and much less formidable.
5. A man has a luxation of his arm, or a fracture of his leg; what does his instinct counsel ? To keep it in such repose, as prevents any movement of the injured member, because the slightest motion excites severe pain ; but experience teaches us, that unless he will submit to the momentary increase of pain, which the manipulations of his surgeon will cause in his efforts to adjust it, he will infallibly loose the use of his member, and very probably too, endure a great amount of subsequent suffering.
In a multitude of cases more, it could be shown that the suggestions of instinct arc faulty and pernicious. After having proved a thousand times the danger of following so untrue a guide, a surer method was sought in the lessons of experience.
The first discoveries that were made on this plan, appeared so admirable and useful, that they were conceived to be a divine inspiration, and those who were regarded as the inventors and propagators, received divine honors. Thus we see, there was a real progress, an efficient amelioration, by adding the lights of experience to the brute suggestions of instinct-in passing from the state of simple nature, to that of the commencement of medical science. It belonged to history and medical philosophy to establish this fact, which sanctions and justifies these early efforts of the race, to lay the foundation of the Healing Art. Thus a serious examination, refutes the eloquent declamations of those philosophers who propose to us, to make the animals our models ; proclaiming continually the unfailing sagacity of instinct ; and so, also, is swept away the apparent wisdom of the following words of J. J. Rousseau, put in the mouth of his pupil ; " If I become sick," says Emilius, in a letter to Sophia, "a very rare circumstance in a man of my temperament, who indulges in no excess of food or care, or labor or rest, do not torment me with efforts to cure me, nor frighten me to death. The young animal that is sick, rests in one place, gets well, or dies: I would do likewise, and I should be the better by it." (Traité de l'Education. 2de Lettre d'Emile a Sophie)
The grave philosopher of Geneva had never reflected, it is reasonable to suppose, on the serious inconveniences of that method, in an infinite number of cases ; among those cited above, there are several in which it would have been fatal.
To his authority, we are able to oppose that of another philosopher, who was his contemporary, and no less celebrated than himself. "It is admitted," says Voltaire, "that a good physician may save our lives in a hundred cases, and restore to us the use of our members. A man falls with apoplexy : it will not be a captain of infantry, nor a counselor of state that will cure him; cataracts form in my eyes: my neighbor can not remove them. I make no distinction here between the physician and the surgeon ; the two professions have been inseparable for a long time. Men who would occupy themselves with studies and efforts to give health to other men, from the sole principles of humanity, should be considered far above the grand of the world ; they were kindred to divinity. To preserve and repair, is nearly as admirable as to create. The Roman people were satisfied to remain five hundred years without physicians. That people only occupied themselves with killing, and made no efforts to save life. What became of those who had a putrid fever, an anal fistula, a carbuncle, or an inflammation of the lungs? They died.(Dictionnaire Philosophique)
But the greater number of the detractors of Medicine, do not deny in an absolute manner, the utility of the Art, in a thousand instances ; they do not contest, for example, the utility of certain surgical operations, nor the regimen in acute diseases; but they reject in general, scientific Medicine, Medicine as an Art. Thus the elder Cato pursued with his ordinary obstinacy, the philosophers, rhetoricians and physicians of Greece, whom he accused of corrupting the manners of the Romans, and he finally succeeded in obtaining a decree for their expulsion ; but not- withstanding all his efforts, the physicians were excepted in the decree. This same Cato wrote a work on domestic and veterinary Medicine ; he treated the men of his household and his animals with remedies prepared by his own hands, and report says, that his wife fell a victim to his prejudices in Medicine. The encyclopedist Pliny, who wrote a materia medica entirely drawn from Greek authors, did not dissimulate any more, the sentiment of profound jealousy that he felt, on account of the superiority of that nation in science and letters. He declaimed against foreign physicians with a blind violence, that led him even to proscribe the use of exotic plants.
At this point naturally belongs the relation of an anecdote, which I once heard told of an old doctor, which I will endeavor to state in his own words. "I was one day," says the worthy practitioner, "at the house of one of my patients, who had recovered from a rather severe attack of illness, when an inhabitant of the neighborhood, who had lately come from Paris, called to pay him a visit. After the first compliments the conversation fell, as is usual in such cases, on medicine and physicians. ' As for me,' said the provincial, ' I have no faith in Medicine ;
I believe that one would recover just as well without, as with it. But then. I have never had a serious attack of sickness.' Your incredulity, then. I replied, arises from that condition, and you will do well to maintain it. I speak only for myself,' added our provincial, 'for, as to others, I am the first to administer remedies to them. As I dwell in the country, far from the residence of all physicians, I have in my house a little pharmacy, which I am careful to keep supplied, and when one of my family or a neighbor falls sick, I always give them the first aid ; and often I effect a cure, before the arrival of the doctor.' But then, said I, you do prepare some medicines, and probably have some little faith in them. ' Oh, doubtless, said the countryman, I have faith in my medicines, because they are so very simple and natural, as I employ neither strong remedies nor instruments.' "
What difference then is there, between the practice of Cato, the censor ; of Pliny the naturalist ; of our rustic citizen, and that of the physicians of their times ; or to speak more generally, what difference is there between the practice of laymen, and that of men of science? This only : the former are ignorant and timid; the latter are relatively more enlightened, firmer, and consequently more efficacious.
There is another class of unbelievers in Medicine whom we should pity more than blame ; I mean those persons who are suffering from incurable diseases, and have exhausted all the resources of cotemporaneous science, without obtaining any notable advantage. Such was the case with our skeptic Montaigne, who, afflicted with a urinary calculus, at an epoch, when surgery, impotent by ignorance, dared not attempt the operation of Lithotomy, gave vent to his spite in epigrams against the Art. Alas, whatever may be done, whatever perfection this Art may attain, there are, and there always will be, cases in which its aid will be inefficacious, and then the patient who demands of us relief for his suffering, who asks of us life, however inexorable may be the law which condemns him to suffer and to die, seeing the impossibility of our aiding him, will accuse us of this inevitable result ; and will declaim against us, unless he be endowed with a lofty philosophy, or profound resignation.
From History of Medicine by P.V. Renouard M.D.
