PREFACE. FACTA PRESTANTIORA VERBIS. THE LECTURES which form the basis of this work were delivered at the Royal College of Physicians in the spring of last year. Since this time I have, as leisure has permitted me, enlarged my observations, and extended them to the active constituents of Opium, each of which has been examined in detail, alone and in combination with Belladonna. The question of the antagonism of Opium and Belladonna, which has assumed a very serious and important phase, has been fully examined. My object throughout has been to ascertain, clearly and definitely, the action of the drugs employed on the healthy body in medicinal doses, from the smallest to the largest; to deduce simple practical conclusions from the facts observed; and then to apply the drug to the relief of the particular conditions to which its action appeared suited. Observations on the lower animals have been as carefully noted as those on man, and my labours have in this respect been amply rewarded; for I find, generally, that for every variation in the effects of a particular drug on man, we may expect to see its exact counterpart in some one or other of the lower animals. It appears, indeed, that the effects which result from a given action. depend, primarily, on the specific development of the nervous system; and, secondarily, on individual peculiarity. Many and varied as the effects of the action of a particular medicine often are, they constitute but one connected series, the members of which are reciprocally complementary. It follows that carefully-observed experiments on the animal series will elicit the whole of the phenomena which may result from the action of the same drug in different individuals of the human species. And in order, therefore, to obtain a complete view of these, we must subject the medicine to the analytical action of that variety of nervous system which characterises the different species of animals. Much time and labour has been expended in laying before the reader observations followed throughout from the beginning to the end of the action of a given dose; and my first endeavour has been to present to the mind, not only the particular effects in the order of their sequence, but also those more general features which convey, as well as imperfect words may do, impressions of the actual condition of the individual subjected to the influence of the drug. Tedious detail and some repetition may have resulted from this endeavour, but such defects are trivial in comparison of insufficiency in the evidence adduced. The study of the action of medicines is more difficult than any other, inasmuch as the conditions are more complex. To gain any knowledge in this direction, the disturbing causes must be eliminated, and the question otherwise reduced to its simplest terms. To recognise and eliminate the disturbing agencies which modify a given effect, is a process much more. difficult than to deduce conclusions from any number of simple facts. The main difficulties, indeed, of therapeutical enquiry lie in correct observation: there are errors to be eliminated, or variations to be accounted for, in the drug itself; while the peculiarity of nervous constitution or idiosyncrasy, the conditions of health and disease, and every variety of external agencies, all interpose disturbances, the value of which in each case it is difficult to estimate. In questions relating to the action of medicines, medical men often betray a want of intelligence as great as that of those who have no special knowledge of the subject. We ask each other to believe statements dependent on the slenderest proofs, and sometimes without proof at all, or even when it points in the opposite direction. Impatient to observe, we satisfy ourselves with general impressions, which, taking the place of logical inferences from carefully-observed facts, ultimately become deeply-rooted convictions. These to other minds are unsatisfactory, and engender at first difficulty, then doubt, indifference, and scepticism. Medicine is proportionately degraded, and the treatment of disease is changed according to fashion. In the present day, the use of secret nostrums is openly sanctioned and adopted. Patients are allowed to drug themselves to death with anodynes and narcotics. The profession includes numbers of men who, if they have faith in their practice, evince an ignorance discreditable to an Anglo-Saxon Leech, and who, if they have not, are the basest of charlatans. Medicine appeals to her honest followers, to maintain the dignity of science and the purity of truth; and if we would answer her appeal, we must avoid hasty conclusions, and patiently study those slighter variations and less obtrusive phenomena, of which the more general and obvious effects are compounded. Our first impressions on entering the wilderness of therapeutical enquiry must indeed be discouraging, and the prospect of reducing anything to order, at first sight, hopeless. A lifetime will seem too short to effect any change, and we shall be inclined to turn back. But let us shut out the desert and the jungle from our view, and turn to the nearest object. Let us clear away the suffocating undergrowth from about it, denude it of the tangled climbers that conceal its trunk, and the moss which covers its branches. Let us lop off the parasites that deform it, and the foreign branches, it may be, which some previous hand has engrafted, and, thus isolated and reduced to its natural simplicity, let us choose it as the special object of our study and care. Life may be long enough to know this single individual; and if we each one effect so much, what. is now an uncultivated wild, with scarcely one well-ordered patch to rest the eyes upon, will soon show signs of culture; and with continued labour become in future generations a fair garden -a health resort-where, with simple directions, we may send our patients to cull the good gifts which a Beneficent Hand has planted and purposed for the relief of the thousand ills that flesh is heir to.' 78 UPPER BERKELEY STREET, PORTMAN SQUARE, W. January 1869. |