THE PREVENTIVE SCHEME OF MEDICINE. In this work we have to study first the nature, secondly the canses, and afterwards the prevention of those calamities which afflict mankind, and which have received the title of diseases. The conception that these afflictions can be prevented is of modern times, and indeed we may say practically of the present century, or even of the latter two-thirds of the present century. The idea which came down almost to us who now live was that diseases of every kind were a portion of the necessary sufferings of human existence, sufferings which might by some art, or conjuration or divination, be removed, but which could not be avoided or prevented. For this reason the so-called curative art, the art of relieving or removing diseases, took, naturally, a first place in the course of human progress. This curative art, brilliant in many of its discoveries, useful in many of its applications, and beneficent alike in discovery and application, could not, however, be expected forever to remain the be-all and end-all of human effort against disease. It was wonderful while it combated the unknown and the invisible. But in course of natural development of knowledge the unknown and the invisible passed away, in so far as belief in them was concerned, and there was left on the mind, in place of that belief, the fact that not one of the diseases long thought to be supernatural and out of the range of inquiry as to first causes, was supernatural at all. Each was traceable, by the acquirement of correct knowledge, and, when traceable, was largely and effectively preventible by a further extension of the same acquirement. In this manner has arisen the science and art of preventive medicine. It is not a science, it is not an art separated necessarily or properly from so-called curative medicine. On the contrary, the study of prevention and cure proceed well together, and he is the most perfect sanitarian, and he is the most accomplished and useful physician, who knows most both of the prevention of disease and of the nature and treatment of disease; he who knows, in fact, the before and the after of each striking phenomenon of disease that is presented for his observation. If I were to speak of the progress that has been made in the past thirty years, I should be obliged, in candor, to confess that great losses of time and great injuries to advancement have been caused by the circumstance that the unity of the two labors has not been duly recognized. A few enthusiastic men, devoted almost exclusively to the grand and new instauration of medicine in its preventive character, have, if I may so say, made war on the curative system which has held such long, such undisputed, and such classical sway. They have consequently often been led to speak and write about diseases without any accurate knowledge of the natural history of disease after its birth, and so have inflicted harm on the principles of preventive art. To use an ap propriate simile, they have reasoned on diseases as another school of philosophers might reason on the antecedents of unborn individuals without knowing anything whatever of the natural history, or the natural life, or the natural peculiarity, or the natural termination of the lives of those individuals after they had come into existence. All this has led to unnecessary and often to enthusiastic and extravagant warfare; and it has had the effect of interrupting the order of reformation of thought amongst the representatives of the curative school, who by inheritance have held the study of disease in their hands. These having few treatises of the past, or little wisdom of the past, descending from great and acknowledged masters, to guide them on the subject of the prevention of first or antecedent causes of disease, have held obstinately by their own principles, and have sometimes stoutly resisted what they have conceived to be an ignorant encroachment on their rightful domain. I confess, for my own part, I have had great sympathy with the curative school, in which I was bred, and with which I remain associated too closely ever to be disconnected from it. At the same time the truth must now be candidly admitted, that the system of relieving mankind of its misery and load of disease can no longer rest alone on what is called curative skill. We have en tered an era in which the steady effort must be, not only to cure disease, but to cure cure. The men who have proclaimed the art of prevention, based upon the art of learning the antecedents of the phenomena of disease and the reasons why diseases are developed at all, are right in principle however widely they may sometimes have erred in details of facts and in endeavors after practical attainments for the realizations of which they were not ready, and for many a long day will not be ready. The grand work of this era is to reconcile the two different schools; to systematize the preventive part of medical science, so far as that is now known; to bring the preventive part into entire accord with the remedial; to let the world at large understand the interrelationships which exist between the two parts; and, by a sympathy of action, based on knowledge, to enable every man and woman to assist in that part which tends towards prevention. With the objects here expressed I write this present volume. I have nothing to say in it that has any relation to the cure of diseases. I base it nevertheless on the curative side of medical learning. In other words, I strive to trace the diseases from their actual representation, as they exist before us, in their natural progress after their birth, back to their origin, and, as far as I am able, I try to seek the conditions out of which they spring. Thereupon I endeavor, further, to investigate the conditions, to see how far they are removable, and how far they are avoidable. The success of my effort will turn on the success with which I am able to carry out this analytical and practical design. I may say at once that I know the effort, though it be ever so laborious, cannot be perfect. The wisest of us who look at disease are still like persons watching the progress of a dramatic representation. We see the various characters, we hear them speak, we observe the scenic conditions, we understand the plot and its development; but as yet we are not acquainted with the players, we are not behind the scenes nor conversant with the very simple means by which the most startling effects are often produced. It is my wish to get at all the truth, as far as is possible, in the study of the phenomena of the great tragic drama of disease which is ever being enacted before us. I ask no pardon for apparent or real failure wherever it occurs, because I am sure that frequent failure in this stage of human knowledge is inevitable. At the same time I know, at the outset, that the attempt cannot be laboriously made by any one without securing some success, since by such an attempt the general reader may be led to learn certain facts which will be useful to him as facts, though he cast all generalizations to the winds as learned dust. By such an attempt the critical reader also may be led to go deeper than he has gone, perchance, into a subject worthy of his criticism, and may thereby have the opportunity of giving to the world a good market of his own founded on my imperfections. Lastly, by such an attempt the candid, thoughtful, and original students of nature in the future, -and they are the men and women I would specially win,—may be induced to follow out, with greater knowledge and wisdom than pertains to me, the height of this argument, and from their more commanding position to recast it perfected. |