FIRST-HAND AXD SECOXD-HAND KNOWLEDGE. 199 



diice. In the first order is the pliysiciau who intelligently studies phys- 

 iology, who recognizes in pathology what I would for the moment 

 call an eccentric physiology ; who says to himself when contemjjlating 

 disease : " I here see such and such organs of the body out of order, 

 such and such functions imperfectly performed ; let me try to place 

 these organs at rest, so that they may recover themselves (where 

 recovery is possible) and perform, perhaps, in time their functions as 

 heretofore " ; who appreciates that in pneumonia the tendency is 

 toward recovery when not interfered with, if the patient's strength is 

 so supported that he can tide over the period during which the lung 

 recovers itself ; who sees in typhoid fever the same necessity for sup- 

 port, Avith the additional one of resting the intestine until the ulcera- 

 tion has time to heal ; who, in the case of diseased kidneys, rests these 

 organs by putting their work on to other organs, such as the skin and 

 intestines, and allows no food which requires the special exercise of 

 the kidneys for purposes of elimination. Similar management with 

 other diseased organs. Here knowledge of physiology precedes knowl- 

 edge of disease, and disease means to this physician disorded physiol- 

 ogy. How different from the meddlesome apothecary of not long ago 

 — never easy without he was pouring his medicines into his patient 

 every few hours, having for every symptom a fresh drug Avhich added 

 to his patient's difiiculties, and for every pain some outward applica- 

 tion which increased his discomfort ! Now, his modern counterpart is 

 he who has learned chiefly from books and untrained observation what 

 he knows of disease ; for, please observe, that constantly seeing pa- 

 tients by no means implies that the faculty of accurately observing 

 has been attained, and if this faculty is not acquired by a man early 

 in life he will blunder on into old age. Such a one does much the 

 same as his predecessor in a milder way when his first consideration 

 takes the form of the inquiry, What is a good medicine for this, and 

 what for that ? He knows what will cure something or other, and so 

 prescribes it. So well is what I am saying beginning to be under- 

 stood that the very expression " cure," unless applied Avith a special 

 meaning, as to an aneurism, a hernia, or the like, has become almost 

 offensive, and will ere long be used only by the ignorant and preten- 

 tious. The physician does not pretend to cure his patients ; he places 

 them in the conditions most favorable to recovery, and is thus often 

 the means of averting death and conducting them to health. You 

 must not think that I am underrating the value of -medicines ; a large 

 number of drugs we know well to be most useful and often necessaries 

 in the treatment of disease, but the practice of ordering medicines to 

 every patient who applies for relief is no longer the practice of phy- 

 sicians, although perhaps it may be followed by those who would on 

 occasions be the last to resort to it, if they had the courage of their 

 opinions. But pathology is better understood than it was a few years 

 since, and with a more comi^lete knowledge of morbid processes has 



