152 
GROUNDS OF BELIEF IN THE VALUE OF MEDICINES. 
Sir William leaner, in an address delivered before the Annual Meeting of the British 
Medical Association at Leeds, made the following remarks on the use of medicines in 
the treatment of disease:—There are special reasons why the members of our profession, 
the practitioners of medicine, should, from time to time, sum up the gams which medi¬ 
cine has been making as a practical art. For in the daily practice of our profession so 
much occurs to damp our spirits; so many cases of difficulty arise m which the remedies 
of our art are doubtful • so many cases in which the practical difficulties in the way of 
diagnosis are insuperable; and so many cases in which, the diagnosis being clear, we 
know that we are impotent to cure; so many cases in regard to which our apparently 
well-founded expectations of effecting a cure prove vain, that even the most hopefully 
minded must be permitted to doubt if medicine be advancing as a practical art. Many 
entertain scepticism as to the value of medicine as an art, and especially as to the 
remedial power of drugs. “ I trust you will not cast a doubt on the efficacy of medi¬ 
cine ” said a distinguished member of our profession. “ They don’t believe much in 
drugs at this hospital,” wrote a reporter to one of our medical journals I desire to re¬ 
pudiate scepticism in regard to medicine. I believe as confidently in the power of the 
physician to treat disease successfully as I did when clinical clerk to one of the first 
practical physicians of his day. Extended knowledge and accumulated experience have 
only increased my confidence in the remedial powers of our art. Nor do I believe that 
others upon whom the imputation of scepticism has been cast are less firm believers than 
myself in the value of treatment. Modern research has shown that a large number of 
acute diseases occurring in previously sound persons, have a tendency to terminate in 
the suspension of health even although no drug be given. This is fact—knowledge— 
not scepticism. Modern observation has also shown certain acute diseases, formerly 
supposed to be of indefinite duration, run a definite course,—that is, end spontaneous at 
a certain date from their outset; and therefore the conclusions as to the efficacy of drugs 
to cut short these diseases—conclusions drawn before their definite duration was known 
_were founded upon false premises, and consequently were not trustworthy. All this 
is surely fact—knowledge—not scepticism. Again, advances in knowledge have fre¬ 
quently been attended by a more correct appreciation of the mode of action by drugs; 
and the expression of this has not uufrequently been most erroneously taken as an evi¬ 
dence of scepticism. Thus, if I believe that saline aperients do not act as I formerly 
supposed they did, namely, by increasing the escape of watery matter from the radicles 
of the portal vein, I am not in the least shaken in my belief that the symptoms which 
I attribute to over-distention of the portal vein are relieved by their action; or that their 
action is followed by a disappearance of watery fluid from the peritoneal cavity and from 
the cellular tissue. Again, if it should be considered, as proved by experiments on dogs, 
that mercurials did not produce increased secretion of bile in man, it would not throw 
doubt on the establishment of a great flow of a yellowish-green coloured fluid from the 
bowel after the administration of a mercurial to man, and the relief of many depressing 
symptoms which follows. A man’s bilious headache, as it is termed, would be none the 
less certainly cured by mercurial treatment, even though it should be shown to the satis¬ 
faction of the whole profession that mercury does not increase the secreting power of the 
liver. Our mode of explaining certain effects in curative medicine would be changed, 
but not the facts themselves. My conclusion then is, that although with regard to the 
virtues of this or that particular drug, and the mode of action of this or that particular 
class of remedies, there is, no doubt, and always will be, difference of opinion—the evi¬ 
dence that satisfies A. being insufficient, from the constitution of his mind, to satisfy 
B —yet with regard to the value of drugs in the abstract, and the value of treatment, 
there is really little difference of opinion amongst physicians well informed as to the 
present state of medical knowledge, and of equal experience in practice. I say amongst 
men equally well informed: let me illustrate my meaning. I was one of three who met 
in consultation concerning a case of apoplexy. In the opinion of one of my colleagues, 
the only treatment to be adopted was as follows, namely, to place the patient in a re¬ 
cumbent position, with the bead and shoulders raised; to enforce absolute rest; to keep 
the bowels so far loose as to prevent straining; to apply cooling substances to the head in 
the event of heat of the part occurring; and to support the patient with light nutritive 
food having regard to his habits. The third gentleman protested against the modern 
