THE chief purpose of the study of medicine is to acquire the knowledge
of a safe and effectual method of curing diseases. The attainment of
this end is intimately connected with the public good. Every endeavour
to promote it, therefore, may be considered as having some claim to a
candid examination. In this persuasion, I submit the following
observations to public inspection.
Few diseases are at present more common than _lues venerea_. For its
cure, mercury is a medicine which is almost universally employed; and
the efficacy with which it operates has long been confirmed by
unquestionable experience. But the successful employment of mercury in
this disease requires very particular attention; and it is to be
regreted, that, while many suffer from the distemper, not a few fall
victims to what is used as the remedy: All therefore that has hitherto
been said on this subject by no means supersedes farther attempts to
improvement. To advance the practice of medicine in this particular, is
the intention of the present publication.
Nothing contributes more to safe and effectual practice, than an
acquaintance with those principles on which remedies operate. Hence,
inquiries concerning the operation of medicines have been, and ever will
be, prosecuted by those who mean to practise on a solid or rational
foundation. Many practitioners, indeed, hold every thing that is in the
least theoretical, in great contempt. They alledge, that a physician
possesses all the knowledge requisite in medicine, who is acquainted
with particular remedies which will infallibly cure particular diseases.
Could such remedies be discovered, their reasoning would indeed hold
good; and medicine, which, of all arts, is in reality the most
difficult, would be the easiest. But it is incumbent on those who reason
in this manner, to shew, that any such remedies actually do exist. This,
however, is a point by no means determined; and, with regard to it, very
great doubts may justly be entertained.
With certain limitations, some few such remedies may perhaps be allowed
to exist. But no one will pretend, that these can, in every case, be
employed with equal success; or that, in all circumstances, they are to
be used in the same manner. By a knowledge of the principles upon which
a medicine operates in curing a disease, we can alone be enabled to
accommodate its use to particular circumstances. He therefore who knows,
not only that a certain remedy will cure a particular disease, but is
likewise acquainted with the manner in which it acts in producing that
effect, has at least a double advantage.
Errors in theory, indeed, often mislead in practice; and opinions,
supported by numerous arguments, after being long believed, have at
length been discovered to be without foundation. But this imperfect
state of theory, in place of being any objection to its utility, is an
additional inducement to continue, with unremitting ardour, a pursuit in
which so much still remains to be done. It is by unwearied assiduity
alone that improvement can be expected in any art. The imperfection of
theory, then, can be no argument for discontinuing farther attempts to
render it more perfect.
Theory in medicine is principally despised by two sets of practitioners,
the ignorant and the lazy; the last are unwilling, and the first are
unable, to acquire the knowledge of it; and, amidst all their boasted
contempt, it will be found, that they principally differ from others in
implicitly adopting whatever opinions they first receive. Theory is
natural to the human mind; and those who are accustomed to think cannot
be satisfied without assigning a reason for every phænomenon which falls
under their observation. Theory by no means precludes observations: On
the contrary, it leads to a more minute attention to facts; and in this
way opinions, of themselves ill founded, have often given rise to useful
discoveries in practice. For these reasons, in treating of mercury in
the venereal disease, I have esteemed it necessary to begin with some
observations on its operations.
There are few medicines, with regard to the operation of which all
practitioners are agreed. Mercury, as well as others, has, in this
respect, been a subject of dispute. It is indeed the misfortune of
medicine, that many points of great consequence still remain in a very
doubtful state. But it affords at least some chance of arriving at
truth, that, in the present age, it is never esteemed criminal to differ
even from the highest authorities: On the contrary, those whose
authority should deservedly have the greatest weight, are unwilling that
any farther deference should be paid to their opinion than arises from
conviction. He therefore who imagines, that an ill-grounded opinion is
generally received, has nothing to restrain him from a candid inquiry.
But arguments adduced in favour of any opinion will have little weight,
if another be previously received as true. To ensure therefore a fair
examination, it is, in the first place, requisite to remove
prepossession. These remarks will sufficiently account for the attention
I have here bestowed in attempting to refute an opinion different from
that which I endeavour to establish.
It is an opinion taught, and at this place very generally received, with
regard to the operation of mercury, that the good effects it produces,
in the cure of _lues venerea_, are to be ascribed to the evacuation
which it occasions. After attentively examining this hypothesis, I
cannot help thinking that it is ill founded. Notwithstanding, therefore,
the authority by which it is supported, I have, with freedom, stated
what to me seem strong objections against it.
After having endeavoured to overturn one hypothesis, I have attempted to
establish another. The opinion I support is by no means new. The honour
of invention therefore must be totally resigned to others; but the
praise of broaching novelties is always to be relinquished when it comes
in competition with the support of truth; and I should consider myself
as having done a great deal, were I able to give satisfactory evidence
of any important but doubtful point.
After this inquiry concerning the operation of mercury in the venereal
disease, I next proceed to make some observations with regard to its
use.
Mercury has been employed in the cure of the venereal disease in a great
variety of forms. Most of these, upon their first introduction into
practice, have been extolled as the safest and most effectual method of
using it in every case. Experience, however, sufficiently demonstrates,
that this holds with regard to no mercurial preparation hitherto
discovered. Whether such a preparation may yet be discovered, is
difficult to say. In this treatise, I have not proposed any mercurial
which was not formerly in use. But if, on the one hand, I have no title
to lay claim to the merit of a discovery, I cannot, on the other, be
charged with being the first proposer of any dangerous practice.
In treating of the use of mercurials in _lues venerea_, my aim has been
different from that of most authors. What I have principally had in
view, is not so much to recommend any particular preparation, as to
determine the comparative advantages of some of the most effectual ones
at present in common use. I have likewise endeavoured to point out those
circumstances to which each is best adapted. To this I have subjoined
the principal cautions to be observed in the employment of mercurials;
those more especially which respect the nature of the medicine, the
condition of the patient, and the necessary regimen.
On these subjects, a good collection of observations would
unquestionably be of the highest utility. How far I have succeeded, must
be left to others to determine. To those who imagine I have not
altogether failed, I need offer no excuse for having published. To those
who are of a contrary opinion, it will be sufficient to observe, that
every attempt to be serviceable should apologise for itself.
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