Green-Mountain freeman. [volume] (Montpelier, Vt.) 1844-1884, 1881-02-23
What to Do When at a Loss.


Speaking of the recognition of the
forms of disease, DR. S. Weir Mitchell has
used, in one Of his gracefully written
popular articles, the admirable simile that
the faint indications of the nature of a
malsdy are, at its outset, rs if we saw
only the first one or two letters of Il word,
and were seeking to read It all These
initials enable Hs only to classify it under
some wide rubric, not to identify 1t; we
wait hours or a day and other symptoms
arise. We see other letters of the word,
and as one after another is revealed the
import and full meaning of the whole at
len 9Th is disclosed.
But we cannot stand idly by and wait
until our information is complete before
we lend Il helping hand. Something must
be done at once: something useful, benef-
cial, at least not harmful. Many time
does the physician find himself in this
predicament. He sees the case early; he
can form no diagnosis. but he is called
upon to prescribe. Beginners especially
find themselves at loss on such occa-
sions.
Some years ago Dr.. Robert Barnes, of
London, delivered quaint lecture. in
which he faced this difficulty. From his
solid suggestions and from some other
sources, we believe we can advance with
confidence some general rules which will
serve a good turn at a pinch. The first
rule to be adopted is to
Enj0in rest This is good rule; good
for the patient and good for the physician.
The PharmacopBia contains no remedy of
50 much value and of such univer al ap-
plca ion. At the outset Of many acute
complaints rest to the part and to the
system is all that is deman led to insure
recovery, safely, and comfortably. 1t has
also its advantages for the medical at,
tendant. 1t gives him time to observe
leisurely and to watch under favorable
conditions the development of ulterior
symptoms. 1t is obvious, however, that
it is not enough to satisfy the expectations
of the patient, no matter how much it
satisfies all the requirements of the case.
The doctor is expected to giUe something; !;
to administer some of the contents of these
mysterious and attr .ctive bottles and jars
which adorn the shelves of his right hand
man, the apothecary. Barnes rule is,
here
When in doubt, glue saltnes. He wisely
observes that there is hardly any disease
in which salines will not do good in the
beginning What is not less important,
there is hardly any disease in which they
will do harm. They give favorable relief
to general and local congestion, and they
afford time for observation. Moreover,
their variety is great, and their strength
can be adjusted to the demands of the
most delicate cases. The third rule may
be to-
Re icve any organ fttnctionalty disturbed
This, however, requires to be admitted
with some exceptions, and to be carried
out with discretion. For example, it is
not always wise to purge when the
bowles are con>tlpated. On the contrary,
opium may be Indicated, and in ntussucep-
ton. The relief of the organ may often
be brought about with better success by
indirect measures. Thus, an engorged
liver is most promptly relieved by stimulat-
ing the functions of TIE kidneys; and
numerous examples of the kind will occur
to every reader. rhe fourth rule is to
Auoid committing yourself. AS it is
ofen impossible positively to know the
complaint before you, it is equally essen
tia( neither to express decided opinion
nor to let it be seen that you have none.
A mistake male at this moment on either
side will be damaging Those who boast
that they can see through a disease at IA
glance are shallow people and but one
step above those quacks who advertise to
tell the complaint without asking the
p ttient u queslon. Nothing is lost, and
often everything is gained, by thorough,
ness. The soundest physicians are those
who proceed warly. The last and
greatest as we'll rs the Oldest maxim to be
observed is that which We owe to Father
Hippocraes. 1t is to
Do no hlrm. If none of the above
precepts seem applicable to the case he
fore YOU, at any rate take care that you do
nothing to aggravate the condition of
your patient. Recollect that there is at
least grain of truth in the satircal re-
mark quoted bv Mr.. Francis Gillton, in
his /" Art of Travel" to the effect that
there is great difference between good
physician and bad one; but very much
less between good physician and none
at all.
If an observance of the above does not
carry the neophyle through the awkward,
ness of all his first visits, and spare to the
more experienced an occasional attack of
worriment, they will, at least in many in
stances, help him through a slough of
doubt t.-MedicaI and Surgical Reporter.