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athartics； sometimes in that of opiates。 I have been told by an intelligent practitioner in a Western town； that the constant prescription of opiates by certain physicians in his vicinity has rendered the habitual use of that drug in all that region very prevalent； more common； I should think； than alcoholic drunkenness in the most intemperate localities of which I have known anything。 A frightful endemic demoralization betrays itself in the frequency with which the haggard features and drooping shoulders of the opium…drunkards are met with in the streets。
The next proposition I would ask you to consider is this： The presumption always is that every noxious agent； including medicines proper； which hurts a well man； hurts a sick one。 ＇ Note B。＇
Let me illustrate this proposition before you decide upon it。 If it were known that a prize…fighter were to have a drastic purgative administered two or three days before a contest； or a large blister applied to his back； no one will question that it would affect the betting on his side unfavorably； we will say to the amount of five per cent。 Now the drain upon the resources of the system produced in such a case must be at its minimum； for the subject is a powerful man； in the prime of life； and in admirable condition。 If the drug or the blister takes five per cent。 from his force of resistance； it will take at least as large a fraction from any invalid。 But this invalid has to fight a champion who strikes hard but cannot be hit in return； who will press him sharply for breath； but will never pant himself while the wind can whistle through his fleshless ribs。 The suffering combatant is liable to want all his stamina； and five per cent。 may lose him the battle。
All noxious agents； all appliances which are not natural food or stimuli； all medicines proper； cost a patient； on the average； five per cent。 of his vital force； let us say。 Twenty times as much waste of force produced by any of them； that is； would exactly kill him； nothing less than kill him； and nothing more。 If this； or something like this； is true； then all these medications are； prima facie； injurious。
In the game of Life…or…Death； Rouge et Noir； as played between the Doctor and the Sexton； this five per cent。； this certain small injury entering into the chances is clearly the sexton's perquisite for keeping the green table； over which the game is played； and where he hoards up his gains。 Suppose a blister to diminish a man's pain； effusion or dyspnoea to the saving of twenty per cent。 in vital force； his profit from it is fifteen； in that case； for it always hurts him five to begin with； according to our previous assumption。
Presumptions are of vast importance in medicine； as in law。 A man is presumed innocent until he is proved guilty。 A medicinethat is； a noxious agent； like a blister； a seton； an emetic； or a cathartic should always be presumed to be hurtful。 It always is directly hurtful； it may sometimes be indirectly beneficial。 If this presumption were established； and disease always assumed to be the innocent victim of circumstances； and not punishable by medicines； that is； noxious agents； or poisons； until the contrary was shown； we should not so frequently hear the remark commonly； perhaps erroneously； attributed to Sir Astley Cooper； but often repeated by sensible persons； that； on the whole； more harm than good is done by medication。 Throw out opium； which the Creator himself seems to prescribe； for we often see the scarlet poppy growing in the cornfields； as if it were foreseen that wherever there is hunger to be fed there must also be pain to be soothed； throw out a few specifics which our art did not discover； and is hardly needed to apply ＇ Note C。＇； throw out wine； which is a food； and the vapors which produce the miracle of anaesthesia； and I firmly believe that if the whole materia medica； as now used； could be sunk to the bottom of the sea； it would be all the better for mankind；and all the worse for the fishes。
But to justify this proposition； I must add that the injuries inflicted by over…medication are to a great extent masked by disease。 Dr。 Hooker believes that the typhus syncopatia of a preceding generation in New England 〃was often in fact a brandy and opium disease。〃 How is a physician to distinguish the irritation produced by his blister from that caused by the inflammation it was meant to cure？ How can he tell the exhaustion produced by his evacuants from the collapse belonging to the disease they were meant to remove？
Lastly； medication without insuring favorable hygienic conditions is like amputation without ligatures。 I had a chance to learn this well of old； when physician to the Broad Street district of the Boston Dispensary。 There； there was no help for the utter want of wholesome conditions； and if anybody got well under my care； it must have been in virtue of the rough…and…tumble constitution which emerges from the struggle for life in the street gutters； rather than by the aid of my prescriptions。
But if the materia medica were lost overboard； how much more pains would be taken in ordering all the circumstances surrounding the patient （as can be done everywhere out of the crowded pauper districts）； than are taken now by too many who think they do their duty and earn their money when they write a recipe for a patient left in an atmosphere of domestic malaria； or to the most negligent kind of nursing！ I confess that I should think my chance of recovery from illness less with Hippocrates for my physician and Mrs。 Gamp for my nurse； than if I were in the hands of Hahnemann himself； with Florence Nightingale or good Rebecca Taylor to care for me。
If I am right in maintaining that the presumption is always against the use of noxious agents in disease； and if any whom I might influence should adopt this as a principle of practice； they will often find themselves embarrassed by the imperative demand of patients and their friends for such agents where a case is not made out against this standing presumption。 I must be permitted to say； that I think the French； a not wholly uncivilized people； are in advance of the English and ourselves in the art of prescribing for the sick without hurting them。 And I do confess that I think their varied ptisans and syrups are as much preferable to the mineral regimen of bug…poison and ratsbane； so long in favor on the other side of the Channel； as their art of preparing food for the table to the rude cookery of those hard…feeding and much…dosing islanders。 We want a reorganized cuisine of invalidism perhaps as much as the culinary； reform； for which our lyceum lecturers； and others who live much at hotels and taverns； are so urgent。 Will you think I am disrespectful if I ask whether； even in Massachusetts； a dose of calomel is not sometimes given by a physician on the same principle as that upon which a landlord occasionally prescribes bacon and eggs；because he cannot think of anything else quite so handy？ I leave my suggestion of borrowing a hint from French practice to your mature consideration。
I may； however； call your attention； briefly； to the singular fact； that English and American practitioners are ap