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Holmes, Oliver Wendell, 1809-1894

"Medical Essays, 1842-1882"

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 medicine--that 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.


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