FOOTNOTES:
[29] Hunter in one of his lectures thus speaks playfully, but most truthfully of the various theories of digestion, which have arisen from exclusive views of different sets of facts. “Some physiologists will have it that the stomach is a mill;—others, that it is a fermenting vat;—others again, that it is a stew-pan; but in my view of the matter, it is neither a mill, a fermenting vat, nor a stew-pan—but a Stomach, gentleman, a stomach.”
[30] If this be a suitable charge for this operation, it would be proper to ask at least an hundred dollars for extracting a tooth, if the prices of operations are to be regulated by their magnitude, or by the amount of skill required in performing them.
[31] ‘Have you ever looked into Homœopathy,—have you ever read Hahneman’s Organon?’ said an eminent divine to an equally eminent physician. ‘No,’ replied the physician, ‘and let me ask you, in return, if you have read the Mormon Bible?’ The clergyman of course answered in the negative, and his medical friend said to him very properly, ‘when you take the trouble to examine Joe Smith’s Bible, I will take the trouble to examine Hahneman’s Organon.’
[32] An Essay on the Philosophy of Medical Science.
[33] The reader will permit the author to gratify his own feelings of regard for Dr. Hale as a man, as well as a physician, by inserting here the following extract from the memoir of him, from the pen of Dr. Channing. “Dr. Hale was an honest man. He was honest in sentiment and in purpose. He had little or no tolerance for what he thought unfair; and any believed misuse or abuse of trusts he resolutely opposed, however active or however strong was the agency by which the wrong was attempted to be consummated. These were not the elements of popularity. You could hardly make a very popular man out of such. But for the honor and exceeding praise of humanity, there are men who have found something better worth living for than the present fame—men who are happy and satisfied to do that which may live after them, and the memory and the use of which can only be for good. Dr. Hale enjoyed life—the best thank-offering for living. He was social and hospitable, for he would contribute to the pleasure of others, as well as his own. He was always cheerful, because he was truly hopeful. He looked on the bright side of disease in himself and in others; and if he labored so well for their recovery, he never questioned his own.
Dr. Hale was a religious man. In the development of the religious sentiment was his power. It was kept active by habitual, daily devotion. It influenced his whole life, making him an earnest student and a faithful practitioner—giving him strong interest in all wise effort to extend Christianity in distant lands, and by his example recommending to others the religious life. In his religion was his benevolence, which with very narrow fortune led him to attempt and to accomplish most important objects. In this was his cheerfulness in suffering and all trial; and out of his religion came the peace and the hope of his death hour.”
CHAPTER X.
POPULAR ESTIMATES OF PHYSICIANS.
There is no class of men whose talents and attainments are so erroneously estimated by the public as are those of physicians. Some of the causes of this erroneous estimate have been brought to view in the chapters on the Uncertainty of Medicine, and on Good and Bad Practice. I propose in this chapter to treat of this subject more distinctly, to point out some other causes operating with those which I have already mentioned, to show the results of this false estimate of medical character and attainments, and to develope some plain principles, on which a correct estimate may for the most part be secured.
I presume it is sufficiently clear to the reader, from the views which I have before presented, that the community cannot judge with any degree of correctness directly, of the practice of physicians,—either of the truth of the principles on which it is based, or of its actual results.
How then shall the community judge of physicians? This question I will endeavor to answer.
The view which I gave, in the first chapter, of the uncertainty of medicine, I trust, made it obvious to the reader, that a thorough education is pre-eminently necessary to the proper practice of the medical art. In endeavoring therefore to form an estimate of the qualifications of any physician, let the evidence of his having obtained such an education be well considered.
But what is this evidence? Is it to be found in the bare fact that he has a diploma, obtained from some respectable medical institution? While a diploma is worth something as evidence, as there must be some improvement of the means of education, in order to pass the examination requisite to obtain it; yet it must necessarily be defective evidence. That the truth may be more fully ascertained, let the inquiry be made, how far the physician has improved the advantages he has had; for it must be remembered, that it is especially true of medicine, that a diligent and wise use of limited opportunities will impart more knowledge and skill, than can be acquired by a careless and unwise use of the most extensive advantages afforded by the profession.
I will allow that there are difficulties in the way of arriving at the truth in this inquiry, and the public are often most grossly deceived by the parade which is made by some physicians, in regard to the opportunities which they have enjoyed. Still, I apprehend, that the erroneous judgment of the public in regard to such cases, arises from a too ready confidence in mere pretensions, and that it can be avoided for the most part by a little more pains-taking in making the inquiry, and by applying tests of another character, to which I shall soon allude.
But education in the science of medicine is practically despised by quite a large portion of the community. Though this sentiment is not often distinctly avowed, yet it exists to a greater extent than is generally supposed. It shows itself in an indifference to the true evidences of a physician’s qualifications, and in a readiness to put the quack on a level with the thoroughly-educated physician, or even above him. These indications of the prevalence of this sentiment, are not confined to the ignorant; but they often appear among the well informed, and even the learned.
Sometimes this sentiment is boldly avowed in language like the following: ‘I care little about the evidence of a physician’s having had an education. The fact that he is successful in treating disease is worth vastly more than a piece of parchment. Many a man has risen to eminence in other professions by his own exertions, without any great amount of education; and why should not this be the case in the practice of medicine? There was Franklin, who rose by his own efforts to a post of honor and usefulness far above multitudes of his cotemporaries, who had a most finished education; and why should there not be Franklins in medicine, as well as in other departments of knowledge?’
The assertion, that success in curing disease is worth more than a piece of parchment, is strictly true. But the evidences, on which a correct estimate of success can be formed, are not ordinarily, as the reader has seen in the chapter on Good and Bad Practice, within the reach of the community; and the attempts which it makes to form an estimate from the defective evidence at its command, often result in the bestowment of the praise due to success upon those who are really unsuccessful.
As to the use which is made of so great a name as that of Franklin to justify a disregard of education in medicine, I remark, that those who hold such language forget three very plain truths. 1st. That self-education is, after all that can be said, education. It is education acquired in spite of difficulties, and without the aids which men usually have. 2d. That education thus obtained indicates the possession of uncommon power of mind. There are but few Franklins in any profession. It is not common for men to rise to eminence with the small means which he enjoyed, and in face of the difficulties which he encountered. 3d. That Franklin, and all those men who have thus risen to eminence, so far from despising education, made most diligent use of all the means of education which they could command, aspiring all the time to higher and higher advantages; and while they lamented the deficiencies of their own early training, they labored most assiduously to give to others the most extensive means of acquiring knowledge. Very different from this, I cannot avoid remarking in this connexion, is the spirit of those pretenders in medicine, who affect to despise education, and who claim that they have an innate skill, which education can neither impart nor improve.
I shall in another chapter maintain, that it is both the duty and the interest of the community, to demand that there shall be a respectable standard of education in the medical profession, and will therefore dismiss this topic for the present.
The second source of evidence, in regard to the qualifications of a physician, is to be found in the unbiassed opinion of his medical brethren. I allow that there are difficulties in the way of obtaining such an opinion. There is, on the one hand, the prejudice of rivalry, and, on the other, the partiality arising from mutual interest. Sometimes these influences extend beyond the individual, and arrange medical men in small parties, or cliques; and these often render it exceedingly difficult to discover the standing which any physician has among his brethren. Yet it is true, that every physician has a general estimate put upon him by the profession, and it is commonly a correct one. And this estimate can ordinarily be ascertained by any one, who makes due allowance for the influences to which I have alluded.
While this strictly professional reputation, which is awarded to every physician by his brethren, is commonly very nearly correspondent with his true merits, that which the public awards to him may be far otherwise. It is often the case, that, while a physician, of whom his brethren have an exalted opinion, meets with but little favor from the community; another, who is a very ordinary practitioner, and who is so considered by the profession at large, has an extensive practice, and a high popular reputation. Such a physician may be treated with much outward deference by his medical brethren, on account of the position in which the public favor has placed him; and this is often very erroneously considered as evidence, that he is held in great estimation by the members of the profession generally.
I pass now to the consideration of a means of estimating the qualifications of physicians, which is of a more practical character, and more certain in its results, than those which I have already mentioned. And yet it is one which has been very generally neglected, for reasons which I shall give in a future stage of my remarks.
There are certain mental qualities, which are essential to the possession of skill in the practice of medicine. Whoever is found to possess these qualities, you may be sure, will with proper education make a good physician. And if they are wanting in any one, no education, nor experience can supply the deficiency. He never can be truly skilful as a physician; and if such an one acquire a reputation for skill, which is no uncommon thing, all that we can say is, that the public are deceived in their estimate of his qualifications.
How then can an intelligent man discover, whether a physician has these requisite mental qualities, and to what extent he has them? What tests can he apply to bring them out, so that he can see them distinctly, and measure them with any good degree of accuracy?
The science of medicine is so much a mystery to the common observer, that he cannot, as you have already seen, apply his tests to a direct examination of the physician’s knowledge. He is not competent to make the estimate in this way; and if he is not aware of this, he will certainly be deceived. If he wishes effectually to avoid error, he must apply a touchstone which he himself understands, and not one of which he is profoundly ignorant. What is this touchstone? Plainly this. Let him observe the mental qualities of the physician, as they are exhibited in regard to any subject, with which he is himself familiar in common with the physician; and he has here a test upon which he may rely with absolute certainty. He discovers in this way the character of the physician’s mind; and it is just to infer that the mental qualities thus laid open to view, stamp their impress upon the practice of his profession, and give to it its character. No change comes over his mind when he passes from other subjects to that of medicine. The same mental powers are there, and he will observe, think reason, and act, just as you have seen him do in regard to common subjects.
Take an illustration from surgery. You see a surgeon set a fractured limb. You cannot judge whether he does it skilfully, because you do not understand how it should be done, so as to bring the broken ends accurately together, and keep them so. But if that surgeon, in passing your house, by some accident breaks the thill of his carriage, you can watch him as he splices the thill, and you can judge, for you are competent to do so, whether he exhibits mechanical talent in the operation. If he does, you can safely infer that the same mechanical talent will be brought into exercise in setting a bone, and that he will set it as skilfully as he spliced the thill. Other talents in a medical man can be tested in a similar manner.
The truth, of which I have given this single illustration, is so obvious when plainly stated that it hardly needs to be dwelt upon at all; and yet, it is so often disregarded by the community, in the estimates which are made of physicians, that it may be profitable to illustrate it somewhat at large. In doing this we shall accomplish another important purpose—we shall obtain a clear view of those qualities which are most necessary in the particular calling of a physician.
Let us then cursorily notice some prominent characteristics, as they are seen in physicians in your daily intercourse with them on common subjects, and apply the criterion which we have under consideration.
Look at the mode in which physicians form their opinions.
You discover in your conversations with a physician upon politics, religion, or the occurrences of the day, that he is very credulous. Have you a doubt that the same credulity follows him into a sick room, and mars the accuracy of his observations of disease and of the influence of remedies? And so, on the other hand, the physician who shows a sceptical cast of mind on other subjects, will assuredly be a doubter on a subject clothed with so much uncertainty as medicine is, and his treatment of disease will be marked by hesitation and lack of energy and firmness.
You see a physician apt to form his opinions on ordinary subjects hastily. Slight evidence satisfies him, and he makes up his mind at once. It may be that he does it with so much shrewdness that he is very apt to be right in his conclusions; but sometimes he is entirely wrong, because he has in his haste overlooked some apparently slight circumstances which are really of vital importance. There is quite a large class of such minds in the medical profession. They are better fitted to practice in acute forms of disease than in chronic cases. These latter require patient investigation to thread out all their intricate complications.
I once knew two physicians of considerable eminence, who had directly opposite casts of mind, in regard to the qualities to which I have just alluded. They lived and practised in the same neighborhood through a long life. The one would spend perhaps an hour in ferreting out all the hidden labyrinths of a chronic case, and I have often been delighted, as he would clearly and in choicest language unfold his views, after he had concluded his examination. The other never wanted more than a few minutes to learn all he wished to know of a case, and he was prepared to act. Possessed of much native shrewdness, it was astonishing to see how he would avoid error in forming his hasty opinions. He seemed to be aware in what his forte lay. He had an abhorrence of all long and intricate cases, and turned them over, so far as he could, to his brethren; and he took peculiar pleasure in managing acute cases, in which the changes were rapid, and the end either for good or ill came soon.
You discover in your conversations with one physician on common subjects, that he is very slow and cautious in adopting opinions, and when he has once adopted them he adheres to them with great tenacity; while another, on the contrary, is exceedingly changeable in his opinions. These opposite qualities, exhibited as they are abroad in society, go with them to the sick chamber, and they exert their full influence. The one will fix upon a course of practice in a given case with all due consideration, and when he has once fixed upon it, he will pursue it most faithfully, even though the progress of the case may furnish conclusive evidence that he is wrong. He will be blind to that evidence, because he believes most assuredly that he is right in his views of the case. The other will not pursue a course long enough to determine whether it be right, but will see continual reasons for change; and his course from the beginning to the end of a case will often present a medley of variations, from which no intelligent conclusions can be drawn. The one will have a few favorite remedies, which he reckons as old and tried friends, and he adds but few to the little group from year to year. The other will make frequent changes in the remedies which he employs, and will try in rapid succession the new medicines, which every fresh periodical bring to his notice.
Some men take strong views of everything which they see. They must always have an opinion, whether the evidence upon which it is based be sufficient or not; and that opinion fills the mind, and actuates all the conduct. They are apt to have very partial and exclusive views, overlooking in their ardor points, which, though they may have little apparent prominence, may, if properly examined, lead to discoveries of great importance. Such men in the medical profession always make a decided impression upon the public mind, and have many strong and ardent friends; and if they possess considerable talent, they generally acquire a dazzling reputation. It is true that they commit frequent and often great errors. But when their bold opinions turn out to be correct, it adds wonderfully to their reputation for acuteness and wisdom, while their errors are mostly concealed, and the whisper that tells of those errors that chance to be discovered, is effectually drowned in the noisy commendation of their enthusiastic adherents.
If I at all succeeded in my object in the chapter on the Uncertainty of Medicine, the reader was convinced that there is no pursuit in which a habit of accurate observation is more needed than in the practice of the medical art.
How then can a common observer test a physician in regard to this talent? If the observer were himself a physician, he could do this by watching him in his examinations of cases of disease. But as he is not, and is therefore ignorant of the subjects to be examined, he will fail in any attempt of this kind. He will be apt to commit, for example, this error. He sees that a physician makes a great many inquiries of his patients in regard to their complaints, and he may for this reason alone conclude that he is a nice observer. This minuteness of examination often gives a physician very unjustly this reputation; and in fact it is one of the most common tricks of the trade. There is often a great parade of questioning with very little true observation. A physician who is a skilful observer will learn more of a patient’s condition, by watching him as he lies in bed, and making a few inquiries, than another will by a multitude of questions; just as one man, who scarcely appears to look at anything as he passes through a street, may really observe and know more about the various objects in that street, than another man, who appears with eyes wide open to look at everything. A mere glance will sometimes reveal to the skilful observer the true nature of the case, when the unskilful have not been able to discover it with the most diligent examination of the symptoms. I will mention a single example. A man who was severely sick was attended by two physicians, who were somewhat at a loss in regard to the nature of his disease. Another physician, who was called in, before asking a single question, suspected from the posture of the patient that he had a hernia, in common language a rupture; and on examination this was found to be the case.
I might mention some other errors, to which the inquirer would be liable, if he attempted to judge directly of the physician’s mode of examining disease, but it is not necessary.
How then, the question recurs, shall he test the physician on the point under consideration?
Let him see how the physician observes in regard to some subject, with which he himself is acquainted. He will discover in this way what his habits of observation are; and he may be sure, that these same habits mark his investigations of disease in the chamber of the sick. No man has different habits of observation for different subjects.
Suppose that you have a curious article in your possession, and you have become acquainted with all the facts in regard to it. If you show it to several physicians, and observe the inquiries which they make in relation to it, you can discover the different characters of their minds, and may thus know how they observe and investigate disease.
One of them asks perhaps but few questions, and some of those are irrelevant. He discovers but little in regard to the article, and you may be sure that he will never discover but little in regard to disease.
Another, after making a few inquiries, starts some supposition or theory, and this directs all his future inquiries. He of course obtains a very partial knowledge of the facts, and this is mingled with errors. And so it is with him in his investigation of medical subjects. He is a theorizing practitioner.
Another makes many inquiries, but they are of a rambling character. He finds out many of the facts in regard to the article, but by no means all of them. His observation is active, but it is without method and incomplete. Though he will be diligent in the investigation of disease, and will appear to most persons to be an acute and skilful observer, he never will obtain a thorough and complete knowledge of any case.
Another, by a natural succession of inquiries, discovers one fact after another, till he knows the whole. He does not ask a single irrelevant question. The answer to every question either developes a new fact, or confirms one already discovered. He separates accurately the probable from the true, wholly rejecting the merely plausible. He frames no theory. His search is only for facts. You may be sure that he will be a skilful observer in the sick room, and that in the investigation of disease he will be constantly adding to his store of valuable and well-arranged facts.
Do you wish to ascertain what characterizes a physician’s measures in the treatment of disease? Instead of watching his practice, of which, as you have seen, you cannot judge with any good degree of correctness, observe what measures he proposes when acting, not in the capacity of a physician, but in that of a citizen, a neighbor, a member of an association, and what reasons he gives for these measures. If you find that he advocates measures which show common sense, shrewdness, and good judgment, and which accomplish the purpose aimed at; you may safely conclude that the same common sense, shrewdness and good judgment mark his treatment of his patients, and that he is a skilful and successful practitioner of medicine.
A very little thing will sometimes develope some characteristic of a physician’s measures. A physician, as he starts his horse to leave you after a pleasant chat, finds the rein caught under some part of the harness. He pulls it up to disengage it; but, as he does not succeed, he gives it a twitch in which he succeeds no better. His face reddens, and he twitches again and again, each time more violently, and finally, by tearing out a loop in his harness, he disengages the rein. You may safely infer that that physician will be apt to have just such twitching measures in his treatment of the sick, and will in this way mar some things which are of some more importance than the loops in his harness.
It is quite a prevalent idea in the community, that a man may be an ignoramus in regard to other subjects, and yet may have great skill in medicine. It is supposed that there is in the healing art a sort of mysterious tact or skill, innate in the man, and not acquired like other knowledge. It is this idea which gives such a reputation, for infallibility almost, to the natural bone-setter. We find here, also, the reason that intemperance in a physician so little impairs the confidence of his employers. It must be obvious that in no employment is a steady and clear state of mind more needed; and the obscurity of mind and recklessness, which intoxication, even when existing only in a slight degree, invariably produces, must unfit the physician for the proper performance of his duties. And yet how many sensible people, who would fear to trust an intemperate stage-driver or engineer, will unhesitatingly commit their health and life to the care of an intemperate physician, because they suppose that he has a peculiar skill, of which even intoxication cannot deprive him. His drunkenness seems to act as a dark background, making his skill appear the brighter by contrast.[34]
In confirmation of this idea of the possession of innate skill, it is said that a man may be a fool on one subject, and yet may be a genius on another. A man may be, for instance, a great arithmetician, or a very ingenious mechanic, and may yet exhibit folly on most other subjects. This may be true in some few instances, but it is not at all common; and rare cases never can establish a general rule or principle. And besides, a genius in medicine, if he be a mere genius, in the popular sense of the term, makes but a poor practitioner. For true skill in the practice of medicine requires the possession of a wide range of talents, and among these sound judgment, or, (as it is familiarly called when used in reference to ordinary subjects,) common sense, is pre-eminent. This is a sine qua non in the physician. The most brilliant talents cannot make one a good practitioner without this qualification. They may make him an interesting lecturer, or writer, and may give him a high reputation in the community. But his lack of this practical talent must render him unsuccessful in the treatment of disease, and the lectures which he may give will be deficient in practical instruction, and the books which he may write will add nothing to that storehouse of facts, which come only from observation, guided by a discriminating judgment, and plain common sense. He may construct beautiful theories, and explain and defend them with ingenuity, but he never can be a reliable source of instruction and information to his medical brethren.
The reader has seen that there are then five ways of judging of the skill and the attainments of a physician. 1st. By examining his opinions on medical subjects, and the reasons upon which they are based. 2d. By observing his practice, and comparing its results with those of the practice of others. 3d. By inquiring into the evidences of his education. 4th. By observing the unbiassed opinions entertained of him by his medical brethren. 5th. By observing his mental qualities as they are exhibited in relation to those subjects which the observer himself understands.
If the inquirer be a physician, he can very properly make use of the two first-named means of arriving at the estimate. But if he be a non-professional observer, he must for the most part give up these means, as being liable to lead him into error, and resort to the remaining ones. That he should entirely give up the two first means I do not claim. All that I claim is, that he should place very little reliance upon them, while his chief reliance should be upon the three last.
If intelligent men would adopt the course which I have indicated, in their attempt to estimate the professional merits of physicians, they would for the most part avoid the errors which they now so frequently commit. But, as it now is, they very generally form their judgment from a direct observation of medical practice, and from the reports which their friends and acquaintances give of their observations; and they make but slight use of those means of judging, which I have shown to be the least liable to error. And I fear that they will be slow to change in this respect, for the simple reason, that they will be slow to admit their incompetence to sit in judgment on modes of treating disease. Dr. Beddoes, an eminent English physician, once remarked, that “there are three things which almost every person gives himself credit for understanding, whether he has taken any pains to make himself master of them or not, These are: 1. The art of mending a dull fire: 2. Politics: and 3. Physic.” And this is especially true of the last of these. Both the well informed and the ignorant seem to think, that they are perfectly competent to decide whether a physician is treating a case properly; and watch the effect of remedies in order to do this, and hesitate not to express their opinions on this point in the most positive manner. So common and inveterate is this habit in the community, that it will be difficult to eradicate it. And yet I think it can in some good degree be done. Intelligent men can be made to see, by a candid exposition of the peculiar liability there is in medical experience to mistake in regard to the relation between cause and effect, that it requires an extensive knowledge of medicine to make accurate observations of the influence of remedies; and that therefore one who has never studied this science, and who has had but limited means of observation, must be but a poor critic on the practice of physicians. They can see that, though such an one may cope with others in the art of mending a dull fire, or on the subject of politics, yet on so abstruse a subject as medicine is, he ought to be somewhat modest in his opinions, and not put them forth, as is now so often done, with all the authority of an oracle.
Why then, let me ask, have not intelligent men been made to look upon this subject in this light? This question I will endeavor to answer.
There is, in the first place, a large class in the medical profession, who desire no change in the views of the community, but prefer to maintain their present false position. Their success, like that of the quack, actually depends on practising upon the credulity of the public. They would dread being scrutinized in the way which I have pointed out, by tests which the observer himself understands. They would prefer that people should continue to judge of them as they have done, by tests of which they are ignorant, because they can in this way continue to deceive them. The number of such men in our profession, I am sorry to say, is very large; and many of them have an extensive practice, and stand high in the public favor, and for this reason are quite indifferent both to their own standing with their brethren, and to the general standing of the profession itself. Though they do nothing perhaps which is sufficient to endanger their loss of caste among physicians, their influence is detrimental to the interests of the profession, and favors in the worst possible way the hold of quackery upon the community.
There is another large class of medical men, who really desire to be honorable in their course, but who have felt themselves obliged to use to some extent the same arts with which the dishonorable impose upon their patients. They feel that they cannot reform public sentiment, but must take it as it is, and do the best they can with it. They find whims and caprices and false ideas among the intelligent, as well as the ignorant; and instead of taking any pains to correct the evil, they succumb to it, and set themselves to work to make capital out of it. They thus place themselves on common ground with the quack and the pretender, and subject themselves to be estimated by the same false rules which are applied to them. They thus have almost insensibly contracted habits of low cunning and shallow pretension; and these are habits which are not easily given up. Of course this class of medical men will be inclined to look with distrust upon any efforts to reform the profession, and the public, in the particulars to which I have alluded; and, though they may not actually oppose such efforts, or may from selfish motives even make a show of favoring them in certain quarters, they cannot be expected to give them any active support.
There is, however, one result of the course which this class of medical men have pursued, which seems to be opening the eyes of the most honorable among them, and which promises to bring them out from their false and degrading position. They find that their cunning subservience to the false opinions of the people, has increased the hold of those opinions upon the public mind; and, as a wide door has thus been opened for quackery, they find that the same arts, in using which they have been so successful, are now used quite as dexterously by the whole herd of ignorant quacks and showy pretenders. They find that the Homœpathist is stealing away some of their best, and, as they thought, their most reliable patients. The Thompsonian, the Chrono-thermalist, &c., are committing similar depredations. And of all this they have no right to complain, because these pretenders obtain these patients by the same artful and deceptive means, by which these physicians at first acquired them, and by which they have so long retained them among their patrons.
The result which I have pointed out is an accumulated result. The community are running wild now after various systems and modes of practice, and the public mind is all afloat, carried about by every wind of doctrine in medicine. It is now the hey-dey of quackery of all kinds and degrees. The causes of the great prevalence of this evil are not temporary and recent, but they have been acting for a long time, and we now see the accumulated result. Among the chief of these causes is the course which has been pursued by a large portion of the medical profession. The profession itself has given birth to much of the quackery of the present day.
The evil of this comes upon the profession generally, but more particularly and grievously upon the class of physicians of which I have just been speaking. The first class which I mentioned are not as much affected, because, being less scrupulous, they have a wider range of arts to be used; and the mortifications to which they are subjected in their competition with quacks are more easily borne, because they have less of honor and conscience to trouble them in relation to their course. While this class will be utterly opposed to any attempts at reform, the second class of which I have spoken, seeing their false position, and beginning to suffer some of its vexatious results, will probably experience a sifting process, whenever efforts at reform shall be thoroughly entered upon. The least honorable, and those whose habits of imposition (for such they must be termed), have become fixed, will join the first class, giving up all scruple, and adopting in full the measures of the quack and charlatan. But I am persuaded, that the largest portion of this class of practitioners have so much of honor and conscience, that, whenever a general effort shall be made to redeem the profession from its false position before the community, they will be ready to unite in that effort.
But this effort is not to begin in this class. There is still another class of physicians who are to originate it. They are the men in our profession who have always pursued an honorable course, and have never yielded to the temptations to use the arts of empiricism, however strong they may have been—who, though they have often seen their brethren use such arts successfully in their competition with them without injuring their standing in the community, have never allowed such mortifications to induce them to swerve from the path of honor and duty. Efforts, it is true, have been made by such physicians to enlighten the public mind in relation to its false estimates of professional merit; but they have been for the most part isolated and individual efforts, and they have soon been given up for reasons to which I have before alluded. A general and united effort is needed, and I have no doubt that it would be successful.