Physician and patient

by Worthington Hooker

FOOTNOTES:

[34] We had some years ago, says Dr. Rush in one of his lectures, a physician in this city of sprightly talents, who was an habitual drunkard. Soon after his death, I was called to attend a gentleman who had been one of his constant patients. He submitted with reluctance to my prescriptions, because they were contrary to the modes of practice of his former physician, to whom he was so much attached, that he declared he would rather be prescribed for by him when drunk, than by any sober physician in the city.

CHAPTER XI.
MEANS OF REMOVING QUACKERY.

It must be obvious to any one who observes the wide influence which quackery maintains in its various forms in the community, amid all the efforts which are made to overthrow it, that there has as yet been discovered no adequate remedy for this evil. It is common for physicians to say that there is no remedy—that there is, and always will be, a class of persons who must, from the very character of their minds, be addicted to quackery; and that it is of no avail to attempt to deliver them from their errors, but they must be left to go from one delusion to another, as they choose, all their lives. If quackery were confined to such persons, it would, I allow, be idle to talk of any remedy. But it is not so confined. We every day see men, who are intelligent and judicious on other subjects, perfectly deceived and captivated with the false pretensions of empiricism. If these individuals were ignorant, and were easily influenced by merely plausible reasoning, or were enthusiastic, or over fond of novelty and change, then 1 should despair of making any impression upon them. But as this is not the case, I am led to the conclusion, that there must be some defects in the mode in which truth on the subject of medicine has been presented to their minds; and that the sources of error have not been so plainly revealed to their view in this, as they have been in other fields of enquiry.

Efforts, it is true, have been made by the medical profession to correct the tendency to empiricism, which is so rife in the community. But I believe that it can be satisfactorily shown that these efforts have, to a great extent, been made with wrong means, and in a wrong direction; and that for this reason they have failed to strike at the root of the evil.

Much reliance has been placed upon giving to the people a knowledge of anatomy, physiology, dietetics, &c. For this purpose books have been published, journals of health have been issued, and lectures have been delivered. All this is very well. Valuable information has thus been communicated. Still, it leaves the great sources of empiricism nearly, if not quite, untouched. These are pouring forth their destructive streams more abundantly than ever, notwithstanding the great increase of late of popular knowledge on medical subjects.

And this is as we should expect it would be from the nature of the case. For the knowledge, which one obtains from popular books and lectures, of the human system as a piece of mechanism, can have but little influence upon his notions in regard to the operation of remedies, on that system; for the operation of remedies, for the most part, lies beyond the mere mechanical principles of the organization, and therefore cannot be materially elucidated by a knowledge of those principles. For example, the knowledge, which the dyspeptic gains, from popular instruction, of the situation and the shape of the stomach, of the number of its coats, and of the process of digestion, cannot enlighten him in regard to the treatment of his disease, and will therefore not guard him against delusion on this subject. He will be just as ready, as he was before he acquired this knowledge, to take some patent medicine, or to resort to some boasting empiric.

None of the common popular errors can be removed by the knowledge referred to. If a man should adopt the notion, that the blood is the seat of all disease, and therefore that remedies relieve disease by purifying the blood, would it be possible to dislodge that error, simply by showing him the heart, and describing to him minutely the circulation? The mechanical contrivances of this beautiful and wonderful piece of machinery have manifestly no reference to the state of the blood contained in it. How can he know, from an examination of the heart and the arteries and the veins, whether he is right in attributing all disease to a corrupt state of the life-giving fluid? Or what light will this examination give him in relation to the remedies which he supposes enter the circulation and rectify the blood, by neutralizing whatever it contains which is bad?

I will even take a case in which one would suppose that a knowledge of the mechanical structure of the body would be of essential service, as an antidote to quackery. I refer to a belief in the skill of the natural bone-setter. How often does the knowledge referred to entirely fail to dislodge this error. You may show the believer in it the structure of the joints, and demonstrate to him by a clearness of proof which would satisfy him on any other subject, that it is as necessary to understand this structure, as it is any other piece of mechanism, in order to be skilful in detecting the nature of the injuries which it receives, and in repairing them. And yet, he will reply, ‘all this looks right, to be sure; but still here is the fact that the bone-setter does set bones some how or other.’ You will have to do something more, to convince him that his confidence is misplaced. You must show him, how it is that the ignorant bone-setter acquires a reputation, in spite of his ignorance, and his consequent blunders. And this can be done by facts. In commenting on these facts you can make use of the knowledge, which your friend may have of anatomy, as an auxiliary in pressing your point; and it may thus prove of great service, though it is wholly unavailing when appealed to alone. For a full view of this subject I refer the reader to the chapter on Natural Bone-Setters.

While a popular knowledge of anatomy and physiology has but little influence in restraining quackery, it sometimes evidently increases it, by giving its possessor an exalted idea of his medical acumen. He upon whom it has had this effect is much disposed to adopt opinions and theories on slight and plausible grounds, and in this way is constantly led into error. The physician meets persons of this character every day. They are always ready to talk with him, and they seem to feel quite at home on medical subjects, and some of them have really acquired considerable information on these subjects; but they have built upon it a superstructure of untenable theories and notions, and they are commonly carried about by every wind of doctrine in medicine.

The quack aware of the prevalence of this superficial knowledge of medicine, gathered from popular books and lectures, often makes provision for the taste thus engendered. He hires some one, perhaps a medical student, to prepare for him a disquisition on some of the principles of medical science, which is to accompany the certificates setting forth the virtues of his nostrums. This disquisition may all be correct, though it is more commonly a mixture of truth and fallacy, so combined, that the superficial reader does not separate the one from the other. It answers the purpose for which it is intended. It convinces most people who read it, that the author (whom they suppose to be the proprietor of the medicines) really has a great knowledge of medical science, and that, therefore, though other patent medicines may be impositions, his cannot be. There is often in these disquisitions page after page of physiological discussions, in learned guise, which have no sort of bearing upon the nature of the medicines recommended, though they do have most manifestly upon their sale, as the result shows.

Let me not be understood to mean, that none but physicians ought to know anything about the human system; nor that the knowledge of it, which is obtained from popular books and lectures, can be of no advantage in the warfare with empiricism. Though, when it is relied upon as the chief, almost the only, weapon in this warfare, it is, as you have seen, of little avail, and is often even turned against the cause of truth and science; yet, as an adjuvant to other means in removing quackery, it may prove very valuable. What then, let us enquire, are those other means?

I have shown in another chapter, that the principal popular errors in medicine arise from partial views of the operations of disease and the effects of remedies, and are false conclusions in regard to the relation of cause and effect. These false conclusions are, as you have seen, the basis of quackery; and therefore one of the chief means of removing quackery is to be found in the exposure of the fallacy of these conclusions.

But it will perhaps be said, that this has often been attempted, and with so slight success, that there is very little encouragement for repeating such attempts; and that it is best on the whole to let the community find out their errors by their own experience, sad as it sometimes is. Those who take this ground assume, that the efforts which have been made for this object have been of a proper character. I think it to be clear that they have ordinarily not been so. There has been too much of ridicule and sarcasm. These are means which are appropriate to a certain extent, as auxiliaries to sober argument; but they never should be relied upon, as the only, or the chief, instruments in combatting error. There has also been too much of denunciation, and calling of hard names. There has not been, on the other hand, enough of calm, candid and patient discussion on the part of physicians with the well-informed, as they meet them from day to day. To the medical man quackery appears so nonsensical, that he has commonly no patience with those who embrace it. He does not remember that many of his own profession have, in their reasonings about cause and effect, committed some of the very same errors which have engendered that quackery. Perhaps, if he looks back upon his own course, he may find that he himself has at some time fallen into an error, which might have led him into empiricism, if he had been out of the profession, but which was prevented from producing this effect upon him by that sense of dignity, which characterizes the man of science, and by that disposition to careful scrutiny, which the pursuit of medical science is peculiarly apt to impart. He should therefore avoid being betrayed, by the ridiculousness of quackery, into the utterance of harsh expressions, or into too free an use of sarcasm. He should, on the contrary, endeavor to show any intelligent friend, who has chanced in some way to be deluded by empiricism, that he has been deceived, and point out to him just how it has been done. He should show him what the mistakes are which he has made, in relation to the connexion between cause and effect; and should endeavor to impress upon his mind the truth, that there is more necessity for cautious discrimination, in forming conclusions on this, than on any other subject in the wide range of science. He should show him how common it is in medicine, to attribute results to causes, which have had no agency in producing them; and that if physicians themselves are apt to commit this error, much more must they be, who are ignorant of medical subjects, and who have but limited means of observation.

It is this individual influence, which may thus be exerted by the profession, that must be relied upon as one of the principal means of ridding the public of the evils of quackery. It is not a mere occasional effort—some address, some short article in a public journal, some fling of biting sarcasm, or some sally of wit—that will do it. Men of strong sense and good judgment, when they are led into error, as such men often are on the subject of medicine, are not to be delivered from that error by such means. Remedies of a more searching character, and a treatment more patient, thorough, and persevering, are required to reach their case.

It is very desirable that this individual influence be exerted by medical men, because the class of persons to whom I have alluded, and who may be successfully reached by it, are the chief pillars of empiricism. It is true, I will allow, that the ignorant, the enthusiastic, and the novelty-seeking, make up the great mass of the patrons of quackery; but they are kept in countenance by those men of acknowledged good sense, who are found in considerable numbers in every community, supporting empiricism in some of its many forms by the weight of their example. The plain unlettered man who takes some patent medicine, is encouraged to do so by the example of some neighbor of general repute for shrewdness and wisdom, or perhaps of commanding talents and influence, and by the array of great names which he sometimes sees appended to certificates. A sort of general license is thus given to empiricism by this occasional endorsement by men of this character.

Some other reasons, besides those already mentioned, for the want of success in efforts for the overthrow of quackery, remain to be noticed.

The credulity in the public mind, that gives rise to the errors on which quackery is based, is encouraged by a similar credulity existing, to a considerable extent, in the medical profession itself. If the physician is seen to believe upon mere plausible evidence one thing, his friends will feel justified in believing some other thing resting on similar evidence. If he is not careful in sifting evidence, he cannot expect that others around him will be. If he, for example, give full credence to all the juggleries of animal magnetism, and all the extravagancies of phrenology, as they are put forth by travelling lecturers, how can he hope to dissuade an undiscriminating public from exercising a like credulity, in regard to the pretensions of quackery, which are not a whit more extravagant and fallacious?

The influence of the example of physicians in sustaining empiricism shows itself occasionally in a still more objectionable mode, than the one just mentioned. The profession sometimes gives its sanction to the credulity of the public, not only by indulging a similar credulity, but by giving currency to some of the measures with which the quack deceives a credulous community. Many physicians, and some of them of high standing, have for various reasons given certificates in regard to patent medicines. Some too, from the love of money, have even ministered to the empirical tastes of the community, by getting up some secret nostrums of their own. Such physicians either boldly bid defiance to an indignant profession, or save themselves from merited disgrace and expulsion, by announcing, that they are willing to make known, to any physician who asks it, the composition of their medicines. By this miserable artifice they comply with the letter of our regulations, while they go directly counter to their spirit. For, after all, the successful sale of their medicines requires the employment of the same measures, to act upon the credulity of the public, which are made use of by the whole herd of ignorant quacks, and they commonly have little scruple in resorting to them.

But there is a greater evil still, beyond all this, that exists in the medical profession, hindering it from waging successful war with empiricism. It is the spirit of quackery, actuating quite a large proportion of the profession. It is not always manifested in palpable shape, and in acts which can be exposed to the contempt of all honorable men, but it exerts a concealed and yet a constant influence upon the habits of intercourse, prompting to the use of cunning arts in order to deceive the community, exciting an overweening desire for reputation, with an indifference to the grounds upon which it is based, and producing a competition among physicians that rests, to a great extent, if not wholly, upon false issues. Where such a spirit exists, the object is not so much to seek after truth, as it is to make out a good case in the eyes of the public. No effort is therefore made to correct the credulity of that public, but this is looked upon as one of the instruments to be used for the attainment of their selfish ends. They follow medicine as a trade, and this is an essential part of their capital.

I need not spend time to show, that this subserviency of medical men to the credulity of the public, is one of the worst obstacles to the eradication of the quackery which results from this credulity. And this mode of self-aggrandizement is an evil, which prevails in the profession to a greater extent than is commonly supposed. It is so covert and sly in the case of many physicians, that it is called by their friends worldly wisdom, or perhaps even good judgment. And the physician who adopts it, if he have much conscience, quiets it with the consideration, that the world cannot be reformed, but we must take it as it is; and he looks upon the honest votary of medical science, that pursues his investigations in obedience to a love of the truth, independent of the whims of a credulous world, as a man who has not sense enough to look out for his own interests.

It must be obvious to my readers, that a reform is needed in the ranks of the medical profession, to enable it to exert any commanding influence in the removal of empiricism. Not only is its dignity impaired, but its energies are crippled, in all its honest endeavors for this object, by the extent to which that spirit, which I have described, prevails among its members. It is not confined to a few of the ignorant and grossly unprincipled, who have stolen into our ranks; but it is seen to a greater or less degree even in some who occupy stations of power and influence, and in quite a large portion of the common mass of practitioners. This may be considered by some as too strong a charge to bring against so noble a profession; but my own observation, and that of other physicians from different parts of our country, prove it to be a true charge.

Let then the profession be purged. Let the true spirit of investigation animate all the members of it, instead of only a portion of them. Let that short-sighted policy, which relies upon the credulity of the community for success, instead of attempting to correct it, be given up. Let all false issues be avoided. Let reputation be sought after on true grounds, and let competition be honorable, and therefore such as will further the cause of truth, and promote the interests of the profession, and not sacrifice them to mere temporary self-aggrandizement, as is now so often done.

If such could be the prevailing spirit of the profession, and if each member of it should undertake to exert his individual influence in the way that I have pointed out, there is no doubt that a most effectual blow would be given at once to the domination of quackery. The whole profession then, instead of being dispirited by the errors and inconsistencies of a large portion of its members, as it now is, conscious of the strength which self-respect always inspires, would present a bold, unbroken front in its warfare with empiricism. The community then would not, as they do now, take a license for their own credulity and quackery from that of medical men; but the uniform example of the profession, in its search after truth, would always rebuke the spirit of empiricism, and prevent, in a great measure at least, the sensible and well informed from coming under its influence. That such a change can be produced, to a great extent at least, I have not a doubt. But in order to accomplish it, all the honorable and the true votaries of medical science must be aroused to the effort, and must make common cause both against the abuses that exist in our own ranks, and the abounding and multiform quackery of the public. And because some of the occasional efforts which have been put forth by individuals for this object have effected but little, we should not therefore despair as to the success of a general and united effort.

We would call upon the stable and well-informed in the community to co-operate with us in effecting this change. They can render us very material assistance. In what ways they can do this I will endeavor very briefly to point out.

One of the most effectual means of eradicating quackery is the promotion of a thorough education of the medical profession. The lower the standard of education is among medical men, the greater will be the number of ignorant pretenders who will gain admission into their ranks, and consequently the greater will be the prevalence of quackery in the profession, and of course in the community. This result is the more certain to follow, because deception and imposture are practised upon the public so much more easily in medicine, than in regard to other subjects. And it is for this reason that it is for the interest of the community to have a proper standard of medical education maintained much more even than it is for the interest of the profession itself. For so little are they qualified to judge on medical subjects, and so much are they obliged to take medical practice upon trust, that it is important for them, that they should have all the benefit of the safeguards the requisitions of our professional organizations throw around them. And this leads me to say, that it is only through these organizations that a proper education of the profession can be secured. Imperfect as they are, and much as they fall short of accomplishing fully the object, if they were done away, as some self-styled reformers, who hate all ‘regularism,’ desire, empiricism would abound vastly more than it does even now, for the door then would be opened widely for the impostures which it so easily practises upon the people.

The community are much at fault in their opinions and practices on this subject. These organizations are lightly esteemed, and sometimes even treated with contempt. Even those who are shrewd and judicious in all other matters, often put the quack of a day on a level with the accredited physician, laden with the carefully gathered experience of years, or perhaps even above him, and welcome with open arms the advocate of some new system for the moment high in favor, with scarcely any regard to the inquiry, whether he has been educated in any proper manner for the responsible post into which he has thrust himself. Many a man of fair address, and a good share of cunning, with but a mere smattering of medical knowledge, has dubbed himself a physician, and, adopting Homœopathy, or some other system just then in fashion, has imposed not only upon the ignorant, but the intelligent and learned.

This ought not so to be. The public should, one and all, feel that they are personally interested in upholding a well-educated medical profession. Here is a science which is confessedly difficult above all others, and in which, as you have seen, careless observation is peculiarly liable to error. How important then, that those who take charge of your health, your life, should be careful and skilful observers. And education is obviously as much needed to form good habits of observation in this, as it is in other sciences. But let me say, that whenever you give countenance to quackery, whether it be in the shape of a secret nostrum, or a fashionable system, you strike a blow at the standard of medical education. You in effect say to the physician, observe, watch, study as much as you will, we esteem all your labor and experience vain. When men of wisdom and influence do thus, as I am sorry to say they often do, it certainly casts contempt upon education, and therefore tends to lower its standard in the profession. For if physicians see, that they can acquire the esteem of the public without study and labor, many will be disposed to give them up, and take the easier path to success, into which they are thus invited. And this is the grand reason, why so many pretenders are found in the ranks of the medical profession.

Before I leave this topic let me correct one error, which is quite prevalent in regard to the basis of our organizations. We are charged with being proscriptive in regard to opinions. We are called in vulgar cant regulars, and we are supposed to have ‘regular’ systems of doctrine and practice, and to maintain a deadly hostility to any opinion which is opposed to these systems. This may be true of individuals, but it is not true of the great body of the profession. We allow of the utmost latitude of belief. We have no creed, nor sets of creeds. We thrust none out of our medical societies for opinion’s sake. Any member may adopt any doctrine or system he pleases, however much opposed to the opinions of the great majority—Homœopathy, Hydropathy, or even Thompsonism. Education is the qualification for admission to our ranks; and nothing but a gross and obstinate infraction of our rules of intercourse, which are based upon truth and honor and benevolence, can be made the ground of expulsion.

Another way in which the stable-minded and well-informed can assist the medical profession, in the eradication of quackery, is by renouncing all fallacious means of judging of the merits of physicians, and relying upon those which I have shown to be so apt to lead to correct conclusions. For an extended view of this subject I refer the reader to the chapter on Popular Estimates of Physicians. And I will only remark here, that, while the honorable practitioner desires from his employers an intelligent confidence, the quack and the quackish physician are very willing, that the community should continue to judge of medical men by the same false rules, which have been so long in vogue, because they subserve so well their narrow and selfish purposes.[35]

The sensible and influential in the community can render effectual aid in the overthrow of quackery, by promoting the strict observance of the rules of medical intercourse. These rules are not sufficiently understood and appreciated by the public. If they were, those who have influence in society would frown down the base arts of a cunning competition, instead of encouraging them, as they now often do; and would give no countenance to the false issues, upon which empirics and dishonorable physicians so much depend for their success. For a full view of this subject I refer my readers to the chapter on the Intercourse of Physicians.

A recent movement of the medical profession in this country, if I mistake not, is destined to exert a great and a permanent agency in the overthrow of empiricism. I refer to the formation of the “American Medical Association” in 1847. Although the meeting in Boston in May last was only the second annual meeting of the Association, so fully did the profession throughout the country respond to the call, that the number of the delegates amounted to about four hundred and fifty. The measures which have already been entered upon, and the spirit which has been manifested, clearly indicate, that the great object for which the Association was formed, “the elevation and advancement of our common calling” will be rigorously and steadily prosecuted. The recurrence of this festival of the profession from year to year, I fully believe, will be marked by real advances in all the interests of medical science.

And now, I ask, is it too much to expect of the stable and well-informed in the community, that they will give their countenance to the objects at which we aim? While we are thus struggling together to elevate the standard of medical education, and to rid our noble profession of the abuses which impair its honor and its usefulness, we have a right to demand of the community, which is to be especially benefitted by these efforts, a cheerful and active support. Whether this shall be given us, will depend upon the men of influence in every profession and occupation in our land. It is to them that we make our appeal, and we believe that it will not be made in vain.