Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

Professor Virchow, the distinguished German pathologist, used to say that popular medicine was in all ages at least fifty years behind scientific medicine. He had himself discovered the principles of cellular pathology nearly half a century before his death, yet he declared that the popular mind still believed in the old doctrines of humoral pathology,—that is, that the conditions of health and disease depended on the constitution of the fluids of the body (the blood, the bile, the mucus, and so forth), and had not generally accepted modern advances in medical knowledge of the underlying basis of disease in the solid tissues. There is no doubt that many old-fashioned notions long since discredited by physicians are still very generally accepted by the popular mind, and even the intelligent classes sometimes harbour convictions with regard to the good or evil effects of habits [{89}] of life, diet, and the operation of drugs of various kinds that are entirely contrary to present-day medical knowledge.

It is extremely important, then, that the clergyman or charitable visitor, in giving views on medical matters, which are sure to have much more weight than he perhaps attributes to them himself, should be careful not to make statements for which he has not good authority in modern medical science. It is very easy, in a matter of this kind, to state principles that are not the result of education, properly so called, but are gleaned from early false impressions obtained one knows not how or where, entirely without definite consciousness as to their real origin. The physician himself finds that he is compelled to be careful of this same tendency to put too much stress on traditions with regard to health which he imbibed before he began to study medicine. It is perhaps not so surprising, then, to hear physicians complain often that clergymen instead of being a help are sometimes a hindrance to the enforcement of modern hygienic rules, because they still cling to old-fogy notions of hygiene and sanitation retained from a defective early training. Owing to the influence that the clergyman is sure to exert, this becomes an extremely important matter. Great harm may be done and the physician discredited, almost without a realisation, on the part of the clergyman, that he is interfering in another's department. Sympathetic coordination of clerical and medical efforts would accomplish much good that is now unfortunately left undone.

There is no doubt that for the important crusade against tuberculosis, for instance, the aid of the clergyman will accomplish much for the reduction of the death rate from this disease. What is needed at the present moment is a universal conviction that tuberculosis is not an hereditary but a communicable disease. This does not mean that it is virulently contagious and that as a result sufferers from tuberculosis must at once be segregated from other members of the family and from the community generally; but it does mean that careful precautions must be taken with regard to the disposal of sputum, with the enforcement of the most exacting cleanliness on the part of consumptives themselves. [{90}] It also means that the person suffering from the disease should not sleep with those as yet unaffected, nor be allowed to live in very close contact, especially with children or susceptible individuals.

The persuasion that tuberculosis is not hereditary will do much to encourage patients suffering from the disease to feel that they are not hopelessly doomed. At the present time it is not unusual to find patients so discouraged, when told that they have tuberculosis, that it is almost impossible to secure a favourable reaction to any mode of treatment. They have seen members of families die one after another, or they have heard stories of the inevitable way in which consumption wiped families out of existence, and they give up hope and become quite cast down. Needless to say, while in this condition any treatment is practically hopeless. On the other hand, the conviction that tuberculosis is only an infectious disease, quite curable in the majority of cases if taken in time, is of itself a most important aid in the treatment of the disease, since courage and faith are the principal requirements for successfully combating the affection.

We have had any number of newly invented remedies for consumption in the last twenty-five years. Scarcely a year has passed in which some new form of treatment, often eventually proved to be the resuggestion of an old therapeutic method, has not been heralded as a positive cure for consumption. In every case the first patients treated by the discoverer of the new remedy have rapidly improved under his care. In the hands of others, however, such results have not been obtained, or only for a very short time at the beginning of the treatment. After a time the new remedy failed in its inventor's hands. The true reason for the improvement was then seen to be, not the remedy suggested, but the favourable influence on the mind of consumptives produced by the faith of the inventor in his remedy, and their reaction to this powerful suggestion when they were put under proper conditions of an abundance of fresh air and a plentiful diet.

This shows, too, the reasonableness of the modern treatment of consumption, which consists not in the giving of [{91}] drugs, but in securing for the patient a plenty of fresh air for many hours a day and the encouragement to consume a liberal amount of nutritious food. Most of the much advertised remedies for consumption are really harmful rather than beneficent. Many of them are ordinary cough mixtures containing considerable opium, which lessens the cough, it is true, but also lessens the appetite and locks up the bowels. Besides, the cough is nature's method of removing material from the lungs which has become disintegrated, and if allowed to remain will certainly bring about the spread of the infection in the pulmonary tissues. Cough is a natural protective reaction to be encouraged, and is not in itself a source of evil needing to be suppressed. If cough is bothering the patient so much at night as to cause loss of sleep, then it is necessary to make a choice between two evils and somewhat to suppress the cough, even though it involves certain other inconvenience to the patient. All these so-called consumption cures contain materials that are almost sure to disturb the appetite and upset the stomach. The fate of a consumptive patient absolutely depends on his stomach; just as little, then, of medicine must be employed as possible. This will indicate the necessity for clergymen rather advising against than in favour of these proprietary medicines which have been definitely known to do so much harm in recent years. Many a patient delays an appeal to medical aid so long, as the result of trusting to such medicines, that a curable case of consumption becomes incurable, or else develops to such a condition as to require years of treatment on the fresh-air, abundant-food plan, where months would have sufficed before.

A very interesting phase of social medicine is the ease and confidence displayed by people, often of more than ordinary intelligence, in recommending various proprietary medicines of which they know nothing except the fact that someone says he, or more often she, was cured of something or other by their use. A chance remark like this to a sufferer becomes a high recommendation. The hardest problem the doctor has before him is to find out what is really the matter with his patients. Not infrequently people having apparently the same set of symptoms are suffering from quite different [{92}] ailments. A symptom like a sore throat, for instance, may very well be due to any one of at least a half-dozen of causes, most of which require their own peculiar treatment. When the affection under consideration is as indefinite as a tired feeling, or indigestion, or some one of the many ailments included under the term biliousness or kidney trouble, from which people are supposed to suffer, then the diagnosis problem becomes by far the most serious question in the case, and is often very difficult. The trained physician prudently hesitates, but the inexpert in medicine steps in and quite volubly announces what the ailment is in his opinion, and what will probably do it good. A little knowledge is indeed a dangerous thing in medical matters. If it be remembered that there is a very general impression among medical men now, as the result of recent acquisitions of scientific information with regard to the origin, pathological basis, and course of disease, that very probably more harm than good has been done by the administration of medicines in the past, not only the futility of lay (or clerical) prescribing will be manifest, but also somewhat of the amount of harm that may be done.

It is often a matter for painful surprise, then, to find that clergymen and members of religious communities allow their names to be used in the recommendation of remedies of whose composition they know nothing, for a disease of which they know less, if possible. This evil becomes especially poignant when the columns of our reputable religious press are allowed to be used for the purpose of exploiting the public in these matters. The remedies most often recommended are the so-called tonics. These are best represented by the sarsaparillas, and by various cures for catarrh, indigestion, and kindred indefinite ills, of which there are a great many on the market. These are not secret remedies, since their composition is well known by those of the medical profession who care to secure the information. Some six years ago an analysis of most of them was made by the Massachusetts State Board of Health. [Footnote 1]

[Footnote 1: 28th Annual Report Mass. Board of Health; food and drug inspection, 1897.]

The principal active agent in all of these remedies was [{93}] found to be alcohol. In most of them it exists in a proportion about equal to that in which it is supposed to occur in ordinary whiskey. Some of them are even stronger in alcoholic contents than the whiskey usually sold in our large cities. This matter has seemed so important that we give the official figures of the Board of Health.