Doctor and Patient

by S. Weir Mitchell

It appears to me from a large mental survey of the gains of my profession, that the English have above all other races contributed the most towards enforcing the fact that on the whole dietetics, what a man shall eat and drink, and also how he shall live as to rest, exercise, and work, are more valuable than drugs, and do not exclude their use.[1]

[Footnote 1: By this I mean that the physician, if forced to choose between absolute control of the air, diet, exercise, work, and general habits of a patient, and use of drugs without these, would choose the former, and yet there are cases where this decision would be a death-warrant to the patient.]

The active physician has usually little time nowadays to give to the older books, but it is still a valuable lesson in common sense to read, not so much the generalizations as the cases of Whytt, Willis, Sydenham, and others. Nearer our own day, Sir John Forbes, Bigelow, and Flint taught us the great lesson that many diseases are self-limited, and need only the great physician, Time, and reasonable dietetic care to get well without other aid.

There is a popular belief that we have learned this from homoeopathy, for the homoeopath, without knowing it, made for us on this matter ample experiments, and was as confident he was giving powerful medicines as we are that he was giving practically none. "He builded better than he knew," and certainly his results aided our ablest thinkers to reach the truth.

I have named one of the most illustrious of physicians, Sydenham, as among the great Englishmen who brought to their work the clearest perception of how nature was to be best aided. He will answer admirably to exemplify my meaning.

Sydenham was born in 1624, and lived in and through the wild periods of Charles I. and Cromwell, and was himself a stanch republican. He more than any other in his century decisively taught caution as to mere medication, and sedulously brought the clear light of common sense to bear upon the practice of his time. It is interesting to note, as his biographer remarks, that his theories were often as worthless as his practice was good. Experience taught him to do that for which he felt forced to find a reason, and the reason was often enough absurd. "The contrast gives a fine light and shadow effect in his biography."[2]

[Footnote 2: R.G. Latham, p. xxxvi.]

His systematic beliefs were ofttimes worthless, but great acuteness in observation was apt to lead him to do wisely in individual cases what was at variance with his creed. Speaking of Hippocrates, he says, "His system led him to assist nature, to support her when enfeebled and to the coercion of her when she was outrageous."

As to mere drugs, Sydenham used them in what was for his day an extremely moderate fashion, and sagaciously limited in the old and young his practice as to bleeding, which was then immensely in vogue. The courage required to treat smallpox, measles, and even other fevered states by cooling methods, must have been of the highest, as it was boldly in opposition to the public and private sentiment of his day. He had, too, the intelligence to learn and teach that the Jesuit bark, cinchona, was a tonic as well as the master of the agues, so common in the England of his time.

He is at his best, however, in his statement of how he treated individual cases, for then his written theories are given to the winds, or the practice is far beyond the creed in its clear common-sense value.