The Gold-Headed Cane

by William Macmichael

From what has been stated of the condition to which I was now reduced, it will be inferred, that it was chiefly from the position which I occupied in the corner of the room in which Dr. Baillie received his patients at home, that I became at all acquainted with what was going on in medicine.

My present was the very reverse, in almost every particular, of my early master, Dr. Radcliffe. In person, Dr. Baillie was considerably below the middle size, with a countenance rather plain than prepossessing, a Scotch dialect, and blunt manners. Than his first address nothing could be less imposing; and yet, before he had been in company with you for five minutes, he would have convinced you that he was one of the most sensible, clear-headed physicians you had ever listened to.

From his habit of public lecturing, he had acquired two great advantages; First, a minute and accurate knowledge of the structure of the human body; and, Second, the most perfect distinctness and excellent arrangement, in what may be called the art of statement. For this latter quality he was very remarkable; and even when he was compelled to relinquish lecturing (by which he had acquired it), in consequence of the growing extent of his practice, it continued to be of daily advantage to him. In examining a patient, for the purpose of learning the symptoms of the complaint, the questions he put were so few as to give an impression of haste and carelessness; in conversing on the case with the physician whom he met in consultation, he was very short and clear; and it was not until the relations or friends of the patient were admitted, and he proceeded to communicate to them the result of the consultation, that he appeared to full advantage. He then gave a short practical lecture, not merely on the symptoms of the patient, but on the disease generally, in which all that was known on the subject was brought to bear on the individual case, and in doing this, his utterance was so deliberate, that it was easy to follow him. His explanations were so concise, that they always excited attention, and never tired; and the simplicity of the language in which they were conveyed, where all technical terms were studiously avoided, rendered them perfectly intelligible.

It was a maxim with him, that the most successful treatment of patients depended upon the exertion of sagacity or good common sense, guided by a competent professional knowledge, and not by following strictly the rules of practice laid down in books, even by men of the greatest talents and experience. “It is very seldom,” was he used to say, “that diseases are found pure and unmixed, as they are commonly described by authors; and there is almost an endless variety of constitutions. The treatment must be adapted to this mixture and variety, in order to be as successful as circumstances will permit; and this allows of a very wide field for the exercise of good common sense on the part of the physician.”

In his view of the case of a patient, he selected the leading features of the subject, and neglecting all minor details, he systematically abstained from touching upon any thing ingenious, subtle, or far-fetched. Hence, in the treatment of disease, he was not fertile in expedients, but aimed at the fulfilment of a few leading indications, by the employment of the simplest means; if these failed, he was often at a loss what to do next, and had not the talent, for which some are distinguished, of varying his prescription every day, so as to retain the confidence and keep alive the expectation of the patient. But this peculiarity of mind, which was perhaps a defect in the practice of his profession, was a great advantage to him in his discourse, and rendered him unrivalled as a lecturer. After writing a prescription, he read it over with great care and consideration, for fear of having committed a mistake.

During his latter years, when he had retired from all but consultation practice, and had ample time to attend to each individual case, he was very deliberate, tolerant, and willing to listen to whatever was said to him by the patient; but when in the hurry of great business, when his day’s work, as he was used to say, amounted to seventeen hours, he was sometimes rather irritable, and betrayed a want of temper in hearing the tiresome details of an unimportant story. After listening, with torture, to a prosing account from a lady, who ailed so little that she was going to the opera that evening, he had happily escaped from the room, when he was urgently requested to step up stairs again; it was to ask him whether, on her return from the opera, she might eat some oysters: “Yes, Ma’am,” said Baillie, “shells and all.”

As I was not present on this occasion, this story, though often related, may possibly not be true; and, indeed, I cannot suppose that so experienced a practitioner would have treated with so much levity the important mystery of cookery. To judge of the true skill and merit of a Physician requires a competent knowledge of the science of medicine itself; but to gain the good opinion of the patient or his friends, there is, perhaps, no method so ready as to show expertness in the regulation of the diet of the sick. Discretion and judgment will of course be required; the rules should not be unnecessarily severe or rigid, otherwise they will not be followed; but the prudent Physician will prescribe such laws as though not the best, are yet the best that will be obeyed. In many cases, however, it is not enough to say “you must avoid meat, fermented liquors, or pastry.” All this is infinitely too vague, too general, and unsatisfactory; you must be precise and peremptory about trifles. In a long illness the mind of the patient is enfeebled, the invention of his attendants has been exhausted, and they all like to be saved the trouble and effort of thought; the Doctor therefore must think for them, and direct the diet of the sick as he would his draught. Besides indicating an anxious solicitude for the comfort of the invalid, it shows a nice discrimination of the virtues and qualities of the ordinary articles of food, not possessed by less sagacious persons.

It is in the judicious management of this branch of our art that French Physicians particularly excel. Par exemple:

“Le déjeûner consistera en thé froid, ou eau froide sucrée, ou non sucrée avec du lait, et du pain à volonté. Le diner permet une ou deux portions de viande fraiche, tendre, du pain rassis et des légumes farineux.