Physician and patient

by Worthington Hooker

Strange as it may seem, it is the experience of every physician, that some of the strongest evidences of ingratitude come from some of those upon whom he has conferred the highest favors, perhaps those which are entirely gratuitous. One would suppose that they who have had the services of a physician without making him any compensation, would from motives of delicacy refrain from speaking ill of him, if they chose to discharge him and employ another. But blame is sometimes dealt out without stint under such circumstances. It would be supposed also that the obligation, which a gratuitous attendance imposes, would always be gratefully recognized by the patient. But it is often otherwise. Many patients are disposed to forget such obligations; and everything which may call them up to their attention, and especially to the attention of others, is carefully avoided. Dr. Rush speaks of some who had been attended gratuitously in humble life, who deserted their family physician after their elevation to rank and consequence in society, “lest they should be reminded, by an intercourse with him, of their former obscure and dependent situation.”

There is not as much gratitude in the world as is commonly supposed. This is particularly true of the services of a physician. These are received by many, as a matter of course, as being something to which they have a sort of natural right. They seem to class them among the common blessings, such as air and water, for which, because they are so common, they have no idea of being grateful. Day after day, and week after week, they may be the objects of the physician’s most assiduous attentions, and his exertions may be blessed, and obviously so, to the preservation of life; but when health comes they will grudge him even the pittance of a half day’s labor from those hands to which his skill has restored strength, though they spend days and weeks every year in the most shiftless idleness. Quite a large proportion of the poor treat the physician in this way.

An old physician of my acquaintance was used to say that there are three kinds of poor—the Lord’s poor, the devil’s poor, and poor devils; that is, the virtuous poor, the vicious poor, and those who are poor from sheer shiftlessness. The virtuous poor are always grateful; and there are none among the wealthy upon whom the physician attends more cheerfully, than he does upon some of this class. Of his kind offices to them, and of their feelings in return to him, it can be said in the beautiful language of Scripture, ‘When the ear heard me, then it blessed me; and when the eye saw me it gave witness to me: because I delivered the poor that cried and the fatherless, and him that had none to help him. The blessing of him that was ready to perish came upon me; and I caused the widow’s heart to sing for joy.’ As the physician goes his daily rounds, there is no one thing that so cheers him on in his course of toil and benevolence, as the gratitude of the virtuous poor. And if there will be tears shed at his death beyond the little circle of friends, in the very bosom of which he lives, they will shed them profusely and long.

Not so, however, with the other two classes of the poor. The shiftless poor, who were denominated by my aged friend ‘poor devils,’ who go just as wind and tide will take them, and carry to ultraism the principle of letting to-morrow take care of itself, are actually too lazy to have so lively a feeling as gratitude. And of the vicious poor it may be said, that it requires something more than the selfish principles of this world to attend upon them with cheerful faithfulness. There is often, it is true, much show of gratitude; but it is seldom, though it is sometimes, more than mere show. The romance of doing good will not stand this trial. Nothing short of the untiring benevolence of Christianity will do it. Sometimes, indeed, so much effect is produced upon the views and feelings of the poor by the bounty and kind attentions of the benevolent, that an actual reform is effected, and an abode of vice and misery is converted into one of virtue and happiness. Then, of course, the most lively gratitude is manifested. But it is rarely so. We must apparently throw away much time and effort, and it is only once in a great while that our hearts can be cheered by any obvious good results, or any real gratitude. Benevolence does now and then seem to have a magic wand, with which, almost in a twinkling, she turns scenes of gloom and desolation into those of beauty, and makes even the wilderness to blossom as the rose. But she is generally employed in real drudgery with little immediate prospect of success. She digs and digs patiently, and with the animation of hope. She finds but few gems; but these, be it remembered, will survive all the changes of time, and will shine in her coronet forever.

It is true that gratitude is sometimes awakened in the heart of the vicious poor, even when our influence does not produce any improvement in their moral condition. But it has only a momentary existence, and, amid the giddy whirl of grovelling enjoyments, our kindness is forgotten, and the recollection of it is excited only by their returning necessities. And then too, the apathy, into which the heart is apt to be schooled by the miserable monotony of a vicious poverty, effaces every trace of feeling which may occasionally be impressed upon it. This state of heart may be read in the very countenance—the wooden features, which our kindness may have roused to some degree of animation, soon resume their wonted inexpressive fixedness after the exciting cause is gone. And often, very often, the favors we dispense are received with a vacant stare, the recipients being strangers themselves to any other motive than selfishness, and therefore taking no cognizance of the existence of anything like benevolence in the bosoms of others.

There is one class of the community that have been accustomed to be attended gratuitously by physicians, who have so often wounded the feelings of our profession by the course which they have pursued, that I cannot pass them by without a particular notice. I refer to clergymen. So scantily are they generally compensated for their services, and so intimate is the relation which they hold to our profession, that medical men have commonly very cheerfully made their attendance upon them gratuitous. This being the case, they have a right to expect of them, if not gratitude, at least a proper regard for their rights as professional men. But I am constrained to say that many of this class have failed to answer this reasonable expectation. The physician often finds, that the clergyman, upon whose family he has attended without charge, perhaps for a long time, gives his certificate in recommendation of some nostrum, or employs some quack, or becomes the noisy advocate of some new system just now rising into popular favor, or perhaps, in his zeal for his sect, becomes the active patron of some practitioner of his own denomination, urging him even upon the families of the physician whose services he has so long gratuitously enjoyed. Such acts as these on the part of men who have received such favors, and who by their station and character can exert so much influence, are among the most vexatious trials of a medical life.

The feelings of the physician are tried not only by the treatment of individuals, but by that general disposition against the medical profession, which is to some extent manifest in every community. If you look candidly upon the public benefits[45] which our profession has conferred upon society, to say nothing of its toils and self-denials, you will be impressed with the fact, that it does not receive that respect and that regard for its interests to which it is fairly entitled. The radicalism which aims to overthrow it is in some measure countenanced by many, of whom we have a right to expect better things. Many of the intelligent and well informed pay an occasional tribute to empiricism, and manifest a distrust towards medicine, which they do not manifest towards any other science. Though they would be sure to employ none but lawyers of known skill, and would sit under the teachings of none but well educated clergymen; if sickness comes, they resort to some secret nostrum, or employ some pretender, of whom perhaps they know little else, than that he calls himself a German, and has an abundance of hair about his visage; and if they have a dislocated or fractured bone, they abjure scientific surgery as unworthy of confidence, and send for a natural bone-setter. The reasons which secure their respect for other sciences fail altogether when they come to medicine. They even indulge in a playful contempt in speaking of its claims. They banish it from the pale of reason; and submit themselves to vagaries and fallacies and pretensions, the folly of which they would see at once in relation to any other subject. They refuse to give to either the science, or the profession, that steady esteem which is clearly due to it from all stable and intelligent men. In seasons of trial even, instead of extending to physicians their confidence and support, they reward their toils with an ungenerous and inconsiderate fault-finding. This ingratitude of the public is sometimes manifested in the most offensive manner. After the yellow fever in Philadelphia in 1798 had subsided, at a meeting of the citizens, in which the committee who superintended the city during the prevalence of the disease was honored with a vote of thanks, a similar vote was proposed in relation to the physicians, but was not even seconded, though, as I have stated in another place, nearly one fourth of their number perished, in their efforts to save that ungrateful people from the ravages of the pestilence.

Let us turn now to the consideration of the pleasures of a medical life. On this branch of the subject I shall be brief, not because the physician has few joys, for he has many, but because they require no extended notice to make the reader appreciate them.

If we look at medicine simply as a science it is full of interest, and the study of it is therefore a rich source of gratification. Its subjects have a wide range and an endless variety. No science has such extensive and intimate connections with other sciences.[46] It gathers to itself the resources of chemistry, botany, mechanics, comparative anatomy and physiology, and mental philosophy; and fills its storehouse of facts with a variety and abundance sufficient to satisfy the wildest and most eager curiosity. The phenomena of life even in the healthy condition are exceedingly diversified; but, as modified by disease, and by the remedies which are administered, their variations are never ending. And then the mysterious connection of mind and body not only varies them still more, but opens to us a mass of facts of a mingled mental and physical character, which awaken an intense interest. The physician looks upon the human body, not merely as a machine filled with contrivances so cunning and elaborate, as to render all the mechanism of man in the comparison rude and bungling; but as a machine instinct with life, having a living nerve attached to every fibre of it, giving to it its power to act; and, more than all, as a machine holding in strange connection with its every fibre a reasoning soul, the image of the Deity, destined, not to perish like the mind of the brute with the perishing body, but to live through the ages of eternity.

The details of a science which treats of phenomena so interesting in their character, and so wide in their range, are never dry and uninteresting, as the details of other sciences sometimes are. There are no tedious technicalities, no dull abstractions. There is no tiresome monotony. There is therefore an absorbing enthusiasm in the pursuit of medical science, which is not so common in other studies. It is an enthusiasm which makes its votary disregard the loathsomeness of putrefaction, and even forget danger, in his search after truth.