Physician and patient

by Worthington Hooker

The physician is continually meeting with evidence, that the community generally have no adequate ideas of the necessity for discrimination in medical practice. He is every day called to patients, who tell him that they have taken some patent pills, or perhaps some pills which they chanced to have in the house, and which they supposed must be “good,” as they express it, though they may not know where they came from, or what they are commonly used for; and this is done by many, without regard to the kind of malady under which they are suffering. All cases must first be dosed by pills, to which they attach this general idea of being “good;” and then, if they do not hit the disease with this random shot, they send for the doctor, not however with the belief, that his shooting will be any less at a venture, but because he may have a greater variety of ammunition.

One of the strongest evidences that the community have a very imperfect conception of the varieties of disease, and of the necessity of accurate discrimination, is the propensity to look for some one grand remedy for all diseases. This propensity is exceedingly common, and exists in every variety of degree. Some, I may say many, have the full belief that there is such a remedy, and try every vaunted medicine that comes along, in their search after the great catholicon, or elixir vitæ. Disease they suppose, in the language of quacks, and we may add of some physicians also, to be an unit, and the remedy for it must therefore be an unit also. Others, (and these form a large portion of the community,) while their ideas are less distinct and exclusive, are still governed in a great measure by this same prevailing notion. They have some favorite remedy, which they use for complaints of almost every kind. The remedy may not always be the same, and commonly is not. The ‘universal cure’ does not ordinarily last a great while, but is at length supplanted by some other, just as universal, which in its turn, is also to be supplanted. Every year, not to say every month, brings to some people a new grand catholicon.

This propensity does not always show itself in relation to some one remedy, but sometimes leads to the adoption of some system or class of remedies. I mention as an example the Thompsonian system. A certain group of remedies was selected by the founder of this system, from the whole kingdom of nature, as the remedies above all others, if not alone, fitted to attack the great unit, disease. The very idea of discrimination was discarded. The unit was to be attacked with these weapons, and the attack kept up till it was destroyed. No fear was indulged that any harm could be done, for Thompson claimed that his remedies had a natural relation to disease, possessed by no other agents, and that therefore, however largely they might be taken, they could not possibly do any injury. How beautifully simple this system of practice is; and, if its claims be just, what a perfect relief it brings to all the uncertainty of medicine! Away then with all care-worn experience, and all study! Keep up a constant fire of lobelia, red pepper, and steam, and you will certainly kill the disease at last—at least if you do not kill the patient. In the infancy of this system, this idea of its simplicity was more distinctly avowed than it is now, and the remedies that were used were much less in number than they now are. The followers of Thompson are certainly departing from the stern principles of his doctrine, and some of them even begin to talk about the necessity of study—a heresy, one would think, glaring enough almost to start Samuel Thompson from his grave!

It is most impudently asserted by Thompsonians, that physicians generally act upon the same exclusive principles that they themselves do—that while Thompsonians give lobelia and cayenne in all cases, we do the same in regard to calomel, antimony, &c. This is undoubtedly true of some physicians, but it is a gross slander when it is applied to the profession in the mass. The real difference in this matter between Thompsonians and physicians is this. While Thompsonians confine themselves to one particular set of remedies for all diseases, physicians use in their daily practice a great variety of remedies, and among them the very medicines used by Thompsonians. We have never claimed, as Thompsonians falsely state that we do, that lobelia and cayenne are not good medicines, but simply that they are not applicable to all cases, any more than is calomel, or any other remedy that may be named.

The quack shows in his advertisements, that he is aware of the prevalence of the propensity of which I have spoken, and here rests his chief hope of success. He begins his advertisement with something of this kind. Disease is an unit; or, All disease is in the blood; therefore the blood must be purified; or, Grand catholicon; or, Grand antidote to disease; or, The real essence of life at last discovered.

This propensity has shown itself in some measure even among physicians. Enthusiasts in our profession have always been disposed to attribute to favorite remedies, a sort of universality in their operation upon disease. Every new medicine that comes up to notice has almost every kind of virtue ascribed to it by such physicians. And it is only by long-continued and well-weighed experience, that the statements made in relation to any remedy can be sifted, and the real truth be discovered in regard to the degree and extent of its efficacy, and the circumstances which should govern us in its use. This process has been gone through with, in the case of every article of the materia medica that has ever had any notoriety. Take for example, digitalis. At one time, this medicine was in common use in many diseases, and especially in consumption; and some enthusiasts, if they did not go so far as to say that it was a certain cure when used sufficiently early, at least extolled it as almost a specific for this disease. The accumulated and compared experience of physicians in regard to it has at length determined pretty nearly its value, and while it is now used far less than it once was, it is used more judiciously from the more definite knowledge of its effects which this experience has gained for us.

The same remarks could be made about other articles.[6] And while the test of experience has corrected our valuation of some remedies, and thus enabled us to use them with more skill; there are others once supposed to be valuable, which, under the application of this test, have gone wholly out of use. I will mention but a single example. Dr. Beddoes, an English physician of some note, but a great enthusiast, thought that some of the gases might be advantageously used in the treatment of disease. The results were said to be astonishing, and the practice of pneumatic medicine, as it was called, became very prevalent. I find in a work, called Medical Extracts, published in 1799, the narrative of sixty-nine cases of various diseases, said to be cured by the respiring of these gases. Among them are certainly some formidable maladies, such as dropsy in the head and chest, consumption, gout, epilepsy, leprosy, scrofula, &c. Some of these cases had been previously under the care of celebrated physicians, and some had even been pronounced by them to be incurable. A description given by one of the patients, a clergyman, of his own case, almost transcends the descriptions given now-a-days by some clergymen of the effects of some patent medicine, or of the infinitesimal doses of homœopathy.

Now, if the respiring of these gases really did produce these results, or any good proportion of them, the same practice would have been in vogue now. But it has not stood the test of experience, and therefore has been rejected. No physician at the present day thinks of setting his patients to breathing these gases.

If it be said that this is the result of change of fashion merely, and that it therefore does not prove that this practice was not successful, I reply that, though fashion in medicine may sometimes temporarily prevent the use of a good remedy, it never effects the entire and continued abandonment of it by medical men. You will find it always true of remedies and modes of practice which are really valuable, that though they may not be as fashionable after a while, as they were when first introduced into notice, and may, from the fact, that they have been estimated too highly, be for a time undervalued, they will never be wholly given up by the profession. Nearly as great stories were told about calomel and digitalis at first, as were told about the gases of Dr. Beddoes. But while experience has shown that calomel and digitalis were over estimated, it has proved that these gases had an entirely false estimate put upon their remedial powers.

It is thus that the medical profession, corrects by experience the errors into which it is led by the uncertainty of medical science. But the community at large pursue a very different course. They never correct their errors, but only supplant one error by introducing another. While physicians reject what is found by experience to be valueless, and retain what is truly valuable, the multitude reject alike the good and the bad, in making their constant changes from remedy to remedy, and from system to system. It is mere caprice, and not a careful discrimination, that leads them to throw aside one favorite medicine or system, and adopt another.