Physician and patient

by Worthington Hooker

CHAPTER VIII.
GOOD AND BAD PRACTICE.

One would suppose at first thought, that the difference between the results of good, and those of bad practice in medicine, would be palpable to the most common and superficial observation. But it is evidently not so. Facts in great abundance show that it is far otherwise. The history both of medicine, and of quackery, furnishes many instructive lessons on this subject. If we confine our view to the medical profession, we see often two directly opposite modes of practice praised by their adherents, as being successful in the same complaints. We see the profession and the community both divided on this point, each party asserting with zeal the claims of its favorite system of practice to pre-eminence.

I will cite but a single example in illustration of these remarks. Some years ago there was a warm discussion carried on among quite a large portion of the medical profession in New England, in regard to the general character of diseases in this part of the country, and their proper mode of treatment. One party, at the head of which was Dr. Gallup, asserted that the diseases of New England had been, since the beginning of the present century, almost altogether sthenic or inflammatory, and therefore had required depleting remedies. Another party, whose chief champions were Doctors Miner and Tully, contended that diseases had been asthenic, or characterized by debility, instead of an inflammatory tendency, and that they therefore required stimulants. While Dr. Gallup denounced the treatment of disease, pursued by the adherents of Drs. Miner and Tully, as “incendiary treatment,” and lauded bleeding as the chief remedy for the present time; Dr. Tully, on the other hand, says that “the lancet is a weapon which annually slays more than the sword,” and that “the king of Great Britain, without doubt, loses every year more subjects by these means”—depleting remedies—“than the battle and campaign of Waterloo cost him, with all their glories.”

Now if it were easy, by looking at results, to decide in all cases what is good, and what is bad practice, it is evident that such diametrically opposite modes of treatment could not be in vogue at the same time. The proper distinctions would be made, and the good practice would be approved, both by the profession and by the public; while that which was seen to be injurious in its results would at once be rejected.

So also, if it were easy to make this distinction, the truly skillful physician could always be recognized as such, while the unskillful and ignorant practitioner would not be able, as he now often is, to obtain from the public, in spite of his deficiencies and his blunders, the meed of praise due to real merit and actual success. The quack, too, would stand forth in his true light, in contrast with the man of science in the results of his practice, instead of claiming, with brazen effrontery, and receiving from the multitude, as he now often does, the credit of being even pre-eminently successful.

There never was such a variety of systems of quackery before the community as there is at the present time. To say nothing of minor claimants, there is Thompsonism, almost parboiling its patients with steam, and shaking them to shreds with lobelia, and burning them up with cayenne; and Hydropathy, that wraps up its devotees in the cold, wet blanket; and then gentle, sweet, refined, sublimated Homœopathy, that starts with horror at the very idea of such harsh means, and professes to neutralize all disease with little else than the mere shadow of medicine. Each one of these systems, so opposite to each other, asserts its claim to be the only true system of medicine, and bases this claim upon the success which attends it. The same claim is also essentially made in behalf of numberless medicines which are before the public.

Amid all these opposing claims many are bewildered, and ever in doubt where the truth lies, are never established upon anything, but fly from one thing to another, as the evidence of success preponderates in favor of this, or that medicine, or system. Others become the firm and enthusiastic advocates of some one of them, but after a while discard this for another, and few adhere to any one thing during a whole life. And it is amusing to see with what ease some make the transition from one mode of practice to another, which is totally different from it, being quite sure that they are right in doing so; and yet, if they are right, the error from which they have escaped is a very great one. They do not however always view it in this light, for they sometimes recur to their former preferences, though they are as inconsistent with their present ones as they well could be. If Homœopathy be right, then Thompsonism must be very wrong; and yet I have known persons, who are disposed to quackery, go from one to the other, and speak in praise of both as being successful modes of practice, without seeming to be aware that they are so entirely opposite to each other. So there are some, who at the same time manifest confidence both in the common practice of medicine, and in Homœopathy; though if Homœopathy be right, almost the whole body of physicians are rank murderers, and if physicians be right, Homœopathy is as ridiculous an error as ever obtained a foothold in the community. And then there are some, who appear in the space of a twelvemonth, at different times, as the advocates of Homœopathy, Thompsonism, Hydropathy, and perhaps Chrono-thermalism, to say nothing of various patent medicines from some College of Health, or some German physician, with a long list of titles, or some Indian doctor laden with remedies fresh from nature’s rudest and most secret arcana.

Now it is clear, that if it were an easy thing to decide what is successful practice and what is not, from an observation of results, then there would not be such diversity, nor such frequent change of opinion in the public mind, in regard to modes of treatment so directly opposed to each other, as those are which I have mentioned. The advocates of them would not so boldly urge their claims, knowing the facility with which these claims could be tested. But the difficulties which actually lie in the way of testing them are such, that the community are exceedingly liable to be deceived. Practice, which is really unsuccessful, is often made by its advocates to appear for a time at least, to be more successful than any other mode of treatment, and it is often only by long continued observation that this error is corrected.

This error exists at this time among a large portion of the community in relation to Homœopathy, and it is to be removed by the same gradual process, by which all kindred errors have been removed hitherto. By observation it will be found by its advocates, one after another, that its reputation for success is founded upon mistake, and it will thus step by step lose its hold upon the public favor, to make way for some other system, which in its turn must go through with the same process.

Those who embrace some form of quackery from mercenary views, are aware of the facility with which the multitude are deceived in regard to the comparative results of different modes of practice; and it is this which makes them so confidently anticipate at least a temporary success. Homœopathy furnishes many examples of this character. While there are a few in the medical profession, of a peculiar cast of mind, who are honest Homœopathists; there are others, of various degrees of intellectual merit, who have adopted this mode of practice, simply because they have failed to acquire business in the ordinary way, or because they saw in the adoption of a system, just now popular, a fair prospect of so increasing business, as to secure wealth instead of a mere competence; and others still, who have dubbed themselves physicians, have gone into the practice of Homœopathy, as mere adventurers, preferring very wisely to try their luck on the tide of a popular error, instead of trusting to knowledge and skill, of which they have little or none. These two last classes of Homœopathic physicians indulge the hope, that the community will be deceived, in regard to the success of their system of practice, a sufficient length of time to enable them to realize their golden expectations; and then, when this false system shall be supplanted by some other, they will be ready to adopt that other for the same solid reasons for which they have adopted this.