Physician and patient

by Worthington Hooker

I will briefly cite two examples in illustration of this point.

A gentleman, who had a friend sick under the care of a physician, who was strongly in favor of the stimulating mode of practice, was led to doubt the propriety of the treatment, and as he watched the case he doubted more and more. He at length ventured to lessen the amounts of brandy and laudanum, taking care to conceal the fact from the patient, who was every now and then calling for them, because he felt a death-like sinking, and he was afraid that his pulse was failing. He found that in proportion as he lessened them the case improved, and he very soon discontinued them altogether. There is not a doubt, that in this case the stimulants, though affording temporary relief to the patient’s sense of exhaustion, kept the man sick, and the discontinuance of them was the cause of his recovery. A similar experience has been detailed to me by others.

Such cases as the one which I have mentioned may appear very badly, and yet the amount of disease may be slight. Some disordered state of stomach, which a very little appropriate medicine, with the aid of rest and a proper diet, would remove, is often the whole of the disease. I will give here the testimony of one among many physicians to substantiate this assertion. The physician, to whom I refer, told me, that when he began to practice, there was an elder physician on the ground, who used brandy and laudanum largely in a certain class of cases. They were cases in which there was disordered stomach, with considerable tendency to a depressed state of the whole system. The patients were commonly sick from one week to three, or even four weeks, and though they excited much alarm among their friends, they all, with but a single exception, finally recovered. He followed the example of his elder friend for some time in similar cases, but he soon began to doubt the propriety of such high stimulation. The result was, that after a while he resorted to a very simple practice in such cases, which produced entire relief in one or two days; whereas, under the stimulating treatment, they would have been long and troublesome.

I might mention many cases from Thompsonian practice, which would illustrate the same point, but it is not necessary.

Though the community do not generally distinguish between cases which are necessarily of a grave character, and those which are made so by bad treatment, there are occasionally individuals, who do to some good extent make this distinction.

A clergyman, who is blessed with a good share of plain common sense, in addition to his high talents, and who has uniformly eschewed quackery in medicine as well as in theology, told me that he was once conversant with the practice of two physicians of entirely opposite characters, during the prevalence of an epidemic. The one gave large amounts of medicine, and much of it was of a stimulating nature. He had a great many very sick patients, and there was much noise made about his wonderful cures. The other went about among the sick very quietly, gave but little medicine, and the number of his cases that were protracted and severe was comparatively small.

Another instance which I will mention was that of a gentleman, who employed a large number of men in a factory. A great many of them were taken sick, one after another, with what was called the “sinking typhus.” He observed that some of them were but slightly ailing at first, and were able to be about the house, but that after a while, under the stimulating practice, they were laid upon their beds. Some died, and many of them were severely sick for some time. He doubted the propriety of the treatment, and his doubts increased with every day’s observation. At length he persuaded some who began to be sick to take some simple medicine, and not send for the physician. The result was successful, and he recommended the same course to a large number, none of whom became very sick.

As the community are not apt to make the discrimination which was made by these two individuals, it is easy to see how the injudicious physician and the quack often get the credit of success, in their management of apparently grave cases, when in fact these cases need never to have been of this character, but they might have been cured at the onset by a judicious course in a very short time, or perhaps by the spontaneous efforts of the curative power of nature. The unskillful and ignorant practitioner often suffers disease to establish itself, and thus makes a long case, though even ordinary skill would have succeeded in at once breaking up the attack. And yet, when the patient at last recovers, he may be applauded throughout a neighborhood, perhaps a whole community, as having raised the sick man almost from the dead, when perhaps in the same neighborhood, in a case of a similar character, the attack was successfully broken up, and no credit was given to the skill which did it. This is a point on which undoubtedly the public often give a wrong verdict in their estimate of comparative success.

In order to show the readiness with which the public commit errors, on the points to which I have alluded, in their estimate of comparative success, I will suppose a case which occurs not very unfrequently. Here are two rival physicians side by side. The one is really skillful, and, if the results of his practice could be justly estimated, he would obtain great credit for success. He engages in medicine, not as a mere trade, but as a noble science. He pursues a straightforward, honorable, and quiet course, resorting to no tricks to acquire business. The other, on the contrary, is unskillful, cares little for medicine as a science, depends upon artifice, rather than real merit, to obtain business, and, though he may desire to be successful, he desires more that he may have the reputation of being so. The issue which is made by these two physicians before the public is a false one. Though the unskillful one loses more patients than the other does, in proportion to the whole number who come under his care; yet he perhaps does not lose as many, in proportion to the number of those which are considered bad cases by the community. For he makes many cases to be bad ones which need not to have been so, and, besides this, represents many as being bad, that are really not attended with any danger.

Suppose, to make this clear, that, each physician has one hundred cases of some prevailing epidemic—that each has thirty bad cases—that the skillful physician loses five of these, the unskillful one eight, the real balance being therefore much against the latter. But the latter more than compensates for this difference, by making ten bad cases out of comparatively mild ones, of which he loses perhaps but one or two, (such cases having, as I have before shown, a strong tendency to recovery,) and by representing ten others to be bad cases which are not so. How then stands the account? The unskillful physician, has, it is true, lost more patients than the other. But then, he has appeared to have more cases of the epidemic fall into his hands; for, while his rival has had but thirty bad cases, he reckons up fifty of his as having been of this character, and the community know but little of those cases which are acknowledged to be mild ones—these make no noise, and are not commonly taken into the account, in the estimates which the public make on this subject.