Physician and patient

by Worthington Hooker

I do not mean to be understood, by stating these results in numbers, that the community generally estimate them in this definite manner. I only present the subject in this way in order to show, that, while the real results tell strongly in favor of the skillful physician, even a numerical estimate might tell against him; that is, as it would be made out by the community, if they should attempt it. If then an erroneous conclusion would be so apt to result from any attempt at a numerical estimate on the part of the community, much greater is the liability to error in the vague general impressions which prevail on this subject. Many an unsuccessful practitioner has obtained a greater reputation for success than his really successful neighbor, from the noise which is made about his numerous bad cases.

I come now to speak of some other points of difference in the results of good and bad treatment, in regard to which the community are commonly even more deceived, than on those of which I have already treated.

In managing a case, in which disease has become so seated, that it cannot be broken up, but must be removed gradually, it is evident that the more judicious are the means which are applied from day to day to the varying states of the case, the shorter will be the sickness. It is in the accurate adjustment of remedial means to the ends to be accomplished, that unskillfulness makes a great failure; and yet it is a failure, which is for the most part concealed from the public, because it can be satisfactorily detected only by a nice comparison of cases. And this comparison cannot be made by the public, for reasons which will soon be stated.

But the adjustment of remedies to the varying states of disease has an influence beyond the mere circumstance of the length of the sickness. The judicious physician saves his patients from unnecessary complications in their diseases; while the injudicious physician and the quack are apt, not only to neglect to prevent or remove such complications, but to excite and foster them. For example, if there arise in the course of a case of fever some local inflammation, the judicious physician notices the symptoms of it, as soon as they appear, and immediately applies remedies to remove it, and commonly succeeds in so doing. On the other hand, unskilfulness would be blind to the fact that such an inflammation exists, and would therefore make no efforts to destroy it, but would perhaps unwittingly increase it. The same difference between skilful and unskilful practice could be pointed out in regard to other kinds of complications—congestions, irritations, and functional derangements of different organs.

But let us look beyond the results which occur during the progress of disease, and examine those which appear after recovery has taken place. When one recovers under injudicious practice, his system is not apt to be in a good state. His convalescence is not a clear one, and his recovery is not full and complete. Perhaps his vital energies are impaired, and his constitution has received unnecessarily an injury, from which it may never wholly recover. Perhaps some local chronic ailment is left behind, which, though it may trouble him but slightly for a long time, may yet be the germ of some future disease. Such a state of things is not inconsistent with a tolerable condition of health, even when there may be such disease, as will gradually accumulate, till it bring him to a bed of sickness, perhaps of death.

These remote consequences of bad practice are the more certain to occur, if the patient go on, after recovery, to administer medicines to himself according to his own whims, or those of others. Many very tedious cases of this kind fall at length under the care of physicians, from the hands of quacks, who are thus often spared from witnessing the results of their ignorance and imposture, and from bearing, in the estimation of the public, any responsibility in relation to them.

The influence of bad practice upon the health of families, it is evident from the above facts, must be very great; and yet it is seldom appreciated at all, and never as fully as it should be. There is no question of the fact that there is generally a much larger amount of sickness, from year to year, in families that employ unskilful physicians or empirics, than there is in those who are under the care of skilful practitioners. And though the public cannot discriminate accurately between individual cases in regard to this point, they can see the evidence of this general fact, especially in comparing good practice with gross quackery. This evidence will go on to increase, inasmuch as the evil effects of quackery, continued in a family from year to year, are constantly accumulating; a result which is materially aided by the unnecessary dosing, commonly pursued by them in the intervals of sickness. And from this accumulation we may infer, that what we now see of the bad consequences of quackery is but a shadow of what we may see hereafter.

Let us now sum up the points in which the practice of the really skilful physician differs in its results, from that of the injudicious practitioner, and the quack.

1. He has a less number of fatal cases in proportion to the whole number that come under treatment.

2. He has a less number of bad cases, because he avoids converting light cases into grave ones, and succeeds in arresting disease in many cases in its very commencement.