Physician and patient

by Worthington Hooker

3. His patients have commonly a shorter sickness.

4. They are in a better condition after they have recovered—less apt to have bad results left behind, and less liable to disease in future.

5. He has a less number of patients, and a smaller amount of sickness, in the same number of families. In order to discover this difference between skilful and unskilful practice, the observation must be extended over some length of time, and quite a large number of families.

That these points of difference between the results of good, and those of bad practice, may be appreciated with any correctness, two things are necessary.

First. We must have a sufficient quantity of evidence. A few facts will not avail in deciding such points—they will only lead to erroneous conclusions. Comparison is to be made, it is true, between individual cases, but there must be many of them in order to secure the avoidance of error.

The second requisite is the capability of observing correctly. I have altogether failed of obtaining one of my principal objects in this and the previous chapters, if the reader’s mind is not strongly impressed with the great liability to error, which attends careless and unskilful observation in medicine. There is no subject, in the wide range of human knowledge, the investigation of which requires more care and skill than this does.

Now it is obvious, that the community in general are very deficient in these two requisites for a proper appreciation of the comparative results of practice. Most men have a very narrow range of facts, upon which they can found such an appreciation. Their observation of sickness extends little beyond their immediate family circle; for what they see of disease any where else is not like watching over it, and what they hear, as you have already seen, is not to be relied upon. There is much which is styled fact that is not so—it is either mis-statement, or the result of hasty and superficial observation. The actual knowledge which any non-professional observer obtains of disease, by any observation of his own, to which he gives any fair amount of attention is very narrow. This assertion may be offensive to many, who are accustomed to utter their opinions, in regard to the results of medical practice, with almost the authority of an oracle. But it is nevertheless true.

But, the reader will say, if it be so difficult, and almost impossible, for me to discriminate between good and bad practice, by my own observation of their results, what shall I do? How shall I judge of the different modes of practice, and of the skill of different physicians? In answer to this enquiry, I remark, that if the reader is really convinced by what I have said, that it is almost impossible for him to judge of practice by the results which come within the compass of his observation, then it is plain that he must give up, for the most part, this source of evidence as a deceptive one, and rely upon other means for arriving at correct conclusions on these points. What these means are I shall point out in the chapter on Popular Estimates of Physicians.

I think that physicians often err in their readiness to appeal to results, to show the public the superiority of their practice to that of the quack. There is no objection to such an appeal, when a sufficient number of well-observed and authenticated facts can be produced, bearing upon the point in question. But this cannot ordinarily be done, when the community are to pass judgment in the case. The quack likes to join issue with the physician here, for he knows how easily the public are deceived in relation to facts, and he makes his appeal before them to results with a bold confidence. The proprietor of a patent medicine points you to his wonderful cures, as the facts which must convince every one of its efficacy and value. The Thompsonian, with his red pepper and lobelia and steam, claims that he is right and every body else wrong, and appeals to his successful results as the proof. The Homœopathist comes with his little globules, and says that, laugh as you may at the tiny doses, his appeal is to the cures, which he claims they effect as if by magic. Talk with some physician who has adopted this mode of practice from purely mercenary views, and who is rather ashamed of it, (for there are such physicians)—ply him with argument, to show the fallacy of his doctrines—drive him from one strong hold to another; and at last you will come to his citadel, in which he feels perfectly secure from all your shafts. He will tell you, with a cool kind of defiance that you have not seen in him before, ‘there are the facts—our medicines cure disease, and the people are beginning to see the truth.’ The Hydropathist too will point you to narratives of scores of patients, cured of all sorts of maladies by nothing but a cold wet blanket, and will say, ‘wonderful as it may seem, there are the results.’

So it ever has been. The same appeal has been made in behalf of all the delusions that have ever obtained a currency in any community. The Indian who performs his strange and uncouth manœuvres, and utters his howling incantations over his patient, and the Chilian doctor who blows vehemently about the bed of the sick, both, like the Thompsonian, and the Homœopath, and the Hydropath, appeal to their facts, their cures, as the sure proof of the efficacy of their practice. The royal touch, the weapon ointment, the tar water of Bishop Berkeley,[27] and the metallic tractors of Dr. Perkins, were each in their time in the same way proved, to the satisfaction of the great public, to be wonderfully successful in the cure of disease. An array of facts appeared in favor of the last mentioned of these delusions, Perkinism, that surpassed altogether the results which are now attributed to Homœopathy. But time has shown that the results were falsely attributed—a fact which should teach the public a lesson, in regard to the apparent results which are appealed to in support of the delusions of the present day.