Physician and patient

by Worthington Hooker

Another error, of a more directly practical character, which existed for a long time in relation to this same disease, will serve as another illustration of the influence of a partial view of facts, in leading to wrong conclusions. Dr. Sutton, one of the early authors on delirium tremens, asserted as the result of his observation, that the patient must sleep or die, and that opium in large doses was the proper remedy to produce the sleep. This opinion was for a long time almost universally adopted, and practised upon. But the compared experience of many observers has demonstrated this practice to be erroneous, and it is now very commonly given up by the profession.

In examining disease, whether in a single case, or in groups of cases, it is essential to the formation of correct conclusions, that all the symptoms be observed, and that their relative importance be duly estimated. Much error has arisen from a disregard of this plain truth. Take for example the observations of different individuals in regard to fever. Boerhaave, looking mainly at one class of symptoms, taught that fever was caused by a bad state of the blood; Cullen looking at another class of symptoms, considered fever to be an affection of the nervous system; Clutterbuck, fixing his eye upon another class of facts, was very sure that the cause of fever is always to be found in the brain; Broussais, directing his attention to the symptoms developed in another quarter of the system, asserted, that all fever arises from an inflammation of the mucous membrane of the stomach and of the upper portion of the intestines; Dr. Cooke of this country, narrowing his vision down to a certain set of symptoms, proclaimed that the primary cause of fever is a weakened action of the heart, producing an accumulation of blood in the venous system; and Samuel Thompson, following in his rude way the example of all previous theorizers on this subject, in taking into view but a part of the facts in the case, declared that fever is a battle between the cold and the heat, and that, if the cold conquer, the patient dies, and if the heat gain the victory, the patient lives.[29]

It is thus that a disposition to form conclusions from a limited experience, and to take partial views of facts, leads to errors of opinion, and consequently errors of practice. I might multiply illustrations on this point, but it is not necessary.

Allied to the influence just mentioned is another, to which I will give a passing notice. I refer to the hobby-riding which is so common in the medical profession. Every good thing seems to be destined to this use till it loses its novelty; and therefore its real value can never be accurately ascertained, till it has passed what may be called the hobby-period of its existence. No careful discriminations are made to any extent until this period is finished. Even the experience, which is recorded in journals of medicine during its continuance, needs to be thoroughly sifted by after observation. The influence of this hobby-riding is therefore a great hindrance to the progress of medical science. And this influence is not confined to the particular subjects to which it is applied. It does not merely throw obstacles in the way of their investigation. It is not thus limited and evanescent, for it is counter to the true spirit of observation, and impairs its hold upon the profession as a whole.

The riding of hobbies is very much regulated by fashion. For there is a fashion in medicine as well as in everything else; and it not only bears rule in the community at large, but it exercises no inconsiderable authority in the medical profession itself. Some particular diseases and modes of treatment, are ever, sometimes one, and sometimes another, uppermost in the popular mind.

When anything new comes up in regard to disease or its treatment, which attracts considerable attention, there is a strong temptation to make a hobby of it. Multitudes suppose that they have the disease, and need the treatment. This may be really true of but few of them, but such is their belief. There is no time for accurate discrimination if the object be to make fame and money. If a physician honestly undertakes to decide what cases need the treatment, and what do not, he will not be as successful in gaining eclat, and in getting the people’s money, as his neighbor will be, who catches the popular breeze with all his sails, knowing that it is not wont to blow in one direction for any length of time.

A few years ago dyspepsia was very fashionable; but now it is so old-fashioned, that we hear but little about it, and no hobby-rider thinks at the present day of setting up any pretensions to great skill in the treatment of this complaint. Diseases of the throat have taken its place in the public mind, and multitudes are running to those, who are reputed to have peculiar skill in clipping off tonsils and palates, and swabbing out windpipes. The new treatment, as it is called, is good practice in some cases; but the almost indiscriminate application which some hobby-doctors make of it is ridiculous and contemptible. The confirmed consumptive, who has his palate clipped, or his throat or windpipe swabbed, and because he fancies that he feels better, revives for a time the delusive hope of recovery, and cheerfully pays the doctor his fee, has a most unjustifiable cheat practised upon him. And such fees! From five to twenty dollars, according to the circumstances of the patient, is asked by some of these doctors for clipping the palate, one of the most trifling operations in surgery.[30]

When this fashion shall have passed by, as pass it will, like all other fashions before it, and this hobby shall have ceased to be ridden, how little will be the actual knowledge of diseases of the throat and windpipe, which will be found to be added to the stock of information in the possession of the profession by those, who have now the reputation in the community of being very skilful in the treatment of these complaints! Some, who have had less eclat, and have therefore reaped less pecuniary benefit, will have made the proper discriminations; and to them will the profession be indebted for all that has been really discovered in relation to the nature and treatment of these diseases.

A habit of making loose and exaggerated statements has become so common in the medical profession, that it is really no small obstacle in the way of the accumulation of accurate observations in medicine. The credulity of the public tempts to an indulgence in such statements, in the common intercourse of physicians with those who are around them, and to whom they relate their cases, and state the results of their experience. If they yield to the temptation, the habit grows, and it inevitably begets and fosters another habit—that of loose observation. The statements of such physicians are not to be relied upon, even when they appear on the pages of some medical journal. Much of the recorded experience of the profession is undoubtedly from this cause worse than valueless.

I mention as another very common cause of inaccurate observation in medicine, an easy credulity, and a consequent fondness for novelty and change. It is a very prevalent opinion that the medical profession is opposed, as a general thing, to anything which is new, and that it really thus stands in the way of the march of improvement. This may have been true once, when the authority of antiquity held an almost undisputed supremacy over all the votaries of learning and science. But it is far from being true now. One of the prominent faults of the medical profession in the nineteenth century is, on the other hand, that it is as a body too fond of new things, and too much disposed to receive them upon doubtful evidence. There is a great disposition to hail every new remedy with enthusiasm. The annals of medicine are therefore burdened with false statements in regard to the effects of remedies. Though the public think that there have been of late many discoveries of new medicines of great value, there really have been but few. There have been many improvements in the forms of medicines. I mention as examples, quinine and morphine, the active principles of bark and opium. But there have been but few absolutely new medicines introduced which are of any importance. Many have been announced with much flourish, and have been extensively used for a time, but the confidence which has been put in them has in most cases been found to be misplaced. And it may be remarked, that physicians, who try all the new remedies recommended from time to time in medical journals, do not add so much to their stock of available experience, as those do who are more cautious, and less ready to adopt everything which is new.