Physician and patient

by Worthington Hooker

Let me not be understood to mean, that none but physicians ought to know anything about the human system; nor that the knowledge of it, which is obtained from popular books and lectures, can be of no advantage in the warfare with empiricism. Though, when it is relied upon as the chief, almost the only, weapon in this warfare, it is, as you have seen, of little avail, and is often even turned against the cause of truth and science; yet, as an adjuvant to other means in removing quackery, it may prove very valuable. What then, let us enquire, are those other means?

I have shown in another chapter, that the principal popular errors in medicine arise from partial views of the operations of disease and the effects of remedies, and are false conclusions in regard to the relation of cause and effect. These false conclusions are, as you have seen, the basis of quackery; and therefore one of the chief means of removing quackery is to be found in the exposure of the fallacy of these conclusions.

But it will perhaps be said, that this has often been attempted, and with so slight success, that there is very little encouragement for repeating such attempts; and that it is best on the whole to let the community find out their errors by their own experience, sad as it sometimes is. Those who take this ground assume, that the efforts which have been made for this object have been of a proper character. I think it to be clear that they have ordinarily not been so. There has been too much of ridicule and sarcasm. These are means which are appropriate to a certain extent, as auxiliaries to sober argument; but they never should be relied upon, as the only, or the chief, instruments in combatting error. There has also been too much of denunciation, and calling of hard names. There has not been, on the other hand, enough of calm, candid and patient discussion on the part of physicians with the well-informed, as they meet them from day to day. To the medical man quackery appears so nonsensical, that he has commonly no patience with those who embrace it. He does not remember that many of his own profession have, in their reasonings about cause and effect, committed some of the very same errors which have engendered that quackery. Perhaps, if he looks back upon his own course, he may find that he himself has at some time fallen into an error, which might have led him into empiricism, if he had been out of the profession, but which was prevented from producing this effect upon him by that sense of dignity, which characterizes the man of science, and by that disposition to careful scrutiny, which the pursuit of medical science is peculiarly apt to impart. He should therefore avoid being betrayed, by the ridiculousness of quackery, into the utterance of harsh expressions, or into too free an use of sarcasm. He should, on the contrary, endeavor to show any intelligent friend, who has chanced in some way to be deluded by empiricism, that he has been deceived, and point out to him just how it has been done. He should show him what the mistakes are which he has made, in relation to the connexion between cause and effect; and should endeavor to impress upon his mind the truth, that there is more necessity for cautious discrimination, in forming conclusions on this, than on any other subject in the wide range of science. He should show him how common it is in medicine, to attribute results to causes, which have had no agency in producing them; and that if physicians themselves are apt to commit this error, much more must they be, who are ignorant of medical subjects, and who have but limited means of observation.

It is this individual influence, which may thus be exerted by the profession, that must be relied upon as one of the principal means of ridding the public of the evils of quackery. It is not a mere occasional effort—some address, some short article in a public journal, some fling of biting sarcasm, or some sally of wit—that will do it. Men of strong sense and good judgment, when they are led into error, as such men often are on the subject of medicine, are not to be delivered from that error by such means. Remedies of a more searching character, and a treatment more patient, thorough, and persevering, are required to reach their case.

It is very desirable that this individual influence be exerted by medical men, because the class of persons to whom I have alluded, and who may be successfully reached by it, are the chief pillars of empiricism. It is true, I will allow, that the ignorant, the enthusiastic, and the novelty-seeking, make up the great mass of the patrons of quackery; but they are kept in countenance by those men of acknowledged good sense, who are found in considerable numbers in every community, supporting empiricism in some of its many forms by the weight of their example. The plain unlettered man who takes some patent medicine, is encouraged to do so by the example of some neighbor of general repute for shrewdness and wisdom, or perhaps of commanding talents and influence, and by the array of great names which he sometimes sees appended to certificates. A sort of general license is thus given to empiricism by this occasional endorsement by men of this character.

Some other reasons, besides those already mentioned, for the want of success in efforts for the overthrow of quackery, remain to be noticed.

The credulity in the public mind, that gives rise to the errors on which quackery is based, is encouraged by a similar credulity existing, to a considerable extent, in the medical profession itself. If the physician is seen to believe upon mere plausible evidence one thing, his friends will feel justified in believing some other thing resting on similar evidence. If he is not careful in sifting evidence, he cannot expect that others around him will be. If he, for example, give full credence to all the juggleries of animal magnetism, and all the extravagancies of phrenology, as they are put forth by travelling lecturers, how can he hope to dissuade an undiscriminating public from exercising a like credulity, in regard to the pretensions of quackery, which are not a whit more extravagant and fallacious?

The influence of the example of physicians in sustaining empiricism shows itself occasionally in a still more objectionable mode, than the one just mentioned. The profession sometimes gives its sanction to the credulity of the public, not only by indulging a similar credulity, but by giving currency to some of the measures with which the quack deceives a credulous community. Many physicians, and some of them of high standing, have for various reasons given certificates in regard to patent medicines. Some too, from the love of money, have even ministered to the empirical tastes of the community, by getting up some secret nostrums of their own. Such physicians either boldly bid defiance to an indignant profession, or save themselves from merited disgrace and expulsion, by announcing, that they are willing to make known, to any physician who asks it, the composition of their medicines. By this miserable artifice they comply with the letter of our regulations, while they go directly counter to their spirit. For, after all, the successful sale of their medicines requires the employment of the same measures, to act upon the credulity of the public, which are made use of by the whole herd of ignorant quacks, and they commonly have little scruple in resorting to them.

But there is a greater evil still, beyond all this, that exists in the medical profession, hindering it from waging successful war with empiricism. It is the spirit of quackery, actuating quite a large proportion of the profession. It is not always manifested in palpable shape, and in acts which can be exposed to the contempt of all honorable men, but it exerts a concealed and yet a constant influence upon the habits of intercourse, prompting to the use of cunning arts in order to deceive the community, exciting an overweening desire for reputation, with an indifference to the grounds upon which it is based, and producing a competition among physicians that rests, to a great extent, if not wholly, upon false issues. Where such a spirit exists, the object is not so much to seek after truth, as it is to make out a good case in the eyes of the public. No effort is therefore made to correct the credulity of that public, but this is looked upon as one of the instruments to be used for the attainment of their selfish ends. They follow medicine as a trade, and this is an essential part of their capital.

I need not spend time to show, that this subserviency of medical men to the credulity of the public, is one of the worst obstacles to the eradication of the quackery which results from this credulity. And this mode of self-aggrandizement is an evil, which prevails in the profession to a greater extent than is commonly supposed. It is so covert and sly in the case of many physicians, that it is called by their friends worldly wisdom, or perhaps even good judgment. And the physician who adopts it, if he have much conscience, quiets it with the consideration, that the world cannot be reformed, but we must take it as it is; and he looks upon the honest votary of medical science, that pursues his investigations in obedience to a love of the truth, independent of the whims of a credulous world, as a man who has not sense enough to look out for his own interests.