Physician and patient

by Worthington Hooker

It must be obvious to my readers, that a reform is needed in the ranks of the medical profession, to enable it to exert any commanding influence in the removal of empiricism. Not only is its dignity impaired, but its energies are crippled, in all its honest endeavors for this object, by the extent to which that spirit, which I have described, prevails among its members. It is not confined to a few of the ignorant and grossly unprincipled, who have stolen into our ranks; but it is seen to a greater or less degree even in some who occupy stations of power and influence, and in quite a large portion of the common mass of practitioners. This may be considered by some as too strong a charge to bring against so noble a profession; but my own observation, and that of other physicians from different parts of our country, prove it to be a true charge.

Let then the profession be purged. Let the true spirit of investigation animate all the members of it, instead of only a portion of them. Let that short-sighted policy, which relies upon the credulity of the community for success, instead of attempting to correct it, be given up. Let all false issues be avoided. Let reputation be sought after on true grounds, and let competition be honorable, and therefore such as will further the cause of truth, and promote the interests of the profession, and not sacrifice them to mere temporary self-aggrandizement, as is now so often done.

If such could be the prevailing spirit of the profession, and if each member of it should undertake to exert his individual influence in the way that I have pointed out, there is no doubt that a most effectual blow would be given at once to the domination of quackery. The whole profession then, instead of being dispirited by the errors and inconsistencies of a large portion of its members, as it now is, conscious of the strength which self-respect always inspires, would present a bold, unbroken front in its warfare with empiricism. The community then would not, as they do now, take a license for their own credulity and quackery from that of medical men; but the uniform example of the profession, in its search after truth, would always rebuke the spirit of empiricism, and prevent, in a great measure at least, the sensible and well informed from coming under its influence. That such a change can be produced, to a great extent at least, I have not a doubt. But in order to accomplish it, all the honorable and the true votaries of medical science must be aroused to the effort, and must make common cause both against the abuses that exist in our own ranks, and the abounding and multiform quackery of the public. And because some of the occasional efforts which have been put forth by individuals for this object have effected but little, we should not therefore despair as to the success of a general and united effort.

We would call upon the stable and well-informed in the community to co-operate with us in effecting this change. They can render us very material assistance. In what ways they can do this I will endeavor very briefly to point out.

One of the most effectual means of eradicating quackery is the promotion of a thorough education of the medical profession. The lower the standard of education is among medical men, the greater will be the number of ignorant pretenders who will gain admission into their ranks, and consequently the greater will be the prevalence of quackery in the profession, and of course in the community. This result is the more certain to follow, because deception and imposture are practised upon the public so much more easily in medicine, than in regard to other subjects. And it is for this reason that it is for the interest of the community to have a proper standard of medical education maintained much more even than it is for the interest of the profession itself. For so little are they qualified to judge on medical subjects, and so much are they obliged to take medical practice upon trust, that it is important for them, that they should have all the benefit of the safeguards the requisitions of our professional organizations throw around them. And this leads me to say, that it is only through these organizations that a proper education of the profession can be secured. Imperfect as they are, and much as they fall short of accomplishing fully the object, if they were done away, as some self-styled reformers, who hate all ‘regularism,’ desire, empiricism would abound vastly more than it does even now, for the door then would be opened widely for the impostures which it so easily practises upon the people.

The community are much at fault in their opinions and practices on this subject. These organizations are lightly esteemed, and sometimes even treated with contempt. Even those who are shrewd and judicious in all other matters, often put the quack of a day on a level with the accredited physician, laden with the carefully gathered experience of years, or perhaps even above him, and welcome with open arms the advocate of some new system for the moment high in favor, with scarcely any regard to the inquiry, whether he has been educated in any proper manner for the responsible post into which he has thrust himself. Many a man of fair address, and a good share of cunning, with but a mere smattering of medical knowledge, has dubbed himself a physician, and, adopting Homœopathy, or some other system just then in fashion, has imposed not only upon the ignorant, but the intelligent and learned.

This ought not so to be. The public should, one and all, feel that they are personally interested in upholding a well-educated medical profession. Here is a science which is confessedly difficult above all others, and in which, as you have seen, careless observation is peculiarly liable to error. How important then, that those who take charge of your health, your life, should be careful and skilful observers. And education is obviously as much needed to form good habits of observation in this, as it is in other sciences. But let me say, that whenever you give countenance to quackery, whether it be in the shape of a secret nostrum, or a fashionable system, you strike a blow at the standard of medical education. You in effect say to the physician, observe, watch, study as much as you will, we esteem all your labor and experience vain. When men of wisdom and influence do thus, as I am sorry to say they often do, it certainly casts contempt upon education, and therefore tends to lower its standard in the profession. For if physicians see, that they can acquire the esteem of the public without study and labor, many will be disposed to give them up, and take the easier path to success, into which they are thus invited. And this is the grand reason, why so many pretenders are found in the ranks of the medical profession.

Before I leave this topic let me correct one error, which is quite prevalent in regard to the basis of our organizations. We are charged with being proscriptive in regard to opinions. We are called in vulgar cant regulars, and we are supposed to have ‘regular’ systems of doctrine and practice, and to maintain a deadly hostility to any opinion which is opposed to these systems. This may be true of individuals, but it is not true of the great body of the profession. We allow of the utmost latitude of belief. We have no creed, nor sets of creeds. We thrust none out of our medical societies for opinion’s sake. Any member may adopt any doctrine or system he pleases, however much opposed to the opinions of the great majority—Homœopathy, Hydropathy, or even Thompsonism. Education is the qualification for admission to our ranks; and nothing but a gross and obstinate infraction of our rules of intercourse, which are based upon truth and honor and benevolence, can be made the ground of expulsion.

Another way in which the stable-minded and well-informed can assist the medical profession, in the eradication of quackery, is by renouncing all fallacious means of judging of the merits of physicians, and relying upon those which I have shown to be so apt to lead to correct conclusions. For an extended view of this subject I refer the reader to the chapter on Popular Estimates of Physicians. And I will only remark here, that, while the honorable practitioner desires from his employers an intelligent confidence, the quack and the quackish physician are very willing, that the community should continue to judge of medical men by the same false rules, which have been so long in vogue, because they subserve so well their narrow and selfish purposes.[35]

The sensible and influential in the community can render effectual aid in the overthrow of quackery, by promoting the strict observance of the rules of medical intercourse. These rules are not sufficiently understood and appreciated by the public. If they were, those who have influence in society would frown down the base arts of a cunning competition, instead of encouraging them, as they now often do; and would give no countenance to the false issues, upon which empirics and dishonorable physicians so much depend for their success. For a full view of this subject I refer my readers to the chapter on the Intercourse of Physicians.