CHAPTER VIII.
GOOD AND BAD PRACTICE,
Not easy to distinguish between good and bad practice by results. If it were, would not be such differences of opinion among physicians and in the community. Examples of these differences. Stimulating and depleting measures. Homœopathy, Hydropathy, Thompsonism. Quacks aware of the difficulty in estimating comparative results—act accordingly. No mode of practice wholly good—none wholly bad. Some good points in all modes. Exclusive systems. Distinctions between good and bad practice pointed out. Cases in which the question of life and death immediately affected by practice. Failure of unskilfulness in such cases. Interesting case. Seldom is the influence of bad practice so manifest as in this case. Difficulty of culling out from the mass cases which are dangerous from the first. Various causes of this. Difficulty inherent. Cases misrepresented by mistake or wilfully. Some said to be very sick when not so. Light cases made bad by treatment—though appear grave, apt to recover. Illustrations. Comparisons between rival physicians as to results. Public often mistake in such comparisons. Notice some less direct effects of bad practice. Unnecessary complications of disease. State of system after recovery. General state of health in families. Length of sickness. Summing up of differences in results between good and bad practice. Two requisites for observing these correctly. 1. Sufficient amount of evidence. 2. Skill in observation. Community deficient in these. Confident appeals of quacks to alleged results. Show what the physician should say in regard to results.
CHAPTER IX.
THEORY AND OBSERVATION,
All real knowledge based upon observation, not on theory. Facts of two kinds—individual and general. General facts ascertained by observation of many individual or particular facts. No theory founded on facts—always goes beyond them. No science in which there has been so much theorizing as in medicine. History of medicine very much a history of theories. Office of theory—suggestive. Abuse of theory in failing to distinguish between the known and the supposed. Newton’s carefulness on this point. Circumstances impairing skill in observation. Mode of reviewing cases. Disposition to form conclusions from a limited range of facts. Young practitioners. Dr. Sewall’s plates. Dr. Sutton’s treatment of delirium tremens. Different theories of fever—Boerhaave, Cullen, Clutterbuck, Broussais, Cooke, Samuel Thompson. Hobby-riding. Diseases of the throat and windpipe. Habit of making loose and exaggerated statements. Credulity and fondness for novelty and change. Changeable state of medicine. No standard authorities as in law and theology. Scepticism in medicine. Easy to theorize—difficult to observe well. Value of good habits of observation. Medical men had too much to do with theories and modes and systems. Eclecticism. Modus operandi of medicines. A reform in progress in medicine. Breaking loose from theory. Promoting rigid observation.
CHAPTER X.
POPULAR ESTIMATES OF PHYSICIANS,