The subject of Temperance, in its present associated forms, had, at this time, just began to be agitated. At least, it had just begun to receive attention in the newspapers which I was accustomed to see. It could not be otherwise than that I should be deeply interested in its discussion.
I had been brought up, as I have before intimated, to a pretty free use of cider and tea; but not of ardent spirits or coffee. Neither of these was regularly used in my father's family; though both occasionally were. But I had abandoned cider long before this time, because I found it had a tendency to produce, or at least to aggravate, those eruptive diseases to which I was greatly liable. Temperance, then, in the popular sense of the term, was, to me, an easy virtue.
And yet as a temperance man—in the circle of my acquaintance—I stood nearly alone. No individual around me was ready to take the ground I occupied. Of this, however, I was not fully apprised, till a patient attempt to recruit the temperance ranks convinced me of the fact. But I will give you a full account of my enterprise, since it has a bearing on my subsequent history and confessions.
With the aid of a Boston paper which I habitually read, I drew up the customary preamble, declaration, and pledge of a temperance society. It involved the great idea of total abstinence from spirituous liquors; though by the term spirituous liquors, as used at that day, was meant chieflydistilledspirits. Having first affixed my own name to the paper I went to the most influential of my patrons and friends and asked them to sign it likewise. But, reader,—will you believeit?—not a single subscriber could I obtain far, or near. They all, with one consent, made excuse.
The elder deacon of the most evangelical church in the place where I resided, had for his apology that he suffered seriously from a complaint for which his physicians had prescribed the daily use of gin, "Now," said he, "though there is nothing in the pledge which goes to prohibit the use of spirits in a case like my own, yet as some might think otherwise and charge me with inconsistency, I must on the whole be excused from signing it."
His son, who was also a deacon in the same church with the father, excused himself by saying he was young, and without influence, and it would be far better for the old people to put their names down first. "Perhaps," said he, "I may conclude to sign the paper by-and-by. I will consider well the matter, and if I conclude to sign it, I will let you know."
Other leading men in the church as well as in the town affairs, refused to sign the pledge, because Deacon H. and son would not. It belonged to the deacons in the church, they said, to take the lead in all good things, and not to them. Whentheyhad puttheirnames to the document, others would not long hesitate to follow.
In short nobody would consent to sign the paper, and it remains to this day, just as it was when I drew it up; and it is now more than thirty years old. There it is, with my name attached to it, as large as life. I have been President, Vice President, Treasurer, Secretary, and "all hands too," of my would-be Temperance Society, from that day to this. I doubt whether many societies can be found which in thirty years have made so little change as the one under consideration.
For about four years from the time of getting up the above-named temperance society, strange as the assertion may seem, I retained the right to use a little beer and a good deal of coffee. But in May, 1830, I abandoned all drinks but water, to which custom I have ever since adhered and in which I shall probably die.
The poet Cowper, in his delineations of a candidate for the pulpit, prescribes, as one needful condition or qualification,
"That he is honest in the sacred cause."
"That he is honest in the sacred cause."
So, when I entered upon the medical profession, which I regarded as next of kin to sacred, I deemed honesty quite a high recommendation; and whatever in the abstract appeared to me to be right, I endeavored to pursue through the routine of every-day life. Alas, that I should ever have had occasion to doubt the policy of common honesty!
I was called to see Mrs. ——. The case was an urgent one. There was no time for deliberation or consultation. I understood her case but very poorly; yet I knew that in order to success I must at leastseemto be wise. Besides, what was to be done must be done quickly; so I boldly prescribed. My prescription was entirely successful, and I left the house with flying colors. I left, moreover, with the full consciousness of having acted in the main like an honest man.
A few days afterward I was sent for by Mrs. ——, who immediately filled my ears with the most piteous complaints, the sum total of which was that she was exceedinglynervous, and I told her so. Of course I did not complain of culpability or crime. But I told her, very plainly, that she needed no medicine—nothing but plenty of air and exercise, and less high-seasoned food. My great frankness gave offence, and impaired my reputation. She employed, in my stead, Dr. Robinson, who continued to attend her till his bill amounted to a sum sufficient to buy a good carriage and harness, and till his credit for skill was advanced in a degree corresponding.
Mr. B.'s child was sick, and his wife besides. He came for my predecessor; but, not finding him at home,—though he still remained in the place,—he was compelled to Hobson's choice—myself or nobody; Dr. Robinson lived at too great a distance. I was accordingly employed, and was soon on the spot. The child was very sick; and for some little time after my arrival I was so much occupied in the performance of my duties that I paid no attention to any thing else. But having prescribed for both my patients, I sat down quietly to look over the newspaper.
Presently I heard from Mrs. B. a deep groan. I was immediately at her bedside, anxious to know the cause. "Oh, nothing at all," she said, "except a momentary feeling of disappointment because Dr. —— did not come." I said to her, "You can send for him now, madam, as soon as he returns. Do not think yourselves compelled to adhere to me, simply because you have been obliged to call me once. I will yield most cheerfully to the individual of your preference."
Mrs. B. apologized. She knew I had done as well as I could, she said; and perhaps no one could have done better. "But little Leonora," said she, "is dreadfully sick; and I do very much want to see Dr. B. He has had more experience than you. These young doctors, just from the schools, what can they know, the best of them?"
I saw her difficulties; but, as I have already intimated, I did not look so wise as Dr. B., nor had I so grave a face, nor so large an abdomen. I could neither tell so good a story, nor laugh so heartily; I could not even descend to that petty talk which is so often greatly preferred to silence or newspaper reading, not only by such individuals as Mrs. B. and her friends, but by most families. A physician must be a man of sympathy. He need not, however, descend to so low a level as that of dishonesty; but he must come down to the level of his people in regard to manners and conversation. He must converse with them in their own language. He must not onlyseemto be devoted, unreservedly, to their interests, but must actuallybeso. This confession is most cheerfully and sincerely and honestly made; and may he who reads it understand.
On a certain occasion I was called to prescribe in a family where the disappointment was so great that the patient was actually made worse by my presence, and an unfavorable turn given to the disease. It may be said that people ought not to yield themselves up to the influence of such feelings; and it is certainly true that they ought not. But sick people are not always rational, nor even judicious. Dr. Johnson says: "Every sick man is a rascal;" but we need not go quite so far as that. Sickness changes us, morally, sometimes for the better, but much oftener for the worse; and in general it makes us much less reasonable.
But it is far enough from being my intention to present a full account of the trials incident to the life of a young medical man; for, in order to do this, I should be obliged to carry you with me, at least mentally, to places which you would not greatly desire to visit. Physicians can seldom choose their patients; they are compelled to take them as they find them. They will sometimes be called to the vilest of the vile and the filthiest of the filthy.
Their office is indeed a noble one; but is noblest of all when performed honestly, in the fear of God, with a view to do good, and not merely to please mankind and gratify their own ambition. Above all, they should not practise medicine for the mere love of money. A physician should have a heart overflowing with benevolence, and should feel it incumbent upon him, at every step in his professional life, not only to do good to his patients, but to all around him. He should be a guide to mankind, physically, for moral ends. He should let his light so shine, that they, seeing his good works, may be led to glorify the Father who is in heaven. His object should be to spread, by the good he performs, the everlasting gospel, just as truly as this should be the object of him who ministers in holy things at the altar. Such a physician, however, at first, I was not. Such, however, I soon aspired to be; such, as I trust, I at length became. Of this, however, the reader will judge for himself, by-and-by. "By their fruits ye shall know them."
For several months of the first year of my medical life, I was a boarder in a family, all of whom were sickly. Some of the number were even continually or almost continually under the influence of medicine, if not of physicians. Here my trials were various, and some of them severe.
But I must give you a particular description of this family; for I have many things to say concerning it, some of which may prove instructive.
Mr. L. had been brought up a farmer; but being possessed of a delicate constitution, had been subsequently converted into a country shop-keeper,—a dealer, I mean, in dry goods and groceries. As is usual in such cases, he was in the habit of keeping a small assortment of drugs and medicines. The circumstance of having medicine always at hand, and ofteninhand, had led him, as it has thousands of others, into temptation, till he had formed and confirmed the habit of frequent dosing and drugging his frail system. But as usually happens in such cases, the more medicine he took, the more he seemed to require, and consequently the more he swallowed. One thing prepared the way for another.
With Mrs. L. matters were still worse. In the vain belief that without a course of medication,she could never have any constitution, as she was wont to express it, her mother had begun to dose and drug her as early as at the age of twelve or fourteen years. And what had been thus early begun, had been continued till she was twenty-four, when she married Mr. L. But she was feebler, if possible, at twenty-four, than at fourteen, and believed herself under the necessity of taking medicine in order to be able to sit up a part of the day andperform a little light, but needful, family labor, such as sewing, mending, etc.
When I first had a seat at their family table, it was by no means uncommon for Mr. and Mrs. L. to begin their meal, as soon as "grace" was over, with Stoughton's bitters, or some other supposed cordial, or strengthener of the appetite. As I not only refused to join them, but occasionally spoke a kind word against the custom into which they had fallen, the bitters at length fell into disuse; and it was found that their meals could be digested as well without the stimulus, as with its aid.
But I was much less successful in preventing the torrent of medicine from producing its wonted —— upon this family, at other times and seasons; for which Mr. L.'s business furnished such facilities. But you must not think of Mrs. L. as a mere tyro in this business of compounding medicine, nor in that of administering it, especially to herself. From the apothecary's shop of her husband, as well as from other sources, she selected one thing after another, not merely for the time, but for permanent purposes, till it was almost difficult to say which had the best assortment, she or her husband. And she not only had it on hand, but she took it, as freely, almost so, as her food and drink.
More than even this should be affirmed. Had she at any time flagged in this work of self-destruction, she would have been brought up again to the line by her mother. For though the latter resided at a considerable distance, she paid Mrs. L. an occasional visit, and sometimes remained in the family several weeks. Whenever she did so, little was heard of in the usual hours of conversation,—especially at the table,—but Sarah's stomach, Sarah's nerves, and what was good for Sarah. It was enough to make onesick at the stomach, to witness the conversation even for a single day; and above all to be compelled to join in it.
She was there once, in the early spring, and remained until the ground was fairly settled. No sooner could she get into the woods, and come to the naked surface of the earth, than the whole country around was laid under tribute to furnishroots "good for the blood." These were put into a beer to be prepared for Sarah. It was supposed by many,—and by this wondrous wise old lady, among the rest,—that the efficacy of these medicinal beers in cleansing the blood, must ever be in due proportion to the number of their respective ingredients. Thus, if twenty articles, "good for the blood," could be procured and boiled in the wort, the result would be a compound which would be worth twenty times as much, or at least bemanytimes as useful, in accomplishing its supposed specific purpose, as if only one kind of root had been obtained.
It was a long time before I could break in upon this tissue of error, to any practical purpose. For so deeply imbedded in the human brain is the idea of purifying the blood by some such unnatural means, that one might almost as well think of building a railroad to the moon, as of overcoming it. They never thought—perhaps never knew—that the blood of the human body of to-day, will be little more the blood of the body to-morrow, than the river which flows by our door to-day will be the river of to-morrow; and that the one can no more be purified independently of any and all things else, than the other.
But it is said to be a long road which never turns. Some good impressions had been made on this family, as we shall see hereafter. Not, indeed, until there had been much unnecessary suffering, and many an unwilling penalty paid for transgression, as well as much money uselessly expended for physicians and medicine. For though I was somewhat a favorite in the family, I was as yet young and inexperienced, and many a wiser head than mine was from time to time invoked, and much time and money lost in other ways, that might have been saved for better and nobler purposes.
Among the items of loss, as well as of penalty, was that of offspring. These were generally still-born. One, indeed, lived about two weeks and then perished. The parents seemed to be written childless. Or rather, they seemed to have written themselves so. They seemed destined moreover, to follow their premature children, at no great distance, to an untimelygrave. For nothing was more obvious—I mean to the medical observer—than at an age when everybody ought to be gaining in bodily no less than in mental and moral vigor, they were both of them growing feeble as well as irresolute.
As a boarder, I left the family some time afterward, though I did not lose sight of it wholly; nor did they entirely forget or disregard the numerous hints I had given them. They made some progress every year. At length, however, I lost sight of them entirely, and only kept up a faint recollection of them by means of an occasional word of intelligence from the place where they resided, showing that they were still alive.
One day, after the lapse of about eight years, as I was passing through a charming New England village, the stage-coach stopped to let the passengers dine, when, to my great surprise, on stepping out of the coach, whom should I see but my old friend Mr. L.? He was equally surprised, and perhaps equally rejoiced, to see me. The interview was utterly unexpected to us both.
"How do you do?" said he, grasping my hand. I returned the compliment by inquiring after his own health and that of Mrs. L. It turned out that he had failed in his business a few months before, and that, as a consequence, he had been compelled to remove to the place where he now was, and engage in an employment which brought his skin into contact with the air, and his muscles into prolonged and healthful activity. It appeared also that both he and his family had long since banished the use of medicine. "And now," said he, "thank God I know what it is, once more, to enjoy health; I can not only eat, but work."
It was Monday, the greatwashing-dayof Yankee house-keepers; and while we were talking together with so much earnestness, that, like Milton's first pair in innocence, we "forgot all time," a female approached, with her sleeves rolled up, greeted me with much cordiality and seized me by the hand. "Can this be Mrs. L.?" I asked. How changed! She was, it is true, like her husband, a little sunburnt; but then she wasas she assured me, and, as I had every reason for believing to be true, comparatively healthy.
While I was still in amazement, hardly knowing whether I was awake or dreaming, a little girl approached us. Though somewhat slender and delicate, she was only slightly diseased; rather, she was only predisposed to disease by inheritance; and mere predispositions no more destroy us, than a train of powder explodes without igniting. The girl was about four or five years old. "Who is this?" I inquired. "Not yours, most certainly," I added, turning to Mr. and Mrs. L. "We call her ours," they said, "and yours; for we, no doubt, owe her life and health, in no small degree, to your instructions."—"This," said I, "is what I little expected to see; but you may thank God for it rather than me, since she lives by virtue of obedience to his laws, and not mine. Then you are not only pretty healthy yourselves," I added, "but you have a healthy child."—"We have two," said they. "The other is in the cradle; we will go and bring her."
At this moment, the loud declaration, "The coach is ready, gentlemen," reminded us that our conversation was at an end for the present, and we were obliged to separate. Not, however, till we had enjoyed a most luxurious mental repast in "the feast of reason, and the flow of soul," with no abatement but the consciousness, on my part, of a little loss to the landlord, who had provided for the passengers a smoking dinner.
This, reader, to speak somewhat paradoxically, was one of the proudest, and yet one of the humblest days of my life. To have been the Heaven-appointed instrument of such a marked change for the better in a human family, was more than could have been foreseen or even expected. It is more than has often fallen to my lot. True, I do not hesitate to regard it as an extreme case; and yet it is, in magnitude, just what I could show you in miniature, at various points in the same vicinity, and indeed, all over the country.
Mr. and Mrs. L. still pursue the even tenor of their way, and have their reward in it. One of their two daughters,—buds of early promise,—though probably more or less scrofulous, hardlyreached maturity, ere she descended to the tomb. The rest enjoy a tolerable degree of health. Of course, I do not speak of their health as greater than that of the average of mankind, notwithstanding their thorough reformation. It is much, all things considered, that it should be equal to that average.
As for the mother of Mrs. L., who still occasionally visits the family, she looks on in silent amazement, hardly knowing whether to recommend any more beer, with all sorts of roots good for the blood in it, or whether to give up the pursuit. I believe, however, that she does not often presume to interfere with their habits. Perhaps she has learned—if not, she may possibly live long enough to acquire the lesson,—to "let well alone," as her children and grandchildren already have. I certainly hope she has. It will conduce greatly to her health and happiness, as well as make her a better citizen and better Christian.
Nearly at the beginning of my practice in medicine, I was called to see a fine and hitherto healthy youth, twelve years old, but who had for several weeks before application was made to me, complained of a steady and sometimes severe pain in his bowels, attended with more or fewer febrile symptoms and a loss of appetite.
In endeavoring to trace out carefully the causes of his disease, the first thing that attracted my attention was his employment. His father was a blacksmith, and being in moderate circumstances and destitute of any other help besides this son, had for a considerable time required him to perform the work of an adult, or nearly such. It had not been suspected at the time, that the work injured him, though he had sometimes complained of great fatigue, and of a slight weakness and uneasiness in the place where the pain had now become fixed. As the result of my investigations, I came to the conclusion that he had been overworked, and certain ligaments of the bowels had been weakened.
My treatment in the case was at first mild and palliative, in the hope that after a few days of rest the trouble would disappear. Instead of this, however, it grew worse. At my special request, various counselling physicians were called in; but I do not know that they were of any service to me. No new light was thrown on the case, though we could all converse very learnedly on the subject.
Like many other young practitioners, I was at that time apt to indulge in gloomy fears about poisons. I seldom had a case of acute disease, without suspecting their influence. I suspected poison now, and accordingly made search into every possiblenook and corner whence such an influence could possibly have emanated. For a long time nothing could be found.
One day, on examining a pot of pickled cucumbers which had hitherto escaped observation, I found that a part of its glazing had been destroyed by the acid. I no sooner saw this than I was ready to say,eureka(I have found it), and to inform the family and my patient. It appeared that the pickles had been there for some time, and that the boy had eaten of them very freely. The parents and friends, though they had much confidence in the wisdom and skill of their physician, were very slow to believe in the injurious tendency of the pickles. They admitted the danger of such cases generally; but how could the boy be injured, and not the rest of them? they asked. They forgot, or did not know, that the poison would be more likely to affect one who was weakened in the abdomen from other causes, than those who were sound; especially when he took much more of it into his stomach than they did.
In my suspicion about lead poisoning, I had very little sympathy from those around me. Even the counselling physicians had little confidence in any such existing cause of disease. They were nearly as ready as other people to leave the case in the dark, and to say, practically, "The finger of Providence is here;" or, in other words, It comes of some cause which God alone knows orcanknow.
How much of human ignorance—ay, and of human credulity and folly, too—is clustered round the well-known decision of many a court of inquest; viz., "Died by the visitation of God!" What do they mean by it? Do they suppose that since Satan or some other personage whom we call Death, is guilty of striking us down here and there, those who are not "struck with death" are struck down by the great Source of light and life?
The far greater probability is, that they know not what theydomean. Mankind are not addicted to thinking, especially on subjects of this sort. It is much easier, or at least much lazier, to refer all our ills and complaints, as well as their unfavorable terminations, to God or Satan, friend or foe,—to some agency exterior to themselves,—than to consider themselves as theprobable cause, and proceed to make diligent search for their own errors.
Thus it was, in a remarkable degree, in the region where it was my lot to meet and palliate and try to cure diseases. I say, here,cure; for the idea would hardly have found a lodgment, at that early period, in any human brain which could have been found in that region of rural simplicity, hardly in my own somewhat more highly enlightened cranium, thatmedical men never cure; and that when people get well, it is the result of the operations and efforts of nature, or of nature's God, who is doing the best thing possible to set matters right.
It was even deemed by many as not only foolish, but almost sacrilegious, to say much about the causes of disease, and especially about lead. And then to talk about lead as connected with the use of their favorite red earthen, which had been in use time immemorial, and which had never, in all past time, killed anybody, as they supposed, was the dictate of almost any thing else rather than of good, sound, sober, common sense.
You can hardly imagine, at this day, in the year 1859, what an air of incredulity the gaping countenances of the family and neighbors of my young friend and patient presented, when I told them stories of lead disease in different parts of the country, especially of such cases as were then recent and fresh in my memory. One of these stories may not be out of place in the present connection.
About the year 1812, the people of Elizabethtown, Penn., put up what they called their apple butter in these same red earthen vessels, glazed, as almost everybody now knows, with an oxyde of lead. There had been a pottery established near the village that very year, and it was thought not a little patriotic to purchase and use its products, thus favoring the cause of home manufacture. Nearly every family, as it appeared in the sequel, had bought and used more or fewer of these vessels.
This was, of course, some time in the autumn. In the progress of a few months a dreadful disease broke out in the village, which baffled the skill of the best physicians, and consignedsome forty or fifty of the inhabitants to the grave. The cause, at first, was not at all suspected. At length, however, from a careful examination of facts, it was ascertained that the disease which had proved so fatal must have had its origin in the glazing of these vessels. The sickness abated only when it had attacked all whose bowels—already weakened by some other cause or causes—were duly prepared for the poisonous operation of the lead. It is indeed true that the physicians supposed the disease came to a stand on account of the overwhelming tendency of huge doses of calomel, which they gave to almost everybody who had used the apple butter; but of this there was no satisfactory evidence. It ceased, as I believe, and as I have already intimated, because—except in the case of those who were enfeebled by other causes, nature was too strong for it, or her recuperative powers too energetic.
Now this story illustrates a case which, in magnitude or in miniature, is in our country of almost every-day occurrence; and the only reason why the results everywhere else are not like those at Elizabethtown, is simply this: that there is not so much of the poison used in any one village, at the same time, as there was at that place in the circumstances which have been mentioned. One is sick here, another there, and another elsewhere. In one, owing to peculiar predisposition or habit, it takes the shape of fever; in another, of palsy; in another, of eruptions or boils; in another, of bowel complaint. And as all these and many other diseases have been known before, and have been induced by other causes equally unobserved or obscure, we have fallen into the habit of supposing that these things must needs be, do what we will. In other words, God the Creator, is supposed to have made the world and appointed to us, for trial or otherwise, these various forms of disease; and they are for the most part dealt out to us arbitrarily; or, if not arbitrarily, by chance or hap-hazard.
But to return to the young man. There was such a hostility of the public mind to the idea that his disease was induced or even aggravated by lead, that I receded in part from my suspicions. At least, I proceeded, with fresh energy and enthusiasm,to search for other and more probable or popular causes. Cause there must have been, of some sort, I was confident; while to all my efforts of this kind the friends of the boy stood opposed. They did not, it is true, say much against it; but then it was perfectly evident from all their conversation and conduct that they regarded it as not only idle, but presumptuous, perhaps wicked. How can it be, they seemed to say, by those looks and actions which so often speak louder than words, that this young doctor is always trying to ferret out the causes of disease, while Dr —— (my predecessor) never attempted any such thing, but rather dissuaded us from it?
Yet thus it was precisely. For three long months I was endeavoring to meet and obviate the symptoms of a disease which I secretly believed was induced by lead, but of which I had no such strong evidence as would have justified the positive affirmation that it was so, or prevented me from searching for other causes. This state of mind was by no means favorable to my success as a medical practitioner; for it somehow greatly impaired or weakened their general confidence in my wisdom and skill. Had I, on the other hand, "looked very wise," declared the disease to be so and so, with great pertinacity, and adhered, through good report and through evil, to my opinion, whenever it was assailed, and withal manifested no desire to receive medical counsel, I should have had a larger measure of their esteem, and a very much larger measure, as a professional man, of their confidence. They might then have thought me a very wise and good physician.
A man who wishes to be greatly popular in the world must learn the ways of the world, and walk in them more or less, whether they are crooked or straight. He must not be over-modest, or over-honest; nor must he be over-solicitous to improve his own mind or heart, or encourage others, by precept or example, to walk in the way of improvement. He must not only make up his mind to take the world as it is, but to suffer it to remain so. The world does not like to be found fault with; it has a great deal of self-confidence.
The young man, in the end, recovered; not, as I now believe,in consequence of the treatment, but in spite of it. Had he been nursed carefully from the first, and kept from every source of irritation, both external and internal, even from food, except a very little of the mildest sort, just enough to keep him from absolute starvation; and had his air been pure and his temper of mind easy, cheerful and hopeful, he would probably have recovered much sooner than he did, and with far better prospects for the future. But he had been frightened about himself, from the very first, by my own inquiries about poison,—which had unwarily been communicated to him,—and his fears never wholly subsided.
How much wisdom from both worlds does it require in order to be a physician! The office of a medical man, I repeat, is one of the noblest under the whole heaven. The physician is, or should be, a missionary. Do you regard this assertion as extravagant or unfounded? Why, then, was it made an adjunct, and more than an adjunct, in the first promulgation of the gospel, and this, too, by the gospel's divine Author? Why is it that our success in modern times, in spreading the gospel, has been greater—other things being equal—in America or China, in proportion as its preachers have attended to the body as well as to the soul?
At the time of my commencing the practice of medicine, I was no more fit for it than I was to preach the cross of Christ; that is, I was almost entirely unqualified for either profession. I was honest, sanguine, philanthropic, but I was uneducated. I knew very little, indeed, of human nature; still less did I know of the sublime art of becoming all things to all men, in the nobler and more elevated sense of the great apostle Paul. I would yield to no other compromise than such as he encourages, of course. Let us be honest and truthful, though the heavens fall.
Medical men well know—should any such condescend to look over this volume—what is meant when I affirm that I was not long in securing to myself a good share ofstanding patients. They are the dread, not to say the curse, of the profession. And yet they abound. They are found throughout the length and breadth of the land, and in great numbers.
They are a class of persons, not always of one sex, who hang continually, like an incubus, on the physician, and yet are forever a disadvantage to him. They are never well enough to let him alone, and yet seldom ill enough to require much medical advice or treatment. And yet, medicine they will have, of somebody, even if they go to the apothecary for it, without so much as the semblance of a medical prescription of any sort. But then, after all, they are seldom reduced to any such necessity. They usually have on hand prescriptions enough of some sort. A dearth of Yankee physicians—could such a thing possibly occur—would still leave us a supply of Indian doctors, mesmeric doctors, nutritive doctors, etc., etc., to say nothing of doctresses, in liberal abundance, ever ready to prescribe.
When I succeeded Dr. ——, in the chair of medicine, surgery, etc., at ----, I received, as if by contract, if not by inheritance, his whole stock of standing patients. They were not slow tocall on, sometimes tocall in, the new doctor. Nor was I often long in the house before comparisons began to be made between my predecessor and myself. They did not, of course, directly traduce or slander Dr. ——, but they were very careful to intimate that, having got his name up, he had grown careless about his patients, especially such of them as did not belong to his clique, political or sectarian; and that, onthis account, they were almost willing to part with him, and to receive and accept as his substitute one who was not only younger and more active, but also less tinctured with conservatism and aristocracy!
A very large amount of valuable time was spent during the first year of my practice as a physician, in endeavors to do good to these very devoted and loving and loyal patients; for if they did not always call me when I had occasion to pass their doors, I knew full well they expected me, and so I usually called. Besides, in many an instance I was sent for in post haste, with entreaties that I would come and see them immediately; and no atonement for neglect or even delay—if such neglect or delay was ventured—would suffice. And yet, despite of their fears of "monarchy and aristocracy," they were my most truly aristocratic patients. They expected me to come and go at their request, whether anybody else was attended to or not. And, to add to the vexation of the case, though they boasted of having paid most enormous bills to my predecessor, they never, if they could avoid it, paid any thing to me.
Now, I do not suppose that every medical man has as large a share of these standing patients as fell to my unhappy lot; but from the knowledge I have acquired of mankind, and from the acquaintance I have necessarily formed with medical men, I do not think I err when I affirm that they are everywhere numerous, and that they are everywhere not only a pest to society at large, but particularly so to the physician.
But the worst feature of the case is, that after all our efforts, we can seldom, if ever, cure them. They are always hanging upon us like an incubus; and yet like Solomon's daughters of the horseleech, are never satisfied. They take the medicine, and follow the advice, if theylikeit; or they take such parts of it as they choose, and reject the rest. Or they take the advice and follow us to-day, but get discouraged and abandon us, at least practically, to-morrow; especially if some smart young physician happens to come along, who has more than an averageshare of empiricism and pretension, and more than he has of real merit.
I must here confess, among other confessions, that at first I was not a little deceived by their open countenances and concealed thoughts, and unintelligent and hence unconfiding professions. It was a long time before I relinquished the hope of doing them good; or at least a portion of them. But I was at length compelled. There was nothing on which to build. If a foundation seemed to be laid one day, it would disappear the next.
One fundamental difficulty lay in the way of these persons to health, as it has to thousands of others. They were all the while talking or thinking about themselves, their ailments and woes and abuses and neglects. They were particularly inclined to turn their attention to their own diseased feelings. Now it may be pretty safe to say that no individual can fully recover from chronic disease,—nervous, stomachic, or glandular—who is always turning his thoughts inward, and watching his own feelings, and perhaps relating his woes to every one he meets with. We must learn to forget ourselves, at least a part of the time, and think of others, if we are in earnest to get rid of chronic disease. I do not say, of course, that everybody would recover of disease, even if they acted right in every particular; but this Idosay, that if every person who is ill would act wisely, and if their physicians, in every instance, were wise enough to take the best course, the number of these standing patients would soon dwindle to a very small remnant. Instead of thousands, or tens of thousands, it would soon be reduced to hundreds.
President Lindsley, late of one of our south western colleges,—a very shrewd and observing, as well as learned and excellent individual—has been often heard to say that no half-educated young physician ever succeeded in obtaining a good run of professional business, and a fair medical reputation, without despatching prematurely to the other world, at least as many as half a dozen of his patients.
It is said that most rules have their exceptions; and it is even affirmed by some, that the exceptions strengthen the rule. If this is so, perhaps the rule of Pres. L. may stand; though to many it seems at first exceedingly sweeping. One known exception to its universality may be worth mentioning, on which the reader may make his own comments, and from which he may draw his own inferences. I was so fortunate for one, as to attain to the eminence he mentions, without killing any thinglikehalf a dozen patients; at least, so far as I know.
And yet, as I verily fear and most honestly confess, Ididkill one or two. Not, of course, with malice aforethought, for they were among my very best friends; and one in particular was a near and highly valued neighbor. Let me give you a few details concerning the latter. It may serve as a lesson of instruction, as well as a confession.
He was about six feet high, with large vital organs; and though by no means possessed of a strong constitution, yet in virtue of a most rigid temperance, generally healthy. He was, however, subjected to the habitual influences of a most miserable cookery. Indeed, I never knew worse. Seldom, ifever, did he pass a single week—I might even say a single day—without having his alimentary organs irritated to subinflammation by more or fewer of what Dr. Dunglison, the physiologist, would call "rebellious" mixtures. I do not wonder, in truth, that he occasionally sickened. The wonder with me is, that he did not sicken and die long before he did. And though the blow that finished his perilous mortal career, was doubtless inflicted by my own hand, I do not hesitate to say that his "housekeeper" had nearly half destroyed him before I was called.
It was a midsummer night, when the messenger came across an intervening field, and aroused me from my slumbers with the intelligence that Mr. M. was very sick, and wanted to have me come and see him immediately. Although it was fully twelve o'clock, and I had been so fully occupied during the preceding evening, that I had but just crawled into bed and begun my slumbers, I was instantly on my feet, and in about twelve minutes at the bedside of the sick man.
He had been affected with a bowel complaint, as it appeared, for several days, during which his wife, who was one of those conceited women who know so much, in their own estimation, that nobody can teach them any thing, had dosed him with various things, such as were supposed to be good for the blood, or the stomach, among which was brandy and loaf sugar. Now his bowels, though they were inflamed, might have borne the sugar; but the brandy was a little too much for them. They had endured it for a time, it is true, but had at length yielded, and were in a worse condition than when she began her treatment. And what was worse, her alcoholic doses, frequently "inflicted," had heated the circulatory apparatus, and even the whole system, into a burning fever.
It needed no very active imagination, in such circumstances, to make out, at least in prospect, a very "hard case." And as he who has a giant foe to contend with, arms himself accordingly, I immediately invoked the strongholds of the Materia Medica for the strongest doses which it could furnish, andthese in no measured or stinted quantity. In short, I attacked the disease with the most powerful agents of which I could avail myself.
I will not trouble the non-professional reader with the names of the various and powerful drugs which were laid under contribution in this trying and dangerous case, and which were most assiduously plied. It is sufficient, perhaps, to say that on looking over my directions—fairly written out as they were, and laid on a small stand near the sick-bed—you might have discovered that hardly a half-hour, by night or day, could pass, in which he was not required to swallow some very active or in other words poisonous medicinal agent or other. For though I was even then greatly opposed, intheory, to the exhibition of much medicine in disease, yet inpracticeI could not free myself wholly from the idea that my prospects of affording aid, or rather of giving nature a chance of saving a patient, was nearly in proportion to the amount I could force into him of opium, calomel, nitrate of silver, carbonate of ammonia, etc.
It was, in short, enough to kill a Samson or a Hercules; and I repeat that I verily fear that it did kill in the present instance; not, however, immediately. For several days and nights we watched over him, heating his brain, in our over-kindness, to a violent delirium on the one hand, or to a stupor almost like the sleep of death on the other.
Not satisfied with our own murderous efforts, we at length applied for medical counsel. My predecessor was not so far off as to be quite beyond our reach, and was in due time on the spot. He, good man, sanctioned the deeds already done, and only made through the force of their prepossessions, an addition to the dark catalogue of demons which already assailed if they did not actually possess him.
For the first time in my medical career, I suffered, here, from a loss of the confidence of my employers. A very mean man, who could gain notoriety in no other way, undertook to insinuate that I did not understand well my profession; and this story for a short time made an impression. However,there was soon a reaction in my favor, so that nothing was lost in the end. More than even this might be said—that I rose higher, as the result of the report.
Mr. M. at length began to decline. Nature, though strongly entrenched in her citadel, and loth to "give up the ship," began to succumb to the powers of disease and the load of medicine; and he gradually descended to the tomb. His whole sickness was of little more than a week's duration.
I was present at the funeral, but I could scarcely hold up my head, or look any person in the face. To my perturbed imagination every one who was but "three feet high" was ready to point at me the finger of scorn, and say, "You have killed that man." The heavens themselves seemed covered with thick darkness, and the green earth with sackcloth and ashes. "Never again," I said to myself a thousand times, "can I bear up under such sad and severe responsibilities."
And yet—will the reader believe it?—no one circumstance of my whole medical life ever did more to establish my reputation than this. True, I had contended on the battle field, and had been beaten, but then it was thought I had contended against a powerful foe. Men sometimes think it honorable even to be beaten. I well remember an instance of this sort. A very great scoundrel heaped insults upon a worthy justice of the peace, till the latter seized him and held him down to the ground for a considerable time. The man was quite respectable afterward, and told the story to his own praise a thousand times over! He had measured lances with 'Squire H.! And though the 'Squire was too much for him, he obtained a town-wide reputation by the contest.
You will see, more and more, as I proceed with these confessions, that it is not in him that willeth nor in him that runneth, to be acceptable as a physician, but in certain circumstances, partly within and partly beyond our control. You will see, however, that the best way in the end is, boldly and fearlessly to do right, and then trust in Him who loves right, and whose throne is in the Heavens, for the final issue. We may not always be popular in doing right—probably we shallnotbe—but we shall, in any event, have a clear conscience.
I was called one morning very early, to see a little girl, five or six years of age, who, it was said, was extremely sick, and without immediate aid could not probably long survive.
She was one of a very numerous family, most of whom, though suffered to run almost wild, like so many rabbits, were comparatively healthy. I do not suppose they had ever called in a physician more than once or twice in a year. In truth, they had very little confidence in physicians; though in extremities, they were accustomed to call on them almost as much as other people. In any event Caroline was very sick now; and they loudly demanded aid. I was forthwith on the spot. Caroline was groaning most piteously. "Where is your distress?" I inquired. She gave no direct answer, but continued to groan and writhe, as if she were impaled. As I could obtain no reliable information from her, and could discover no special or exciting cause of her suffering, and as the case was urgent, I proceeded to dosomething, though, as I must honestly confess, it was to labor quite in the dark. One thing I knew, it is true; that there were spasms, and that it depended on a diseased condition of the brain and nervous system; but what the cause or causes were, I could hardly divine. Nor, in truth, had I time to ask many questions.
Though the days of Hydropathy had not yet arrived, the world, even then, had a good deal of water in it, and physicians were sometimes wise enough to use it. It was demanded, as I thought, on the present occasion. It would, at least, by whiling away the time, give opportunity for further observation and reflection, and deeper investigation. There was a good fire in the kitchen, and I ordered a warm bath immediately.
Every effort was made to hasten the process of warming the water, as well as to keep the patient quiet and within doors; for she raved like a maniac—partly indeed from a childish fear, but partly also from real bodily suffering. The family and neighborhood—for the latter were very largely collected together—were almost as much alarmed and distressed as the little patient, and this reacted on the patient to her increased disadvantage.
As there were no special preparations in those days for bathing—I mean in the region of which I am now speaking—we used a large wash-tub. The water was soon ready, and was made rather warm, quite above 100° of Fahrenheit. I had taken the precaution to have my patient already undressed, so as to lose no time. The very instant the bath was ready, she was plunged into it. It cost some trouble, for she resisted with almost superhuman strength, and uttered most terrific screams. But as the ox is dragged to the slaughter, she was dragged into the water and held in it.
The effect was like magic. She had not been in the water twenty seconds before every thing was quiet; and I do not know that she has ever had another pang to the present hour. Certain it is that she seemed to be entirely cured by this single bath, and none of her spasms ever returned.
The family were greatly delighted, and so were the neighbors. And was the physician, think you, an uninterested spectator? Had he been wholly destitute of the love of doing good, by relieving human distress, he must at least have been susceptible of receiving pleasure from general approbation.
He certainly sought respectability as a physician. And this he was by degrees now attaining.
It is hardly possible to refer the sudden quiet which followed in this instance from the application of warm water, to a mere coincidence, as if the system was ready, just at this very instant, to react or rally. The bath must have had something more than a mere imaginary or accidental effect, though its prescription may be said to have been empirical.
Had the experiment in the present instance wholly failed,it is by no means improbable the physician would still have been on a par with other men. Theguesshe made was hisonlythought. He had nothing in reserve. But he was successful; heguessed right, and it built him up. His fame now began to spread far and wide, wafted, as it were, on the wings of every breeze. If he succeeded, it was supposed to be undeniable proof of his skill; if he failed, it was not supposed to be so much his fault as the result of circumstances; or, more properly, the severity of the disease. And even in the case of failure, as I have said elsewhere, he often gained credit; for he had boldly contended, at great odds, with a mighty because intangible antagonist!
It is an old proverb,—but by no means the less true for its age,—that when a person is going down hill every one will give him a kick. But is it not equally true that when he is resolutely going up hill, they are equally ready to help him on? So at least I found it at this period of my progress.
Although I was opposed to the frequent and free use of medicine, I early fell into one habit which was as diametrically opposed to my general theory as could possibly have been. I refer to the habit of giving my patients, at least occasionally, most enormous doses of those more active preparations which should seldom, if ever, be administered in this way. As nearly as I can now recollect, I fell into this habit in the following manner:
Among my standing patients, before mentioned, were several drunkards. Occasionally, however, they were more than standing or standard patients; they had attacks of mania, or as it is usually called in the case of drunkards, delirium tremens. In these circumstances, among these patients, I often had the most severe trials. Sometimes I could relieve them; but sometimes, too, I failed.
One night, while endeavoring to relieve the sufferings of one of these patients in delirium tremens, almost to no purpose, the thought struck me, "What effect would a prodigious dose of calomel have on the poor creature? Can it kill him? I doubt it. I will venture on the trial."
So, without communicating the slightest hint to any one around me of what I was about to do, I contrived to insinuate a hundred grains or more of this substance into the man's stomach, that like a chemical receiver took what was poured into it. Having succeeded in the administration of the dose, I waited patiently the issue.
The medicine had, in due time, its full ordinary effect; but the degree of its cathartic effect was not in proportion to the largeness of the dose. Its activity hardly amounted to violence.It seemed, however, to quiet the brain and nerves as if by magic; nor am I aware that any injurious effects, either local or general, ever followed its exhibition. I had the full credit of a speedy and wonderful cure.
Another fact. I was frequently called to prescribe for children who were threatened with the croup. One night, on being called to a child of some eight or ten months, I thought of large doses of calomel. Was there any great risk in trying one? I ventured. I gave the child almost a teaspoonful of this active cathartic. It was indeed a gigantic dose, and the treatment was bold if not heroic.
For a couple of hours the patient breathed badly enough. There was evidently much oppression, not only of the lungs but of the nervous system. The parents and friends of the child grew uneasy. They were not, however, more uneasy than their physician. But I consoled myself by laboring to compose them. I preached to them long and loud, and to some extent with success.
At the end of about two hours, the latter part of which had been marked by a degree of stupor which almost discouraged me, a gentle vomiting came on, followed by moderately cathartic effects; and the child immediately recovered its mental activity, and in a few days was well.
Empirical as this practice was, I ventured on it again and again, and with similar success. At length the practice of giving giant doses in this disease became quite habitual with me, and I even extended it to other diseases. Not only calomel, but several other active medicines were used in the same bold and fearless manner. I do not know that I ever did any direct or immediate mischief in this way. On the contrary, I was regarded as eminently successful.
And yet I should not now dare to repeat the treatment, however urgent might seem to be the demand, or recommend it to others. It might, perhaps, be successful; but what if it should prove otherwise? I could make no appeal to principle or precedent in justification of my conduct. It is true, I have met with one or two practitioners whose experience has been similar;but what are a few isolated cases, of even honest practice, in comparison with the deductions of wise men for centuries? There may be after consequences, in these cases, which are not foreseen. Sentence against an evil work, as Solomon says, is not always executed speedily.
Should any medical man look through these pages, he may perchance amuse himself by asking where the writer obtained his system of classification of disease. It will not, certainly, be very easy to find such a disease as the lambskin disease in any of our modern nosologies. But he will better understand me when he has read through the chapter. He may be reminded, by its perusal and its quaint title, of the classification which is found in Whitlow's New Medical Discoveries, founded, as the doctor says, on the idea that "every disease ought to be named from the plant or other substance which is the principal exciting cause of such disease." It is as follows: