CHAPTER III.POPULAR ERRORS.

My intention in this chapter is to notice some of the popular errors, which have resulted from the uncertainty of medicine.

One of the most common of these errors is a false estimate of the importance ofpositivemedication. This error appears in a great variety of forms. I will notice a few of them.

A patient once avowed to me the opinion, that in all cases of recovery from sickness, the recovery is to be attributed to medicine, and that nature never cured anybody of anything that could properly be called disease. Though this error is seldom carried to such a point of ultraism as this, it does exist, to a great extent, even in the medical profession, and it is exceedingly prevalent in the community at large. It therefore exerts a great influence upon the popular modes of the treatment of disease.

One of the most common examples of this false reference of a curative result to the agency of medicine, is to be seen in the prevalent popular notion in regard to the healing of wounds. The cure in this case, is usually attributed to some healing property in the applications made to the wounds. But the truth is, that the union of the dividedparts is effected entirely by a natural process; and the only use of any applications, is to put the lips of the wound in apposition, so that this process may be effectual in securing this union. The popular error on this subject, is not as prevalent now, as it once was, and the array of salves and ointments for the healing of wounds, is fast passing away. At a time when this error was in full favor with the people, some one broached the idea, that the medicaments ought to be applied to the instrument that inflicted the wound, instead of being applied to the wound itself. This new mode of practice proved successful in comparison with the old, for the plain reason, that the wounds thus treated were not subjected to applications, which would irritate them, and thus interfere with nature’s process of healing. It acquired a great reputation all over England, and I believe, in other countries also; and the results of the practice were triumphantly referred to as proofs of its success, that were not to be gainsayed. It is related that in one case, in which the wound became very painful, it was suggested that something might have happened to the axe with which the wound was made, and which had therefore been duly anointed with a healing salve; and as the axe happened to be at some distance, a messenger was sent in great haste, who found that it had fallen down from its place, and the dressings were consequently deranged. Here was certainly the cause of all the pain, and accordingly it was ascertained, that at the very time that the messenger re-applied the salve to the axe, and set it up in its place, the patient became perfectly easy![4]

As another very common example of an undue disposition to refer results in the course of disease to positive medication, I would mention the fact, that those who have the care of the sick, often attribute any change that may occur, whether it be favorable or unfavorable, almost as a matter of course, to the remedy that was administered immediately before the change took place. They do this sometimes when the medicine has not had time to produce any effect at all. They do not reflect that some remedies act much more slowly than others, nor that changes are often induced by other agencies than the action of medicine. This error is met with every day, and the cunning and dishonorable physician makes capital out of it whenever he can. A physician of this character was once called to a case of quinsy, in which the abscess in the throat was just ready to break. Perceiving that here was a fair chance for making the “post hoc, propter hoc” mode of reasoning subserve his purpose, he assured the suffering patient that he had some powders, which were “sure to break the quinsy.” While he was preparing some of them in an adjoining room, the nurse came out and told him that they should not need his powders, for the quinsy had broken. The wily doctor could not help remarking in an undertone to a student, whom he was indoctrinating in thearts, as well as in the science of medicine, “I wish that I had been lucky enough to have got down one of my powders before that quinsy broke.”

When one recovers from sickness, it is very common for his neighbors and friends to inquire, what it was that cured him—as if there was some one remedy that effected thecure. It is true, that in some cases, the agency of some one medicine is so prominent, that it may very properly be said to have been the cause of the recovery. But this does not often happen. In the great majority of cases, the cure is to be attributed to the whole course of treatment, including many different remedies and measures.[5]And very often the negative portions of the course are of as much importance as the positive remedies that have been given, perhaps even more so. Thus, in some cases of inflammation of the eye, the exclusion of light is as necessary to the cure as the leeching, the blistering, &c. So also in inflammation of the brain, the exclusion of noise and excitement from the room of the patient, is as essential as any of the positive medication which may be employed.

The undue reliance which is placed upon positive medication is also seen in the disposition, which is so very common, to demand of the physician, that he shall be doing something all the time to overcome the disease. They who make this demand, do not reflect, that in the warfare with disease, as well as in every other warfare, there are times to do, andtimes also to rest from doing. In some cases, indeed, there are periods when it would be certain death to the patient to employ any positive agencies of any amount,of power. It was the remark of a shrewd old physician, who was often found fault with for giving so little medicine, that it takes as much knowledge to knowwhat not to do, as it does to know what to do? This is an important truth; and I have not a doubt that, in the practice of every physician, who is disposed to give much medicine, sickness often results in death in really curable cases, simply because he did not know whatnotto do, and therefore did what he ought to have left undone. And yet those who drug their patients freely, are more apt to satisfy the mass of the community, than those who place less reliance upon positive medication. The friends of persons who have died, often remark, as a matter of consolation, that they are sure enough was done, that no means of relief that was suggested was left untried, &c., not seeming to dream that it was possible that too much was done. It appears sometimes to be the idea of the friends of the sick, that one remedy after another must be tried, in order to overcome the disease, until the effectual one is found; and that all the remedies which fail in this trial, simply fail, and do no positive harm. Accordingly, when any grave case occurs, they are disposed to call in many physicians, one after another, with the idea that “one may think of something that another did not.” And they are satisfied with no one who is thus called in, unless he recommend to the attending physician some medicine or measure, that has not yet been tried in the case. If he recommend the lessening of some medicine in quantity, or the discontinuance of it, this does not satisfy such persons, though the change may be of so great importance, that it may be justly considered as an entirely new course of treatment—as really new as it would be, if a new set of remedies were adopted.

It is a very common idea, that medicines have a sort ofnatural relation to disease. This idea appears in different forms. Some talk about disease as if it were a palpable thing, which is to be attacked, to be hit, to be driven out, or drawn out from its hiding place; and they suppose that there are certain remedies which are calculated to effect these different objects. They therefore speak of the drawing off of “bad matter,” by a blister, and of the “bad blood,” which is taken from one by bleeding, as if the disease itself in palpable shape, was abstracted in these ways from the system.

The most common of these palpable shapes which disease is supposed to assume, is that of “humors,” as they are termed in popular language. The disappearance of a “humor” is theeffectquite as often as it is the cause of disease; and yet it is very difficult to make people understand this—they persist in thinking it always to be a cause. So also, if a patient, on recovering from any sickness, has some eruption appear upon the skin, it is taken for granted, that it was this “humor” that has been inside all the time, which has caused all the sickness; and now that it has ceased to play its pranks among the internal organs, and has come out, the patient as a consequence gets well. It never enters their minds, that the eruption may be simply a result of that revival of the energies of the system, which is consequent upon its escape from the depressing influence of disease.

This idea of the palpable shape of disease gives rise to the popular error, which is so prevalent, in regard to the necessity of getting outallthe eruption in such diseases, as scarlet fever, measles, &c. The idea is that there is a certain amount in the system, and that this mustallbe brought out upon the skin, or the patient will suffer some bad consequences from this retention of morbid matter.This notion is entirely erroneous. The eruption in such cases is not the coming out or throwing off of diseased matter contained in the system, but it is merely one of a succession of processes in the natural course of the disease. It is indeed necessary that this process should be well executed, and if the natural energies of the system do not prove adequate, they should be assisted by medicine. But ordinarily they are adequate; and in comparatively very few cases, is there any need of any assistance from art in bringing out the eruption. Most of the dosing so common in scarlet fever and in measles, for this purpose, is worse than useless—it aggravates the symptoms, multiplying and inflaming the eruption beyond the necessities of the case, and it increases the complications which are incidental to it. Death is often the consequence of such officious interference with nature’s regular processes.

Some talk about disease as if it were a poison, whose power can be destroyed by the appropriate agents, very much as an alkali neutralizes an acid. All medicines which do not have this neutralizing influence are, in their view, mere palliatives. It is this idea which lies at the foundation of the opinion, so often expressed, that opium never cures any real disease, but merely gives temporary relief. No opinion can be more erroneous than this. Opium, in its various forms, is one of our chief means ofcuringdisease, as well as of alleviating its sufferings. It is an effectual remedy for many painful affections. For example, it is the great remedy for spasmodic colic. There are auxiliary remedies, which can be used with profit, it is true; but after all opium is the chief remedy. And in the great majority of cases of disease, with which the physician meets in his daily practice, opium materially assists in its cure, by soothing and quieting the irritation of the system,so that the curative power of nature (the vis medicatrix naturæ, of which so much was said in my first chapter), may pursue undisturbed and without hindrance, her processes of restoration.

Another error, to which this idea of the neutralizing influence of medicines gives rise, is this. What is found to be useful in any disease is supposed to be so in all cases of that disease. If a remedy be “good” for a certain malady, fever for example, it is apt to be considered as being “good” in all cases of fever, without regard to circumstances. There is a great proneness to suppose all cases of one disease to be alike, and to require therefore similar remedies. The physician finds it difficult often to make people understand that two cases, in which the disease bears the same name, may require very different, and perhaps almost opposite modes of treatment. The accompanying circumstances of disease vary so much in different cases, that this supposed invariable relation of particular remedies to the cure of particular diseases is impossible. This remark applies even to our most efficient remedies. Colchicum is one of the most effectual remedies which we have for rheumatism; and yet there are many cases of this disease, in which its use is forbidden by the condition of the patient.

The idea, that medicines have a kind of natural relation to disease, assumes sometimes a more definite shape than either of those to which I have alluded. Some suppose that almost all, if not all, diseases have their specific remedies and antidotes. It is often said by those who have this idea, that there are medicines in the plants that grow in any country, which can cure every disease that prevails in that country, if they could only be found. Indians and “Indian doctors” are supposed to know of many of these specifics.The newspapers announce too occasionally the discovery of specifics for the most formidable of diseases, consumption, cancers, hydrophobia, locked jaw, &c., &c. These announcements are accompanied sometimes with statements of cures of the most positive character. No doubt the statements are correct in one respect—the patients recovered. So were the wounds healed when the ointments were applied to the instruments that made them. In some way these specifics after a while lose their reputation. There is a constant succession of them, all equally infallible for the time, but the period of their infallibility is short. Their reputation is built upon the “post hoc, propter hoc” mode of reasoning, and therefore does not stand the test of any continued experience.

In order that this subject may be fairly understood by my readers, they should know what we mean by a specific remedy. A specific remedy for a disease is one which will cure that disease under all ordinary circumstances—that is, when there are no circumstances in the case, apart from the disease, which tend to prevent the cure. Many doubt the existence of any specifics at all. If there be any, they are certainly very few in number. Sulphur and some mercurial preparations, as remedies for Psora (itch), and some other cutaneous diseases, have as strong a claim to be considered specifics as any medicines that can be mentioned. Iodine has been said to be a specific for scrofula, but it by no means holds good its claim. Though tuberculous consumption is a disease of a very definite and specific form, no specific remedy has been as yet discovered for it, and probably none will ever be, though Dr. Rush and others have indulged the pleasing hope that some plant may yet be found that will arrest the ravages of this disease. I would remark in this connection, that there is one specific preventive.I refer to vaccination as a preventive of small-pox. But this fact stands entirelyalone—there is no other fact like it.

The physician is continually meeting with evidence, that the community generally have no adequate ideas of the necessity for discrimination in medical practice. He is every day called to patients, who tell him that they have taken some patent pills, or perhaps some pills which they chanced to have in the house, and which they supposed must be “good,” as they express it, though they may not know where they came from, or what they are commonly used for; and this is done by many, without regard to the kind of malady under which they are suffering. All cases must first be dosed by pills, to which they attach this general idea of being “good;” and then, if they do not hit the disease with this random shot, they send for the doctor, not however with the belief, that his shooting will be any less at a venture, but because he may have a greater variety of ammunition.

One of the strongest evidences that the community have a very imperfect conception of the varieties of disease, and of the necessity of accurate discrimination, is the propensity to look for some one grand remedy for all diseases. This propensity is exceedingly common, and exists in every variety of degree. Some, I may say many, have the full belief that there is such a remedy, and try every vaunted medicine that comes along, in their search after the great catholicon, or elixir vitæ. Disease they suppose, in the language of quacks, and we may add of some physicians also, to be an unit, and the remedy for it must therefore be an unit also. Others, (and these form a large portion of the community,) while their ideas are less distinct and exclusive, are still governed in a great measure bythis same prevailing notion. They have some favorite remedy, which they use for complaints of almost every kind. The remedy may not always be the same, and commonly is not. The ‘universal cure’ does not ordinarily last a great while, but is at length supplanted by some other, just as universal, which in its turn, is also to be supplanted. Every year, not to say every month, brings to some people a new grand catholicon.

This propensity does not always show itself in relation to some one remedy, but sometimes leads to the adoption of some system or class of remedies. I mention as an example the Thompsonian system. A certain group of remedies was selected by the founder of this system, from the whole kingdom of nature, as the remedies above all others, if not alone, fitted to attack the great unit, disease. The very idea of discrimination was discarded. The unit was to be attacked with these weapons, and the attack kept up till it was destroyed. No fear was indulged that any harm could be done, for Thompson claimed that his remedies had a natural relation to disease, possessed by no other agents, and that therefore, however largely they might be taken, they could not possibly do any injury. How beautifully simple this system of practice is; and, if its claims be just, what a perfect relief it brings to all the uncertainty of medicine! Away then with all care-worn experience, and all study! Keep up a constant fire of lobelia, red pepper, and steam, and you will certainly kill the disease at last—at least if you do not kill the patient. In the infancy of this system, this idea of its simplicity was more distinctly avowed than it is now, and the remedies that were used were much less in number than they now are. The followers of Thompson are certainly departing from the stern principles of his doctrine, and some of them even begin to talkabout the necessity of study—a heresy, one would think, glaring enough almost to start Samuel Thompson from his grave!

It is most impudently asserted by Thompsonians, that physicians generally act upon the same exclusive principles that they themselves do—that while Thompsonians give lobelia and cayenne in all cases, we do the same in regard to calomel, antimony, &c. This is undoubtedly true of some physicians, but it is a gross slander when it is applied to the profession in the mass. The real difference in this matter between Thompsonians and physicians is this. While Thompsonians confine themselves to one particular set of remedies for all diseases, physicians use in their daily practice a great variety of remedies, and among them the very medicines used by Thompsonians. We have never claimed, as Thompsonians falsely state that we do, that lobelia and cayenne are not good medicines, but simply that they are not applicable to all cases, any more than is calomel, or any other remedy that may be named.

The quack shows in his advertisements, that he is aware of the prevalence of the propensity of which I have spoken, and here rests his chief hope of success. He begins his advertisement with something of this kind. Disease is an unit; or, All disease is in the blood; therefore the blood must be purified; or, Grand catholicon; or, Grand antidote to disease; or, The real essence of life at last discovered.

This propensity has shown itself in some measure even among physicians. Enthusiasts in our profession have always been disposed to attribute to favorite remedies, a sort of universality in their operation upon disease. Every new medicine that comes up to notice has almost every kind of virtue ascribed to it by such physicians. And itis only by long-continued and well-weighed experience, that the statements made in relation to any remedy can be sifted, and the real truth be discovered in regard to the degree and extent of its efficacy, and the circumstances which should govern us in its use. This process has been gone through with, in the case of every article of the materia medica that has ever had any notoriety. Take for example, digitalis. At one time, this medicine was in common use in many diseases, and especially in consumption; and some enthusiasts, if they did not go so far as to say that it was a certain cure when used sufficiently early, at least extolled it as almost a specific for this disease. The accumulated and compared experience of physicians in regard to it has at length determined pretty nearly its value, and while it is now used far less than it once was, it is used more judiciously from the more definite knowledge of its effects which this experience has gained for us.

The same remarks could be made about other articles.[6]And while the test of experience has corrected our valuation of some remedies, and thus enabled us to use them with more skill; there are others once supposed to be valuable, which, under the application of this test, have gone wholly out of use. I will mention but a single example. Dr. Beddoes, an English physician of some note, but a great enthusiast, thought that some of the gases might be advantageously used in the treatment of disease. The results were said to be astonishing, and the practice ofpneumatic medicine, as it was called, became very prevalent. I find in a work, called Medical Extracts, published in 1799, the narrative of sixty-nine cases of various diseases, said to be cured by the respiring of these gases. Among them are certainly some formidable maladies, such as dropsy in the head and chest, consumption, gout, epilepsy, leprosy, scrofula, &c. Some of these cases had been previously under the care of celebrated physicians, and some had even been pronounced by them to be incurable. A description given by one of the patients, a clergyman, of his own case, almost transcends the descriptions given now-a-days by some clergymen of the effects of some patent medicine, or of the infinitesimal doses of homœopathy.

Now, if the respiring of these gases really did produce these results, or any good proportion of them, the same practice would have been in vogue now. But it has not stood the test of experience, and therefore has been rejected. No physician at the present day thinks of setting his patients to breathing these gases.

If it be said that this is the result of change of fashion merely, and that it therefore does not prove that this practice was not successful, I reply that, though fashion in medicine may sometimes temporarily prevent the use of a good remedy, it never effects the entire and continued abandonment of it by medical men. You will find it always true of remedies and modes of practice which are really valuable, that though they may not be as fashionable after a while, as they were when first introduced into notice, and may, from the fact, that they have been estimated too highly, be for a time undervalued, they will never be wholly given up by the profession. Nearly as great stories were told about calomel and digitalis at first, as were toldabout the gases of Dr. Beddoes. But while experience has shown that calomel and digitalis were over estimated, it has proved that these gases had an entirely false estimate put upon their remedial powers.

It is thus that the medical profession, corrects by experience the errors into which it is led by the uncertainty of medical science. But the community at large pursue a very different course. They never correct their errors, but only supplant one error by introducing another. While physicians reject what is found by experience to be valueless, and retain what is truly valuable, the multitude reject alike the good and the bad, in making their constant changes from remedy to remedy, and from system to system. It is mere caprice, and not a careful discrimination, that leads them to throw aside one favorite medicine or system, and adopt another.

It is amusing to watch the movements of the community in relation to quack medicines. Of these there are a multitude constantly appealing to the credulity of the public. Some of them in some way, acquire a currency above their fellows, and from the extent to which they are used, and from the tales of their wonder-working from all quarters of the land, and from all conditions of life, one would suppose that these remedies would never go out of use until mankind cease to be sick. But look again, only a few years after, and these vaunted medicines have gone out of use, and the flaming advertisements proclaiming their virtues have disappeared, and other remedies have taken their places in the public mind, and on the public tongue, and of course in the public stomach. This process of change in the prominent remedies before the public, has ever been going on. Take a single example. A few years ago, almost every invalid was swallowing the Hygeian pills, fromthe pauper that purchased them with his begged pittance, up to lords and ladies, and senators, and generals, and clergymen. But in a short time, Brandreth’s effulgent glory burst upon the earth, and the Hygeian orb faded, and glimmered, and sunk to rise no more. And now Brandreth is rapidly on the decline, giving way to others who are rising to take his place.

These successive changes in popular remedies show, that the public have always been egregiously mistaken, whenever they have attributed to them such wonderful efficacy. Else the very high and extensive reputation gained by each could not have been so utterly lost in so short a time. If, for instance, a tithe of the fame of the Hygeian pills was well founded, the thousands of mouths that swallowed them would not have been, as they were almost in a twelvemonth, just as wide open to receive the magic pills of Brandreth. Either a large portion of the community have committed a great error, in ascribing such marvellous efficacy to these remedies; or they have committed a greater one in so soon discarding them. Either the one or the other of these errors has been committed, in regard to each one of the most popular remedies, that have succeeded each other in the favor of the public, from time immemorial—not one that has not had itsdecline, as well as itsrise, and itsacme. And what is remarkable is, that when once a remedy has thoroughly passed from the popular favor, no matter how great its fame has been, it never can be revived again, unless it be under an entirely new name, and with new pretensions. Why? Because it has been tried, and its reputation was found to be a splendid bubble that has burst and fallen. And the public, like the child, when a bubble has burst, has done with that one forever, and busies itselfat once in raising another, which, in its turn, is succeeded by another, and so on to the end, if end there be, which seems to be hardly a possibility with the bubbles of quackery.

FOOTNOTES:[4]Many varieties of weapon-ointment were used. Some of the articles in them which were considered most essential were powder of mummy, human blood, and moss from the skull of a thief hung in chains.It is a humiliating fact in the history of human wisdom, that Lord Bacon, the wisest man of his time, could only say of the pretended efficacy of this ointment, that he, himself, “as yet, is not fully inclined to believe it.”[5]The popular disposition to look to some one remedy for a disease, is seen in the conversations in every circle at the present time, in regard to the cholera. The inquiry is for some one specific remedy,—and physicians are constantly asked if something has not yet been discovered of this character. Though the newspapers are filled with new andcertaincures, nonewremedy has been discovered for this disease since its former visitation in this country. Physicians do however know better how to treat it, than they did then; but it is only because experience has taught them betterhowto use the appropriate remedies, and not because any very important new medicines are added to the list of those which are applicable to this disease.[6]Ether and chloroform, which are now exciting so much discussion among medical men, furnish a good illustration. The value of the discovery which has recently been made in regard to them, great as it undoubtedly is, cannot as yet be exactly ascertained. But the profession will be learning more and more in relation to them, and multiplied and extended observations will at length determine their precise value, and the circumstances which should govern us in their use.

[4]Many varieties of weapon-ointment were used. Some of the articles in them which were considered most essential were powder of mummy, human blood, and moss from the skull of a thief hung in chains.It is a humiliating fact in the history of human wisdom, that Lord Bacon, the wisest man of his time, could only say of the pretended efficacy of this ointment, that he, himself, “as yet, is not fully inclined to believe it.”

[4]Many varieties of weapon-ointment were used. Some of the articles in them which were considered most essential were powder of mummy, human blood, and moss from the skull of a thief hung in chains.

It is a humiliating fact in the history of human wisdom, that Lord Bacon, the wisest man of his time, could only say of the pretended efficacy of this ointment, that he, himself, “as yet, is not fully inclined to believe it.”

[5]The popular disposition to look to some one remedy for a disease, is seen in the conversations in every circle at the present time, in regard to the cholera. The inquiry is for some one specific remedy,—and physicians are constantly asked if something has not yet been discovered of this character. Though the newspapers are filled with new andcertaincures, nonewremedy has been discovered for this disease since its former visitation in this country. Physicians do however know better how to treat it, than they did then; but it is only because experience has taught them betterhowto use the appropriate remedies, and not because any very important new medicines are added to the list of those which are applicable to this disease.

[6]Ether and chloroform, which are now exciting so much discussion among medical men, furnish a good illustration. The value of the discovery which has recently been made in regard to them, great as it undoubtedly is, cannot as yet be exactly ascertained. But the profession will be learning more and more in relation to them, and multiplied and extended observations will at length determine their precise value, and the circumstances which should govern us in their use.

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