CONTENTS.
CHAPTER I.
UNCERTAINTY OF MEDICINE,25
UNCERTAINTY OF MEDICINE,
25
Importance of the subject. Definiteness of results in chemistry. Only a distant and humble approach to this possible in medicine. Illustration from chemistry.Causes of the Uncertainty of Medicine.1. Sympathy between different organs; 2. Symptoms produced at a distance from the seat of disease. Disease extended by sympathy. Transposition of disease from one organ to another. 2. Influence of unseen or secret causes. Nature of many causes of disease unknown. Combination of many agencies in producing disease, some of them having acted a long time. Cases rendered complex by treatment before physician is applied to. 3. Natural changes in the system arising from the curative power of nature, and from the principle of self-limitation in diseases. Illustrations of the operation of thevis medicatrix naturæ—vomiting to remove offending matters from the stomach—suppuration and discharge of a swelling. Tendency of diseases to come to a conclusion—more definite and regular in some complaints than in others. Mistakes from confounding the effects of remedies with the changes produced by these two tendencies. 4. Mental influences. Connection of mind with body modifying disease. Effects produced through the mind often attributed to physical causes and remedies. Case of the dyspeptic. 5. Individual peculiarities.
CHAPTER II.
SKILL IN MEDICINE,50
SKILL IN MEDICINE,
50
Show in what medical skill consists, in view of the uncertainty of medicine—appreciating the condition of the patient in all respects, and applying remedies in the best manner to relieve this condition. Errors impairingskill. Taking limited views of disease. Directing attention too much to particular organs. Undue attachment to certain modes of investigation. Difficulties in the way of deciding what it is best to do. Course of different physicians in view of these difficulties. Accurate proportioning of means and ends. Value of experience. Illustration of some of these points in the case of a sick traveller assisted by his friend in going through a mountain pass.
CHAPTER III.
POPULAR ERRORS,63
POPULAR ERRORS,
63
False estimate of the importance ofpositivemedication. This error appears in various ways. Healing of wounds—anointed axe. Attributing effects to agencies just preceding them—post hoc propter hocmode of reasoning. Referring the cure of a case to someoneremedy or measure, when commonly the result of many. Disposition to have something done all the time. Disease considered often as a palpable thing—a humor—a poison—medicines supposed to neutralize it. Specifics. Supposed to be many—really few, if any. Definition. Inadequate ideas of the community of the necessity for discrimination in medical practice. Propensity to look for some universal catholicon. Disease supposed by some to be an unit. A sort of universality of operation attributed to favorite remedies, even sometimes among physicians. Dr. Beddoes’ gases. Physicianscorrecttheir errors by experience—the public only exchange one error for another in medicine. Changes in popular opinion in regard to quack remedies.
CHAPTER IV.
QUACKERY,80
QUACKERY,
80
The grand source of quackery the false reference of effects to causes. The way in which a remedy, whether active or inert, acquires its reputation. Quack medicines principally ofthreekinds. 1. Evacuants. Great similarity in these—made up mostly of articles in common use. 2. Those which are supposed to act upon the system in a gradual way, as alternatives. Preparations of sarsaparilla. Impositions. 3. Those which are supposed to act especially upon the lungs. Harm done by their indiscriminate use. Quantities of inert and damaged articles used in preparing quack medicines. Importance of thenameof a medicine in giving itcurrency. Ridiculousness of quack advertisements. Certificates. Chiefly offourkinds. 1. Forgeries. 2. Essentially, sometimes wholly, untrue. How obtained. 3. Those given by invalids imagining themselves to be relieved. 4. Those given by invalids who are relieved while taking the medicine—inferred to be donebythe medicine. Certificates of clergymen. Rule of the medical profession in regard to nostrums. Proposed mode of guarding against imposition. Quackery as a monstrous business interest. Press and legislatures trammelled by it. Itinerant quack lecturers. Lectures especially to the ladies. Animal magnetism. Paracelsus the “prince of quacks.” St. John Long. Perkins’ tractors. Forms of Quackery many, but the materials from which they are formed always the same. No discoveries have ever been made by quackery.
CHAPTER V.
THOMPSONISM,103
THOMPSONISM,
103
Principles of the system as promulgated by its founder. Bold confidence of Thompson in his mode of practice. Points in his theory. Obstructed perspiration. Strife between the heat and the cold. Simplicity of the system. No need of “learned doctors.” Thompsonian views of themodus operandiof medicines. Radicalism of Thompsonism. Prejudice against mineral medicines. No article injurious simplybecauseit is mineral. The most deadly poisons in nature vegetable. Effects of vegetable poisons generally as abiding as those of mineral. Lobelia a poison, sometimes fatal, though Thompsonians claim it to be perfectly harmless. Definition ofpoison. Some poisons more rapid than others in their effects. Poison sometimes used in a relative sense. This word one of the watch-words of Thompsonians, though they daily use poisons as common articles of food. Changes in Thompsonian practice since the system was first promulgated.
CHAPTER VI.
HOMŒOPATHY,120
HOMŒOPATHY,
120
Brief notice of the founder of Homœopathy. His exalted ideas of his “discovery.” Two principles in his theory. 1.Like cures like.According to Hahneman there are three modes of practice—allopathic, antipathic, homœopathic. The last alone truly successful, according to him. The name allopath wrongly bestowed by Hahneman upon physicians.2.Minute division, with agitation and trituration, communicates a new power to medicines.Subdivision very minute, and extremely particular directions given by Hahneman for effecting it. Whether such a power is thus communicated to be decided by facts. “Observations” on which the opinion is founded. Character of them illustrated from Jahr’s manual. Their extreme minuteness. Mode of collecting them. Based upon the ridiculous idea that all states of the body are to be referred to the remedy taken. Notices of some particular remedies in illustration. Alleged success of Homœopathy.Apparentsuccess to be attributed to six causes. 1. Mental influence. 2. A strict regard to diet and regimen. 3. Operation of thevis medicatrix naturæ, or curative power of nature. 4. Comparisons made between the results of homœopathic practice and those of over-dosing physicians. 5. An occasional stealthy use of remedies in ordinary doses. 6. The facility with which people are deceived in regard to comparative results. Parallel case of a German clergyman. Empty boasts of homœopathists as to the character of their physicians. Points of resemblance and of difference between Thompsonism and Homœopathy.
CHAPTER VII.
NATURAL BONE-SETTERS,146
NATURAL BONE-SETTERS,
146
Setting of bones wholly mechanical. There cannot be aninnateskill in this, any more than there can be in any other kind of mechanics. Explanation of bone-setting. Skill obtained in this just as in anything else. Bone-setterlearnsall that he actually knows, by his own observation, and from others. It is notbornwith him. Gets some of his knowledge by stealth.Errors committed by natural bone-setters.Supposing a fracture to be a dislocation. Injuries of joints in which there is neither dislocation nor fracture—harm sometimes done in such cases by the bone-setter. Failure in themedicalpart of the treatment in some cases. Failure in the management of fractures. Physicians not all good bone-setters. Mechanical tact requisite. Though so many cases of mal-practice can be found among the patients of natural bone-setters, generally supposed by the community to be infallible. Difficulty in getting a verdict of damages against them.Reasons why they, in spite of their errors, acquire a reputation for skill.Setting sprains. Facility of the imposition practised. Breaking up old adhesions. Stiff joints and contracted tendons—efficacy of rubbing. Imagined tenderness and inability of motion. Sub-luxations—random pulling. False reports of cases.
CHAPTER VIII.
GOOD AND BAD PRACTICE,172
GOOD AND BAD PRACTICE,
172
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 bevery sickwhen 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,200
THEORY AND OBSERVATION,
200
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 standardauthoritiesas 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 operandiof medicines. A reform in progress in medicine. Breaking loose from theory. Promoting rigid observation.
CHAPTER X.
POPULAR ESTIMATES OF PHYSICIANS,222
POPULAR ESTIMATES OF PHYSICIANS,
222
No class of men so erroneously estimated as physicians. Object of this chapter to show how the community can judge of them correctly. Education of physicians—evidences of it. Medical education practically despised by a large portion of the public. Standing of medical man among his brethren criterion of merit. Difficulty in getting their unbiased opinions. Certain mental qualities essential to skill in the practice of medicine. How the common observer can detect and measure these qualities.Observe them as exhibited in regard to subjects which he understands in common with the physician.Illustration from surgery. Illustrations of same truth in relation to various characteristics of medical men. Formation of opinions—credulous—sceptical—hasty and changeable—cautious and tenacious—strong and ardent. How can test one’s habits of observation. Asking many questions no sure proof of accurate and minute observation. Enquiries of different physicians about an article of curiosity. Same rule for judging of themeasuresof the physician, as we have applied to his opinions. A genius in medicine. Innate skill. Rules which have been pointed out for estimating comparative merits of physicians not in common use with the public. A change necessary in this respect. Cannot easily be effected. Many physicians would be opposed to such a change—would rather false tests continue to be applied. But the change can be effected.
CHAPTER XI.
MEANS OF REMOVING QUACKERY,242
MEANS OF REMOVING QUACKERY,
242
The credulous, ignorant, and novelty-seeking, not the only persons imposed upon by quackery. Many of the judicious and intelligent also. Efforts to undeceive the public on this subject have been often faulty. Too much reliance on popular knowledge of anatomy, physiology, dietetics, &c. This should only be auxiliary to other means. Relied upon alone, leads to error. Individual influence of physicians in showing their friends their mistakes in connecting cause and effect in medicine. This influence to be exerted upon the intelligent who uphold quackery. Too much sarcasm and ridicule and invective used against quackery. Credulity of the public takes a license from that of medical men. Certificates of physicians in favor of nostrums. Secret medicines put forth by physicians. Spirit of quackery in the medical profession. Exhibited in various ways. Quite prevalent, crippling the profession in its warfare with empiricism. Reform needed. Can be effected. The stable and intelligent can help in effecting it, by promoting medical education—by sustaining the organizations of the profession—by renouncing fallacious means of estimating professional merit—by favoring strict observance of the rules of intercourse among physicians. Formation of the American Medical Association, an important movement in the destruction of quackery.
CHAPTER XII.
INTERCOURSE OF PHYSICIANS,258
INTERCOURSE OF PHYSICIANS,
258
Erroneous views in regard to consultations. “Jury of doctors.” Dictation not consultation. Giving opinions in relation to the past treatment. Offices of theconsulting, and of theattendingphysician defined. Freedom in consultation necessary. Between enemies, useless. Should be alone in consultation. Intrigues of dishonorable practitioners. Supposed want of agreement—favoring the impression for base purposes. Attributing changes, good or bad, to some remedy for selfish ends. Failing to defend a medical brother when circumstances fairly demand it. Making comparisons between cases. Undue attentions to the patients of others. Conduct of some when called to see the patient of another in case of unnecessary alarm. Physicians supposed to be too much attachedto etiquette. Not so usually. Differences and quarrels of physicians—circumstances giving rise to them. Facility with which deception is practised in medicine. Peculiar relation of the physician to his employers. Cliques. Sectarian and other associations. Avoiding quarrels. Relations of elder physicians to their brethren.
CHAPTER XIII.
INTERFERENCE WITH PHYSICIANS,275
INTERFERENCE WITH PHYSICIANS,
275
Confidence which one feels in his physician no reason for disparaging others. Interference proper in some cases—quackery—gross ignorance—intemperance. Reckless attacks upon professional character. The lawyer rebuked. Free canvassing of the merits of physicians not improper. Interference in the sick room. Destroying confidence. Recommending medicines. Restricting physicians as to remedies employed. Frequency of physician’s visits to be mostly left to him. Anxiety of friends of the sick often embarrasses the physician. Case of the wife of Napoleon. Harrassing practitioner with inquiries and criticising his practice distract his attention, and therefore foil his skill. Same effect produced by the same causes in regard to other subjects. Criticised clergyman. Watched juggler. Defects in these analogies.
CHAPTER XIV.
MUTUAL INFLUENCE OF MIND AND BODY IN DISEASE,288
MUTUAL INFLUENCE OF MIND AND BODY IN DISEASE,
288
Inadequate views of this influence prevalent. Importance of understanding it. Connection of mind and body. No proof that mind is essentially indestructible. Manifestations of mind connected with and dependent upon the material organization. Brain in some sense seat of mind—central organ of the nervous system, with which mind is connected. Other subordinate nervous centres. Bichat’s idea of the seat of the moral sentiments. Weakness of mind in sickness. Slight causes affect it strongly. Importance of quiet in sick room. Difficult to secure it. Visitors. Conversation. Children as easily disturbed as adults. Holding up physician as a bugbear to them. Exciting the mind commonly irritates bodily disease, whether in the brain, or in some other organ. Death of Hunter caused by a fit of passion. Duty of physician sometimes to excite the mind in various ways and degrees. Influence of imagination upon the body. Use to be made of mentalassociationin the treatment of disease.Diversionof the mind. Influence of change of scene on the invalid. Monotony of sick room. Settled gloom with which the sick sometimes afflicted. How removed. Want of tact in managing whims of the sick. Notional dislikes. Fretfulness and impatience. Deranged sensations erroneously supposed to be mere imaginations. Importance of a faithful study of mental influences to the physician.
CHAPTER XV.
INSANITY,320
INSANITY,
320
Two classes of causes—those which act upon the mind, and those which act upon the body. Insanity always, strictly speaking, a disease of the organization. Too much disposition to look to some one thing as the cause. Tables of causes in Hospital reports.Formof the insanity not necessarily indicative of its cause, or of the character of the patient.Causes of insanity.Indulgence of passions. Wrong views of life. Exclusive and prolonged attention to one subject. Insanity rare among savages, and those under despotic governments. Great prevalence in this country. Religious excitement. Debilitated system predisposing to insanity. Intemperance. Children seldom insane, though very liable to temporary derangement in sickness. Foundation of insanity, however, often laid in childhood.Forms and signs of insanity.Cases in which the disease comes on slowly. Monomania.Moralinsanity. Treatment of the insane. Change produced by Pinel.Advantages of Retreats or Hospitals.1. Removal of patient from theassociationsunder which his insanity originated. 2. Judicious medical treatment. 3. Better mental and moral management than can have among his friends. Mistakes of friends of the insane in their management. Reasons why insane apt to dislike their nearest friends most. Helplessness of insane poor. Duty of the State in regard to them. Legal relations of insanity. Absurd and inconsistent opinions and practices of our courts of justice. Professional evidence in France, and in this country, when prisoner suspected of insanity. Insane often been executed. Plea of insanity. Importance ofpreventingthe acts for which the insane are brought before our courts as criminals. Laws deficient at this point. Necessity of a commission of lunacy.
CHAPTER XVI.
INFLUENCE OF HOPE IN THE TREATMENT OF DISEASE,344
INFLUENCE OF HOPE IN THE TREATMENT OF DISEASE,
344
Physician’s employment a cheerful one. Contrary opinion quite prevalent, but erroneous. Cases in which he can neither cure nor palliate few. Prevailing cast of physician’s mind, therefore, hopeful. Hope should always be based on intelligent grounds. Hope in the different stages of a case. Seldom should all hope be given up—even in apparently desperate cases recovery sometimes occurs. Interesting case. Hope a cordial—as necessary as the cordial draught, and as improper to withhold it. Giving falseassuranceswrong. Often done by quacks and quackish physicians. Views and feelings of patients in regard to prospect of death often misunderstood. Extinction of all hope of recovery not commonly desirable in cases certain to be fatal. This extinction of hope not essential to perfect resignation. Influence of collateral circumstances upon the manner in which death is met. Occasional pauses in the onward progress of fatal chronic disease. Duty of the physician in regard to the hope awakened at such times. Supposed salutary moral influence of the certain expectation of death. Tendency to hope in consumptive patients. Curability of consumption.
CHAPTER XVII.
TRUTH IN OUR INTERCOURSE WITH THE SICK,357
TRUTH IN OUR INTERCOURSE WITH THE SICK,
357
Variety of opinion and practice on this subject. Percival’s views in his Medical Ethics. Advocates falsehood. Object of this chapter to present the practical considerations bearing on this subject, illustrating them with cases. 1. Knowledge concealed from the patient by falsehood it is wrong to assume would certainly do him harm if communicated to him. 2. Deception as commonly practised generally fails to be carried out. Case of the deceived child. 3. The discovery of the deception, when it takes place, has a worse effect on the patient than a full statement of the truth could produce. 4. Destruction of confidence occasioned by discovered deception injurious to the persons deceived. Children. The insane. Detected deception not only increases insanity, but modifies it. 5.Generaleffect of deception, extending beyond the individual on whom it is practised. General distrust of the veracity of physicians. 6. If adopted as a common rule that deception is sometimes proper, the object of the deception would be defeated. 7. If the door for deception be once opened thereis no limit. Though proper sometimes to withhold the truth, wrong to put falsehood in its place. Enquiries of the sick not always to be directly and fully answered. Too definite opinions often given by physicians.
CHAPTER XVIII.
MORAL INFLUENCE OF PHYSICIANS,383
MORAL INFLUENCE OF PHYSICIANS,
383
Intimate relation of physician to his patients. Mutual confidence. Abuse of confidence. Guilt of it, especially in case of females. Sympathy of the physician—active—grows constantly stronger and more tender. Self-control mistaken for want of feeling. Manifestations of feeling—surgical operation. Certain nervous effects erroneously supposed to be evidences of feeling. Sympathy of the physician a means of influence. Physician at home everywhere. Opportunity of studying every variety of character. Physicians often fail to exert the influence which these advantages enable them to do. Influence on moral questions. Temperance. Acting as a peace-maker. Influence of daily conduct—little hourly acts. Physician in sick room. Communion with the spirit in its most momentous hours. Physician’s great object to cure the patient—nothing should interfere with it. Cordial influence of hope. Little confidence to be placed in death-bed repentance and reformation. Opportunities of doing good in lingering chronic cases. Mode of doing it. Injudicious intercourse with the sick. In some cases duty clear—in others, doubtful. Conference between physician, clergyman, and friends. Opportunity of doing good in convalescence. Moral influence of the physician in his strictly-professional character.
CHAPTER XIX.
TRIALS AND PLEASURES OF A MEDICAL LIFE,404
TRIALS AND PLEASURES OF A MEDICAL LIFE,
404
Great mental and bodily toil. Irregularity of life. No command over time. Exposure to causes of disease. Physicians a short-lived class. Compensation generally small. Medicine not a money-making business. Less obligation felt by many to pay physician than to pay others. Physician often obliged to see the quack and hobby-rider getting rich by their impostures. Facility with which the people are imposed upon, a great trial to the honorable practitioner. Especially so when imposition is practised by his brethren. Valuable lives sacrificed to ignorance and unskilfulness. Witnessing sad scenes. Mutual sympathy and confidenceadd in such cases to physician’s sorrow. Irreligion and vice at hour of death. Frequency of sad scenes in times of pestilence. Ingratitude of those on whom the physician has conferred favors. Services of faithful physician not to be measured by pecuniary considerations. Dismissing physician for frivolous or improper reasons. Not so much gratitude in the world as commonly supposed. Virtuous and vicious poor. Clergymen generally attended upon gratuitously. What, therefore, is due from them to our profession. Conduct of some of them. Want of respect to the medical profession, on the part of the community generally. Public ingratitude.Pleasures of a medical life.Medicine as a science, full of interest. Its intimate union with other sciences. Enthusiasm in its pursuit. All discoveries, however small, add to the capabilities of the medical art in relieving misery and prolonging life. Pleasure in unraveling the perplexities of medical practice—in guiding and assisting Nature’s processes when salutary, and in arresting them when not so. Mental management of the sick. Results of practice of the judicious physician gratifying. The physician a hopeful, cheerful man. Gratification of his humanity and benevolence. His attachments. His social enjoyments. His opportunity for exerting a good moral influence.