Baker & Scribner’s Valuable Publications.

PHYSICIAN AND PATIENT.

PHYSICIAN AND PATIENT;
OR,
A PRACTICAL VIEW
OF THE
MUTUAL DUTIES, RELATIONS AND INTERESTS
OF THE
MEDICAL PROFESSION
AND THE
COMMUNITY.

BY WORTHINGTON HOOKER, M.D.

I here present thee with a hive of bees, laden some with wax, and some with honey. Fear not to approach. There are no wasps, there are no hornets here. If some wanton bee should chance to buzz about thine ears, stand thy ground and hold thy hands; there’s none will sting if thou strike not first. If any do, she hath honey in her bag will cure thee too. Quarles.

NEW YORK:
BAKER AND SCRIBNER,
145 NASSAU STREET AND 36 PARK ROW.
1849.

Entered according to Act of Congress in the year 1849, by
BAKER AND SCRIBNER,
In the Clerk’s Office of the District Court of the United States for the Southern
District of New York.

Printed by
C. W. BENEDICT,
201 William street.

PREFACE.

A few words may be proper in explanation of the objects for which this book was written.

The forms which quackery assumes are endless; but the material out of which they are evolved is essentially the same in all ages and in all countries. There are certain medical errors which are common to man everywhere and in every condition. It is these which constitute the material of quackery, whether it appear among the savage or the civilized, the rude or the refined, the illiterate or the learned. One object of this book is to develop these fundamental errors, and to show the modus operandi by which the genius of imposture has produced from them the fantastic and ever-changing shapes of empiricism.[1] I notice particularly some of the specific forms of quackery which are now prevalent, not because they differ essentially from those which have preceded them, but because they have a present interest to the reader.

One of the objects at which I aim is to expose to the public the fallacy of those sources of evidence, upon which they rely in estimating the comparative merits of physicians, and to show them what tests they have at command, which will not prove fallacious. The proper use of these tests would save the public from mistaking, as they now often do, the plausible pretensions of the superficial practitioner, and the charlatan, for the evidences of real skill and wisdom.

Another object will be to present the claims of the medical profession to the respect and the confidence of the community. As it now is, the profession stands in a somewhat false position before the public. The grounds upon which we ask their regard and trust are not generally understood. The confidence which is reposed in us is not as intelligent as it should be. It is unsettled and capricious. It is overweening at one time, and it is entirely withheld at another, and for the most frivolous reasons. The inconsistencies of even the well informed on this subject are surprising. Many, who on some occasions confide implicitly in nothing but educated science, are found at other times submitting themselves and their families to the haphazard administrations of empiricism.

But while I attempt to establish the claims of the medical profession to the confidence of the people, and to defend it against the aspersions which are unjustly cast upon it, I endeavor to exhibit faithfully the abuses which exist in the profession itself. The quackery which is practised among medical men is a much greater evil than that which is abroad in the community. I attack it therefore with an unsparing hand. In so doing I expose many of the tricks and manœuvres which are employed by those physicians, who, pursuing medicine as a trade instead of a profession, study the science of patient-getting to the neglect of the science of patient-curing. When the rules of an honorable professional intercourse shall come to be properly understood and appreciated by the public, one of the great sources of the success of quackery will be removed.

In exposing the errors and faults of the medical profession and of the public, while I have unflinchingly aimed at the truth I have endeavored to avoid a censorious spirit, and to give to human frailty all the tolerance that can properly be demanded. I trust the reader will therefore find, that, in the language of my motto, “there are no wasps, there are no hornets here.” That I have escaped all error myself I do not claim. Some points may be too strongly stated, and some provisionary and modifying considerations may be omitted. I ask of the reader a reasonable indulgence, but none which shall be inconsistent with an honest and candid criticism.

In the practice of medicine there are some points upon which there should be a common understanding between the physician and the friends and attendants of the sick. From the want of such an understanding the purposes and plans of the practitioner are often interfered with, and sometimes are effectually thwarted. A considerable portion therefore of this work is devoted to an elucidation of the points referred to.

In the chapter on the uncertainty of medicine, and in other places, also, I point out the difficulties which are encountered in the study and practice of medicine. These difficulties demand of the physician the exercise of higher and more cultivated powers, than are needed for the successful prosecution of most other studies and pursuits. I therefore make it a principal object to urge, by every consideration, the importance of a well-educated medical profession. Every man has a personal interest in maintaining the barriers by which the organizations of the profession undertake to protect the community from the evils, which they would suffer from ignorance and imposture, if these barriers were destroyed. It is especially for the advantage of the people, and not, as is commonly supposed, of physicians, that there should be a proper standard of medical education.

My first chapter, on the uncertainty of medicine, may perhaps be considered by some as too strictly professional for the common reader. I ask for it, however, a careful perusal. I have endeavored to strip the subject of all technicalities, and a full understanding of the views there presented is necessary to a proper appreciation of the considerations contained in some of the succeeding chapters.

I write in part for the profession, and in part for the community at large. I ask both to look candidly at the views which I present of their ‘mutual duties, relations, and interests.’ A reform is needed in the opinions and practices both of physicians, and of the people, in regard to medical subjects. This reform is fairly begun in the profession, and there may be seen, even amid all the present diversified and flaunting displays of quackery, some indications of its commencement in the community. The volume which I now offer to the public is a humble effort to promote this reform.

W. HOOKER.

Norwich, Conn., June, 1849.

FOOTNOTES:

[1] It will be obvious to the reader that I use this word, wherever it appears, in its popular sense, and not in its professional one. I use it as synonymous with quackery.

CONTENTS.

CHAPTER I.

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 the vis 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]

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 impairing skill. 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]

False estimate of the importance of positive medication. This error appears in various ways. Healing of wounds—anointed axe. Attributing effects to agencies just preceding them—post hoc propter hoc mode of reasoning. Referring the cure of a case to some one remedy 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. Physicians correct their 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]

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 of three kinds. 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 the name of a medicine in giving it currency. Ridiculousness of quack advertisements. Certificates. Chiefly of four kinds. 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 done by the 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]

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 the modus operandi of medicines. Radicalism of Thompsonism. Prejudice against mineral medicines. No article injurious simply because it 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 of poison. 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]

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. Apparent success to be attributed to six causes. 1. Mental influence. 2. A strict regard to diet and regimen. 3. Operation of the vis 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]

Setting of bones wholly mechanical. There cannot be an innate skill 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-setter learns all that he actually knows, by his own observation, and from others. It is not born with 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 the medical part 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]

Not easy to distinguish between good and bad practice by results. If it were, would not be such differences of opinion among physicians and in the community. Examples of these differences. Stimulating and depleting measures. Homœopathy, Hydropathy, Thompsonism. Quacks aware of the difficulty in estimating comparative results—act accordingly. No mode of practice wholly good—none wholly bad. Some good points in all modes. Exclusive systems. Distinctions between good and bad practice pointed out. Cases in which the question of life and death immediately affected by practice. Failure of unskilfulness in such cases. Interesting case. Seldom is the influence of bad practice so manifest as in this case. Difficulty of culling out from the mass cases which are dangerous from the first. Various causes of this. Difficulty inherent. Cases misrepresented by mistake or wilfully. Some said to be very sick when not so. Light cases made bad by treatment—though appear grave, apt to recover. Illustrations. Comparisons between rival physicians as to results. Public often mistake in such comparisons. Notice some less direct effects of bad practice. Unnecessary complications of disease. State of system after recovery. General state of health in families. Length of sickness. Summing up of differences in results between good and bad practice. Two requisites for observing these correctly. 1. Sufficient amount of evidence. 2. Skill in observation. Community deficient in these. Confident appeals of quacks to alleged results. Show what the physician should say in regard to results.

CHAPTER IX.

THEORY AND OBSERVATION,

[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 standard authorities as in law and theology. Scepticism in medicine. Easy to theorize—difficult to observe well. Value of good habits of observation. Medical men had too much to do with theories and modes and systems. Eclecticism. Modus operandi of medicines. A reform in progress in medicine. Breaking loose from theory. Promoting rigid observation.

CHAPTER X.

POPULAR ESTIMATES OF PHYSICIANS,

[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 the measures of 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]

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]

Erroneous views in regard to consultations. “Jury of doctors.” Dictation not consultation. Giving opinions in relation to the past treatment. Offices of the consulting, and of the attending physician 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 attached to 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]

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]

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 mental association in the treatment of disease. Diversion of 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]

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. Form of 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. Moral insanity. Treatment of the insane. Change produced by Pinel. Advantages of Retreats or Hospitals. 1. Removal of patient from the associations under 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 of preventing the 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]

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 false assurances wrong. 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]

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. General effect 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 there is 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]

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]

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 confidence add 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.

CHAPTER I.
UNCERTAINTY OF MEDICINE.

The uncertainty of medicine is a common topic in all circles; and yet it is one which is very generally misunderstood, even by the intelligent and reflecting in the community. They mistake as to the nature of this uncertainty, its causes, its practical influence in the treatment of disease, the means which should be resorted to in order to diminish it, and the best methods of guarding against the errors into which it is liable to lead us. These errors are, I may remark, so numerous and so common, and interfere so constantly with the usefulness of the physician among high and low, educated and uneducated, almost equally, that the subject is one of vast practical importance. It is important not only to physicians, but to the people, and to the people especially, for they are the sufferers from the multiform and often fatal injuries, which these errors engender.

It will be profitable then to examine the different points to which I have alluded, so that it may be seen how far the science of medicine merits confidence, and by what tests an intelligent and thinking man may distinguish between that which rests upon good and substantial evidence, and that which is uncertain and delusive. This is a distinction which often fails to be made, (as the physician has occasion every day to lament,) by the shrewd and learned, as well as the ignorant and unwary; and the deductions of a rational and careful experience are continually confounded with the false assumptions, and plausible fallacies of the mere pretender, and the fanciful vagaries of the enthusiast. So far as my remarks will enable the reader to make the distinction to which I have referred, just so far will my object be accomplished.

When the chemist mixes substances together, the composition of which he knows, he arrives at results which may be strictly denominated certain and invariable. If he be not able to do this at once, he can do so ultimately, by a series of experiments, varied to test each doubtful point. The results which he thus obtains are so exact, that they can be expressed by numbers and definite proportions. The physician can imitate the chemist, it is true, in the application of tests in the investigation of disease; but it is necessarily a very humble and distant imitation, and no approach to the certainty and definiteness of chemical analysis and synthesis can be expected in medical practice. When the chemist mixes substances together, he knows what they are; and when he sees their effect upon each other, he has a right to expect the same effect to follow, with absolute certainty, whenever he shall make the same mixture again. But the physician cannot infer from the effect of a remedy in one case, that the same result will certainly occur in another case which appears to be precisely similar. For he cannot know enough of the circumstances of the two cases, to determine beyond a doubt that they are exactly alike. There are often causes, utterly undiscoverable by human wisdom, which essentially modify the effects of remedies.

If you suppose that the chemist knows the nature of only a part of the substances which he puts into his retort,—that the retort itself is made of materials which will act upon these substances, and be acted upon by them, and that in the midst of his experiment some other substance is introduced accidentally or by stealth, producing an entire change in the process; you will then make the chemist to resemble the physician in the uncertainty of his results. He would then be obliged, as the physician is, to go through with a great many observations to establish any one fact; and instead of making, as he now does, a well-defined line of separation between what is known and what is not known, he would, like the physician, have a wide middle ground of probability and supposition.

The causes which make disease complicated, and prevent uniformity in the effects of remedies, are principally these, viz.:

1. The sympathy which exists between the different organs of the body.

2. The influence of unseen causes or agents.

3. Natural changes, arising from the tendency which exists in the system to throw off disease, appropriately called the vis medicatrix naturæ, or restoring power of nature; and in connection with this the tendency to a definite limit manifest in many diseases; for example, small pox, whooping cough, measles, scarlet fever, &c.

4. Mental influences.

5. Idiosyncrasies, or individual peculiarities.

We will examine in a familiar way each class of these causes separately.

1. The sympathy which exists between the different organs of the body.

The fact that when one organ is disordered in any way other organs sympathize, or suffer with it, is familiar to every one. This sympathy destroys the simplicity of disease, in two ways. In the first place, it produces many symptoms at a distance from the organ affected. Pain, for example, is often far away from the disease which causes it. The pain in the right shoulder from disease of the liver, in the knee from disease of the hip joint, and in the head from disordered stomach, are familiar instances. Convulsions, in the great majority of cases, especially in children, are a mere symptom developed by the sympathy of the brain and nervous system with disease in some other organ—for example, a disordered stomach, the irritation of teething, &c. Now if sympathy renders disease complex, by developing such marked symptoms as those we have mentioned, at a distance from the affected organ, much more will it do this by the numerous less observable, and less definite symptoms, attendant upon our various bodily maladies.

In the second place, sympathy destroys the simplicity of disease, not only by exciting symptoms in organs at a distance from the part affected, but also by creating actual disease in those organs. A single example will suffice. The child, whose brain sympathizes with the disease in its stomach, may have inflammation after a time fastened upon its brain in consequence of this sympathy, the symptoms at first being obscure, but at length clear and unequivocal.

The influence of sympathy in modifying disease occasions constantly much perplexity in the mind of the physician. He often finds it difficult, and sometimes impossible, to decide whether an organ, which he sees to be affected, is really diseased, or is merely sympathizing with some other organ.

The simplicity of disease is thus destroyed by sympathy, even when all the organs, except the one which is attacked, are in a healthy state at the time of the attack. And when they are already in an unhealthy, unnatural condition from previous disease, the complication is rendered still greater. Chronic[2] cases especially are often so complex from this cause, that it requires the most discriminating acumen to unravel their history, and make out the starting point of the disease. Often it is impossible to discover any such starting point; and sometimes there is none, but there are several different diseases in different organs, all affecting each other through sympathy, and presenting together a confused and changing medley of symptoms. In such cases, the manifestations of diseased action are at one time most prominent in one organ, and at another time in another. These variations in the phase of the disease are often so unaccountable, as to seem capricious, and they always embarrass the physician, as he attempts to determine the effect of his remedies, and to proportion them to the importance of the symptoms, as they show themselves in the various organs. It would sometimes almost seem, that a tricksy little spirit were playing its pranks among the organs, now here and now there, eluding his search, and escaping his grasp.

In some cases, disease will leave the organ in which it seems to be obstinately fixed, and appear in full force in some other organ, which has been up to that time only sympathetically affected. This is more apt to occur in children, because the sympathies are more lively in them than they are in adults. Such changes, taking place often without any obvious cause, and so suddenly, and sometimes, we may add, so secretly, you can readily see, must tend to make our knowledge of disease, and of the effect of remedies, confused and uncertain.

2. The influence of unseen or secret causes, is another source of uncertainty in medicine.

The fact, that some causes, whose nature and extent cannot be appreciated, are at work modifying disease, and the effects of remedies, constantly forces itself upon the attention of the practitioner. The causes of disease, and of the changes that occur during its progress, are much more concealed from our view than is generally supposed. Patients are fond of fixing upon something to which they can attribute their sickness; but in the great majority of cases, the conclusion which they adopt with so much confidence is a mere supposition, and does not rest upon any substantial proofs. Even in the case of a common cold, you will find that the reasons given for believing that this or that cause produced it, often will not bear a strict examination, according to the acknowledged rules of evidence. Ordinarily some exposure is looked upon as being without a doubt the cause, when it may have been only one of the causes, or may even have had no agency at all in producing the result.

Some of the causes of disease, though, from their definite and invariable results, we may be perfectly aware of their presence, are yet of an occult nature, escaping all the tests devised to detect them. For instance, the miasm, as it is termed, which is the cause of intermittent fever, has never yet been detected in the atmosphere, by the application of any chemical test. And yet, no result in the wide range of disease is more definite and palpable than that which this miasm produces. And so secretly does it make its impression, that the disease sometimes lies dormant for a long period, even for weeks and months—the system all the while showing no signs of its presence. I once had a case of intermittent fever, which was not developed till a year had elapsed from the time of the patient’s exposure to the cause.

The nature and mode of operation of the causes of many diseases are involved in mystery, and are subjects of discussion and dispute among medical men. The formidable, and often fatal malady, that results from a wound received in dissection, is attributed by some to a poison evolved in the decomposition of the body; while others suppose that it arises from the irritation of the wound simply, circumstances concurring to increase the irritation in one case, while it is left to subside in others. It is agreed, on all hands, that the contingencies on which the disease depends are not ascertained; and they are so often absent, that the cases in which the malady does actually occur bear a very small proportion to the whole number of instances in which such a wound is received.

The same may be substantially said of the causes of typhus fever, cholera, scarlatina, &c. Some think that these diseases are caused by subtle poisons, which enter the system in various supposed ways; while others believe that they arise from causes which make impressions merely upon the system, and thus awaken trains of morbid action. Whatever may be our opinion on these disputed points, the fact that there is so much secrecy in the operation of morbific influences, must, it is clear, make much of our knowledge of disease uncertain.

If, then, there be so much ground for difference of opinion in regard to the nature of the causes of disease, and their mode of operation, where the results are of so definite a character, as we see in the disorders to which I have alluded; much more is this the case with those diseases, which, with their Protean shapes, make up a large proportion of the maladies that call for the daily attention of the physician. These do not commonly spring from one cause, but from many causes concurring together, some of which may be ascertained, while others are only suspected, or are wholly concealed from the most scrutinizing investigation. Under these circumstances, the physician has a difficult task to discover the actual condition of the patient. It would be a comparatively easy one, if he knew what all the agents were that had combined to produce the disease, even though they were numerous and complicated in their operation. He could then thread out with some success, the trains of morbid action, and, perhaps, give to each cause its proper place in his estimate of their agency in causing the disease. But, in some cases, he knows but little of the nature and mode of action, even of those agents, whose influence he can perceive: and then, there are some quite as important, which act in entire secrecy, developing results that cannot be foreseen, and that cannot be calculated upon after they have made their appearance. Such developments are often observed in the progress of disease, and necessarily embarrass us in its treatment. They sometimes completely alter, either gradually or suddenly, the whole character of the case; and yet they may be the consequences of causes, which have been secretly, but surely, doing their work from the first onset of the disease. In some cases, which were in the commencement comparatively mild, a group of severe symptoms all at once start up, exciting astonishment and alarm in the mind of the practitioner. Sometimes there are precursors of the full development, half showing themselves, and the watchful physician may discover in them the coming storm, long before the indications are manifest to the common observer. Even after convalescence has, to all appearance, fairly begun, and the symptoms seen during the progress of the disease are gone, some new symptoms may appear—the upshot of a train of morbid influences, which had been all the while imperceptibly advancing to this result; just as I have seen a fire, supposed to be extinguished, burst forth like a new fire in another part of the building, to which it had secretly made its way.

It is sometimes impossible to detect the immediate cause of an attack of sickness, even when the transition from health to disease is apparently instantaneous. Take, for example, this case. A gentleman, while quietly sitting in his counting-room, was attacked, as suddenly as if it were from a blow, with a great sense of oppression in the region of the heart, almost arresting the action of this organ, and at once prostrating his strength. No reason could be discovered why this attack should occur at that time rather than at some other. And yet there was some hidden cause, or combination of causes, which, at that moment, did its work; and we know not how long a time a preparation had been going on for this consummation, and so silently, too, as to occasion no disturbance.

The physician often finds, on making his first call upon a patient, that although he may think that his attack is only a thing of to-day, there is evidence that disease must have been preying upon his system for some length of time, gradually extending its ravages, till, at length, it has made a palpable outbreak. The patient may attribute his sickness to some one cause; but there have been many causes uniting together, one after another, and swelling the still current of disease, which has now broken forth as a flood.

And, as a general rule, the longer this preparation has been going on, the more obstinate does the physician expect the case will be, and the more difficulty does he find in getting a definite knowledge of the nature and extent of the malady. And if he could always trace every train of disease up to all its sources, both original and tributary, he would often be obliged to go back weeks, months, and sometimes years. In some cases, such an exploration would lead him through almost endless labyrinths. As it is, he often finds, in attempting such a search, that those facts which are the least material in the eyes of the patient, and which may be overlooked by him in giving the history of his case, reveal, far back in the distance, causes which have had more influence than any other in producing this result. A sort of cross-questioning, and that sometimes of a rigid character, is often needed, to develop material facts. The patient’s own story, without such questioning, would generally give to the physician very erroneous ideas of his case.

The remarks that I have made apply with greater force to chronic than they do to acute diseases. For in them more especially, as you have already seen, does the sympathy which exists between the different organs extend and complicate the morbid condition, and the operation of unseen causes contributes, sometimes very largely, to this result.

Many chronic cases become exceedingly complex, and therefore obstinate, from the course which the patient takes with himself, before he comes under regular and systematic treatment. Perhaps, first, he goes through with domestic medication, and then takes patent medicines, recommended to him by kind neighbors, or blazoned forth in the newspapers. Then he tries some vaunted system—Thompsonism, or hydropathy, or homœopathy, or chrono-thermalism, or perhaps all of them in succession. After going through all this, unless some one of these measures chance to benefit his case, (as anything may chance to do it), he at last comes to a physician, and puts himself under his care. The case which was, perhaps, sufficiently complicated in the beginning to require strict investigation, is now rendered, by all this variety of practice, very intricate. The difficulty in understanding it lies in the varied effects which the different agents brought to bear on it have produced—effects, which, in the retrospect, it is almost impossible to estimate with any correctness, because the physician has only the history given him by the patient, and the appearance of his present symptoms, to guide him in making up his opinions. If he had himself seen the case in its untouched condition, and then had witnessed the operation of the different remedies, he would have been better able to arrive at satisfactory conclusions. A chronic case, in its best estate, needs to be watched for some little time, in order to acquire a just and thorough knowledge of its character. And when it has gone through a series of processes at haphazard, with no intelligent eye to observe it, it is no wonder that its condition should become a complicated and puzzling one. The physician, with such a case before him, is situated very much as the chemist would be, into whose hands should be put a mixture which had been experimented upon over and over again by different chemists, and those, too, who were ignorant and bungling. And as you would not demand of him, that he should arrive at once at definite results in examining the composition of such a mixture, but would give him time to apply various tests to it, so it should not be expected of the physician that he should fully understand at once a case which has been dabbled with by ignorant experimenters, one after another; but time must be given him to watch his tests, that he may see them bring out to view its real character and condition.

It must be obvious to the reader, that those who go through this round of experimenting, before they put themselves under the care of an intelligent physician, not only lose valuable time by so doing, but generally inflict upon themselves positive harm. The remedies which they have used, if they have had no good effect, have helped to fasten the disease upon the system, and have increased its severity. They have done this by irritating the system, and, of course, the diseased organs, and by extending the complaint far beyond its original limits. You have seen that, through the sympathy existing between different organs, disease becomes extended and complicated. Well-directed treatment has a tendency to prevent this extension of disease: mere blind experimenting, on the other hand, is apt to promote it; and if it does not have this effect, the patient is very fortunate.

3. I pass now to the consideration of the third class of causes which render medicine an uncertain science, viz., natural changes, arising from the tendency which exists in the system to throw off disease, appropriately called the vis medicatrix naturæ, or curative power of nature; and, in connection with this, the tendency to a definite limit, which is manifest in many diseases, as, for example, small pox, measles, hooping cough, scarlet fever, &c.

To recur to our chemical illustration. I have said that it would add vastly to the uncertainty of the results of the chemist’s experiments, if the retort, into which he puts his substances to be experimented upon, could itself act upon these substances, and thus modify their action upon each other. The body of the patient may be considered as the physician’s retort, and the diseases and the remedies introduced, as the materials contained in it. Under this head we are to examine certain principles which reside in this retort, and which have a constant and important influence upon diseases and their remedies, modifying, sometimes manifestly, and sometimes secretly, their action upon each other.

I will speak first of the tendency to throw off disease, the vis medicatrix naturæ. I need not spend time in proving to you the existence of such a tendency. It requires not the exercise of any scientific acumen to discover it. It is obvious to the most superficial observer. And yet the extent to which it operates is far from being properly appreciated, even by medical men; and much less is it by those who are out of the profession. The changes which it produces are constantly confounded with the effects of remedies; and this is one of the chief sources of the errors which encumber the annals of medical experience.

The reader will see, as we proceed, that boast as doctors often will of their cures, as if they were wholly theirs, this vis medicatrix naturæ is the chief doctor after all; and she, good, kind angel, hovering over the bed of sickness, without fee, and often without even any acknowledgment of her services, saves the life of many a poor patient, who is near being drugged to death by some ignorant quack, or some over-dosing doctor.

That the reader may be somewhat acquainted with the extent of the influence which this curative principle exerts, I will cite some examples of its operation.

If some offending substance be present in the stomach, vomiting is produced, the substance is evacuated, and this organ, having thus relieved itself by an effort of nature, as it is commonly expressed, now goes on with the performance of its usual functions. In this case, the ordinary action of the organ is entirely reversed, in obedience to the curative principle. If an attempt be made to allay the vomiting before the offending substance is thrown off, it is an injurious interference with a salutary effort. Sometimes the effort is ineffectual, and needs the assistance of art. It is often difficult to decide whether vomiting is prompted by this curative principle, or is caused by irritation, which should be quieted by medicine. Want of due discrimination, either from lack of knowledge, or from carelessness, very often leads to errors on this point.

The operation of this principle is beautifully exhibited in the succession of the processes of inflammation. You see a swelling. It, after a while, begins to soften. There is matter in it, but it is not yet very near the surface. But soon, at some point, it comes nearer and nearer to the surface, the wall of the abscess thus becoming constantly more thin, till, at length, it opens and discharges. The discharge continues till the swelling is nearly all gone, and the remainder is absorbed, and the part is restored to its natural state.

Now, this is quite a series of processes, all contributing to one result, and it is presided over, or directed, by the vis medicatrix naturæ. The object of this series is a definite one; and each process does its part in effecting it, and does it commonly at the right time, and in the right manner. Just look for a moment at the complicated character of this apparently simple operation. Here is quite a large deposition of substance which is to be removed; and this is the object to be effected. Observe how it is done. The softening of the swelling is not a mere change of solid substance into a fluid, as if by decay, but it is the result of an active process, which we call suppuration. When this process is properly performed, good pus is made, or as the old writers in medicine rather quaintly expressed it, laudable pus. This process of suppuration, when it is well done, does not go on here and there in the swelling, making it like a honeycomb with a multitude of little abscesses; but there is a consent, an agreement of action by the vessels of the part, as really as if they worked intelligently. It is this consent of action which not only makes the line of movement in the abscess, but points it towards the surface, instead of giving it some other direction, laterally, or inward, upon some of the internal organs. But it is farther to be observed, that in this agreement of action, the vessels of the part do not all do one thing. Three different offices are performed by them in the different quarters of the abcess. While some of these little workmen are forming the pus, there are others thinning the wall of the abcess in the direction of the surface, by absorbing or taking up the substance there; while there are others still, in the rear, and at the sides of the abcess, depositing substance, in order to make a barrier to prevent the pus from being diffused in the surrounding parts. Each class of these workmen perform their particular work with even more exactness and harmony than would be expected of any company of intelligent laborers under the direction of a leader. The absorbents absorb together, the wall builders build together, and the makers of pus make pus together, and deposit it in a common reservoir.

But observe farther, and you will soon see an entire change come over the whole scene of operations. When the absorbents have completed their passage for the matter through the skin, the pus is gradually discharged from its reservoir, and the “occupation” of the pus makers is soon “gone.” The wall builders also cease their work, and while the vacancy becomes filled up by contraction and deposition, the wall of defense, so carefully maintained, so long as it was needed, is now taken up by the absorbents—workmen which seem to know just when, as well as how, to do their duty, and is emptied into the common circulation, to be discharged from thence with the general refuse, by the various outlets of the system.

The object of all this is the restoration of the part to its healthy condition, and it is effected by a principle existing in the system—it matters little comparatively by what name you call it. The name is simply expressive of a great, general fact, as the term gravitation is, and is not intended, any more than that term is, as an explanation of the nature of the fact indicated.

This same principle is in operation in all diseases, resisting them, hemming them in, and as they retreat, following hard upon their footsteps, repairing their injuries as well as it can. It is true that its efforts are often ineffectual, that they are sometimes overpowered by disease, that they are frequently perverted by injudicious interference, and that they are sometimes stimulated to a higher degree than is necessary, producing over-action, and thus making this conservative principle an instrument of injury, perhaps destruction. It would be interesting and profitable to illustrate these several points in the operation of this principle, but it is not essential to our purpose.

We will pass now to the consideration of the principle of self-limitation,[3] which we find existing in many diseases. These diseases have a regular rise and decline, including a set of processes, and a succession of symptoms peculiar to themselves. When they have once fairly begun, they cannot be abridged; neither are they prolonged beyond their natural limits, though they may, and often do, leave results behind them, which are sometimes mistaken for a continuance of the disease itself. The period of continuance is more definite and fixed in some of these diseases than in others, and there is a similar difference also in regard to uniformity of shape. Thus small pox runs through its course with more regularity of period, and with a more uniform series of phenomena than scarlet fever, which, though having a certain general character and average period, is extremely diversified in its degree of severity, and in its accompanying circumstances. The more simple and regular and definite any disease is, the more accurate can our observations be in regard to it, and the less apt are we to confound the effects of remedies with the natural changes that take place in its progress.

This principle of self-limitation is found in the movements of other diseases of a less definite character than those which I have mentioned, though it does not manifest itself so fully, and with so much uniformity. You have already seen, that in a common inflammatory swelling there is a regular set of processes going on to its termination, in the restoration of the part to its healthy condition. The tendency of the inflammation ordinarily is to finish itself, just as is the case with any of the definitely shaped diseases, but its rate of progress cannot be so well calculated upon. The same can be said of inflammation of any of the organs of the body, in regard to this tendency to come to a conclusion of itself; the ways in which it does this varying much, according to the texture of the part affected, and other circumstances.

The reader is now prepared to see how it is, that mistakes may be made, by confounding the effects of remedies with the changes that arise from the two tendencies, of which I have been speaking. These mistakes have often been committed, even in those diseases which are commonly simple and uniform, and definite in their shape and course. Take, for example, small pox. It was once the custom of physicians to give much medicine in this disease, with the idea that it was controlled and lessened by such a course, and the system was thus enabled to throw it off more easily and effectually. But experience has corrected this error, and the physician now stands by, and sees results occur in the progress of this malady without the agency of medicine, which he used once to consider as produced, in part at least, by the drugs that he administered. Let me not be understood to say that no medicine at all should be given in this disease. The office of the physician is to watch it, and if nature, in going through the processes necessary to a favorable termination, needs to be assisted by art, it should be done. But we should be careful not to ascribe to art what is really effected by nature, for we should be led by this error to a too officious interference with her efforts. We may often do much good by medicine—we may moderate the fever, support the strength when languishing, bring out the eruption when it recedes, &c. But to attribute the successful termination of small pox in all cases to the remedies which have been used, would be as great an error as it would be to maintain that the poultices, and other applications made to an inflammatory swelling, are of course the cause of its suppuration and discharge—or, in other words, that they cured the inflammation. All that can be truly said of them is, that they assisted nature in the cure. And as these applications may sometimes be of too stimulating a character to suit the case, and therefore may increase and extend the inflammation; so the remedies used in a case of small pox, if they be not actually needed, may aggravate the disease. And if the patient recover under such injudicious treatment, it may be supposed that the medicines cured him, though he actually recovered in spite of them, because that same blessed vis medicatrix naturæ came to the rescue.

If there be so much liability to error in a disease so simple and uniform as small pox is, it is still greater in those complaints which are more complicated, from collateral and accidental influences and affections. Perhaps I cannot adduce a better example for our purpose than is to be found in scarlet fever. There is no disease, the history of whose treatment shows so strikingly the uncertainty of medical knowledge and experience as this does. The most opposite and various remedies and modes of treatment have been lauded as successful, in standard medical works, and in medical journals, and multitudes of certain cures have been proclaimed in the newspapers. What is praised by one is condemned by another; and it is the individual experience of every rational and candid practitioner, that a mode of treatment which at one time is attended with marked success at another is wholly unsuccessful. It cannot be otherwise in a disease which varies so much as this does in its degree of severity, in its real character, and in its attendant circumstances. A respected medical friend, in reviewing his cases of scarlet fever, found that he had treated one hundred cases since he had lost a patient with this complaint. But on the very day on which he made this review, he was called to a case of scarlet fever which ended fatally, and out of thirteen cases in the same neighborhood he lost seven. With such variations in the severity of this disease, it is very difficult to avoid erroneous inferences as to the comparative success of modes of treatment. This difficulty is increased by the fact, which is remarkable in this disease, that the degree of severity, or amount of danger, is by no means always capable of being measured by the symptoms which present themselves. In the experience of every physician, who has seen much of this complaint, many cases have ended fatally, which, up to within a short period before death, appeared to be doing better than some others in which recovery took place. There was much wisdom in the reply that one physician made to another, who asked him what his mode of treatment was in scarlet fever. “I have no treatment,” said he. “I manage each case as an individual case, just as it strikes me at the time.” And to this conclusion will experience lead every judicious practitioner.

Let me not be understood to mean that experience, so valuable in the treatment of all other diseases, is nothing worth in this complaint—that it establishes no facts, and no general principles. All that I mean is, that this disease is so variable in its character and tendencies, that extreme caution is necessary in applying these principles, and that the treatment must be at the very antipodes of stereotype—as variable as the disease itself.

I trust that it is sufficiently obvious to the reader that great uncertainty must necessarily rest upon our knowledge of a disease so varied as this is, and that all our experience of the effects of remedies upon it must be thoroughly sifted, in order to attain to any measure of accuracy. It is a disregard of this important truth, that has made the testimony of medical men so conflicting in regard to the treatment of this disease.

I need not spend time to show how the same uncertainty must embarrass us, to a greater or less degree, in our investigation of all other diseases. The errors resulting from this source may be avoided, in part, by observing accurately the changes which arise from the two tendencies that we have been considering, their modes, periods, signs, and accompanying circumstances. The efficacy of this precaution against error is, as I have already hinted, in proportion to the simplicity and uniformity of disease. In disorders which are complicated, and which vary much in their shape and other circumstances, it is exceedingly difficult to decide, how much agency, in bringing about the curative changes, is justly to be referred to the remedies, and how much to the natural energies of the system. Too much credit is very commonly given to medicine, and too little to nature; and sometimes, when some remedy is praised for its efficacy, and the patient and his friends, and perhaps even the physician, think that it has saved his life, it had no agency in promoting his recovery, and perhaps it retarded it.

I pass now to the consideration of the fourth class of the causes of the uncertainty of medicine—mental influences.

It never should be forgotten in our observation of disease, that we have not to deal with the body alone, but with the body inhabited by a mind, which is connected with every particle of that body by countless nervous filaments, and therefore acting through them upon it, and affecting to a greater or less degree all its diseased conditions.

The influence of causes acting through the mind is often concealed from our view, and even when it can be plainly seen it is difficult to estimate its amount with correctness. Effects are often produced through the mind, which are attributed by the patient, and sometimes by the physician, too, to some remedy that has been administered. Take a very common case. A dyspeptic, who has contracted his disorder from mental effort, or from the anxieties of business, applies to his physician. He prescribes some medicine, and at the same time recommends him to take a journey, or go to some watering place. He returns cured, and he perhaps gives the credit for the most part to the medicine, or to the medicinal waters which he has drank with scrupulous regularity, either of which may have had little if anything to do with the cure, and relaxation and diversion of mind may have been the chief or sole causes of his recovery. This is a palpable instance of erroneous inference; but we shall have but a narrow idea of the influence of mind upon disease, if we confine our view to cases of so decided a character. Its influence is constant in all diseases; sometimes plain to be seen, as in the case just mentioned; often entirely concealed from the most careful scrutiny; and sometimes revealing itself slightly, so that the watchful eye of the physician catches mere glimpses of it, like passing shadows gone in a moment. Besides the secret griefs and troubles that often hinder recovery, there are varying states of mind, some of which the patient may be hardly conscious of himself, that modify in a thousand ways the movements of disease, and the action of remedies. For example, the cordial which is administered is often in part or wholly neutralized by mental depression, while it is essentially aided in its effects by the genial and animating influence of hope.

The points to which I have alluded the reader will find fully illustrated in the chapter on the mutual influence of mind and body in disease. I will therefore dismiss them for the present, and will merely recur again for a moment to our chemical illustration. If the retort of the chemist, besides being composed of substances which will act upon its contents, should have residing in it some secret and subtile principle, whose existence is known only by its effects, and which acts both upon the retort itself and on whatever it contains, the results of his experiments would be rendered very uncertain. To follow out the analogy—the human body being the physician’s retort, the mind is just such a secret and subtile principle, acting in an unseen way both on the retort and its contents, modifying therefore the effects of remedial agents, so as to embarrass the physician in his investigations, and render his conclusions uncertain.

The fifth class of causes of the uncertainty of medical science remains to be noticed, viz.: individual peculiarities or idiosyncrasies, as they are termed.

Every individual may, strictly speaking, be said to be peculiar to some extent, and there is much force in the popular idea of the benefit resulting from a physician’s being acquainted with his patient’s constitution. But besides these common differences, some have very great peculiarities. A few examples will be sufficient. There are some persons in whom the odor of roses will produce asthma. Ipecac has the same effect in some individuals. Some persons are uniformly made sick by eating strawberries even in small amount. Cases are constantly met with by physicians in which some medicines have a peculiar effect. The various effects produced by opium in different individuals furnish many examples. I call to mind a patient, who though a laboring man of considerable power of endurance, is extremely prostrated by vomiting, by whatever agent it is produced. I once gave him an emetic without knowing this peculiarity. He was so much prostrated, that I supposed that the apothecary had made a mistake, and that he had taken an overdose. But a short time after, I witnessed in him the same effect induced by undigested food, and this revealed the idiosyncrasy in his case.

When idiosyncrasies are known, they can be calculated upon. But they are not always known. We cannot be aware of them when they respect the action of remedies which the patient had never taken. And in relation to remedies which produce no marked and obvious effect, peculiar susceptibilities may exist without being readily ascertained. If there be an idiosyncrasy in regard to such a medicine as an emetic, or an opiate, it is easily discovered. But if it exist in regard to a remedy that acts silently and slowly, it may not show itself clearly. The only evidence that we have of its existence may be the fact, that the medicine after a while is observed to fail in producing the effects which we ordinarily expect from it in such cases. And it may be very doubtful whether this failure is to be attributed to this cause, or to some other.

Let us recur once more to our illustration from chemistry. If the retorts used by the chemist, (which, I have supposed to carry out the analogy, to be composed of materials which would act upon their contents,) were not all made exactly alike, but varied a little always in their composition, and sometimes considerably, and that too without the variation always being appreciable, this fact would obviously still further complicate his experiments, and render them uncertain in their results. So also the peculiarities in the different human systems, which are the physician’s retorts into which he introduces his agents, must have the same effect upon his investigations.

I have now finished the consideration of the various causes of uncertainty in medical science. If I have succeeded at all in making them to be properly appreciated, the reader will agree with me when I say, that there is no science that requires higher talents for its successful investigation, and none that is so liable to wrong influences and conclusions, if the student of it be a careless and credulous observer. Notwithstanding this liability, imperatively demanding caution on the part of the physician, there has been much of careless observation in this science; and the recorded experience of the medical profession is therefore encumbered with a mass of errors. In order to get rid of these errors, and to establish the proper distinctions between the certain and the uncertain, between the true and the probable, while the merely plausible shall be entirely rejected, a judicious sifting and testing of evidence must be resorted to, credulity and skepticism both being equally avoided.

FOOTNOTES:

[2] The terms chronic and acute it may be well to define for the benefit of some of my non-professional readers. An acute disease is one which runs its course in a short time. A chronic disease, on the other hand, is one which has a long duration. For example, pneumonia, (commonly called lung fever,) is an acute disease of the lungs, while consumption is a chronic disease of the same organ. The term, acute, has reference to the violence of the symptoms of the diseases to which it is applied, rather than to their duration; while its opposite term, chronic, has reference to duration only. Use, however, has given them a technical sense which is not liable to be mistaken.

[3] This subject may be found fully illustrated by Dr. Bigelow in the Annual discourse for 1835, before the Massachusetts Medical Society.

CHAPTER II.
SKILL IN MEDICINE.

The uncertainty of medicine is often most unjustly made to give a free license to blind experimenting. It should the rather stimulate to the most careful and searching observation of all the doubtful points of the case in hand, so that whatever of experimenting may be necessary, shall be as rational and intelligent as possible. This leads me to remark, that the views, which we have taken of the uncertainty of medicine, show us in what real skill in the practice of the medical art consists. It consists in appreciating the actual state of the patient in all respects, and then applying such remedies, and in such quantities and forms as will do the greatest probable amount of good. This is apparently a very simple proposition. But if we consider it in all its bearings, we shall find that more is included in it than at first sight appears. I will therefore dwell on some of these points in the order in which they are suggested to my mind.

Appreciating the true condition of the patient does not consist merely in finding out the seat, the nature, and the amount of the disease. This is exceedingly important, it is true. But it is by no means all of the case. Sometimes it is but a very partial view of it. For example, suppose that the patient has an inflammation of some organ, and to make the case stronger, let it be a chronic inflammation. In chronic diseases, as you have seen, there are extensive results from sympathy and from the action of concurrent causes in different parts of the system. The physician, in investigating such a case, in order to proportion his curative measures with any accuracy to the ends to be accomplished, must look beyond the main disease, and take into view the whole case, the state of the different organs, and the state of the system as a congeries of organs.

A disregard of this important point is very common, and leads to many errors in practice. Let us look at a few of them.

Many physicians are disposed to consider the morbid state of the system in almost every case as arising from disease in some particular organ. They therefore, in examining the symptoms, search for this disease; and when they think that they have found it, they refer to this, either directly or indirectly, all the phenomena which the case presents. In their treatment of the case, therefore, they direct their remedial means principally to the local disease. They lose sight of the fact, that often there are several organs simultaneously affected, and that the organ which seems to be most diseased is sometimes found to be less so than some other organ, which exhibited no marked signs of its morbid state. They forget too another important fact—that the disease of an organ is often a mere result of a general bad condition of the system. If in such a case the physician considers the local disease the main thing to be attacked by remedies, and directs his efforts to that point, he commits a great error. And this is an error which occurs, I have no doubt, very often in regard to the most common of all chronic complaints—consumption. The local disease is a result, and not a cause, much more often than is generally supposed, even by physicians.

Some physicians acquire exclusive and narrow notions of disease, by having their attention particularly directed to the diseases of certain organs. They get a sort of attachment to some localities in the system, and are disposed always to look to their favorite quarters in their search after the seats of disease. With such an inclination it is no wonder that they often suppose an organ to be the seat of fixed disease, which is merely sympathetically affected.

An undue attachment to certain modes of investigation, to the exclusion of others, is also frequently a source of error. I mention as an example a too implicit and exclusive reliance upon what are called the physical signs of disease. Percussion and auscultation are valuable sources of evidence, but when they are relied upon to the exclusion of other sources, as is often the case, they lead to error. Some who have attained to a high degree of skill in the use of the stethoscope, have on this account sometimes adopted very erroneous conclusions, which might have been avoided by a careful examination of all the sources of evidence in the case.

Having pointed out some of the errors produced by narrow and exclusive views in the investigation of the symptoms of disease, let us now attend to some of the errors which result from this cause, in the application of remedies.

A remedy may be applicable to a disease which the physician finds developed in a given case, but there may be some condition of some organ, which may render it wholly inapplicable to that case. For example, in a case of inflammation of the lungs, the state of the stomach may be such as utterly to forbid the use of some remedies, which would otherwise be proper. If they be administered in spite of this circumstance, they may perhaps produce a beneficial effect upon the inflammation, and yet may do a great injury to the patient, perhaps even a fatal one, by their direct effect upon the diseased stomach. Errors of this kind do often occur in the practice of those who observe inaccurately, or who have fallen into a sort of routine of practice from disinclination to mental effort.

The general condition of the patient sometimes fails to be appreciated by the practitioner. He may be pursuing a course which would be admirably adapted to cure the same disease in a more vigorous patient, and yet in the case in hand it may be ruinous. Though it may relieve and even cure the disease, it yet may destroy the patient. The judicious physician in some cases feels obliged to let morbid processes go on, because the violence which must necessarily be done to the debilitated system by the attempt to arrest them, would put the patient’s life in greater jeopardy, than it would to let them have their course. Questions frequently arise on this point, which tax the physician’s skill and judgment to the utmost. Even when it is proper to moderate the activity of a diseased process, it is often a very delicate point to determine just how far this can be done without doing harm to the patient. Fever is often moderated by means that irritate the system, or prostrate its powers to such an extent, that bad results, sometimes fatal ones, occur; when, if these means had been used less largely, or perhaps even if they had not been used at all, a recovery might have taken place.

Sometimes fearful issues depend upon the decision of the physician. For instance, here is a case which has been going on for some time without giving much occasion for anxiety; but all at once it assumes a new aspect. A new set of formidable symptoms have come on, requiring an entire change in the treatment. A variety of perplexing questions now arise in the mind of the physician,—such as these. If the attempt be made to remove the new symptoms, how much reason is there to fear that that attempt will so affect the debilitated patient as to destroy life? Severe as the symptoms are, is there a probability that, if a mild course be pursued, the patient may weather the storm? Will he certainly die if the symptoms are left to go on without any attempt to arrest them? And if so, what measures will probably arrest them with the least amount of risk to the patient’s life? Such are some of the momentous questions which press upon the physician’s mind; and, though he would like time to give them a patient examination, he cannot have it; for there is necessity for immediate decision and action. The reader can plainly see, that in order to decide such questions under such circumstances properly, great comprehensiveness and concentration of thought, and a cool and clear judgment, are requisite; and that a mind of narrow views, and loose habits of observation and reasoning, must often fail to come to a right decision of them.

Some, in such circumstances, amid all the uncertainty that beclouds this nice balancing of probabilities, will doubt and doubt, till the time in which anything effectual can be done is past by; and the patient dies without having a single intelligent effort put forth to save him. Others, in their confusion of ideas, pursue a vacillating course—at one moment inefficient, at another destructive; and no rational and steady plan is adopted. Others still, without waiting to consider the different questions which I have mentioned, see in the new group of symptoms nothing but a new enemy to be attacked, and plunge, at once, into the fight. A reckless course is entered upon, which must either kill or cure.

The truly judicious physician, in contrast with all these, is neither bewildered nor precipitate. He takes a rapid view of all the circumstances of the case, and looks carefully at the important and perplexing questions which start up one after another in his mind, and then decides intelligently, coolly, and definitely upon his plan of treatment. He may err, it is true; but if he does, it is not his fault, for he has made use of all possible precautions to prevent error. The plan which he fixes upon, he does not pursue obstinately, as being, without a doubt, the best. While it is that which he believes to be the best at the time, he watches its progress, and if he see reason afterward to alter it, he does so. Aware of the uncertainty of his knowledge, while he decides at every step what it is best to do, he is ready to reverse that decision, and change his course, whenever any new development in the case shall call for it.

Sometimes he decides that it is best to wait and watch the movements of the case. Many seem to demand that he shall pursue an active course of treatment all the time, to conquer the disease—that he shall be keeping up a constant cannonade upon it from beginning to end, not reflecting that if he do so, many of his shots must be worse than lost. And some physicians yield to this demand, and pursue this destructive course. The public call them bold practitioners; and they do gain some apparently splendid victories over disease; but if the results of their whole campaign (to carry out the illustration) could be fairly estimated, they would be found not to deserve the reputation for success, which is accorded to them. The prudent and judicious physician, like the prudent and judicious general, fires as few random shots as possible, taking good care, too, that he hit none but enemies—husbands carefully all his resources—rests from his battle with disease whenever it is best to do so, maintaining, for the time, a “masterly inactivity”—retreats when he finds his line of movement is likely to prove disastrous—calculates probabilities as accurately as he can at every step, and endeavors to make every measure tell upon the great result, avoiding, as far as possible, those which will not, and especially those which will hinder or defeat it.

Sometimes the physician finds that he must be satisfied for the present with but a partial view of the case before him. He sees that there are some agencies at work, which are hidden from his view. Under such circumstances, while the careless and adventurous practitioner makes up his theory of the case confidently, and acts upon it, supplying what is not known from his own imagination, and mingling all together in one confused mass; the judicious physician, on the other hand, cautiously distinguishes between what he actually knows and what may be supposed, acts upon this knowledge, and watches for farther developments to clear up what is doubtful. He treats the case according to the indications of the presenting symptoms, carefully scrutinizing the effects of his remedies. Perhaps he succeeds in cutting off at first some of the tributaries of the disease; and, by so doing, patiently and perseveringly, he at length comes at the main disease—the starting point of the whole case.

In pointing out the characteristics of medical skill, allusion was made to the quantities and forms in which remedies are administered. These must, of course, be varied to suit each individual case. Sometimes a very nice adaptation is necessary, especially in regard to quantity. A remedy, which is appropriate to a case, may be given in such a quantity as to be injurious. The use of a medicine may be continued too long. It may have accomplished all the good that it can; and the continuance of it will do harm, perhaps even beyond the undoing of all the good which it has effected. Sometimes a change occurs in the condition of the patient of such a character, that a remedy, which has been up to that time beneficial in its influence, will now produce bad results. Medicine is often continued under such circumstances. Such are some of the errors to which the physician is liable in regard to the quantity of medicine to be given, if he be at all loose in his habits of observation.

Perhaps there is no one thing in medical practice in which failure is so common, as in the accurate proportioning of remedies to the condition of each case. A physician may discover very clearly the nature of the malady, and decide with great correctness upon the appropriate medicines, and yet, may err after all in applying these medicines in the proper amounts, and at the proper intervals. The variations, in these respects, required by different cases, have a wide range—some demanding large doses to produce the needed effects, and others being strongly affected by small ones. In some cases of severe pain, for example, very large doses of opium in some of its forms are necessary to give relief; while, in other cases, in which, perhaps, the pain is by no means slight, quite small doses accomplish the purpose. Similar variations in the quantities of remedies, are required by other circumstances, which are less obvious in their indications on this point, than so palpable a symptom as pain is. The contingencies on which these variations depend, are often, indeed, so uncertain and so secret, that they elude the most watchful and patient investigation, much more that which is hasty and careless.

Experience gives to the shrewd and judicious physician a sort of tact in detecting these contingencies, and in so modifying his practice as to meet with some good degree of fitness the various indications which they present. This tact is to be acquired at the bedside of the sick, by patient watching of the workings of disease, and of the influence of remedies upon it; and though the experience of others is a valuable auxiliary in acquiring it, it is only an auxiliary, and cannot communicate it alone. There are a thousand little things that are observed in watching disease from day to day, which materially influence the physician in the details of his treatment, but which it is impossible to record in the history of the case. It is therefore peculiarly true of the wise and skillful physician, that when he dies much wisdom will die with him. And the student of medicine always finds, when he comes to actual practice, that disease, in the sick chamber, is a very different thing from what he supposed it to be when listening to descriptions of it in the lecture-room. One of the first lessons that he learns is, that the long troup of maladies, arranged in the syllabus of the professor, gives but a faint idea of the various and Protean shapes of disease, as they appear before him, in all their complications, with mingled and confused lineaments, instead of the distinct ones with which they are necessarily described in books and lectures. He sees that the general principles which he has learned, are to be applied with almost endless variations; and that a searching and ever-vigilant observation is needed to apply them aright.

The points which I have endeavored to elucidate, in regard to skill in the management of disease, are very commonly disregarded by the community, and too often even by physicians. To impress them more vividly upon the mind of the reader, I will resort to an illustration, in which some of the same principles are applied to quite a different matter.

Two travellers are wending their way through a mountain-pass to their home. Their path is a perilous one; now lying along on the very brink of a precipice, and now across a succession of points of rock, with an abyss yawning below. Often the foothold of the traveller is but a slight one, and would scarcely suffice were there not some shrub near by that could be caught hold of, or some projecting point of rock on which he could hook his fingers. One of the travellers is weary and sick, and the other is helping him along. The shades of evening have come on, and the flying clouds occasionally obscure the light of the moon that shines upon their path.

It needs a watchful eye, a strong arm, and a firm foot, to go through this pass with safety, even by broad daylight. How fearful, then, are the dangers that threaten the sick traveller? If he were alone, he could not possibly get to the journey’s end. He would fail to reach some foothold, or would let go his grasp upon some shrub, or totter from some giddy height, and be dashed to pieces. His companion sees the difficulties of the task before him, and bidding the poor sick man to be of good cheer, nerves himself for labors that will tax all his strength and all his skill.

See how varied is the assistance which he renders! Now he is before, with outstretched hand raising him up; and now behind, doing the same office, while the feeble man clings to some branch, or to some projecting point of rock. Now you see him gently supporting his tottering steps, as he leads him slowly along a narrow path on the edge of a precipice, where, if he but stumble, he is lost. The effort is now but a slight one; but it requires caution, firmness, and skill. And now there is needed a strong, almost an Herculean effort. He must raise him to the top of a rock just large enough to stand upon, and there let him rest a moment, so that he may step carefully to another rock which offers a secure resting-place. He pauses before making the effort, to calculate with precision the amount of force needed. He sees that if he come short of raising him to the right spot even an inch, his feet may slip, and he is gone. And on the other hand, if he use too much force, he may throw him too far, and then he will plunge over beyond. His courage almost fails him, as he sees the fearful issues—the issues of life and death, that hang on that one effort. But it must be made. Uttering the cheerful words of hope in his companion’s ear, with his whole frame roused to its utmost tension, he makes the attempt. The poor man’s feet just reach a jutting edge of the rock, while he catches with his fingers upon another projection, and there he hangs. His strength is almost exhausted; but he knows that if he lets go he is lost. His friend presses his feet fast to the rock, and tells him to hold on. Then finding some foothold by which he can raise himself a little higher, he lifts his sick companion gently to the summit. There he remains a few moments, trembling, and almost poised upon a point, fearing to move, or even to look down from that giddy height, lest he should slip off. But soon, with the little rest that he gets in this perilous situation, and encouraged by the firm and cheerful voice of his friend, he steps to the next rock, where a broad and sure foothold enables him to pause and recover his little strength, which was well-nigh exhausted by his anxiety and his exertions.

The path is now an easy one for some distance, but soon they are confronted by a high crag, up which they must clamber. It looks gloomy and formidable in the dim and fitful light of the partially-obscured moon. The sick man’s heart almost dies within him, as his companion eyes narrowly the small footholds which are notched up its steep side. Some of them he sees but faintly; but soon the full light of the moon, through the breaking clouds, shows him every notch with distinctness. He calculates their distances in a moment, and as his eye runs upward to the top, he plans out the whole of his ascent. In an instant he seizes his friend; and, again bidding him be of good cheer, tells him to place his foot in the first notch, then raises him gently, but firmly, to the second, and so on to the summit.

It is thus that the sick man, aided and cheered by his friend, after going through with many narrow escapes, at length reaches his home.

The points of resemblance between this journey and the journey of sickness, are sufficiently obvious to suggest themselves at once to the minds of my readers. The journey of sickness has sometimes the same variety of peril, and demands of the physician the same variety of assistance, to suit its various stages and conditions. His efforts, in rendering this assistance, must sometimes be strong and sometimes gentle; sometimes bold and sometimes cautious; always careful and never precipitate. The uncertain and varying light, shining upon the path of the traveller, has its counterpart in the journey of sickness; and sometimes the darkness is so great, that the physician must stop short, and not move at a venture amid such perils. There are times, too, when the light breaks through the clouds of uncertainty that hang over his path, and his eye must be open and ready, as was the traveller’s, to discern all that the light may reveal of that which lies before him.

Often, in most of the journey of sickness, a gentle, but firm support and guidance are needed, on the part of the physician, just as it was in the case of the traveller, when the path lay along the edge of a precipice; and here, in the one journey as well as in the other, an officious and hurrying assistance might prove ruinous. Then there are times (and fearful times they are) when the physician sees, as did the sick man’s companion, that while mighty efforts are required of him, even a slight error in regard to the right proportion in those efforts, may prove fatal. And, as the traveller found occasionally some broad and sure resting-place, where his friend could recruit his wasted energies after a severe effort; so in the journey of sickness there are such resting-places, and the physician must take care to give his patient the benefit of them, and not run the risk of an entire exhaustion of his powers, from too much anxiety to hasten to the journey’s end.

One more point of resemblance, and one which I deem of no small importance, I will barely notice. As the sick man, in all the way through the mountain-pass, was encouraged by his friend, so should the physician cheer his patient with his hopeful voice and manner, amid all the gloom and peril of the journey of sickness; and should hold out to him, in all seasons of despondency, so far as truth will allow him to do so, the hope that he will at length reach the end of that journey in safety.

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 of positive medication. 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 divided parts 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 the arts, 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 the cure. 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, and times 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 know what 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 what not to 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 of natural 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 the effect quite 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 out all the eruption in such diseases, as scarlet fever, measles, &c. The idea is that there is a certain amount in the system, and that this must all be 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 of curing disease, 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 entirely alone—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 by this 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 talk about 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 it is 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 of pneumatic 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 told about 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, from the 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 its decline, as well as its rise, and its acme. 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 itself at 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 and certain cures, no new remedy 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 better how to 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.

CHAPTER IV.
QUACKERY.

The reader is now prepared, by the facts and considerations presented in the previous chapters, to see in what way quackery, in its various forms, has obtained such a hold upon the community. If results in medical treatment could always be traced to their real cause, there would be no room for the arts of the empiric. But the reader has seen that, in the progress of every case of disease, there are many causes acting together in the development of results, and that many of these act secretly; and that there is, therefore, special need of caution in our conclusions, in regard to the operation of remedies. And yet, notwithstanding the manifest necessity for caution, there is no subject to which the ‘post hoc propter hoc’ mode of reasoning is so frequently, and so incautiously applied. It is the erroneous reference of effects to causes, consequent upon this mode of reasoning, which is the great source of quackery.[7]

Let us see how this result is produced.

Take any remedy, no matter what it is, whether it be positive in its character, or entirely inert, and it can be made to acquire an extensive reputation for curing disease. Suppose that it is of a positive character. Let quite a large number of persons in a community be persuaded to take it. It would be appropriate to a few out of the whole number of cases, just as a man firing into a crowd of men at random would be apt to hit some of them. Then there are some, who, through the recovering power of nature, get well while using the medicine, perhaps even in spite of it, and falsely attribute the cure to it. The many that are not benefitted soon, give up the use of the remedy, and the fact that they have taken it is known to but few, and is soon forgotten even by them. But the few that chance to derive benefit from it, or that are cured by nature while taking it, proclaim everywhere the virtues of the remedy with the ardent gratitude of restored health, and willingly give certificates of their cure for the benefit of suffering humanity. All this helps to get the new remedy in vogue in other places; and wherever it is introduced, the same result, for the most part, is realized. The consequence is, that the remedy comes into extensive use, and continues in the popular favor, till some other remedy, by the same process, supplants it.

Even if the remedy be not of a positive character, but wholly inert, enough of the whole number that take it will get better, from the curative power of nature, and from mental influence, to give it, for a time, the reputation of curing disease. Many examples might be given. An amusing instance of the celebrity sometimes gained by inert remedies, occurred in Paris. A man who had sold to great profit an eye-water, at length died without communicating to any one the composition of it. His widow regretted the loss of the profits which came from the sale of the eye-water. Without telling her trouble to any one, she filled up the phials from the River Seine, and went on to sell the eye-water as usual. Cures occurred as before, and everybody believed that her husband had bequeathed the recipe to her. On her death-bed her conscience was much disturbed on account of the deception which she had thus practised upon the community, and she made confession to the physician who attended upon her. He, however, quieted her mind by telling her, that he was sure she need give herself no uneasiness, for her medicine had at least done no harm—a consolation which most venders of secret medicines could not have.

The variety of both active and inert remedies, which have enjoyed, in the way that I have indicated, a temporary popularity, is very great. Even calomel, which now seems to be especially despised by all empirics and their followers, has had its hey-day of popular favor. It was one of the chief remedies of Paracelsus, who has been styled the prince of quacks. And some years ago an empiric, in the staid city of Boston, acquired a great reputation for wonderful cures, by giving calomel in very large doses, even by the teaspoonful. His reputation was, of course, short-lived; for, though he seemed to make some capital hits, so glaring an abuse of a good remedy could not but be attended with bad results, occasionally of so palpable a character, as to undeceive even the credulous public.

The most prominent quack medicines are principally of three kinds.

1. Evacuants. To this class belong the almost numberless varieties of pills advertised in the newspapers. There is a great similarity in the composition of these pills, although each kind is ushered into notice with all the pretensions of an entirely new discovery. Aloes, gamboge, &c., medicines in common use, form the basis of nearly all of them. They are simply good cathartic preparations, and have none of the extraordinary virtues attributed to them. And, as those who are ailing are commonly benefitted by producing some amount of cathartic effect, these different pills actually do some good to quite a large proportion of the cases to which they are applied. The difficulty with them is, that used indiscriminately, as they so generally are, they in many cases do injury, and in some to a fatal extent.

2. The second class of quack medicines are those which are supposed to act upon the system slowly, producing a change in its general condition. The general term alterative may be properly applied to them.

The various preparations of sarsaparilla belong to this class. The same remark can be made in regard to these that was made in relation to the great variety of popular pills. They are all very much alike, although the proprietor of each claims for his preparation that it is entirely new in its combination, and that it is pre-eminently successful. A single fact, which came to the knowledge of the author, will show what kind of imposition some of these discoverers of new preparations of sarsaparilla practice upon the community. Twenty years ago, Carpenter’s Fluid Extract of Sarsaparilla had a high reputation, both with the profession and with the public. No secret was made of its composition. A student of medicine copied the formula. A few years ago he furnished an apothecary with this formula, who forthwith came out before the public with what purported to be a new preparation of sarsaparilla, which, by the usual machinery of quackery, obtained extensive popular favor, and made a fortune for the apothecary. His preparation was not a new one, but was made according to Carpenter’s formula, with some slight additions to alter the taste and the appearance of the medicine. The sale of this once famous preparation of sarsaparilla has, with that of its rivals, almost, if not wholly gone by; and others are now the candidates for fame and money with their entirely new preparations.

3. As consumption is the most common of all chronic diseases, there is a very large class of remedies which are supposed to act especially upon the lungs. Each one of these is claimed by its proprietor to be a certain cure for this formidable disease. They are generally combinations of articles which are in common use among physicians in affections of the lungs. In the indiscriminate use to which they are put by the empiric, while they benefit some cases to which they happen to be appropriate, in the great majority of instances they undoubtedly do harm; and in the forming stage of many cases, they fasten the disease irrecoverably, when a judicious and discriminating treatment might have saved the patient. These nostrums, therefore, add much to the mortality of consumption in the community.

It is well understood by any one who proclaims the discovery of a new medicine for any disease, that his day of prosperity must necessarily be short. He knows that his medicine, whatever amount of popular favor it may acquire, will soon be supplanted by some other newly-discovered preparation. He must, therefore, make the most of his time. Accordingly, as soon as he succeeds in getting his name up by certificates, advertisements, &c., he throws as large quantities as possible of his medicine into market, and has but little care for the quality of the materials of which it is made. Great quantities of sarsaparilla and other articles which have been damaged, or have become inert by age, are constantly used up in this way, furnishing a profitable outlet for the refuse, which accumulates annually in the shops of the dealers in such articles. Large amounts, too, of adulterated articles are used in the manufacture of quack remedies.

Another imposition of a kindred character deserves a passing notice. When any particular article is high in favor with the public, every empiric incorporates it into the name which he gives to his medicine, in order to ensure its popularity, though there may be little, perhaps none, of the article used in its composition. If the article command a high price, or if there be any difficulty in obtaining it in sufficient quantity, other substances can supply its place—the name is all that is essential to secure a profitable sale of the medicine. Much of the sarsaparilla which is sold, has little or none of the real Spanish sarsaparilla in it; and as the Canchalagua of California is now rising into notice, there will, undoubtedly, be much sold as the genuine article, which will be composed of substances that Californians never saw.

The fact that the quack’s advertisement is not only ridiculously pompous and grandiloquent, but palpably false, does not seem to injure the sale of his medicine, even with quite sensible people. A medical student in Boston amused himself with writing a burlesque quack advertisement. An apothecary, to whom he read it, proposed to buy it of him, and said that he would prepare a medicine, which, he had no doubt, could be sold in large quantities by the aid of that advertisement. The young man was astonished that his friend should suppose that any such use could be made of what he intended should be so exceedingly ridiculous. But the bargain was struck, the advertisement was put forth, and the medicine was, for a time, among the prominent quack remedies. Ridiculous as was this burlesque advertisement, it has since been surpassed by many of those which occupy so large a space in the newspapers.

The certificates of cures, which are so important in giving currency to quack medicines, may be divided into four classes.

1. Some of these certificates are forgeries.

2. Many of them are essentially, sometimes wholly, untrue. Some of this class are written by the local agents of the proprietor; and the individuals are persuaded to sign them, because the medicine had been gratuitously furnished, or for some other reason. I know many facts which I could adduce in proof of this statement. I will mention, however, but one case. One who had been an apothecary, and had sold large amounts of quack medicines, stated, that in one year he sold three thousand dollars’ worth of one medicine—that he had no satisfactory proof of its having cured a single case of disease—that he had obtained, however, many certificates of cure, but not one from any person who had paid for the medicine.

3. Another class of certificates are obtained in this way. Invalids are very apt, on taking a new medicine, to imagine themselves for a little time to be benefitted; but after a while they find that it is mere imagination. Many certificates are obtained of such persons at the time when they feel encouraged in regard to their prospect of recovery. The empiric understands that this is the golden opportunity for him, and he will have no delay if it can be avoided. It is astonishing what sensible people are sometimes caught in this way. A deaf gentleman once asked me my opinion of an empiric, who pretended to have uncommon skill in the cure of deafness. He found, among the published certificates, a letter from a gentleman of his acquaintance, of the highest standing both in character and intellect, expressing great gratitude for the relief which he had experienced from the practice of this ear doctor. He wrote to his friend a letter of inquiry. His friend replied, that when he returned from his visit to this quack, he thought himself to be somewhat better, and was so much delighted that he magnified the improvement in his imagination, and in this condition wrote that certificate; and that he was now satisfied that he unwittingly made in that certificate a really false representation of his case.

4. Another class of certificates come from those who are really relieved while using the medicines, in regard to which they certify. The inference, according to the ‘post hoc propter hoc’ mode of reasoning is, that the medicines, of course, cured them. I need not stop to show that this inference can by no means always be a correct one. I trust that the facts presented in the previous chapters are sufficient to satisfy the reader on this point.

No class of men have done more harm by giving certificates of cures by quack medicines, than clergymen. They are so situated in the discharge of their parochial duties, that they are apt to be drawn into the signing of such certificates. They hear the glowing statements recited by patients and their friends. They, of course, sympathize with the relieved sufferers. They do not sift and examine the statements, for it seems almost unfeeling to doubt. They often, therefore, give these statements full credence, and furnish the empiric with certificates. Certificates from such sources are highly prized, and are, therefore, eagerly sought for. But clergymen should consider what they are doing by this course. The facts which I have stated show, that by such acts they uphold a system of impositions, and help quackery to destroy the lives of their fellow men.

The feeling which physicians manifest in regard to empiricism, is very commonly supposed to be prompted by self-interest. This is far from being true. It would not be at all for the pecuniary interest of physicians to have quackery suppressed; for it is continually furnishing them with patients, in whom disease has been created or aggravated by the use of empirical remedies.

I trust that it is obvious to the reader, from the facts which I have stated, that the medical profession are right in the ground which they have for the most part maintained against secret and patent medicines. The rule which they have adopted, in regard to themselves, on this point, is thus given in Percival’s Medical Ethics: “No physician or surgeon should dispense a secret nostrum, whether it be his invention or exclusive property; for if it be of real efficacy, the concealment of it is inconsistent with beneficence and professional liberality. And if mystery alone give it value and importance, such craft implies either disgraceful ignorance or fraudulent avarice.”[8]

This rule recognizes a very just distinction between inventions in medicine and all other inventions. As medicine has to do with such important interests as health and life, the principles of benevolence demand, that any invention or discovery in this art, should be promulgated without any hindrance. And this is the more necessary, because nearly all of the so-called new medicines, put forth from time to time, have nothing new in them, and mystery alone gives them their value and importance in the eyes of the public. The claims which are set up for the great mass of popular remedies, blazoned forth in newspaper, pamphlet, almanac, and handbill so profusely, are gross impositions; and an exposure of the formulas, according to which these medicines are compounded, would show them to be so.[9]

The only way in which this imposition, so constantly practised upon the community, can be guarded against effectually, is to oblige every one who sells a medicine, to make the composition of it known on the wrapper in which each parcel of the medicine is enclosed. Such a law is now, I understand, in force in the State of Maine. I hope that the law will be sustained, and that so just and noble an example will everywhere be followed.

If it be objected that the inventor in medicine should, like other inventors, have something more as a reward than the consciousness of doing good, and the reputation which his invention gives him, this can be provided for without any difficulty. Let a board be constituted, whose duty it shall be to examine all medicines offered to them, rejecting all that have nothing new in material or in the form of combination, and recommending all that are really valuable. Let it also be the duty of this board to award to the proprietor of every medicine, which they approve, as being a real invention or discovery, a suitable sum to be paid him out of the public treasury. Such a board, constituted on the most liberal principles that any one could desire, would find but few among the multitude of remedies now before the public, of which they could conscientiously approve; and there would be no ground for fear of any great drain upon the public treasury, by the awards which they would make to inventors.

Quackery has, at length, come to be so monstrous an evil, that there will be great difficulty in removing it. The credulity of the public is so great and so extensive, that the plainest and strongest facts, brought out even in multitudinous array, are almost powerless before it. Then, too, the capital invested in this vast system of imposture is large in amount. It has become one of the great interests in the community,[10] and is so linked in with other interests in the relations of business, as to have a strong hold in this way upon the public. It has even subsidized the press; and it has done it so thoroughly, that it has not only muzzled it, so far as speaking out the truth on this subject is concerned, but it has compelled it to utter freely the falsehoods which it demands for its purposes. I speak of our secular newspapers. If there are any that are not guilty, they are exceptions. There may be a few. I know of not one. Not content with advertising quack medicines, they, for a liberal fee, admit into their columns, articles which have the appearance of editorial recommendations; and these are copied as such into advertisements in other newspapers. And besides all this, respectable editors have often refused to publish any exposure of the impositions of quackery. Our legislators, too, are afraid to move in any way against a system of impostures which has so strong a hold upon the community. Still, though these formidable obstacles are in the way of a radical reform on this subject, let the facts continue to be brought out, and let the truth be told fearlessly; and this evil, grown now to be so monstrous, will at length yield to our efforts.

I have thus far spoken of only one form of quackery—the sale of secret medicines. It appears in various other forms. I shall give some examples of only a few of them.

Many empirics have become itinerant lecturers. They, of course, always have something to sell—books, medicines, braces, breathing-tubes, &c. Their lectures are partly, sometimes wholly, gratuitous, which, certainly, looks like being somewhat benevolent. The lectures are made up of some very plain truths, borrowed from some medical works, which, mingled with some popular errors, and spiced with the prevailing ultraism of the present day, in order to make them interesting, are urged upon the audience as being both new and important. A variety of illustrations and analogies, some of which are true and some merely plausible, are made use of to effect the lecturer’s purpose; which is, to convince the audience that he has examined the subject particularly, and is a thorough master of it. If he succeed in doing this, there is a great rush of invalids to his rooms in the intervals of his lectures. His remedies are costly, but his advice is gratuitous; and this is commonly a very successful bait for the poor invalid. He receives a large amount of money from his numerous patients for what cost him but very little. For the time being, he is the great medical lion of the place. But great as he is, when he is once gone, he is gone never to return to that place again: his vocation there is ended.

Some of these empirical lecturers have, as a special attraction, one or two lectures particularly for the ladies, to which no gentleman can be admitted; and one or two also for gentlemen, from which the ladies are excluded. I will only say, that in every case in which I have known this to be done, the character of the lectures has been such as no virtuous community should tolerate.

Animal magnetism, as applied to medicine, has made quite a figure in the world of quackery. Miss Martineau, and many other people reputed to be very sensible, have been entrapped by this delusion. The magnetized subject, or clairvoyant, who attends the lecturer on this “science,” in his travels, is said to be able to look into the sick, and see exactly what is going on there. If this be so, animal magnetism must be capable of rendering essential aid in investigating disease—more essential, indeed, than any other means which we have at our command; and every physician should have his clairvoyant to attend him in his daily visits. The hits which are sometimes made by clairvoyants, are said to be astonishing; but they are so for precisely the same reason that the hits of the fortuneteller are sometimes truly wonderful. The clairvoyant has ears, and can hear what may be said aloud or in whisper about different invalids; and the magnetizer can hear for her.

I will give an example or two, to show what convenient use can be made of ears by these clairvoyants.

I once heard a lecturer state the case of a young man, who, he said, had for a long time suffered severe pain, and had applied to many physicians without obtaining any relief, or any satisfactory explanation of his case. His clairvoyant at once directed that a particular tooth be removed, and said that an abscess could then be opened above it, the discharge of which would relieve the pain. This was done, and the patient was relieved. Every one supposed, from his manner of relating the case, that no one had ever hinted at the real seat of the disease, and that it was a fresh discovery of his clairvoyant. It was found, however, that physicians had taken this view of the case, and that it had been talked about in the family. The clairvoyant, probably, got her knowledge by her ears, before she was put into the ‘magnetic state.’

A very shrewd lady accompanied a friend on a visit to a clairvoyant, in Boston, whom she wished to consult in regard to her child, who had, by a fall, injured his side. She watched the proceedings of the parties very narrowly. The clairvoyant was for some time quite in the dark about the case, and used very indefinite language in regard to it. At length her mind became suddenly clear in its views; and it seemed to be done by a whisper uttered by one of the party to another, in relation to the fall. She at once said, “The child must have had some accident—he fell down, and as he stretched out his hands, he struck on his chest, and the bones have shot by each other.” The clairvoyant went a little too far. There is no such thing as the shooting by of any bones in the chest, at least in any ordinary accident. These clairvoyants, that see right into people, often have an anatomy of their own.

We sometimes have an opportunity of testing the clearness of the medical vision of these clairvoyants. One of them, a few years since, on examining the case of a child, saw in its intestines three kinds of worms, which she described with great exactness. It was a very clear and distinct vision. The child died two days after, and I assisted in its examination after death. The worms, so distinctly seen, were not to be found. The magnetizer and his clairvoyant immediately left for another field of labor.

Some names have become quite celebrated in the annals of quackery. I will give a passing notice to a few of them.

Paracelsus has been called the prince of quacks. He flourished in the beginning of the sixteenth century. In order to give himself dignity, he assumed the names of Philippus, Aureolus, Theophrastes, Paracelsus, Bombastes de Hohenheim. He discarded all the commonly-received doctrines and modes of practice, and pretended to have been searching after the truth for many years. He put forth a pompous proclamation of his travels and researches, and pretended to have made great acquisitions in medical science. The remedies which he used were mostly of the heroic kind; and though he killed many by his rash practice, he stumbled on some great cures, (and what quack has not?). These were proclaimed in the most bombastic manner. The result was that his practice was immense in amount and extent. The magistrates of Basle engaged him, at a large salary, to fill the chair of medicine in their university. At his first lecture he burned the works of Galen and Avicenna, and asserted that there was more knowledge in his cap than in the heads of all physicians, and that there was more experience in his beard than in all the universities. “Greeks, Romans, French and Italians,” said he, “you Avicenna, you Galen, you Rhazes, you Mesne—you doctors of Paris, you of Montpelier, you of Swabia, you of Prussia, you of Cologne, you of Vienna—and all you throughout the countries that are washed by the Danube and the Rhine, and you who inhabit the islands of the sea, Athenian, Greek, Arab, and Jew: you shall follow and obey me: I am your king—the monarchy of physic is mine!”

Though he did not long retain his professorship, and though he was grossly intemperate in the last years of his life, he maintained his reputation for extraordinary cures even to his death. Great and learned men were among his patients, and even the noted Erasmus consulted this arrant charlatan.[11]

It is but a few years ago that St. John Long had immense multitudes of patients in London, though his notions were of the most ridiculous character, and were attacked with the shafts of reason and ridicule on every side. His theory was, that all diseases were produced by a semi-mercurial fluid, and that in order to cure the disease, the seat of this fluid must be found, and the fluid must in some way be got out. He had discovered a very summary way of doing this. He used a liniment, which he applied over the seat of the fluid, and extracted it at once. Though this liniment had such wonderful power, it would produce no effect when applied over a part which was not diseased—so that in any case, in which the seat of the disease was not obvious, instead of going through with a strict and long investigation after the vulgar way of regular doctors, St. John Long only had to apply his liniment here and there, till he found that the disease was extracted. One would hardly suppose that such nonsense could be believed in any civilized community; but the theory of this painter, who had thrown aside his brush and dubbed himself doctor, ridiculous as it was, found such favor with the public, that the prominent journals came out with weighty articles against it. Reasoning was not only in vain, but worse than in vain. The wonder grew—it was not put down. Quackery never yet was killed—it always dies a natural death, and so did the quackery of St. John Long. After running the gauntlet amidst the heavy blows of wise and powerful enemies, and coming forth unharmed at every heat, it at length laid itself down, and died the most quiet death imaginable. It fell asleep; and this is the end of all quackery.

Who has not heard of Perkins’ Tractors? The inventor, Doctor Elisha Perkins, was born in the town where the author resides. He was the son of a physician, who was for forty years in extensive practice, and was himself, for some time a respectable physician in the town of Plainfield in this State. He was undoubtedly an honest man. He duped others, it is true, but he duped himself, too. He was a deluded enthusiast, and died a victim to his enthusiasm only three years after he published to the world his grand ‘discovery.’ He had conceived the idea that a free use of salt as an antiseptic would cure the yellow fever. He therefore went to New York in the year 1799, when this disease was raging, and, full of confidence in his mode of practice, offered his services most generously to the poor as well as the rich. At the end of four weeks he himself caught the fever, and being exhausted by his labors he survived but four days after his attack.

The promulgation of Dr. Perkins’ ‘discovery,’ which occurred in 1796, was preceded, it is said, by a long series of experiments, which were suggested by the supposition, that metallic substances might remove disease by some electrical or galvanic power. The Tractors, which were the final result of these experiments, are two pieces of metal about three inches long, blunt at one end, and running to a point at the other. One of them appears to be brass, and the other steel, but what their real composition is, is not known, as the invention was patented.

The fame of the Tractors spread with unaccountable rapidity, and marvelous cures were everywhere reported. Certificates came in from all quarters, and from all kinds of dignitaries. Not only captains, and colonels, and generals, and ’squires sounded the praises of the Tractors, but clergymen and senators and doctors and professors. And their fame was not confined to this country. Benjamin Douglass Perkins, a son of the inventor, went to London to obtain the patronage of the British public for the Tractors. Great cures were forthwith effected all over the kingdom, of which there were multitudes of certificates from the wise and good, and, what is better, from the titled and wealthy. Similar cures were also reported from other countries in Europe, especially from Denmark.

To prove that imagination had nothing to do with these results, there were related many instances of cure in infants and in horses. It was found by some sage observer that, though horses could be cured by the Tractors, they had no influence at all upon sheep. He supposes that this is owing to the unctuous matter in the wool, and he remarks that “even pomatum, it is well ascertained, prevents the Tractors from relieving pains in that part of the head over which the pomatum is used.” A lame crow, supposed to have the cramp, was operated upon so successfully by the Tractors, that though he had not been able to put his foot to the ground for a week, he walked perfectly well the next morning after the application.[12]

The multitude of cases which were collected from every quarter were occasionally published. I have in my possession a volume of nearly two hundred pages published in London, containing a great number of these cases. The testimony is of the most decisive character. Pain was relieved in a trice by a few strokes of the Tractors; inflammations were drawn out; swellings were dispersed, and, in some cases, with such rapidity that they were seen to lessen during the application; rheumatism, which had baffled the best medical skill was removed; the paralytic was made to walk—such were the reports which were constantly put forth.

The success of the Tractors was attested not only by multitudes of wealthy and titled and learned men, but even by many of the medical profession; and selfish motives were unhesitatingly attributed to all physicians who were unbelievers. A physician, who was of sufficient respectability to be a president of a medical society, said of such unbelievers, that “like infidels to the gospel, they admit of no mysteries, and refuse to believe what they do not readily comprehend.” Dr. Haygarth, an eminent physician of Bath, and some others, drew down a storm of public wrath upon their heads, because they asserted that a pair of wooden Tractors, painted so as to resemble the real metallic ones, had produced in their hands as marked effects as those which were purchased of Mr. Benjamin Douglass Perkins, at five guineas a pair. So strong was the hold which ‘the new science of Perkinism,’ as it was called, had obtained upon the public favor, that the son of the inventor of the Tractors was spoken of as being most unjustly persecuted by a large proportion of the medical profession; and his name was often associated with those of Galileo and Harvey and Jenner, who, it was said, had suffered like persecution before him, from the stereotyped hatred of everything that is new.

The efficacy of the Tractors was almost universally acknowledged; and the only difficulty seemed to be to account for their operation. Many ingenious electrical and galvanic theories were broached by learned men in England and in other countries. Perkinism, as it was called by acclamation, was hailed as one of the greatest of discoveries, and it was supposed to form a new era in medicine. The Tractors were sold in abundance at five guineas a pair. That the poor might be benefitted equally with the rich, the liberality of the British public was appealed to, and not in vain. A ‘Perkinean Institution’ was formed under the patronage of the first men in the kingdom. Lord Rivers was president, and there is a long list of titled vice presidents.

A pamphlet, giving an account of this institution was published, of which I have a copy. The regulations were evidently based upon the idea that it was to be a permanent establishment. One of them prescribes that a donation of ten guineas constitute a governor for life. As many ladies were very enthusiastic patrons of the Tractors, as they are now of infinitesimal globules, one of the regulations was, that “ladies have liberty to vote by proxy, given to any governor of the institution, or by letter to the chairman.”

In this account it is stated that the published cases of cures by the Tractors up to March, 1802, amounted to about five thousand. “Supposing,” the author goes on to say, “that not more that one cure in three hundred, which the Tractors have performed has been published, and the proportion is probably much greater, it will be seen that the number, to March, 1802, will have exceeded one million five hundred thousand. It is believed that no medical remedy ever yet discovered has been supported by so many well-authenticated and important cures, performed in so short a time.”

And now, I ask, where is the Perkinean Institution, with its troop of governors for life, and where is the Perkinean practice, with its list of five thousand published cures? The institution expired while the governors for life were almost to a man in the land of the living; and in less than ten years after the summing up of the five thousand cures, Perkinism was only thought of as a thing that was past, and the far-famed Tractors were almost forgotten.

And what became of Benjamin Douglass Perkins, who suffered for the cause of science and humanity such persecution as Galileo and Harvey and Jenner suffered before him? He returned to his native land with ten thousand pounds of John Bull’s money, as a reward of his patient endurance of persecution, and his active benevolence!

I might extend this notice of names which have been famous in the history of quackery, but it is not necessary. Those which I have noticed will answer as illustrations of the mode in which medical delusions obtain their hold upon the public mind, and of the facility with which each in its turn is supplanted by some other. The essential materials of quackery, as I remarked in the Preface, have been the same in all ages; and its history would be only a description of the endless forms into which these materials have been moulded. Great as is the variety in the series of phantasmagoria with which quackery has excited the wonder of the world, they have all been produced upon the same canvas, and by the same old magic lantern.

And busy and multiform as quackery has been, and lofty as have been its claims, I know not that it has ever made a single discovery in medicine. It may possibly have stumbled upon some discovery, but I am not aware that it has done even this. On the other hand, all the discoveries which have been made in the medical art, so far as I know, have been the results of a truly scientific observation, and fairly belong to that ‘regular’ profession, which so many consider as being opposed to everything which is new.

FOOTNOTES:

[7] The following anecdote of an ignoramus, who set himself up as a doctor, furnishes a good illustration of this erroneous mode of reasoning. His first case was that of a butcher, who recovered. As he gave his patient beefsteak and wine quite liberally, he referred the cure to these articles, and put down in his note-book—beefsteak and wine will cure a butcher. His next case was that of a tailor, which, under the same treatment, resulted unsuccessfully. He, therefore, added to the above note—but will kill a tailor.

You laugh at the use which this man made of the ‘post hoc propter hoc’ mode of reasoning; but, after all, his inference is no farther from the truth than many of the inferences of wise dabblers in physic, promulgated in the newspapers, or even of learned doctors, gravely recorded in the annals of medicine. The only real difference is, that among the many preceding circumstances, to which results might be attributed, he chose one, and they chose some other, a little more plausible, perhaps, than his, but no nearer the truth.

[8] The whole course of the medical profession, in regard to discoveries in medicine, has been open and generous, and not secret and mercenary. Dr. Stevens, in his eloquent address before the New York State Medical Society, thus speaks on this point: “Was the introduction of inoculation for the small-pox a speculation? Was the discovery of the preventive power of vaccination, (the labor of close, unremitting, and careful research during a period of several years,)—was that made or conducted with a view to personal emolument? As a matter of course, Dr. Jenner, as soon as he had completed his discovery, published it—made it free to all mankind. When quinine was first discovered, the mode of preparing it was immediately made known. Recently, when some feeble attempts were made to obtain a patent for the use of ether, and to conceal the process of etherization, the indignation of the profession was aroused from one end of our country to the other. The money changers were driven from the temple of humanity.”

[9] For example, the famous Balm of Gilead, which, in its time, was said to cure all manner of disease, is nothing but brandy spiced with cardamoms and other like seeds, and made a little more stimulating with Spanish flies. The use of this medicine, therefore, was really only one of the modes of dram drinking.

Louis XV. purchased, for a considerable sum, of Madame Nouffleur, a nostrum for the cure of tape-worm. The medicine proved to be the powder of the male fern, which was used for the same complaint by Galen in the second century, but which, in spite of the recommendations of this illustrious physician, and the princely reward paid to Madame Nouffleur for her discovery of it—in, shall I say, some musty book—it has somehow lost its reputation.

Examples of the same kind might be given almost indefinitely.

[10] A few facts will show the present enormous growth of this interest. Ten years ago, the revenue of the English government, from the sale of patent medicines, was only a little short of fifty thousand pounds sterling. The cost of advertising quack medicines in the United States, was estimated at that time at 200,000 dollars. But it is vastly more now. Dr. Stevens, in his recent address states, that the advertising outlay of some of the most notorious patent medicine proprietors, is reckoned by its fifty and hundred thousand dollars per annum. Quack advertisements occupy a large space in our newspapers. In the twenty columns of a country political paper published tri-weekly, I once counted eleven filled with such advertisements, while only nine were devoted to other advertisements, news, miscellaneous matters, editorials, &c.

[11] After he left his professional chair, he wandered about the country, generally intoxicated, seldom changing his clothes, or even going to bed. And though like other quacks who have succeeded him, he boasted that he had discovered a panacea, which would cure all disease at once, and even prolong life almost indefinitely, this prince of empirics died after a few hours’ illness, in the forty-eighth year of his age, at Salzburg in Bavaria, with a bottle of his panacea in his pocket.

[12] At one time live toads were a popular remedy for hemorrhage, tied behind the ears, or under the arm pits, or to the soles of the feet. It was supposed by some that the effect was altogether mental. But, as in the case of the Tractors, it was contended that this could not be so, because the same effect was produced upon animals. Michael Mercatus asserts that “if you hang the toad round a cock’s neck for a day or so, you may then cut off his head, and the neck will not bleed a single drop.” One cannot help being reminded by this of the experiments with the Brocchieri water a year or two since upon animals, which, though reported as perfectly successful, have not saved this remedy from going to the tomb of the Capulets, to which all its predecessors have gone before it.

CHAPTER V.
THOMPSONISM.

Thompsonism, or Thomsonianism, as it is more often called, or written, is a system of quackery, which, though it is evidently declining in public favor, is still so prominent, that it seems to merit a separate notice.

The principles of this system shall be stated in the language of its founder.

“My system of practice is founded upon these few, simple, and I think, just principles.

1st. That the constitutions of all mankind are essentially alike, and differ only in the different temper of the same materials of which they are composed. The materials, of which all men are formed, may be resolved into the four elements. Earth and water constitute the solids of the body, which is made active by air and fire. And this last element in a peculiar manner gives life and motion to the rest; and when entirely overpowered, from whatever cause, by the other elements, death ensues.

2d. That the construction and organization of the human frame is in all men essentially the same. They have similar solids and fluids, viz., bones, cartilages, tendons, nerves, muscles, veins, arteries, flesh, blood, and other juices, body and parts, or members.

3d. That all are sustained in a manner as similar as their formation, from the earth, the common mother of us all. Of the elements man is made, and by the same elements he is supported.

4th. That a state of perfect health arises from a due balance or temperature of these elements. But when it is by any means destroyed, the body is more or less disordered. And when this is the case, there is always an actual diminution or absence of the element, fire or heat, and in proportion to this diminution or absence, the body is affected with its opposite, cold. The former may be denominated nature itself, the best physician of the body, the latter its enemy; the first is the health and life of the body; the last its disease and death.

5th. That all diseases, however various the symptoms, and different the names by which they are called, arise directly from obstructed perspiration. The many evils derived from hence, must be obvious, when it is considered that the discharge from the body thereby is greater than by all the other evacuations combined. Obstructed perspiration may be produced from a great variety of effects which produce the same cause, originating from cold.

Now as all men have similar constitutions, being formed of the same materials differently tempered; as their construction and organization essentially agree; as they are all sustained from the same elements which form their composition; as a just balance or temperature of these elements produces a state of health, and the reverse destroys it; as all disease takes its immediate rise from obstructed perspiration in a greater or less degree; and as this is an effect universally produced, it is evident that those medicines which are most agreeable to nature, and efficacious in removing obstructions, and the evils thereby produced, and restoring the perfect equilibrium, activity and energy of the system, must be the best, and universally applicable.

I shall now describe the fuel which continues the fire or life of man. This is contained in two things—food and medicine, which are in harmony with each other, often grow in the same field, and are created to be used by the same people. People who are capable of raising their food and preparing the same, may as easily learn to collect and prepare their own medicine, and administer the same when it is needed. Our life depends on heat; food is the fuel that kindles and continues that heat. The digestive powers being correct causes the food to consume; this continues the warmth of the body, by continually supporting the fire.

The stomach is the deposit from which the whole body is supported. The heat is kindled in the stomach by its consuming the food; and all the body and limbs receive their proportion of nourishment and heat from that source; as the whole room is warmed by the fire which is consumed in the fire-place. The greater the quantity of wood consumed in the fire-place, the greater the heat in the whole room. So in the body; the more food well digested, the more heat and support through the whole man. But by constantly receiving food into the stomach, which is sometimes not suitable for the best nourishment, the stomach becomes foul, so that the food is not well digested. This causes the body to lose its heat; then the appetite fails; the bones ache, and the man is sick in every part of the whole frame.