Part 61

There may be a great many easy and concurring Means of erecting and endowing such, with very little new Expence; and immense Advantages might result from them: besides, however considerable the Expenses might prove, is not the Object of them of the most interesting, the most important Nature? It is incontestably our serious Duty; and it would soon be manifest, that the Performance of it would be attended with more essential intrinsic Benefit to the Community, than any other Application of Money could produce. We must either admit, that the Multitude, the Body of the People is useless to the State, or agree, that Care should be taken to preserve and continue them. A very respectable English Man, who, after a previous and thorough Consideration of this Subject, had applied himself very assiduously and usefully on the Means of increasing the Riches and the Happiness of his Country-men, complains that in England, the very Country in which there are the most Hospitals, the Poor who are sick are not sufficiently assisted. What a deplorable Deficience of the necessary Assistance for such must then be in a Country, that is not provided with a single Hospital? That Aid from Surgery and Physic, which abounds in Cities, is not sufficiently diffused into Country-places: and the Peasants are liable to some simple and moderate Diseases, which, for Want of proper Care, degenerate into a State of Infirmity, that sinks them into premature Death.

Sec. 579. In fine, if it be found impossible to extinguish these Abuses (for those arising from Quacks are not the only ones, nor is that Title applied to as many as really deserve it) beyond all Doubt it would be for the Benefit and Safety of the Public, upon the whole, entirely to prohibit the Art, the Practice of Physic itself. When real and good Physicians cannot effect as much Good, as ignorant ones and Impostors can do Mischief, some real Advantage must accrue to the State, and to the whole Species, from employing none of either. I affirm it, after much Reflection, and from thorough Conviction, that Anarchy in Medicine is the most dangerous Anarchy. For this Profession, when loosed from every Restraint, and subjected to no Regulations, no Laws, is the more cruel Scourge and Affliction, from the incessant Exercise of it; and should its Anarchy, its Disorders prove irremediable, the Practice of an Art, become so very noxious, should be prohibited under the severest Penalties: Or, if the Constitution of any Government was inconsistent with the Application of so violent a Remedy, they should order public Prayers against the Mortality of it, to be offered up in all the Churches; as the Custom has been in other great and general Calamities.

Sec. 580. Another Abuse, less fatal indeed than those already mentioned (but which, however, has real ill Consequences, and at the best, carries out a great deal of Money from us, though less at the Expense of the common People, than of those of easy Circumstances) is that Blindness and Facility, with which many suffer themselves to be imposed upon, by the pompous Advertisements of some Catholicon, some universal Remedy, which they purchase at a high Rate, from some foreign Pretender to a mighty Secret or Nostrum. Persons of a Class or two above the Populace do not care to run after a Mountebank, from supposing they should depretiate themselves by mixing with the Herd. Yet if that very Quack, instead of coming among us, were to reside in some foreign City; if, instead of posting up his lying Puffs and Pretentions at the Corners of the Streets, he would get them inserted in the Gazettes, and News-papers; if, instead of selling his boasted Remedies in Person, he should establish Shops or Offices for that Purpose in every City; and finally, if instead of selling them twenty times above their real Value, he would still double that Price; instead of having the common People for his Customers, he would take in the wealthy Citizen, Persons of all Ranks, and from almost every Country. For strange as it seems, it is certain, that a Person of such a Condition, who is sensible in every other Respect; and who will scruple to confide his Health to the Conduct of such Physicians as would be the justest Subjects of his Confidence, will venture to take, through a very unaccountable Infatuation, the most dangerous Medicine, upon the Credit of an imposing Advertisement, published by as worthless and ignorant a Fellow as the Mountebank whom he despises, because the latter blows a Horn under his Window; and yet who differs from the former in no other Respects except those I have just pointed out.

Sec. 581. Scarcely a Year passes, without one or another such advertized and vaunted Medicine's getting into high Credit; the Ravages of which are more or less, in Proportion to its being more or less in Vogue. Fortunately, for the human Species, but few of these Nostrums have attained an equal Reputation with Ailbaud's Powders, an Inhabitant of Aix in Provence, and unworthy the Name of a Physician; who has over-run Europe for some Years, with a violent Purge, the Remembrance of which will not be effaced before the Extinction of all its Victims. I attend now, and for a long time past, several Patients, whose Disorders I palliate without Hopes of ever curing them; and who owe their present melancholy State of Body to nothing but the manifest Consequences of these Powders; and I have actually seen, very lately, two Persons who have been cruelly poisoned by this boasted Remedy of his. A French Physician, as eminent for his Talents and his Science, as estimable from his personal Character in other Respects, has published some of the unhappy and tragical Consequences which the Use of them has occasioned; and were a Collection published of the same Events from them, in every Place where they have been introduced, the Size and the Contents of the Volume would make a very terrible one.

Sec. 582. It is some Comfort however, that all the other Medicines thus puffed and vended have not been altogether so fashionable, nor yet quite so dangerous: but all posted and advertized Medicines should be judged of upon this Principle (and I do not know a more infallible one in Physics, nor in the Practice of Physic), that whoever advertises any Medicine, as a universal Remedy for all Diseases, is an absolute Impostor, such a Remedy being impossible and contradictory. I shall not here offer to detail such Proofs as may be given of the Verity of this Proposition: but I freely appeal for it to every sensible Man, who will reflect a little on the different Causes of Diseases; on the Opposition of these Causes; and on the Absurdity of attempting to oppose such various Diseases, and their Causes, by one and the same Remedy.

As many as shall settle their Judgments properly on this Principle, will never be imposed upon by the superficial Gloss of these Sophisms contrived to prove, that all Diseases proceed from one Cause; and that this Cause is so very tractable, as to yield to one boasted Remedy. They will perceive at once, that such an Assertion must be founded in the utmost Knavery or Ignorance; and they will readily discover where the Fallacy lies. Can any one expect to cure a Dropsy, which arises from too great a Laxity of the Fibres, and too great an Attenuation or Thinness of the Blood, by the same Medicines that are used to cure an inflammatory Disease, in which the Fibres are too stiff and tense, and the Blood too thick and dense? Yet consult the News-papers and the Posts, and you will see published in and on all of them, Virtues just as contradictory; and certainly the Authors of such poisonous Contradictions ought to be legally punished for them.

Sec. 583. I heartily wish the Publick would attend here to a very natural and obvious Reflection. I have treated in this Book, but of a small Number of Diseases, most of them acute ones; and I am positive that no competent well qualified Physician has ever employed fewer Medicines, in the Treatment of the Diseases themselves. Nevertheless I have prescribed seventy-one, and I do not see which of them I could retrench, or dispense with the Want of, if I were obliged to use one less. Can it be supposed then, that any one single Medicine, compound or simple, shall cure thirty times as many Diseases as those I have treated of?

Sec. 584. I shall add another very important Observation, which doubtless may have occurred to many of my Readers; and it is this, that the different Causes of Diseases, their different Characters; the Differences which arise from the necessary Alterations that happen throughout their Progress and Duration; the Complications of which they are susceptible; the Varieties which result from the State of different Epidemics, of Seasons, of Sexes, and of many other Circumstances; that these Diversities, I say, oblige us very often to vary and change the Medicines; which proves how very ticklish and dangerous it is to have them directed by Persons, who have such an imperfect Knowledge of them, as those who are not Physicians must be supposed to have. And the Circumspection to be used in such Cases ought to be proportioned to the Interest the Assistant takes in the Preservation of the Patient; and that Love of his Neighbour with which he is animated.

Sec. 585. Must not the same Arguments and Reflections unavoidably suggest the Necessity of an entire Tractability on the Part of the Patient, and his Friends and Assistants? The History of Diseases which have their stated Times of Beginning, of manifesting and displaying themselves; of arriving at, and continuing in their Height, and of decreasing; do not all these demonstrate the Necessity of continuing the same Medicines, as long as the Character of the Distemper is the same; and the Danger of changing them often, only because what has been given has not afforded immediate Relief? Nothing can injure the Patient more than this Instability and Caprice. After the Indication which his Distemper suggests, appears to be well deduced, the Medicine must be chosen that is likeliest to resist the Cause of it; and it must be continued as long as no new Symptom or Circumstance supervenes, which requires an Alteration of it; except it should be evident, that an Error had been incurred in giving it. But to conclude that a Medicine is useless or insignificant, because it does not remove or abate the Distemper as speedily, as the Impatience of the Sick would naturally desire it; and to change it for another, is as unreasonable, as it would be for a Man to break his Watch, because the Hand takes twelve Hours, to make a Revolution round the Dial-plate.

Sec. 586. Physicians have some Regard to the State of the Urine of sick Persons, especially in inflammatory Fevers; as the Alterations occurring in it help them to judge of the Changes that may have been made in the Character and Consistence of the Humours in the Mass of Blood; and thence may conduce to determine the Time, in which it will be proper to dispose them to some Evacuation. But it is gross Ignorance to imagine, and utter Knavery and Imposture to persuade the Sick, that the meer Inspection of their Urine solely, sufficiently enables others to judge of the Symptoms and Cause of the Disease, and to direct the best Remedies for it. This Inspection of the Urine can only be of Use when it is duly inspected; when we consider at the same time the exact State and the very Looks of the Patient; when these are compared with the Degree of the Symptoms of the Malady; with the other Evacuations; and when the Physician is strictly informed of all external Circumstances, which may be considered as foreign to the Malady; which may alter or affect the Evacuations, such as particular Articles of Food, particular Drinks, different Medicines, or the very Quantity of Drink. Where a Person is not furnished with an exact Account of these Circumstances, the meer Inspection of the Urine is of no Service, it suggests no Indication, nor any Expedient; and meer common Sense sufficiently proves, and it may be boldly affirmed, that whoever orders any Medicine, without any other Knowledge of the Disease, than what an Inspection of the Urine affords, is a rank Knave, and the Patient who takes them is a Dupe.

Sec. 587. And here now any Reader may very naturally ask, whence can such a ridiculous Credulity proceed, upon a Subject so essentially interesting to us as our own Health?

In Answer to this it should be observed, that some Sources, some Causes of it seem appropriated merely to the People, the Multitude. The first of these is, the mechanical Impression of Parade and Shew upon the Senses. 2, The Prejudice they have conceived, as I said before, of the Conjurers curing by a supernatural Gift. 3, The Notion the Country People entertain, that their Distemper and Disorders are of a Character and Species peculiar to themselves, and that the Physicians, attending the Rich, know nothing concerning them. 4, The general Mistake that their employing the Conjurer is much cheaper. 5, Perhaps a sheepish shame-faced Timidity may be one Motive, at least with some of them. 6, A Kind of Fear too, that Physicians will consider their Cases with less Care and Concern, and be likely to treat them more cavalierly; a Fear which increases that Confidence which the Peasant, and which indeed every Man has in his Equal, being sounded in Equality itself. And 7, the Discourse and Conversation of such illiterate Empirics being more to their Tast, and more adapted to their Apprehension.

But it is less easy to account for this blind Confidence, which Persons of a superior Class (whole Education being considered as much better are regarded as better Reasoners) repose in these boasted Remedies; and even for some Conjurer in Vogue. Nevertheless even some of their Motives may be probably assigned.

The first is that great Principle of Seity, or Selfness, as it may be called, innate to Man, which attaching him to the Prolongation of his own Existence more than to any other thing in the Universe, keeps his Eyes, his utmost Attention, continually fixed upon this Object; and compels him to make it the very Point, the Purpose of all his Advances and Proceedings; notwithstanding it does not permit him to distinguish the safest Paths to it from the dangerous ones. This is the surest and shortest Way says some Collector at the Turnpike, he pays, passes, and perishes from the Precipices that occur in his Route.

This very Principle is the Source of another Error, which consists in reposing, involuntarily, a greater Degree of Confidence in those, who flatter and fall in the most with us in our favourite Opinions. The well apprised Physician, who foresees the Length and the Danger of a Disease; and who is a Man of too much Integrity to affirm what he does not think, must, from a necessary Construction of the human Frame and Mind, be listened to less favourably, than he who flatters us by saying what we wish. We endeavour to elongate, to absent ourselves, from the Sentiments, the Judgment of the first; we smile, from Self-complacency, at those of the last, which in a very little time are sure of obtaining our Preference.

A third Cause, which results from the same Principle is, that we give ourselves up the most readily to his Conduct, whose Method seems the least disagreeable, and flatters our Inclinations the most. The Physician who enjoins a strict Regimen; who insists upon some Restraints and Self-denials; who intimates the Necessity of Time and Patience for the Accomplishment of the Cure, and who expects a thorough Regularity through the Course of it, disgusts a Patient who has been accustomed to indulge his own Tast and Humour; the Quack, who never hesitates at complying with it, charms him. The Idea of a long and somewhat distant Cure, to be obtained at the End of an unpleasant and unrelaxing Regimen, supposes a very perilous Disease; this Idea disposes the Patient to Disgust and Melancholy, he cannot submit to it without Pain; and he embraces, almost unconsciously, merely to avoid this, an opposite System which presents him only with the Idea of such a Distemper, as will give Way to a few Doses of Simples.

That Propensity to the New and Marvellous, which tyrannizes over so large a Proportion of our Species, and which has advanced so many absurd Persons and Things into Reputation, is a fourth and a very powerful Motive. An irksome Satiety, and a Tiresomeness, as it were, from the same Objects, is what our Nature is apt to be very apprehensive of; though we are incessantly conducted towards it, by a Perception of some Void, some Emptiness in ourselves, and even in Society too: But new and extraordinary Sensations rousing us from this disagreeable State, more effectually than any Thing else, we unthinkingly abandon ourselves to them, without foreseeing their Consequences.

A fifth Cause arises from seven Eighths of Mankind being managed by, or following, the other Eighth; and, generally speaking, the Eighth that is so very forward to manage them, are the least fit and worthy to do it; whence all must go amiss, and absurd and embarrassing Consequences ensue from the Condition of Society. A Man of excellent Sense frequently sees only through the Eyes of a Fool, of an intriguing Fellow, or of a Cheat; in this he judges wrong, and his Conduct must be so too. A man of real Merit cannot connect himself with those who are addicted to caballing; and yet such are the Persons, who frequently conduct others.

Some other Causes might be annexed to these, but I shall mention only one of them, which I have already hinted, and the Truth of which I am confirmed in from several Years Experience; which is, that we generally love those who reason more absurdly than ourselves, better than those who convince us of our own weak Reasoning.

I hope the Reflexions every Reader will make on these Causes of our ill Conduct on this important Head, may contribute to correct or diminish it; and to destroy those Prejudices whose fatal Effects we may continually observe.

_Chapter XXXIV._

Containing Questions absolutely necessary to be answered exactly by the Patient, who consults a Physician.

_Sect._ 588.

Great Consideration and Experience are necessary to form a right Judgment of the State of a Patient, whom the Physician has not personally seen; even though he should receive the best Information it is possible to give him, at a Distance from the Patient. But this Difficulty is greatly augmented, or rather changed into an Impossibility, when his Information is not exact and sufficient. It has frequently happened to myself, that after having examined Peasants who came to get Advice for others, I did not venture to prescribe, because they were not able to give me a sufficient Information, in order to my being certain of the Distemper. To prevent this great Inconvenience, I subjoin a List of such Questions, as indispensably require clear and direct Answers.

General Questions.

What is the Patient's Age?

Is he generally a healthy Person?

What is his general Course of Life?