Physician and Patient

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.

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