Story type: Essay
In the minds of the public there is a mystery about the practice of medicine. It deals more or less with the unknown, with the occult, it appeals to the imagination. Doubtless confidence in its practitioners is still somewhat due to the belief that they are familiar with the secret processes of nature, if they are not in actual alliance with the supernatural. Investigation of the ground of the popular faith in the doctor would lead us into metaphysics. And yet our physical condition has much to do with this faith. It is apt to be weak when one is in perfect health; but when one is sick it grows strong. Saint and sinner both warm up to the doctor when the judgment Day heaves in view.
In the popular apprehension the doctor is still the Medicine Man. We smile when we hear about his antics in barbarous tribes; he dresses fantastically, he puts horns on his head, he draws circles on the ground, he dances about the patient, shaking his rattle and uttering incantations. There is nothing to laugh at. He is making an appeal to the imagination. And sometimes he cures, and sometimes he kills; in either case he gets his fee. What right have we to laugh? We live in an enlightened age, and yet a great proportion of the people, perhaps not a majority, still believe in incantations, have faith in ignorant practitioners who advertise a “natural gift,” or a secret process or remedy, and prefer the charlatan who is exactly on the level of the Indian Medicine Man, to the regular practitioner, and to the scientific student of mind and body and of the properties of the materia medica. Why, even here in Connecticut, it is impossible to get a law to protect the community from the imposition of knavish or ignorant quacks, and to require of a man some evidence of capacity and training and skill, before he is let loose to experiment upon suffering humanity. Our teachers must pass an examination–though the examiner sometimes does not know as much as the candidate,–for misguiding the youthful mind; the lawyer cannot practice without study and a formal admission to the bar; and even the clergyman is not accepted in any responsible charge until he has given evidence of some moral and intellectual fitness. But the profession affecting directly the health and life of every human body, which needs to avail itself of the accumulated experience, knowledge, and science of all the ages, is open to every ignorant and stupid practitioner on the credulity of the public. Why cannot we get a law regulating the profession which is of most vital interest to all of us, excluding ignorance and quackery? Because the majority of our legislature, representing, I suppose, the majority of the public, believe in the “natural bone-setter,” the herb doctor, the root doctor, the old woman who brews a decoction of swamp medicine, the “natural gift” of some dabbler in diseases, the magnetic healer, the faith cure, the mind cure, the Christian Science cure, the efficacy of a prescription rapped out on a table by some hysterical medium,–in anything but sound knowledge, education in scientific methods, steadied by a sense of public responsibility. Not long ago, on a cross-country road, I came across a woman in a farmhouse, where I am sure the barn-yard drained into the well, who was sick; she had taken a shop-full of patent medicines. I advised her to send for a doctor. She had no confidence in doctors, but said she reckoned she would get along now, for she had sent for the seventh son of a seventh son, and didn’t I think he could certainly cure her? I said that combination ought to fetch any disease except agnosticism. That woman probably influenced a vote in the legislature. The legislature believes in incantations; it ought to have in attendance an Indian Medicine Man.
We think the world is progressing in enlightenment; I suppose it is–inch by inch. But it is not easy to name an age that has cherished more delusions than ours, or been more superstitious, or more credulous, more eager to run after quackery. Especially is this true in regard to remedies for diseases, and the faith in healers and quacks outside of the regular, educated professors of the medical art. Is this an exaggeration? Consider the quantity of proprietary medicines taken in this country, some of them harmless, some of them good in some cases, some of them injurious, but generally taken without advice and in absolute ignorance of the nature of the disease or the specific action of the remedy. The drug-shops are full of them, especially in country towns; and in the far West and on the Pacific coast I have been astonished at the quantity and variety displayed. They are found in almost every house; the country is literally dosed to death with these manufactured nostrums and panaceas–and that is the most popular medicine which can be used for the greatest number of internal and external diseases and injuries. Many newspapers are half supported by advertising them, and millions and millions of dollars are invested in this popular industry. Needless to say that the patented remedies most in request are those that profess a secret and unscientific origin. Those most “purely vegetable” seem most suitable to the wooden-heads who believe in them, but if one were sufficiently advertised as not containing a single trace of vegetable matter, avoiding thus all possible conflict of one organic life with another organic life, it would be just as popular. The favorites are those that have been secretly used by an East Indian fakir, or accidentally discovered as the natural remedy, dug out of the ground by an American Indian tribe, or steeped in a kettle by an ancient colored person in a southern plantation, or washed ashore on the person of a sailor from the South Seas, or invented by a very aged man in New Jersey, who could not read, but had spent his life roaming in the woods, and whose capacity for discovering a “universal panacea,” besides his ignorance and isolation, lay in the fact that his sands of life had nearly run. It is the supposed secrecy or low origin of the remedy that is its attraction. The basis of the vast proprietary medicine business is popular ignorance and credulity. And it needs to be pretty broad to support a traffic of such enormous proportions.
During this generation certain branches of the life-saving and life-prolonging art have made great advances out of empiricism onto the solid ground of scientific knowledge. Of course I refer to surgery, and to the discovery of the causes and improvement in the treatment of contagious and epidemic diseases. The general practice has shared in this scientific advance, but it is limited and always will be limited within experimental bounds, by the infinite variations in individual constitutions, and the almost incalculable element of the interference of mental with physical conditions. When we get an exact science of man, we may expect an exact science of medicine. How far we are from this, we see when we attempt to make criminal anthropology the basis of criminal legislation. Man is so complex that if we were to eliminate one of his apparently worse qualities, we might develop others still worse, or throw the whole machine into inefficiency. By taking away what the phrenologists call combativeness, we could doubtless stop prize-fight, but we might have a springless society. The only safe way is that taught by horticulture, to feed a fruit-tree generously, so that it has vigor enough to throw off its degenerate tendencies and its enemies, or, as the doctors say in medical practice, bring up the general system. That is to say, there is more hope for humanity in stimulating the good, than in directly suppressing the evil. It is on something like this line that the greatest advance has been made in medical practice; I mean in the direction of prevention. This involves, of course, the exclusion of the evil, that is, of suppressing the causes that produce disease, as well as in cultivating the resistant power of the human system. In sanitation, diet, and exercise are the great fields of medical enterprise and advance. I need not say that the physician who, in the case of those under his charge, or who may possibly require his aid, contents himself with waiting for developed disease, is like the soldier in a besieged city who opens the gates and then attempts to repel the invader who has effected a lodgment. I hope the time will come when the chief practice of the physician will be, first, in oversight of the sanitary condition of his neighborhood, and, next, in preventive attendance on people who think they are well, and are all unconscious of the insidious approach of some concealed malady.
Another great change in modern practice is specialization. Perhaps it has not yet reached the delicate particularity of the practice in ancient Egypt, where every minute part of the human economy had its exclusive doctor. This is inevitable in a scientific age, and the result has been on the whole an advance of knowledge, and improved treatment of specific ailments. The danger is apparent. It is that of the moral specialist, who has only one hobby and traces every human ill to strong liquor or tobacco, or the corset, or taxation of personal property, or denial of universal suffrage, or the eating of meat, or the want of the centralization of nearly all initiative and interest and property in the state. The tendency of the accomplished specialist in medicine is to refer all physical trouble to the ill conduct of the organ he presides over. He can often trace every disease to want of width in the nostrils, to a defective eye, to a sensitive throat, to shut-up pores, to an irritated stomach, to auricular defect. I suppose he is generally right, but I have a perhaps natural fear that if I happened to consult an amputationist about catarrh he would want to cut off my leg. I confess to an affection for the old-fashioned, all-round country doctor, who took a general view of his patient, knew his family, his constitution, all the gossip about his mental or business troubles, his affairs of the heart, disappointments in love, incompatibilities of temper, and treated the patient, as the phrase is, for all he was worth, and gave him visible medicine out of good old saddle-bags–how much faith we used to have in those saddle-bags–and not a prescription in a dead language to be put up by a dead-head clerk who occasionally mistakes arsenic for carbonate of soda. I do not mean, however, to say there is no sense in the retention of the hieroglyphics which the doctors use to communicate their ideas to a druggist, for I had a prescription made in Hartford put up in Naples, and that could not have happened if it had been written in English. And I am not sure but the mysterious symbols have some effect on the patient.
The mention of the intimate knowledge of family and constitutional conditions possessed by the old-fashioned country doctor, whose main strength lay in this and in his common-sense, reminds me of another great advance in the modern practice, in the attempt to understand nature better by the scientific study of psychology and the occult relations of mind and body. It is in the study of temper, temperament, hereditary predispositions, that we may expect the most brilliant results in preventive medicine.
As a layman, I cannot but notice another great advance in the medical profession. It is not alone in it. It is rather expected that the lawyers will divide the oyster between them and leave the shell to the contestants. I suppose that doctors, almost without exception, give more of their time and skill in the way of charity than almost any other profession. But somebody must pay, and fees have increased with the general cost of living and dying. If fees continue to increase as they have done in the past ten years in the great cities, like New York, nobody not a millionaire can afford to be sick. The fees will soon be a prohibitive tax. I cannot say that this will be altogether an evil, for the cost of calling medical aid may force people to take better care of themselves. Still, the excessive charges are rather hard on people in moderate circumstances who are compelled to seek surgical aid. And here we touch one of the regrettable symptoms of the times, which is not by any means most conspicuous in the medical profession. I mean the tendency to subordinate the old notion of professional duty to the greed for money. The lawyers are almost universally accused of it; even the clergymen are often suspected of being influenced by it. The young man is apt to choose a profession on calculation of its profit. It will be a bad day for science and for the progress of the usefulness of the medical profession when the love of money in its practice becomes stronger than professional enthusiasm, than the noble ambition of distinction for advancing the science, and the devotion to human welfare.
I do not prophesy it. Rather I expect interest in humanity, love of science for itself, sympathy with suffering, self-sacrifice for others, to increase in the world, and be stronger in the end than sordid love of gain and the low ambition of rivalry in materialistic display. To this higher life the physician is called. I often wonder that there are so many men, brilliant men, able men, with so many talents for success in any calling, willing to devote their lives to a profession which demands so much self-sacrifice, so much hardship, so much contact with suffering, subject to the call of all the world at any hour of the day or night, involving so much personal risk, carrying so much heart-breaking responsibility, responded to by so much constant heroism, a heroism requiring the risk of life in a service the only glory of which is a good name and the approval of one’s conscience.
To the members of such a profession, in spite of their human infirmities and limitations and unworthy hangers-on, I bow with admiration and the respect which we feel for that which is best in this world.