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.