MEANS OF REMOVING QUACKERY.
It must be obvious to any one who observes the wide influence which
quackery maintains in its various forms in the community, amid all
the efforts which are made to overthrow it, that there has as yet
been discovered no adequate remedy for this evil. It is common for
physicians to say that there is no remedy—that there is, and always
will be, a class of persons who must, from the very character of
their minds, be addicted to quackery; and that it is of no avail to
attempt to deliver them from their errors, but they must be left to
go from one delusion to another, as they choose, all their lives. If
quackery were confined to such persons, it would, I allow, be idle
to talk of any remedy. But it is not so confined. We every day see
men, who are intelligent and judicious on other subjects, perfectly
deceived and captivated with the false pretensions of empiricism. If
these individuals were ignorant, and were easily influenced by merely
plausible reasoning, or were enthusiastic, or over fond of novelty
and change, then 1 should despair of making any impression upon them.
But as this is not the case, I am led to the conclusion, that there
must be some defects in the _mode_ in which truth on the subject of
medicine has been presented to their minds; and that the sources of
error have not been so plainly revealed to their view in this, as
they have been in other fields of enquiry.
Efforts, it is true, have been made by the medical profession
to correct the tendency to empiricism, which is so rife in the
community. But I believe that it can be satisfactorily shown that
these efforts have, to a great extent, been made with wrong means,
and in a wrong direction; and that for this reason they have failed
to strike at the root of the evil.
Much reliance has been placed upon giving to the people a knowledge
of anatomy, physiology, dietetics, &c. For this purpose books have
been published, journals of health have been issued, and lectures
have been delivered. All this is very well. Valuable information
has thus been communicated. Still, it leaves the great sources of
empiricism nearly, if not quite, untouched. These are pouring forth
their destructive streams more abundantly than ever, notwithstanding
the great increase of late of popular knowledge on medical subjects.
And this is as we should expect it would be from the nature of the
case. For the knowledge, which one obtains from popular books and
lectures, of the human system as a piece of mechanism, can have but
little influence upon his notions in regard to the operation of
remedies, on that system; for the operation of remedies, for the most
part, lies beyond the mere mechanical principles of the organization,
and therefore cannot be materially elucidated by a knowledge of those
principles. For example, the knowledge, which the dyspeptic gains,
from popular instruction, of the situation and the shape of the
stomach, of the number of its coats, and of the process of digestion,
cannot enlighten him in regard to the treatment of his disease, and
will therefore not guard him against delusion on this subject. He
will be just as ready, as he was before he acquired this knowledge,
to take some patent medicine, or to resort to some boasting empiric.
None of the common popular errors can be removed by the knowledge
referred to. If a man should adopt the notion, that the blood is the
seat of all disease, and therefore that remedies relieve disease by
purifying the blood, would it be possible to dislodge that error,
simply by showing him the heart, and describing to him minutely
the circulation? The mechanical contrivances of this beautiful
and wonderful piece of machinery have manifestly no reference to
the state of the blood contained in it. How can he know, from an
examination of the heart and the arteries and the veins, whether
he is right in attributing all disease to a corrupt state of the
life-giving fluid? Or what light will this examination give him in
relation to the remedies which he supposes enter the circulation and
rectify the blood, by neutralizing whatever it contains which is bad?
I will even take a case in which one would suppose that a knowledge
of the mechanical structure of the body would be of essential
service, as an antidote to quackery. I refer to a belief in the skill
of the natural bone-setter. How often does the knowledge referred to
entirely fail to dislodge this error. You may show the believer in it
the structure of the joints, and demonstrate to him by a clearness
of proof which would satisfy him on any other subject, that it is
as necessary to understand this structure, as it is any other piece
of mechanism, in order to be skilful in detecting the nature of the
injuries which it receives, and in repairing them. And yet, he will
reply, ‘all this looks right, to be sure; but still here is the fact
that the bone-setter does set bones some how or other.’ You will
have to do something more, to convince him that his confidence is
misplaced. You must show him, how it is that the ignorant bone-setter
acquires a reputation, in spite of his ignorance, and his consequent
blunders. And this can be done by facts. In commenting on these
facts you can make use of the knowledge, which your friend may have
of anatomy, as an auxiliary in pressing your point; and it may thus
prove of great service, though it is wholly unavailing when appealed
to alone. For a full view of this subject I refer the reader to the
chapter on Natural Bone-Setters.
While a popular knowledge of anatomy and physiology has but little
influence in restraining quackery, it sometimes evidently increases
it, by giving its possessor an exalted idea of his medical acumen.
He upon whom it has had this effect is much disposed to adopt
opinions and theories on slight and plausible grounds, and in this
way is constantly led into error. The physician meets persons of
this character every day. They are always ready to talk with him,
and they seem to feel quite at home on medical subjects, and some of
them have really acquired considerable information on these subjects;
but they have built upon it a superstructure of untenable theories
and notions, and they are commonly carried about by every wind of
doctrine in medicine.
The quack aware of the prevalence of this superficial knowledge of
medicine, gathered from popular books and lectures, often makes
provision for the taste thus engendered. He hires some one, perhaps
a medical student, to prepare for him a disquisition on some of the
principles of medical science, which is to accompany the certificates
setting forth the virtues of his nostrums. This disquisition may
all be correct, though it is more commonly a mixture of truth and
fallacy, so combined, that the superficial reader does not separate
the one from the other. It answers the purpose for which it is
intended. It convinces most people who read it, that the author (whom
they suppose to be the proprietor of the medicines) really has a
great knowledge of medical science, and that, therefore, though other
patent medicines may be impositions, his cannot be. There is often in
these disquisitions page after page of physiological discussions, in
learned guise, which have no sort of bearing upon the nature of the
medicines recommended, though they do have most manifestly upon their
_sale_, as the result shows.
Let me not be understood to mean, that none but physicians ought
to know anything about the human system; nor that the knowledge of
it, which is obtained from popular books and lectures, can be of no
advantage in the warfare with empiricism. Though, when it is relied
upon as the chief, almost the only, weapon in this warfare, it is,
as you have seen, of little avail, and is often even turned against
the cause of truth and science; yet, as an _adjuvant_ to other means
in removing quackery, it may prove very valuable. What then, let us
enquire, are those other means?
I have shown in another chapter, that the principal popular errors
in medicine arise from partial views of the operations of disease
and the effects of remedies, and are false conclusions in regard to
the relation of cause and effect. These false conclusions are, as
you have seen, the basis of quackery; and therefore one of the chief
means of removing quackery is to be found in the exposure of the
fallacy of these conclusions.
But it will perhaps be said, that this has often been attempted, and
with so slight success, that there is very little encouragement for
repeating such attempts; and that it is best on the whole to let
the community find out their errors by their own experience, sad
as it sometimes is. Those who take this ground assume, that the
efforts which have been made for this object have been of a proper
character. I think it to be clear that they have ordinarily not been
so. There has been too much of ridicule and sarcasm. These are means
which are appropriate to a certain extent, as auxiliaries to sober
argument; but they never should be relied upon, as the only, or the
chief, instruments in combatting error. There has also been too much
of denunciation, and calling of hard names. There has not been, on
the other hand, enough of calm, candid and patient discussion on the
part of physicians with the well-informed, as they meet them from
day to day. To the medical man quackery appears so nonsensical, that
he has commonly no patience with those who embrace it. He does not
remember that many of his own profession have, in their reasonings
about cause and effect, committed some of the very same errors which
have engendered that quackery. Perhaps, if he looks back upon his
own course, he may find that he himself has at some time fallen
into an error, which might have led him into empiricism, if he had
been out of the profession, but which was prevented from producing
this effect upon him by that sense of dignity, which characterizes
the man of science, and by that disposition to careful scrutiny,
which the pursuit of medical science is peculiarly apt to impart.
He should therefore avoid being betrayed, by the ridiculousness of
quackery, into the utterance of harsh expressions, or into too free
an use of sarcasm. He should, on the contrary, endeavor to show any
intelligent friend, who has chanced in some way to be deluded by
empiricism, that he has been deceived, and point out to him just how
it has been done. He should show him what the mistakes are which he
has made, in relation to the connexion between cause and effect; and
should endeavor to impress upon his mind the truth, that there is
more necessity for cautious discrimination, in forming conclusions
on this, than on any other subject in the wide range of science. He
should show him how common it is in medicine, to attribute results
to causes, which have had no agency in producing them; and that if
physicians themselves are apt to commit this error, much more must
they be, who are ignorant of medical subjects, and who have but
limited means of observation.
It is this individual influence, which may thus be exerted by the
profession, that must be relied upon as one of the principal means
of ridding the public of the evils of quackery. It is not a mere
occasional effort—some address, some short article in a public
journal, some fling of biting sarcasm, or some sally of wit—that will
do it. Men of strong sense and good judgment, when they are led into
error, as such men often are on the subject of medicine, are not
to be delivered from that error by such means. Remedies of a more
searching character, and a treatment more patient, thorough, and
persevering, are required to reach their case.
It is very desirable that this individual influence be exerted by
medical men, because the class of persons to whom I have alluded,
and who may be successfully reached by it, are the chief pillars
of empiricism. It is true, I will allow, that the ignorant, the
enthusiastic, and the novelty-seeking, make up the great mass of the
patrons of quackery; but they are kept in countenance by those men
of acknowledged good sense, who are found in considerable numbers
in every community, supporting empiricism in some of its many forms
by the weight of their example. The plain unlettered man who takes
some patent medicine, is encouraged to do so by the example of some
neighbor of general repute for shrewdness and wisdom, or perhaps of
commanding talents and influence, and by the array of great names
which he sometimes sees appended to certificates. A sort of general
license is thus given to empiricism by this occasional endorsement by
men of this character.
Some other reasons, besides those already mentioned, for the want
of success in efforts for the overthrow of quackery, remain to be
noticed.
The credulity in the public mind, that gives rise to the errors
on which quackery is based, is encouraged by a similar credulity
existing, to a considerable extent, in the medical profession itself.
If the physician is seen to believe upon mere plausible evidence
one thing, his friends will feel justified in believing some other
thing resting on similar evidence. If he is not careful in sifting
evidence, he cannot expect that others around him will be. If he,
for example, give full credence to all the juggleries of animal
magnetism, and all the extravagancies of phrenology, as they are
put forth by travelling lecturers, how can he hope to dissuade an
undiscriminating public from exercising a like credulity, in regard
to the pretensions of quackery, which are not a whit more extravagant
and fallacious?
The influence of the example of physicians in sustaining empiricism
shows itself occasionally in a still more objectionable mode, than
the one just mentioned. The profession sometimes gives its sanction
to the credulity of the public, not only by indulging a similar
credulity, but by giving currency to some of the measures with which
the quack deceives a credulous community. Many physicians, and some
of them of high standing, have for various reasons given certificates
in regard to patent medicines. Some too, from the love of money, have
even ministered to the empirical tastes of the community, by getting
up some secret nostrums of their own. Such physicians either boldly
bid defiance to an indignant profession, or save themselves from
merited disgrace and expulsion, by announcing, that they are willing
to make known, to any physician who asks it, the composition of their
medicines. By this miserable artifice they comply with the letter
of our regulations, while they go directly counter to their spirit.
For, after all, the successful sale of their medicines requires the
employment of the same measures, to act upon the credulity of the
public, which are made use of by the whole herd of ignorant quacks,
and they commonly have little scruple in resorting to them.
But there is a greater evil still, beyond all this, that exists in
the medical profession, hindering it from waging successful war with
empiricism. It is the _spirit_ of quackery, actuating quite a large
proportion of the profession. It is not always manifested in palpable
shape, and in acts which can be exposed to the contempt of all
honorable men, but it exerts a concealed and yet a constant influence
upon the habits of intercourse, prompting to the use of cunning arts
in order to deceive the community, exciting an overweening desire
for reputation, with an indifference to the grounds upon which it
is based, and producing a competition among physicians that rests,
to a great extent, if not wholly, upon false issues. Where such a
spirit exists, the object is not so much to seek after truth, as it
is to make out a good case in the eyes of the public. No effort is
therefore made to correct the credulity of that public, but this is
looked upon as one of the instruments to be used for the attainment
of their selfish ends. They follow medicine as a trade, and this is
an essential part of their capital.
I need not spend time to show, that this subserviency of medical men
to the credulity of the public, is one of the worst obstacles to
the eradication of the quackery which results from this credulity.
And this mode of self-aggrandizement is an evil, which prevails in
the profession to a greater extent than is commonly supposed. It is
so covert and sly in the case of many physicians, that it is called
by their friends worldly wisdom, or perhaps even good judgment. And
the physician who adopts it, if he have much conscience, quiets it
with the consideration, that the world cannot be reformed, but we
must take it as it is; and he looks upon the honest votary of medical
science, that pursues his investigations in obedience to a love of
the truth, independent of the whims of a credulous world, as a man
who has not sense enough to look out for his own interests.
It must be obvious to my readers, that a reform is needed in the
ranks of the medical profession, to enable it to exert any commanding
influence in the removal of empiricism. Not only is its dignity
impaired, but its energies are crippled, in all its honest endeavors
for this object, by the extent to which that spirit, which I have
described, prevails among its members. It is not confined to a few
of the ignorant and grossly unprincipled, who have stolen into our
ranks; but it is seen to a greater or less degree even in some who
occupy stations of power and influence, and in quite a large portion
of the common mass of practitioners. This may be considered by some
as too strong a charge to bring against so noble a profession; but my
own observation, and that of other physicians from different parts of
our country, prove it to be a true charge.
Let then the profession be purged. Let the true spirit of
investigation animate all the members of it, instead of only a
portion of them. Let that short-sighted policy, which relies upon
the credulity of the community for success, instead of attempting
to correct it, be given up. Let all false issues be avoided. Let
reputation be sought after on true grounds, and let competition be
honorable, and therefore such as will further the cause of truth, and
promote the interests of the profession, and not sacrifice them to
mere temporary self-aggrandizement, as is now so often done.
If such could be the prevailing spirit of the profession, and if
each member of it should undertake to exert his individual influence
in the way that I have pointed out, there is no doubt that a most
effectual blow would be given at once to the domination of quackery.
The whole profession then, instead of being dispirited by the errors
and inconsistencies of a large portion of its members, as it now is,
conscious of the strength which self-respect always inspires, would
present a bold, unbroken front in its warfare with empiricism. The
community then would not, as they do now, take a license for their
own credulity and quackery from that of medical men; but the uniform
example of the profession, in its search after truth, would always
rebuke the spirit of empiricism, and prevent, in a great measure
at least, the sensible and well informed from coming under its
influence. That such a change can be produced, to a great extent at
least, I have not a doubt. But in order to accomplish it, all the
honorable and the true votaries of medical science must be aroused
to the effort, and must make common cause both against the abuses
that exist in our own ranks, and the abounding and multiform quackery
of the public. And because some of the occasional efforts which
have been put forth by individuals for this object have effected
but little, we should not therefore despair as to the success of a
general and united effort.
We would call upon the stable and well-informed in the community to
co-operate with us in effecting this change. They can render us very
material assistance. In what ways they can do this I will endeavor
very briefly to point out.
One of the most effectual means of eradicating quackery is the
promotion of a thorough education of the medical profession. The
lower the standard of education is among medical men, the greater
will be the number of ignorant pretenders who will gain admission
into their ranks, and consequently the greater will be the prevalence
of quackery in the profession, and of course in the community. This
result is the more certain to follow, because deception and imposture
are practised upon the public so much more easily in medicine,
than in regard to other subjects. And it is for this reason that
it is for the interest of the community to have a proper standard
of medical education maintained _much more even than it is for the
interest of the profession itself_. For so little are they qualified
to judge on medical subjects, and so much are they obliged to take
medical practice upon trust, that it is important for them, that
they should have all the benefit of the safeguards the requisitions
of our professional organizations throw around them. And this leads
me to say, that it is only through these organizations that a proper
education of the profession can be secured. Imperfect as they are,
and much as they fall short of accomplishing fully the object, if
they were done away, as some self-styled reformers, who hate all
‘regularism,’ desire, empiricism would abound vastly more than it
does even now, for the door then would be opened widely for the
impostures which it so easily practises upon the people.
The community are much at fault in their opinions and practices on
this subject. These organizations are lightly esteemed, and sometimes
even treated with contempt. Even those who are shrewd and judicious
in all other matters, often put the quack of a day on a level
with the accredited physician, laden with the carefully gathered
experience of years, or perhaps even above him, and welcome with
open arms the advocate of some new system for the moment high in
favor, with scarcely any regard to the inquiry, whether he has been
educated in any proper manner for the responsible post into which he
has thrust himself. Many a man of fair address, and a good share of
cunning, with but a mere smattering of medical knowledge, has dubbed
himself a physician, and, adopting Homœopathy, or some other system
just then in fashion, has imposed not only upon the ignorant, but the
intelligent and learned.
This ought not so to be. The public should, one and all, feel that
they are personally interested in upholding a well-educated medical
profession. Here is a science which is confessedly difficult above
all others, and in which, as you have seen, careless observation
is peculiarly liable to error. How important then, that those who
take charge of your health, your life, should be careful and skilful
observers. And education is obviously as much needed to form good
habits of observation in this, as it is in other sciences. But let me
say, that whenever you give countenance to quackery, whether it be in
the shape of a secret nostrum, or a fashionable system, you strike a
blow at the standard of medical education. You in effect say to the
physician, observe, watch, study as much as you will, we esteem all
your labor and experience vain. When men of wisdom and influence do
thus, as I am sorry to say they often do, it certainly casts contempt
upon education, and therefore tends to lower its standard in the
profession. For if physicians see, that they can acquire the esteem
of the public without study and labor, many will be disposed to give
them up, and take the easier path to success, into which they are
thus invited. And this is the grand reason, why so many pretenders
are found in the ranks of the medical profession.
Before I leave this topic let me correct one error, which is quite
prevalent in regard to the basis of our organizations. We are charged
with being proscriptive in regard to opinions. We are called in
vulgar cant _regulars_, and we are supposed to have ‘regular’ systems
of doctrine and practice, and to maintain a deadly hostility to
any opinion which is opposed to these systems. This may be true of
individuals, but it is not true of the great body of the profession.
We allow of the utmost latitude of belief. We have no creed, nor sets
of creeds. We thrust none out of our medical societies for opinion’s
sake. Any member may adopt any doctrine or system he pleases, however
much opposed to the opinions of the great majority—Homœopathy,
Hydropathy, or even Thompsonism. Education is the qualification
for admission to our ranks; and nothing but a gross and obstinate
infraction of our rules of intercourse, which are based upon truth
and honor and benevolence, can be made the ground of expulsion.
Another way in which the stable-minded and well-informed can
assist the medical profession, in the eradication of quackery, is
by renouncing all fallacious means of judging of the merits of
physicians, and relying upon those which I have shown to be so apt to
lead to correct conclusions. For an extended view of this subject I
refer the reader to the chapter on Popular Estimates of Physicians.
And I will only remark here, that, while the honorable practitioner
desires from his employers an _intelligent_ confidence, the quack and
the quackish physician are very willing, that the community should
continue to judge of medical men by the same false rules, which have
been so long in vogue, because they subserve so well their narrow
and selfish purposes.[35]
The sensible and influential in the community can render effectual
aid in the overthrow of quackery, by promoting the strict observance
of the rules of medical intercourse. These rules are not sufficiently
understood and appreciated by the public. If they were, those who
have influence in society would frown down the base arts of a cunning
competition, instead of encouraging them, as they now often do; and
would give no countenance to the false issues, upon which empirics
and dishonorable physicians so much depend for their success. For a
full view of this subject I refer my readers to the chapter on the
Intercourse of Physicians.
A recent movement of the medical profession in this country, if I
mistake not, is destined to exert a great and a permanent agency
in the overthrow of empiricism. I refer to the formation of the
“American Medical Association” in 1847. Although the meeting in
Boston in May last was only the _second_ annual meeting of the
Association, so fully did the profession throughout the country
respond to the call, that the number of the delegates amounted to
about four hundred and fifty. The measures which have already been
entered upon, and the spirit which has been manifested, clearly
indicate, that the great object for which the Association was formed,
“the elevation and advancement of our common calling” will be
rigorously and steadily prosecuted. The recurrence of this _festival_
of the profession from year to year, I fully believe, will be marked
by real advances in all the interests of medical science.
And now, I ask, is it too much to expect of the stable and
well-informed in the community, that they will give their countenance
to the objects at which we aim? While we are thus struggling together
to elevate the standard of medical education, and to rid our noble
profession of the abuses which impair its honor and its usefulness,
we have a right to demand of the community, which is to be especially
benefitted by these efforts, a cheerful and active support. Whether
this shall be given us, will depend upon the men of influence in
every profession and occupation in our land. It is to them that we
make our appeal, and we believe that it will not be made in vain.
FOOTNOTES:
[35] There is nothing by which the quackish practitioner is more
plainly distinguished from the honorable one, than by the mode of
competition in which he engages, and the kind of reputation at which
he aims. He resorts to tricks, and raises false issues. He boasts of
success; and, if he do it skilfully, he does not much endanger his
reputation for a proper degree of modesty. He is always finding out
something wonderful in his cases—something which it is supposed other
physicians have not acuteness enough to discern. He loves to see the
credulous, whether learned or unlearned, gaze at his wonders, and
to hear the loose tongues of gossipers busy in his praise. He aims
at a reputation for performing great cures in cases in which others
have been said to fail—_a reputation which no honorable physician
ever has, however eminent he may be, because he does not seek after
it_. Every quack seeks for it, and acquires it to a greater or less
extent. The physician can have it if he will make it his aim, but in
doing this he puts himself on a level with the quack in the common
field of empiricism.