SCIENCE AND FASHION.
Full ready had he his apothecaries,
To send him drugs and his electuaries;
For each of them made other for to win!
Their friendship was not newè to begin.
—_Chaucer._
He was a very perfect practisoùr,
* * * * *
His study was but little in the Bible.
—_Chaucer._
Nothing in his curriculum puzzled our embryo physician so much as the
different methods of treatment advocated by his teachers. With many of
them, it is only fair to say, the only treatment they advocated was the
extension of the palmaris muscle in the hand, known to anatomists as
the guinea muscle, for the purpose of receiving the fee. Men of the new
school declared the only treatment necessary for any medical, as
distinct from surgical disease, was a good warm bed, and discarded all
drugs. As, however, these gentlemen lived by the practice of their
profession, it was a question if they were not liable to be charged
with obtaining money by false pretences, as they did nothing whatever
to assist their client’s recovery.
Some, on the other hand, wrote great books on therapeutics, and gave
you a list of some score or so of drugs, more or less deadly, for the
cure of every complaint, real or imaginary, leaving the selection to
the practitioner, as he, when he combined them, left Nature to take
what she thought would best answer her purpose.
King James the First declared that the perusal of Hooker’s
“Ecclesiastical Polity” (written as an apology for the Church of
England) made him a Roman Catholic. How many students having heard at
the hospitals the defence its professors have to make for it, and seen
its practice in the wards, have retained any faith at all in the
science of medicine? King James found that the arguments of Hooker did
not go far enough. The student of medicine finds his teachers go a
great deal too far; and becoming a medical sceptic when he has obtained
his diploma, he generally adopts “the expectant treatment,” and leaves
everything to the _vis medicatrix naturæ_—in other words, he leaves
his case exactly where he found it, and takes much scientific credit to
himself for his non-interference.
You could always, if you liked, have the expectant treatment exhibited
at St. Bernard’s; it was rather a favourite experiment. You got two
cases as nearly as possible of the same type of the same disease, say
typhoid fever, in exactly the same stage of development. You put the
cases side by side in the same ward. With the one you adopted all the
therapeutic routine which might just then be the fashion—for fashion
in medicine is as variable as in ladies’ dress—and in the neighbouring
case you gave no drugs at all, but water simply coloured with burnt
sugar as a placebo, lest the patient should think himself neglected.
You watched the progress of the malady, you adopted in each case the
same diet, and at the end of three weeks or a month, both cases
terminated by recovery as nearly as possible at the same time. Dr.
Oliver Wendell Holmes said,“if all drugs were cast into the sea, it
would be so much the better for men, and so much the worse for the
fish.” They quite went in for this idea at St. Bernard’s, with an
exception in favour of newly discovered drugs whose physiological
actions were yet to be investigated, and till all was known of them
which could be learned, they compelled their patients to swallow them.
This was part of the expectant treatment. Mr. Micawber, it will be
remembered, was somewhat of a disciple of this school. It is most
unfair to argue that nobody got any good from this method, because
many papers were produced for the medical journals on these new
preparations; though, as an inquisitive lady reader once remarked, the
cases all seemed to end with an autopsy.
But then, you see, a “P.M.” is like a lady’s P.S., quite the most
important part of the whole concern. The drug bill at our hospital was
a very heavy one, because all these new remedies at their first
introduction are necessarily costly from their limited demand. Then all
sorts of worthless articles of diet, much belauded by the journals
which received large sums from the proprietors who advertised their
wares in their columns, had to be tried. Poor wines, with high-sounding
titles, at prices to match, were for mysterious reasons certified by
the physicians of the place to be particularly “rich in phosphorus, and
peculiarly suitable to invalids suffering from dyspepsia and want of
nervous tone;” and were used in the hospital generally, in proof of the
favour in which they were held, by Dr. Octavius Puffemup, M.R.C.P.
(Lond.), Lecturer on Diseases of the Supra-Orbital Nerve at St.
Bernard’s Hospital, London, Fellow of the Royal Society of Diana
Lucina, and Member of the Royal Institution of Cynegetics, etc., etc.,
etc. All these much-belauded nostrums, like our little systems, “had
their day and ceased to be;” they cost the charity a great deal of
money, and served merely to advertise the members of the staff who
demeaned themselves by praising them.
Did a member of the staff invent a new bed, a new inhaler, a new
instrument, or a new kind of invalid’s clothing, it must be purchased,
no matter what the cost, as often as he chose to order it for his
patients. It served to keep his name before the public; it was one of
the many ways in which the charity could recompense him for the time he
devoted to its work.
A bookseller once declared, if his customers only purchased the books
they were likely to read, he would not get bread and cheese. If only
the pharmaceutical preparations were purchased which the patients
really required, the makers of them would be in the same predicament.
It is so easy to be liberal when you don’t have to pay. With proper
conscientious management, directed for the patient’s benefit alone, the
expenses of our great hospitals might easily be reduced one-half. But
then there must be a good deal of self-sacrifice.