CHAPTER VIII.

GOOD AND BAD PRACTICE,

. 172

Nor 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 accord-
ingly. 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 dan-
gerous 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. Con-
fident appeals of quacks to alleged results. Show what the physician
should say in regard to results.

CHAPTER IX.

THEORY AND OBSERVATION,

. 200

ALL real knowledge based upon observation, not on theory. Facts of
two kinds-individual and general. General facts ascertained by obser-
vation of many individual or particular facts. No theory founded on facts
-always goes beyond them. No science in which there has been so
much theorizing as in medicine. History of medicine very much a his-
tory of theories. Office of theory-suggestive. Abuse of theory in fail-
ing to distinguish between the known and the supposed. Newton's care-
fulness on this point. Circumstances impairing skill in observation.

Mode of reviewing cases. Disposition to form conclusions from a limited
range of facts. Young practitioners. Dr. Sewall's plates. Dr. Sutton's
treatment of delirium tremens. Different theories of fever-Boerrhave,
Cullen, Clutterbuck, Broussais, Cooke, Samuel Thompson. Hobby-riding.
Diseases of the throat and windpipe. Habit of making loose and ex-
aggerated statements. Credulity and fondness for novelty and change.
Changeable state of medicine. No standard authorities as in law and、
theology. Scepticism in medicine. Easy to theorize-difficult to observe
well. Value of good habits of observation. Medical men had too much
to do with theories and modes and systems. Eclecticism. Modus operandi
of medicines. A reform in progress in medicine. Breaking loose from
theory. Promoting rigid observation.

CHAPTER X.

POPULAR ESTIMATES OF PHYSICIANS,

222

No class of men so erroneously estimated as physicians. Object of this
chapter to show how the community can judge of them correctly.
Education of physicians-evidences of it. Medical education practically
despised by a large portion of the public. Standing of medical man
among his brethren criterion of merit. Difficulty in getting their un-
biased opinions. Certain mental qualities essential to skill in the
practice of medicine. How the common observer can detect and measure
these qualities. Observe them as exhibited in regard to subjects which he
understands in common with the physician. Illustration from surgery.
Illustrations of same truth in relation to various characteristics of medical
men. Formation of opinions-credulous-sceptical-hasty and change-
able-cautious and tenacious-strong and ardent. How can test one's
habits of observation. Asking many questions no sure proof of accurate
and minute observation. Enquiries of different physicians about an
article of curiosity. Same rule for judging of the measures of the phy-
sician, as we have applied to his opinions. A genius in medicine. In-
nate skill. Rules which have been pointed out for estimating compara-
tive merits of physicians not in common use with the public. A change
necessary in this respect. Cannot easily be effected. Many physicians
would be opposed to such a change--would rather false tests continue to
be applied. But the change can be effected.

CHAPTER XI.

MEANS OF REMOVING QUACKERY,

242

THE credulous, ignorant, and novelty-seeking, not the only persons im-

posed upon by quackery. Many of the judicious and intelligent also.

Efforts to undeceive the public on this subject have been often faulty.

Too much reliance on popular knowledge of anatomy, physiology,

dietetics, &c. This should only be auxiliary to other means. Relied

upon alone, leads to error. Individual influence of physicians in show-

ing their friends their mistakes in connecting cause and effect in medi-

cine. This influence to be exerted upon the intelligent who uphold

quackery. Too much sarcasm and ridicule and invective used against

quackery. Credulity of the public takes a license from that of medical

men. Certificates of physicians in favor of nostrums. Secret medicines

put forth by physicians. Spirit of quackery in the medical profession.

Exhibited in various ways. Quite prevalent, crippling the profession in

its warfare with empricism. Reform needed. Can be effected. The

stable and intelligent can help in effecting it, by promoting medical edu-

cation-by sustaining the organizations of the profession-by renouncing

fallacious means of estimating professional merit-by favoring strict ob-

servance of the rules of intercourse among physicians. Formation of the

American Medical Association, an important movement in the destruc-

tion of quackery.

CHAPTER XII.

INTERCOURSE OF PHYSICIANS,

. 258

ERRONEOUS views in regard to consultations. "Jury of doctors."

Dictation not consultation. Giving opinions in relation to the past treat-
ment. Offices of the consulting, and of the attending physician defined.
Freedom in consultation necessary. Between enemies, useless. Should
be alone in consultation. Intrigues of dishonorable practitioners. Sup-
posed want of agreement-favoring the impression for base purposes.
Attributing changes, good or bad, to some remedy for selfish ends. Fail-
ing to defend a medical brother when circumstances fairly demand it.
Making comparisons between cases. Undue attentions to the patients of
others. Conduct of some when called to see the patient of another in
case of unnecessary alarm. Physicians supposed to be too much at-

tached to etiquette. Not so usually. Differences and quarrels of phy-
sicians-circumstances giving rise to them. Facility with which decep-
tion is practised in medicine. Peculiar relation of the physician to his
employers. Cliques. Sectarian and other associations. Avoiding quar-
rels. Relations of elder physicians to their brethren.

CHAPTER XIII.

INTERFERENCE WITH PHYSICIANS, .

275

Confidence which one feels in his physician no reason for disparaging
others. Interference proper in some cases-quackery-gross ignorance-
intemperance. Reckless attacks upon professional character. The lawyer
rebuked. Free canvassing of the merits of physicians not improper. In-
terference in the sick room. Destroying confidence. Recommending
medicines. Restricting physicians as to remedies employed. Frequency
of physician's visits to be mostly left to him. Anxiety of friends of the
sick often embarrasses the physician.
Case of the wife of Napoleon.
Harrassing practitioner with inquiries and criticising his practice dis-
tract his attention, and therefore foil his skill. Same effect produced by
the same causes in regard to other subjects. Criticised clergyman.
Watched juggler. Defects in these analogies.

CHAPTER XIV.

MUTUAL INFLUENCE OF MIND AND BODY IN DISEASE,

288

Inadequate views of this influence prevalent. Importance of under-
standing it. Connection of mind and body. No proof that mind is essen-
tially indestructible. Manifestations of mind connected with and de-
pendent upon the material organization. Brain in some sense seat of mind
-central organ of the nervous system, with which mind is connected.
Other subordinate nervous centres Bichat's idea of the seat of the moral
sentiments. Weakness of mind in sickness. Slight causes affect it
strongly. Importance of quiet in sick room. Difficult to secure it. Vis-
itors. Conversation. Children as easily disturbed as adults. Holding up
physician as a bugbear to them. Exciting the mind commonly irritates
bodily disease, whether in the brain, or in some other organ. Death of
Hunter caused by a fit of passion. Duty of physician sometimes to excite
the mind in various ways and degrees. Influence of imagination upon
the body. Use to be made of mental association in the treatment of dis-

Influence of change of scene on the in-

ease. Diversion of the mind.
valid. Monotony of sick room.
times afflicted. How removed. Want of tact in managing whims of the
sick. Notional dislikes. Fretfulness and impatience. Deranged sensa-
tions erroneously supposed to be mere imaginations.
faithful study of mental influences to the physician.

Settled gloom with which the sick some-

Importance of a

INSANITY,

CHAPTER XV.

320

Two classes of causes-those which act upon the mind, and those which

act upon the body. Insanity always, strictly speaking, a disease of the or-

ganization. Too much disposition to look to some one thing as the cause.

Tables of causes in Hospital reports. Form of the insanity not necessa-

rily indicative of its cause, or of the character of the patient. CAUSES

OF INSANITY. Indulgence of passions. Wrong views of life. Exclusive

and prolonged attention to one subject. Insanity rare am ong savages, and

those under despotic governments. Great prevalence in this country.

Religious excitement. Debilitated system predisposing to insanity. In-

temperance. Children seldom insane, though very liable to temporary

derangement in sickness. Foundation of insanity, however, often laid in

childhood. Forms and signs of insanity. Cases in which the disease

comes on slowly. Monomania, Moral insanity. Treatment of the in-

sane. Change produced by Pinel. ADVANTAGES OF RETREATS OR HOS-

PITALS. 1. Removal of patient from the associations under which his

insanity originated. 2. Judicious medical treatment. 3. Better mental

and moral management than can have among his friends. Mistakes of

friends of the insane in their management. Reasons why insane apt to

dislike their nearest friends most. Helplessness of insane poor. Duty of

the State in regard to them. Legal relations of insanity. Absurd and in-

consistent opinions and practices of our courts of justice. Professional

evidence in France, and in this country, when prisoner suspected of insan-

ity. Insane often been executed. Plea of insanity. Importance of pre-

venting the acts for which the insane are brought before our courts as

criminals. Laws deficient at this point. Necessity of a commission of

lunacy.