Forty Years in the Wilderness of Pills and Powders

Some of these blessings have been alluded to in Chapter XXXVI. But the subject is one of too much importance to be left in an unfinished state, and I have concluded to make it the principal topic of a separate chapter.

A man came to me, one day, with sundry grievous complaints about his head and stomach. It was easy to see, at once, that they were not of mushroom growth, and that they could not be removed either in an hour or a day. However, I did the best I could with him, and charged him to follow, implicitly, my directions, which he promised faithfully to do. I told him, even, that he was in danger of a severe disease, but counselled him to do his utmost to escape it, if possible.

He was, in the first place, a New England or Yankee farmer. Not quite satisfied with the products of his farm from the labors of the day, he coupled with them the night labors of managing a saw-mill and a distillery. And not satisfied with even these, he sometimes burned charcoal, which also involved more or less of nocturnal labor. In truth, these employments and avocations kept him up a great many nights during a considerable portion of the year, and were evidently wearing him out prematurely; for, though less than forty years of age, he had the appearance of being fifty or sixty.

This severe tasking of his system, had led him greatly into temptation. Not only had he acquired the habit of chewing tobacco, as a solace in his seclusion and toil, but also of drinking very freely of cider and cider brandy; the last two of which, as might naturally be inferred from what has been said, he was accustomed to manufacture in large quantities. He was not a great eater, though I have no doubt he ate too much. But he did not take time to eat – he did not masticate any thing; almost every thing was swallowed in masses, and washed down with tea, coffee, or cider. Then, lastly and finally, he ate, as it were, by the job, when he did eat; for his meals were very irregular and sometimes very infrequent.

Another thing should be noticed. His cider and perhaps his tobacco, having leagued together, took away his appetite. Cider, as is well known, practically and in a gradual way, takes away the appetite, and so does coffee. Many a farmer will tell you that it is a matter of economy to give his laborers cider or coffee, since they will not eat so much. It is highly probable that brandy, and indeed all extra stimulants, have the same appetite-destroying effect.

And as the result of his various irregularities and abuses, his digestive and nervous systems had become very much deranged and disordered, and I could hardly help foreboding evil concerning him. I prescribed for him as well as I could, and requested him to call on me in two or three days, and "report progress."

On the next day but one, I was summoned to his bedside. My medicine had indeed appeared to afford him a little temporary relief, but it was only temporary. He was now much worse than ever before. I prescribed again; but it was with similar effect. Nature, somewhat relieved, as I then vainly imagined, seemed disposed to rally, but was unable. Every successive effort to rally, showed more and more clearly how much she had been crippled. At least she seemed to succumb either to the treatment or the disease, which last became in the end quite formidable.

But though Nature had yielded, apparently vanquished, she still made occasional faint efforts, every two or three days, to regain the supremacy, or, in other words, to set things right; and sometimes we were led to indulge in hope. But the remissions of disease and of suffering were only temporary, and were succeeded, in every instance, by a worse condition of things than before. I called for sage medical counsel, but all to no permanent purpose. Downward he tended, step by step, and no human power or skill seemed likely to arrest his progress.

In this downward course his constitution held out – for he was by nature exceedingly tenacious of life – till about the twenty-third day, when the vital forces began to retreat. He died on the twenty-fifth.

One practical but general error deserves to be noticed, for want of a better place, in this very connection. Notwithstanding the great difficulty of convincing a person who habitually uses extra stimulants, narcotics, or any medicinal agents, all the way from rum, opium, and tobacco, down to tea, coffee, and saleratus, that they are injuring him at all, as long as he does not feel very ill, yet it ought to be clearly and fully known that every one who is thus addicted to unnatural habits, and being thus addicted is seized with disease of any kind and from any cause whatever, is certain to have that disease with greater severity than if his habits had been, from the first, perfectly correct or normal. Nor is this all. Medical aid, whenever invoked under these circumstances, is more questionable as to its good tendencies. No medical man of any skill or observation but must feel, in such a case, most painfully, the terrible uncertainty of that treatment of the living machine which is quite enough so when the habits have been most favorable, by being most correct.

One caution of quite another kind may be interposed here. My patient above had neglected to call on me for several days in the beginning of his disease, under the very general impression of ignorant people, that if he called a physician he should certainly be severely sick; for if he was not already very sick, any efforts to prevent disease would only serve to make him so.

Now this is, as a general rule, a very great mistake. It would be much more safe to call a physician very early, than to wait till Nature is so much embarrassed and even crippled that we can place very little reliance on her efforts. Worse still is it for the physician, when called late, to load down the enfeebled system with medicine by way of atoning for past neglects. Thousands have made the mistake here alluded to, and have thus been a means of hastening on a fatal termination of the disease. It is not by any means improbable that such was the result in the foregoing instance.

CHAPTER XLV

THE INDIAN DOCTOR

A little child about two years of age, severely afflicted with bowel complaint, came under my care during the first year of my medical practice, and proved the source of much difficulty.

She was the child of a mother who had been trained to delicacies, in the usual fashionable way, and who had begun to carry out the same wretched course of education in her own family. In addition to a generally wrong treatment, the child had been indulged, for many weeks before I was called, with a large amount of green, or at least very unripe, fruit.

It was at a season of the year when both children and adults were suffering from bowel complaints much more than at any other; but as the hot days and nights were expected soon to give way to the cooler and longer nights of October, I fastened my hopes of the child's final recovery, very largely, on the natural recuperative effects of the autumnal season. I did not attempt to give much medicine. My reliance was almost wholly on keeping up what I was wont to call a good centrifugal force, or in keeping the skin – the great safety valve of the system – in proper and healthful activity. Much that I ordered was in the way of bathing, local and general, especially warm bathing.

The parents of the child were among my most confidential, not to say influential, friends. If there was a family within the whole of my medical circuit with whom my word was law, it was this. Yet after all they were ignorant, especially of themselves; and such people always were and always will be credulous. They would open their ears, not only to the thousand and one insinuations of malice and envy, which at times are ventured against a young physician, – especially if he is going ahead, and as they say "getting rich" too fast, and thus securing more than they believe to be his share of public popularity; – but to the still larger number, if possible, of weak criticisers in his practice.

My friend's residence, moreover, was in a neighborhood contiguous to quacks and quackery, in the pretensions to which there were many believers. These dupes of ignorance and assurance were ever and anon filling the heads of my "patrons" with their stories of wonderful cures, in cases almost exactly like that of my own little patient, and urging the poor half-distracted parents to try something new – either medicine or physician. They would appeal to their feelings by asking them how they could be willing, as parents, – however great might be their confidence in me as a physician, – to let a darling child lie, day after day, and yet make no extra effort to save it.

Their appeals were not wholly ineffective; indeed, what else could have been expected? My first suspicion of any thing radically wrong, arose from a decidedly unexpected effect from a little medicine I had previously ordered. It seemed quite clear to my mind that a neutralizing agent had been at work somehow, by design or otherwise. And yet I shrunk from making an inquiry. In the end, however, I found myself morally compelled to do so. The results were very nearly what I had feared, and what might have been expected.

One of the reliabilities of the wise ones of the neighborhood went by the name of the "Indian" doctor. Whether in addition to a very little Indian blood he was half or three-fourths Spanish, Portuguese, or Canadian, I never knew, for I never took pains to inquire. But he had Indian habits. He was at times intemperate and vicious. No one who knew him would have trusted him with a sixpence of his own honest earnings, at least any longer than he was within his sight or reach. Yet many people would and did trust him with their own lives and the lives of their children.

There was one redeeming circumstance in connection with the history of this Indian doctor. He would never prescribe for the sick when in a state of intoxication. He knew, in this respect, his own weakness. But then it must be confessed he was not often free from intoxication. He was almost always steeped in cider or spirits. He was seldom, if ever, properly a sane or even a steady man.

On pressing the parents of the sick child more closely than usual, they frankly owned that though they had not of themselves called in the Indian doctor, they had permitted Mrs. A. B. to invite him in, and had permitted the child to take a little of his medicine.

The secret was now fully revealed, and it was no longer a matter of wonder with me, why poison did not work well against poison. The wonder was why, together, we had not killed the poor child. And yet it was by no means certain that the Indian's prescription was of much force, save the few drops of alcohol which it contained, for all his medicine was to be taken in alcohol.

I stated to the parents the probable issues – that unless the child possessed more than ordinary tenacity of life, it must ultimately sink under the load it was compelled to sustain. But to our great surprise – certainly my own – it survived; and, though it was suspended for weeks between life and death, it finally recovered.

The most mortifying circumstance of all was, that this miserable mongrel of a man had the credit of curing a child that only survived because it was tough and strong enough to resist the destructive tendency of two broadside fires – mine and his own. But medical men are compelled to put up with a great many things which, of course, they would not prefer. They must take the world as it is – as the world does the corps of physicians. They must calculate for deductions and drawbacks; and what they calculate on, they are pretty sure to experience. But, like other men with other severe trials, they have their reward.

CHAPTER XLVI

DYING OF OLD AGE, AT FIFTY-EIGHT

Within the usual limits assigned me in the daily routine of my profession, but on its very verge, there resided an individual of much general reputation for worth of character, but of feeble constitution and cachetic or deranged habits, for whom as well as for his numerous family I had frequently prescribed.

He was at length, one autumn, unusually reduced in health and strength, and I was again sent for. There was evidently very little of real disease about him, and yet there was very great debility. All his bodily senses were greatly deranged, and all his intellectual faculties benumbed. His internal machinery – his breathing, circulation, and digestion – was all affected; but it seemed more the result of debility than any thing else. There was no violence or excess of action anywhere, except a slight increase of the circulation.

The man was about fifty-eight years of age. Had he been ninety-eight or even eighty-eight, I should have had no difficulty in understanding his case. I should have said to myself, "Nature, nearly exhausted by the wear and tear of life, is about to give way;" or in other words, "The man is about to did (?die) of mere old age." But could he have been thus worn out at the age of fifty-eight?

I gave him gentle, tonic medicine, but it did not work well. Without increasing his strength, it increased his tendencies to fever. Yet, as I well knew, depletion would not answer in a case like this, whether of bleeding, blistering, or cathartics. In these circumstances, I contrived to while away the time in a routine of that negative character which, in true medical language, means laboriously doing nothing.

He was visited about twice a week. I heard patiently all his complaints, and endeavored to be patient under all my disappointments, for disappointments I had to encounter at nearly every step. No active treatment whatever would have the general effect I desired and intended. If I gave him but a single dose of elixir paregoric for his nervousness, it only added, nine times in ten, to the very woes it was intended to relieve. My policy – and I fully believe it was the only true policy – was to leave him to himself and to Nature, as much as possible.

Though I have spoken here of what I regarded as the true policy in the case then under my care, yet, after all, the truest course would have been to call for consultation some wiser head than my own. Another individual, even though he were no wiser than I, might have aided me most essentially, in compliance with, and in confirmation of, the good old adage – "Two eyes see more than one."

Why, then, did I not call on some inquiring and highly experienced physician? It was not that I was too proud to do so, nor that I was too jealous of my reputation. It was not that I feared any evil result to myself. It was rather because I did not, at first, think it really necessary; and then, subsequently, when I supposed it to be really needful, I feared my patient would grudge the expense. This fear, by the way, was grounded in something more than mere conjecture. The proposal had been practically made, and had been rejected.

In this general way things went on for some time. The friends grew uneasy, as they should have done; and one or two of them, now that it was almost too late, spoke of another physician as counsel. My own readiness and more than readiness for this seemed to have the effect to quiet the patient, though it had the contrary effect on his friends. They appeared to construe my own liberality and the admixture of modesty and conscientiousness, which were conspicuous in my general behavior, into self-distrust, and hence began themselves to distrust me.

The patient's state of mind – for he was a man whose habits of thinking and feeling approximated very closely to those of the miser – more than once reminded me of some doggerel verses I have seen, perhaps in an old almanac, which are so pertinent in illustration of the point in my patient's character which these remarks are intended to expose, that I have ventured to insert them: —

"The miser Sherdi, on his sick-bed lying,

Affrighted, groaning, fainting, wheezing, dying,

Expecting every hour to lose his breath,Enters a Dervise: 'Holy Father, say,As life seems parting from this sinful clay,What can preserve me from the jaws of death?'"'Sacrifice, dear son, good joints of meat, —Of lamb and mutton for the priest and poor.Nay, shouldst thou from the Koran lines repeat,Those lines might possibly thy health restore,'"'Thank you, good father, you have said enough;Your counsels have already given me ease.Now as my sheep are all a great way off,I'll quote holy our Koran, if you please.'"

At length my patient began, most evidently, to decline. There were various marks on him and in him, of approaching dissolution. When pressed, as I frequently was, to say definitely what the disease was – that is, to give it a name – under which Mr. – labored, I only replied that he was suffering from premature old age. This always awakened surprise, and led to much and frequent inquiry how it was that a man of fifty-eight years could be dying of mere old age. My explanations, whenever attempted, – for sometimes in my pride of profession I wholly evaded them, – were usually, in substance like the following: —

"Mr. – was feeble by inheritance. He never had that firmness of constitution which several of his brothers now possess. Then, too, he was precocious. His body and mind, both of them, came to maturity very early; which, as you know, always betokens premature decay. Men live about four times as long, when not cut short by disease, as they are in reaching maturity. As he was apparently mature at fourteen or fifteen, he might very naturally be expected to wear out at or before sixty.

"But then, in addition to this, he has all his lifetime labored too hard, not only from necessity, but from habit and choice. His ambition, it is well known, has been unlimited, except by his want of strength to accomplish. He has only ceased to labor hard when he had strength to labor no longer, or when it was so dark or so cold or so stormy as to prevent him.

"Then of late years he has had the care and anxiety which are almost inseparable from the work of bringing up a numerous family. It is indeed true that he has not been called to that severest of all possible trials pertaining to the family, the pain of seeing that family or any of its members go materially wrong. Still he has had a world of care; of its effects none are aware who have not been called to the same forms of experience.

"There is one thing more; Mr. – has, at times, taken a good deal of medicine: not alcohol, in any of its forms, I admit, but substances which for the time were, in their effects, almost equally bad for him. He has used tea immoderately, and even tobacco. His constant smoking has been very injurious to his nervous system, and along with other things has, doubtless, greatly hurried on the wheels of life."

Remarks like these had their intended effect on a few individuals, especially such of them as were couched in language with which they were already familiar. On most, however, they fell lifeless and hopeless. What knew they about precocity and its effects on the after life? In short, it was quite doubtful then, and is still more doubtful with me now, whether, on the whole, any thing was gained by attempts at explanation. For example, when I spoke of my patient being worn out, prematurely, by overworking, it was asked by one man, "But how is this? Other men as well as Mr. – have worked too hard, and brought up large families, and perhaps taken a great deal of medicine, and smoked a vast amount of tobacco? Why are they not affected in this way as well as Mr. – ?"

It was not easy to make current the idea that Mr. – was about to die of old age; although partly from conviction, but partly, also, to conceal my ignorance, I still endeavored to promulgate it. It was the only apology I could make for suffering a man to run down and die, without appearing to those around him to be very sick.

But he died, after some time, to my infinite mortification and great regret. I was invited to his funeral, as I was usually to the funerals of my patients. In this case, however, I contrived to be absent. So great was my consciousness of ignorance and so much ashamed was I of my ill success, that I felt as if the veriest ignoramus would be disposed to point at me, and to charge me with having been, practically, the murderer of the much-beloved head of a family, and a worthy and highly respected member of society. But, whether others would deem me culpable for my ignorance or not, I could not avoid the pangs of habitual condemnation.

There were, I grant, a few extenuating circumstances in the case. One or two causes existed, of premature decline, on which, in a work like this, I cannot stop to expatiate. It was also very unfortunate for him that he was accustomed to look on the dark side of things, and to forebode ills, where, oftentimes, none existed.

Notwithstanding my former ignorance and doubt, and numerous misgivings, in cases like the foregoing, I have of late years, on a maturer review, been obliged very frequently to confirm my earlier decisions. In the case which has been detailed in this chapter, I have, on the whole, come to a belief that my first judgment was nearly correct; and that the patient actually perished, as much as men ever do, of premature old age. It is, indeed, very possible that had I pursued a different course in several important particulars, his life might have been prolonged for a year or two. Men have a tendency to become what they are taken to be; and many a person has died much sooner for being taken to be near his end, and treated accordingly. If we would have our patients recover, we must take for granted that recovery is at least possible.

In the case above, I believe I lost reputation, in large measure. Several shrewd people insisted, at the time and long afterward, that I ought to have had medical counsel. Mr. – , they said, was too good a man to lose without a more persevering effort to raise him. They charged me with having got my name up, and having at the same time grown careless. Had he been properly doctored, they said, from the very first, they believed he might still have been alive to ornament and bless society.

CHAPTER XLVII

DAUGHTERS DESTROYING THEIR MOTHER

There are, of course, many ways of destroying or killing people. To kill, with malice aforethought, though sometimes done, is a much less frequent occurrence than killing in the heat of passion, or by carelessness; by leading into bad habits, or by the injudicious use of medicine.

Then, again, there is such a thing as killing by omitting to keep alive. Thus we have sins of omission as well as of commission. If I leave a man in a mill-pond and suffer him to drown, or if I suffer him to take a dose of arsenic or Prussic acid, when I might, with the utmost ease, or even with considerable difficulty, prevent it, – is it not, in a practical sense, to destroy or kill him?

It is certainly within the wide range of human possibility, that a daughter may, without bludgeon or pistol, and even without poison, kill her mother. And it is quite notorious and a plain matter of fact that many a mother kills her own children. It could be demonstrated that thousands, if not tens of thousands of children are destroyed every year by their own mothers; as truly so as if they had received at their hands a quantity of arsenic. Why, then, may not children sometimes kill their parents?

I have known people, in very many instances, kill, in trying to save. I have even known the medical man do this, as may be seen by turning back to Chapter XXX. Then, too, I have known the attendants of the sick, though among their dearest friends, sometimes kill in this very way. In truth, such killing is not uncommon.

One of the most painful instances of this last kind of killing came under my own immediate observation, and was in the range of my own practice.

I was visiting a sick woman, whose only property lay in three or four lovely and loving children. Two of these, who were full-grown daughters, resided in her house and took care of her. She was severely afflicted with typhoid dysentery. Her daughters in turn watched over her, both by day and night, and would not suffer her to be left in the care of anybody else for a single minute. And, in general, their faithfulness was above all praise.

One day, however, disliking the appearances of a part of my medicine, they mutually agreed to throw it into the fire; and the deed was done. They had supposed it to be calomel, as it had the color and general appearance of that drug, and to calomel they had a most inveterate and irreconcilable hatred. It was a hatred, however, which whether well or ill founded, very extensively prevails.