Forty Years in the Wilderness of Pills and Powders

Now this story illustrates a case which, in magnitude or in miniature, is in our country of almost every-day occurrence; and the only reason why the results everywhere else are not like those at Elizabethtown, is simply this: that there is not so much of the poison used in any one village, at the same time, as there was at that place in the circumstances which have been mentioned. One is sick here, another there, and another elsewhere. In one, owing to peculiar predisposition or habit, it takes the shape of fever; in another, of palsy; in another, of eruptions or boils; in another, of bowel complaint. And as all these and many other diseases have been known before, and have been induced by other causes equally unobserved or obscure, we have fallen into the habit of supposing that these things must needs be, do what we will. In other words, God the Creator, is supposed to have made the world and appointed to us, for trial or otherwise, these various forms of disease; and they are for the most part dealt out to us arbitrarily; or, if not arbitrarily, by chance or hap-hazard.

But to return to the young man. There was such a hostility of the public mind to the idea that his disease was induced or even aggravated by lead, that I receded in part from my suspicions. At least, I proceeded, with fresh energy and enthusiasm, to search for other and more probable or popular causes. Cause there must have been, of some sort, I was confident; while to all my efforts of this kind the friends of the boy stood opposed. They did not, it is true, say much against it; but then it was perfectly evident from all their conversation and conduct that they regarded it as not only idle, but presumptuous, perhaps wicked. How can it be, they seemed to say, by those looks and actions which so often speak louder than words, that this young doctor is always trying to ferret out the causes of disease, while Dr – (my predecessor) never attempted any such thing, but rather dissuaded us from it?

Yet thus it was precisely. For three long months I was endeavoring to meet and obviate the symptoms of a disease which I secretly believed was induced by lead, but of which I had no such strong evidence as would have justified the positive affirmation that it was so, or prevented me from searching for other causes. This state of mind was by no means favorable to my success as a medical practitioner; for it somehow greatly impaired or weakened their general confidence in my wisdom and skill. Had I, on the other hand, "looked very wise," declared the disease to be so and so, with great pertinacity, and adhered, through good report and through evil, to my opinion, whenever it was assailed, and withal manifested no desire to receive medical counsel, I should have had a larger measure of their esteem, and a very much larger measure, as a professional man, of their confidence. They might then have thought me a very wise and good physician.

A man who wishes to be greatly popular in the world must learn the ways of the world, and walk in them more or less, whether they are crooked or straight. He must not be over-modest, or over-honest; nor must he be over-solicitous to improve his own mind or heart, or encourage others, by precept or example, to walk in the way of improvement. He must not only make up his mind to take the world as it is, but to suffer it to remain so. The world does not like to be found fault with; it has a great deal of self-confidence.

The young man, in the end, recovered; not, as I now believe, in consequence of the treatment, but in spite of it. Had he been nursed carefully from the first, and kept from every source of irritation, both external and internal, even from food, except a very little of the mildest sort, just enough to keep him from absolute starvation; and had his air been pure and his temper of mind easy, cheerful and hopeful, he would probably have recovered much sooner than he did, and with far better prospects for the future. But he had been frightened about himself, from the very first, by my own inquiries about poison, – which had unwarily been communicated to him, – and his fears never wholly subsided.

How much wisdom from both worlds does it require in order to be a physician! The office of a medical man, I repeat, is one of the noblest under the whole heaven. The physician is, or should be, a missionary. Do you regard this assertion as extravagant or unfounded? Why, then, was it made an adjunct, and more than an adjunct, in the first promulgation of the gospel, and this, too, by the gospel's divine Author? Why is it that our success in modern times, in spreading the gospel, has been greater – other things being equal – in America or China, in proportion as its preachers have attended to the body as well as to the soul?

At the time of my commencing the practice of medicine, I was no more fit for it than I was to preach the cross of Christ; that is, I was almost entirely unqualified for either profession. I was honest, sanguine, philanthropic, but I was uneducated. I knew very little, indeed, of human nature; still less did I know of the sublime art of becoming all things to all men, in the nobler and more elevated sense of the great apostle Paul. I would yield to no other compromise than such as he encourages, of course. Let us be honest and truthful, though the heavens fall.

CHAPTER XXIX

STANDING PATIENTS

Medical men well know – should any such condescend to look over this volume – what is meant when I affirm that I was not long in securing to myself a good share of standing patients. They are the dread, not to say the curse, of the profession. And yet they abound. They are found throughout the length and breadth of the land, and in great numbers.

They are a class of persons, not always of one sex, who hang continually, like an incubus, on the physician, and yet are forever a disadvantage to him. They are never well enough to let him alone, and yet seldom ill enough to require much medical advice or treatment. And yet, medicine they will have, of somebody, even if they go to the apothecary for it, without so much as the semblance of a medical prescription of any sort. But then, after all, they are seldom reduced to any such necessity. They usually have on hand prescriptions enough of some sort. A dearth of Yankee physicians – could such a thing possibly occur – would still leave us a supply of Indian doctors, mesmeric doctors, nutritive doctors, etc., etc., to say nothing of doctresses, in liberal abundance, ever ready to prescribe.

When I succeeded Dr. – , in the chair of medicine, surgery, etc., at – , I received, as if by contract, if not by inheritance, his whole stock of standing patients. They were not slow to call on, sometimes to call in, the new doctor. Nor was I often long in the house before comparisons began to be made between my predecessor and myself. They did not, of course, directly traduce or slander Dr. – , but they were very careful to intimate that, having got his name up, he had grown careless about his patients, especially such of them as did not belong to his clique, political or sectarian; and that, on this account, they were almost willing to part with him, and to receive and accept as his substitute one who was not only younger and more active, but also less tinctured with conservatism and aristocracy!

A very large amount of valuable time was spent during the first year of my practice as a physician, in endeavors to do good to these very devoted and loving and loyal patients; for if they did not always call me when I had occasion to pass their doors, I knew full well they expected me, and so I usually called. Besides, in many an instance I was sent for in post haste, with entreaties that I would come and see them immediately; and no atonement for neglect or even delay – if such neglect or delay was ventured – would suffice. And yet, despite of their fears of "monarchy and aristocracy," they were my most truly aristocratic patients. They expected me to come and go at their request, whether anybody else was attended to or not. And, to add to the vexation of the case, though they boasted of having paid most enormous bills to my predecessor, they never, if they could avoid it, paid any thing to me.

Now, I do not suppose that every medical man has as large a share of these standing patients as fell to my unhappy lot; but from the knowledge I have acquired of mankind, and from the acquaintance I have necessarily formed with medical men, I do not think I err when I affirm that they are everywhere numerous, and that they are everywhere not only a pest to society at large, but particularly so to the physician.

But the worst feature of the case is, that after all our efforts, we can seldom, if ever, cure them. They are always hanging upon us like an incubus; and yet like Solomon's daughters of the horseleech, are never satisfied. They take the medicine, and follow the advice, if they like it; or they take such parts of it as they choose, and reject the rest. Or they take the advice and follow us to-day, but get discouraged and abandon us, at least practically, to-morrow; especially if some smart young physician happens to come along, who has more than an average share of empiricism and pretension, and more than he has of real merit.

I must here confess, among other confessions, that at first I was not a little deceived by their open countenances and concealed thoughts, and unintelligent and hence unconfiding professions. It was a long time before I relinquished the hope of doing them good; or at least a portion of them. But I was at length compelled. There was nothing on which to build. If a foundation seemed to be laid one day, it would disappear the next.

One fundamental difficulty lay in the way of these persons to health, as it has to thousands of others. They were all the while talking or thinking about themselves, their ailments and woes and abuses and neglects. They were particularly inclined to turn their attention to their own diseased feelings. Now it may be pretty safe to say that no individual can fully recover from chronic disease, – nervous, stomachic, or glandular – who is always turning his thoughts inward, and watching his own feelings, and perhaps relating his woes to every one he meets with. We must learn to forget ourselves, at least a part of the time, and think of others, if we are in earnest to get rid of chronic disease. I do not say, of course, that everybody would recover of disease, even if they acted right in every particular; but this I do say, that if every person who is ill would act wisely, and if their physicians, in every instance, were wise enough to take the best course, the number of these standing patients would soon dwindle to a very small remnant. Instead of thousands, or tens of thousands, it would soon be reduced to hundreds.

CHAPTER XXX

KILLING A PATIENT

President Lindsley, late of one of our south western colleges, – a very shrewd and observing, as well as learned and excellent individual – has been often heard to say that no half-educated young physician ever succeeded in obtaining a good run of professional business, and a fair medical reputation, without despatching prematurely to the other world, at least as many as half a dozen of his patients.

It is said that most rules have their exceptions; and it is even affirmed by some, that the exceptions strengthen the rule. If this is so, perhaps the rule of Pres. L. may stand; though to many it seems at first exceedingly sweeping. One known exception to its universality may be worth mentioning, on which the reader may make his own comments, and from which he may draw his own inferences. I was so fortunate for one, as to attain to the eminence he mentions, without killing any thing like half a dozen patients; at least, so far as I know.

And yet, as I verily fear and most honestly confess, I did kill one or two. Not, of course, with malice aforethought, for they were among my very best friends; and one in particular was a near and highly valued neighbor. Let me give you a few details concerning the latter. It may serve as a lesson of instruction, as well as a confession.

He was about six feet high, with large vital organs; and though by no means possessed of a strong constitution, yet in virtue of a most rigid temperance, generally healthy. He was, however, subjected to the habitual influences of a most miserable cookery. Indeed, I never knew worse. Seldom, if ever, did he pass a single week – I might even say a single day – without having his alimentary organs irritated to subinflammation by more or fewer of what Dr. Dunglison, the physiologist, would call "rebellious" mixtures. I do not wonder, in truth, that he occasionally sickened. The wonder with me is, that he did not sicken and die long before he did. And though the blow that finished his perilous mortal career, was doubtless inflicted by my own hand, I do not hesitate to say that his "housekeeper" had nearly half destroyed him before I was called.

It was a midsummer night, when the messenger came across an intervening field, and aroused me from my slumbers with the intelligence that Mr. M. was very sick, and wanted to have me come and see him immediately. Although it was fully twelve o'clock, and I had been so fully occupied during the preceding evening, that I had but just crawled into bed and begun my slumbers, I was instantly on my feet, and in about twelve minutes at the bedside of the sick man.

He had been affected with a bowel complaint, as it appeared, for several days, during which his wife, who was one of those conceited women who know so much, in their own estimation, that nobody can teach them any thing, had dosed him with various things, such as were supposed to be good for the blood, or the stomach, among which was brandy and loaf sugar. Now his bowels, though they were inflamed, might have borne the sugar; but the brandy was a little too much for them. They had endured it for a time, it is true, but had at length yielded, and were in a worse condition than when she began her treatment. And what was worse, her alcoholic doses, frequently "inflicted," had heated the circulatory apparatus, and even the whole system, into a burning fever.

It needed no very active imagination, in such circumstances, to make out, at least in prospect, a very "hard case." And as he who has a giant foe to contend with, arms himself accordingly, I immediately invoked the strongholds of the Materia Medica for the strongest doses which it could furnish, and these in no measured or stinted quantity. In short, I attacked the disease with the most powerful agents of which I could avail myself.

I will not trouble the non-professional reader with the names of the various and powerful drugs which were laid under contribution in this trying and dangerous case, and which were most assiduously plied. It is sufficient, perhaps, to say that on looking over my directions – fairly written out as they were, and laid on a small stand near the sick-bed – you might have discovered that hardly a half-hour, by night or day, could pass, in which he was not required to swallow some very active or in other words poisonous medicinal agent or other. For though I was even then greatly opposed, in theory, to the exhibition of much medicine in disease, yet in practice I could not free myself wholly from the idea that my prospects of affording aid, or rather of giving nature a chance of saving a patient, was nearly in proportion to the amount I could force into him of opium, calomel, nitrate of silver, carbonate of ammonia, etc.

It was, in short, enough to kill a Samson or a Hercules; and I repeat that I verily fear that it did kill in the present instance; not, however, immediately. For several days and nights we watched over him, heating his brain, in our over-kindness, to a violent delirium on the one hand, or to a stupor almost like the sleep of death on the other.

Not satisfied with our own murderous efforts, we at length applied for medical counsel. My predecessor was not so far off as to be quite beyond our reach, and was in due time on the spot. He, good man, sanctioned the deeds already done, and only made through the force of their prepossessions, an addition to the dark catalogue of demons which already assailed if they did not actually possess him.

For the first time in my medical career, I suffered, here, from a loss of the confidence of my employers. A very mean man, who could gain notoriety in no other way, undertook to insinuate that I did not understand well my profession; and this story for a short time made an impression. However, there was soon a reaction in my favor, so that nothing was lost in the end. More than even this might be said – that I rose higher, as the result of the report.

Mr. M. at length began to decline. Nature, though strongly entrenched in her citadel, and loth to "give up the ship," began to succumb to the powers of disease and the load of medicine; and he gradually descended to the tomb. His whole sickness was of little more than a week's duration.

I was present at the funeral, but I could scarcely hold up my head, or look any person in the face. To my perturbed imagination every one who was but "three feet high" was ready to point at me the finger of scorn, and say, "You have killed that man." The heavens themselves seemed covered with thick darkness, and the green earth with sackcloth and ashes. "Never again," I said to myself a thousand times, "can I bear up under such sad and severe responsibilities."

And yet – will the reader believe it? – no one circumstance of my whole medical life ever did more to establish my reputation than this. True, I had contended on the battle field, and had been beaten, but then it was thought I had contended against a powerful foe. Men sometimes think it honorable even to be beaten. I well remember an instance of this sort. A very great scoundrel heaped insults upon a worthy justice of the peace, till the latter seized him and held him down to the ground for a considerable time. The man was quite respectable afterward, and told the story to his own praise a thousand times over! He had measured lances with 'Squire H.! And though the 'Squire was too much for him, he obtained a town-wide reputation by the contest.

You will see, more and more, as I proceed with these confessions, that it is not in him that willeth nor in him that runneth, to be acceptable as a physician, but in certain circumstances, partly within and partly beyond our control. You will see, however, that the best way in the end is, boldly and fearlessly to do right, and then trust in Him who loves right, and whose throne is in the Heavens, for the final issue. We may not always be popular in doing right – probably we shall not be – but we shall, in any event, have a clear conscience.

CHAPTER XXXI

A SUDDEN CURE

I was called one morning very early, to see a little girl, five or six years of age, who, it was said, was extremely sick, and without immediate aid could not probably long survive.

She was one of a very numerous family, most of whom, though suffered to run almost wild, like so many rabbits, were comparatively healthy. I do not suppose they had ever called in a physician more than once or twice in a year. In truth, they had very little confidence in physicians; though in extremities, they were accustomed to call on them almost as much as other people. In any event Caroline was very sick now; and they loudly demanded aid. I was forthwith on the spot. Caroline was groaning most piteously. "Where is your distress?" I inquired. She gave no direct answer, but continued to groan and writhe, as if she were impaled. As I could obtain no reliable information from her, and could discover no special or exciting cause of her suffering, and as the case was urgent, I proceeded to do something, though, as I must honestly confess, it was to labor quite in the dark. One thing I knew, it is true; that there were spasms, and that it depended on a diseased condition of the brain and nervous system; but what the cause or causes were, I could hardly divine. Nor, in truth, had I time to ask many questions.

Though the days of Hydropathy had not yet arrived, the world, even then, had a good deal of water in it, and physicians were sometimes wise enough to use it. It was demanded, as I thought, on the present occasion. It would, at least, by whiling away the time, give opportunity for further observation and reflection, and deeper investigation. There was a good fire in the kitchen, and I ordered a warm bath immediately.

Every effort was made to hasten the process of warming the water, as well as to keep the patient quiet and within doors; for she raved like a maniac – partly indeed from a childish fear, but partly also from real bodily suffering. The family and neighborhood – for the latter were very largely collected together – were almost as much alarmed and distressed as the little patient, and this reacted on the patient to her increased disadvantage.

As there were no special preparations in those days for bathing – I mean in the region of which I am now speaking – we used a large wash-tub. The water was soon ready, and was made rather warm, quite above 100° of Fahrenheit. I had taken the precaution to have my patient already undressed, so as to lose no time. The very instant the bath was ready, she was plunged into it. It cost some trouble, for she resisted with almost superhuman strength, and uttered most terrific screams. But as the ox is dragged to the slaughter, she was dragged into the water and held in it.

The effect was like magic. She had not been in the water twenty seconds before every thing was quiet; and I do not know that she has ever had another pang to the present hour. Certain it is that she seemed to be entirely cured by this single bath, and none of her spasms ever returned.

The family were greatly delighted, and so were the neighbors. And was the physician, think you, an uninterested spectator? Had he been wholly destitute of the love of doing good, by relieving human distress, he must at least have been susceptible of receiving pleasure from general approbation.

He certainly sought respectability as a physician. And this he was by degrees now attaining.

It is hardly possible to refer the sudden quiet which followed in this instance from the application of warm water, to a mere coincidence, as if the system was ready, just at this very instant, to react or rally. The bath must have had something more than a mere imaginary or accidental effect, though its prescription may be said to have been empirical.

Had the experiment in the present instance wholly failed, it is by no means improbable the physician would still have been on a par with other men. The guess he made was his only thought. He had nothing in reserve. But he was successful; he guessed right, and it built him up. His fame now began to spread far and wide, wafted, as it were, on the wings of every breeze. If he succeeded, it was supposed to be undeniable proof of his skill; if he failed, it was not supposed to be so much his fault as the result of circumstances; or, more properly, the severity of the disease. And even in the case of failure, as I have said elsewhere, he often gained credit; for he had boldly contended, at great odds, with a mighty because intangible antagonist!

It is an old proverb, – but by no means the less true for its age, – that when a person is going down hill every one will give him a kick. But is it not equally true that when he is resolutely going up hill, they are equally ready to help him on? So at least I found it at this period of my progress.

CHAPTER XXXII

GIGANTIC DOSES OF MEDICINE

Although I was opposed to the frequent and free use of medicine, I early fell into one habit which was as diametrically opposed to my general theory as could possibly have been. I refer to the habit of giving my patients, at least occasionally, most enormous doses of those more active preparations which should seldom, if ever, be administered in this way. As nearly as I can now recollect, I fell into this habit in the following manner:

Among my standing patients, before mentioned, were several drunkards. Occasionally, however, they were more than standing or standard patients; they had attacks of mania, or as it is usually called in the case of drunkards, delirium tremens. In these circumstances, among these patients, I often had the most severe trials. Sometimes I could relieve them; but sometimes, too, I failed.