In 1846, Sir John Forbes, then at the head of the medical profession in England, said, concerning that part of medical science which more immediately addresses itself to the curing of diseases, “things have become so bad, that they cannot be worse; they must mend or end.” He proceeded to show in what particulars “things were so bad” and in what manner they might be “mended.”
The truthfulness of this essay, in the way both of exposure and of instruction, has been generally admitted. It was an earnest appeal to the medical profession to rescue their art from the ruin into which it was sinking — a solemn admonition to “mend” it, before its inherent iniquities should accomplish its “end.”
Some of the older physicians of the day thought Forbes had done a great mischief. A few of the medical magnates of Boston considered it a misfortune to mankind that he had ever lived, and after his death they virtuously refused to subscribe to his monument-fund.
A great many of his younger contemporaries concluded that to “mend” the art of medicine as Forbes had shown the way, was very hard indeed — whereas to “end” it would be much easier for them and quite as well for the public. From this time therefore it began to be quite fashionable to deny the possibility of curing disease, of arresting or curtailing any morbid process. Thus the science of Therapeutics began to be “ended” rather than “mended.”
Of that art about the “mending” of which he had written so enthusiastically and so wisely in 1846, very little is said. The burden of the essay is that the “end” of Therapeutics is at hand — that there is in effect, almost no such thing as “curing” a disease, and that hence there can be no art of curing.“ Giving up the idea of ”mending things“ he announces and, by the weight of his authority, may be said to decree their ”end.“
On many particular questions of Therapeutics the opinions of thoughtful physicians have undergone great changes within twenty years. On none is this change more striking than on that of the use and abuse of Mercury. It has been practically proven that, at least certain forms of syphilis are more readily cured without Mercury than by means of it. The same is true of iritis, remittent, bilious and yellow fevers, in which, at one time, Mercury was the universal remedy. Earnest and persevering endeavors have been made to convince the profession, by reasoning and by statistics, that Mercury has been terribly abused as a remedy, to the great detriment of the human race — to demonstrate that in this particular of the art of medicine “things” are very “bad,” and that they sadly need “mending.”
And, now, after this endeavor has been making for thirty years, with very little success, the Surgeon-General of the United States Army issues an order in which he says, substantially, “things in this respect,” the use of Mercury, “have become so bad, that they cannot be worse; they must either mend or end;” and then, despairing of any ”mending“ (of which, indeed, the thirty years past have given no sign), he concludes to ”end“ them by prohibiting the use of Calomel (and Tartar emetic) in the Army!
From this time on, so long as the war shall last, 600,000 men of the United States are safe from the danger of the Mercurial Cachexy. It may be reasonably estimated that 10,000 are relieved from a daily dose of Calomel!
This remarkable order was based by the surgeon-General upon tabular returns from army hospitals, which showed that the wholesale administration of Calomel and Tartar emetic had produced evil effects, far outweighing any good that might have resulted from a proper use of these substances.
The effect of the order upon the profession, outside of the army, presents some very interesting phenomena. While many physicians belonging to the Expectant, or to what styles itself the Physiological School, hail the order with pleasure as a great blow at once at the prevalent fashion of drugging, and at the doctrine that diseases are capable of being arrested or abbreviated by medicines — for in this fashion-and this doctrine they have no faith — the majority of medical men protest against the order. They argue that the use of Calomel and Tartar emetic is no more prevalent in the army than in civil practice, since most of the surgeons of our volunteer army were drawn from civil life and represent civil practice. If, then, these drugs are so hurtful to citizen- soldiers they must be almost, if not quite, equally hurtful to citizens at home. If the soldiers stand a better chance for life, while battling with disease, when unaided by these potent drugs than when duly dosed in more majorum — the inference is irresistible that civilians also would stand a better chance of recovery without these drugs than with them. The public will not be slow to draw this inference and to demand a radical change in the general practice of medicine. This argument furnishes a strong ground of opposition to the order, and was warmly urged at the recent meeting of the American Medical Association in Chicago.
The blow is the more severe, coming as it does from a member of the profession so highly esteemed for scientific attainments as Surgeon-General Hammond, a man who has in addition shown himself to be the most efficient and capable member of the Executive branch of the Government.
The views of old school journals are interesting. The American Medical Times in its first allusion to the order, says, that “doubtless all quacks and irregulars are congratulating themselves and each other upon the appearance of this order.”
However this may be, we cannot, for our own part, perceive how any member of the profession who has its real dignity at heart, can regard this order of the Surgeon General with any other feelings than regret for its necessity and mortification that there should be no way of preventing the abuse of drugs, save the prohibition of their use.
We have before taken occasion to object to legislative or administrative prescription or prescription of any particular method, whether in civil or in military medical practice. We objected on this ground to the enforced introduction of Homoeopathy into the army, and at the same time to the administrative exclusion of homoeopathic practitioners from Government service. Holding that the physician in attendance upon a case is and should be the only person capable of judging and pronouncing upon the particular method or drug most likely to cure the case, we maintain that he should be absolutely free, so far as law, influence and opinion are concerned, to select method, drugs and appliances according to his convictions. The supervision, which Government is authorized and bound to exercise, is anterior to all this. It is the duty of the Government to take care that none are admitted to exercise the functions of the physician in any position, unless duly qualified for the performance of their duties. Once thus qualified and admitted, the supervision of Government over his actions should cease, unless by the commission of misdemeanors, he come under the category of malefactor.
But this claim for absolute freedom for the qualified practitioner involves certain serious obligations on his part. He is not only to be well educated when admitted to practice. He must keep himself well educated as years pass on. He must not allow the tide of scientific progress to sweep past him. If this obligation were honestly fulfilled there could be no pretext for prescription or prescription of any system or of any drugs.
Has any new method of treatment been discovered which is shown to be an advance in Therapeutics? There will be no need of a legislative ordinance to compel its adoption, if the medical men have been faithful to their duties; for they will have taken note of this advance in science, and will already, by their own free choice, have adopted it in their practice.
On the other hand have increasing knowledge, and more extended investigations shown certain drugs to be unnecessary or hurtful which had formerly been regarded as indispensable and salutary. If physicians have kept themselves informed of the progress of knowledge, there will be no need of any enactment prohibiting the use of these drugs in medical practice. They will have ceased to be used, by the spontaneous volition of medical men, as soon as a knowledge of their hurtfulness has been proclaimed.
The grounds of Dr. Hammond's objections to Calomel and Tartar emetic are facts, as accessible to all medical men as to Dr. Hammond. Why did they not work a practical conviction in other minds as they did in his?
But, it may also be asked, why did not Dr. Hammond issue an essay against the abuse of these drugs, instead of a peremptory order forbidding their use? The question is plausible. Be it remembered however that the facts in the case are nothing new. They have been accumulating before the profession for thirty years. Williams, Fergusson, Bennett have demonstrated the needlessness, the hurtfulness of Calomel as generally used. What more could Hammond hope to do? The profession ”have Moses and the prophets.“
A sad spectacle, then, is presented us. A gentleman selected from among the medical men of the whole country, for his scientific attainments and for his administrative tact and ability, for the express purpose of reorganizing on a gigantic scale the Medical Department of the Army, virtually proclaims by his order, that the medical men of the country are so behindhand in knowledge as to be ignorant of facts which have led to settled convictions in his own mind, and are moreover so dull or so prejudiced that their conviction, by a statement of facts, is not to be hoped for. They must therefore be led to improvement through the instrumentality of a peremptory order.
Thus to expose the sad moral and intellectual status of a profession we love and honor, is an ungrateful though a necessary task. It furnishes an explanation of the relations of Homoeopathy to what is called the Regular Practice and a refutation of a well worn argument against Homoeopathy.
It is often triumphantly said, if Homoeopathy were really what its advocates claim, medical men everywhere would have adopted it, of their own volition, for they are, from the necessities of their profession, ever on the lookout for improvements. Or, if its claims have hitherto escaped their notice, a simple exposition of them will be all that is needed to ensure instant attention- and prompt conviction and adoption.
Very well. Now by a parity of reasoning we may say. If Calomel and Tartar emetic be, indeed, the engines of mischief which their enemies assert them to be, medical men everywhere must have discarded them already, voluntarily. Or if, through inadvertence, they have not done so, it will need only a tractate on the subject to induce them instantly with one accord to strike them from their lists of remedies. Did Dr. Hammond think this good reasoning? On the contrary, he was satisfied that neither their present knowledge nor any that they might acquire through any statement of facts, that could be presented, would so far affect their practice as even to lessen the abuse of these drugs, and so he resorted to a direct prohibition of their use. He ought to know the minds of his colleagues. From his knowledge of them as displayed in his order, we are compelled to conclude that no investigations of their own, nor any statement from others would lead the medical profession to a correct estimate of Homoeopathy; and, indeed, if they are not to be trusted to form a correct judgment about Calomel and Tartaremet., how could they be expected to form one respecting an entirely new and difficult system of practice? If they may not bo trusted to judge aright of the merits of Calomel as a drug, how could they be confided in to judge of Homoeopathy as a system? DUNHAM.
|The American Homoeopathic Review Vol. 04 No. 02, 1863, pages 48-55
|Mend Or End.
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