Like many other young pract.i.tioners, I was at that time apt to indulge in gloomy fears about poisons. I seldom had a case of acute disease, without suspecting their influence. I suspected poison now, and accordingly made search into every possible nook and corner whence such an influence could possibly have emanated. For a long time nothing could be found.
One day, on examining a pot of pickled cuc.u.mbers which had hitherto escaped observation, I found that a part of its glazing had been destroyed by the acid. I no sooner saw this than I was ready to say, _eureka_ (I have found it), and to inform the family and my patient. It appeared that the pickles had been there for some time, and that the boy had eaten of them very freely. The parents and friends, though they had much confidence in the wisdom and skill of their physician, were very slow to believe in the injurious tendency of the pickles. They admitted the danger of such cases generally; but how could the boy be injured, and not the rest of them? they asked. They forgot, or did not know, that the poison would be more likely to affect one who was weakened in the abdomen from other causes, than those who were sound; especially when he took much more of it into his stomach than they did.
In my suspicion about lead poisoning, I had very little sympathy from those around me. Even the counselling physicians had little confidence in any such existing cause of disease. They were nearly as ready as other people to leave the case in the dark, and to say, practically, "The finger of Providence is here;" or, in other words, It comes of some cause which G.o.d alone knows or _can_ know.
How much of human ignorance--ay, and of human credulity and folly, too--is cl.u.s.tered round the well-known decision of many a court of inquest; viz., "Died by the visitation of G.o.d!" What do they mean by it?
Do they suppose that since Satan or some other personage whom we call Death, is guilty of striking us down here and there, those who are not "struck with death" are struck down by the great Source of light and life?
The far greater probability is, that they know not what they _do_ mean.
Mankind are not addicted to thinking, especially on subjects of this sort. It is much easier, or at least much lazier, to refer all our ills and complaints, as well as their unfavorable terminations, to G.o.d or Satan, friend or foe,--to some agency exterior to themselves,--than to consider themselves as the probable cause, and proceed to make diligent search for their own errors.
Thus it was, in a remarkable degree, in the region where it was my lot to meet and palliate and try to cure diseases. I say, here, _cure_; for the idea would hardly have found a lodgment, at that early period, in any human brain which could have been found in that region of rural simplicity, hardly in my own somewhat more highly enlightened cranium, that _medical men never cure_; and that when people get well, it is the result of the operations and efforts of nature, or of nature"s G.o.d, who is doing the best thing possible to set matters right.
It was even deemed by many as not only foolish, but almost sacrilegious, to say much about the causes of disease, and especially about lead. And then to talk about lead as connected with the use of their favorite red earthen, which had been in use time immemorial, and which had never, in all past time, killed anybody, as they supposed, was the dictate of almost any thing else rather than of good, sound, sober, common sense.
You can hardly imagine, at this day, in the year 1859, what an air of incredulity the gaping countenances of the family and neighbors of my young friend and patient presented, when I told them stories of lead disease in different parts of the country, especially of such cases as were then recent and fresh in my memory. One of these stories may not be out of place in the present connection.
About the year 1812, the people of Elizabethtown, Penn., put up what they called their apple b.u.t.ter in these same red earthen vessels, glazed, as almost everybody now knows, with an oxyde of lead. There had been a pottery established near the village that very year, and it was thought not a little patriotic to purchase and use its products, thus favoring the cause of home manufacture. Nearly every family, as it appeared in the sequel, had bought and used more or fewer of these vessels.
This was, of course, some time in the autumn. In the progress of a few months a dreadful disease broke out in the village, which baffled the skill of the best physicians, and consigned some forty or fifty of the inhabitants to the grave. The cause, at first, was not at all suspected.
At length, however, from a careful examination of facts, it was ascertained that the disease which had proved so fatal must have had its origin in the glazing of these vessels. The sickness abated only when it had attacked all whose bowels--already weakened by some other cause or causes--were duly prepared for the poisonous operation of the lead. It is indeed true that the physicians supposed the disease came to a stand on account of the overwhelming tendency of huge doses of calomel, which they gave to almost everybody who had used the apple b.u.t.ter; but of this there was no satisfactory evidence. It ceased, as I believe, and as I have already intimated, because--except in the case of those who were enfeebled by other causes, nature was too strong for it, or her recuperative powers too energetic.
Now this story ill.u.s.trates 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 circ.u.mstances 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 un.o.bserved or obscure, we have fallen into the habit of supposing that these things must needs be, do what we will. In other words, G.o.d 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 pract.i.tioner; 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 a.s.sailed, 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 n.o.blest under the whole heaven. The physician is, or should be, a missionary. Do you regard this a.s.sertion 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 n.o.bler 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 cla.s.s of persons, not always of one s.e.x, 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 subst.i.tute 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 pa.s.s 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 x.x.x.
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 const.i.tution, 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 pa.s.s 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 n.o.body 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 circ.u.mstances, 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 quant.i.ty. 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 a.s.siduously 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 pa.s.s, 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 a.s.sailed 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 succ.u.mb 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."