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Doctors and Patients.

Sarah O. Jewett.

      In the first place, doctors. And what I wish to say is that they are apt to be much abused.

      One hears a great deal more in these days about the patients being abused, and I have not the slightest doubt that much of it is melancholy truth. Le Sage certainly thought so. 'Death,' says he, 'has two wings; on one are painted war, plague, famine, fire, shipwreck, with all the miseries that present him at every instant with a new prey. On the other wing you behold a crowd of young physicians about to take their degree before him. Death, with a demon smile, dubs these doctors, having first made them swear never to alter in any way the established practice of physic.[']

      It is hard to understnad how men can deliberately attempt to carry such responsibilities, knowing as they inevitably must, from ill-success alone, their utter incapacity. There must be a wonderful self-satisfaction in the hearts of some of our fellow-creatures; and it is discouraging to see how many of them are contented with such low standards in life, showing perfect resignation to staying where they are, and indifference to the results upon others. Not only among doctors, can one see such perverted, narrow ideas, and disregard of the claims of the world, because of a business a man has undertaken. Who has not known quack clergymen who are, perhaps, the most deplorable class of all and, -- but we might continue such meditations at great length, and our minds would soon be in such a state that we could not call this publication The Tonic any more; but The Depressant [Depressent].

      Besides these guilty members of the profession, there are some who are unsuccessful, because, however learned they may be, they are not practical; like some lawyers who are capital students, and yet can never make themselves successful pleaders or ready counsellors.

      But the doctors of whom I thought in the beginning, are the 'good doctors,' who study and think, and care for their patients as well as they can; the men who are willing to tell you what they cannot do, for it is only an impostor who promises you everything. These men are often blamed on unreasonable grounds, where the fault, the non-recovery, is wholly owing to the patient himself, or mis-management on the part of friends, not that I mean to say that the doctors are entirely wise or wholly bad; for the best man must make an occasional mistake, and the most unmistakable quack has his lucky hits and successes.

      People seem to have a lurking conviction oftentimes, that a physician must have made some blunder, when his patient dies. Of course we must measure his ability, somewhat by this test of life or death, but not wholly, for does not the most renowned medical man lose a large proportion of his patients; those who are incurable and go to him as their last hope? We cannot change the fact that everyone of us must die sooner or later, in spite of the most acute perceptions and greatest learning of the individual, or undreamed of progress in the science of medicine.

      It is very common, as I have said, that a doctor is found fault with deservedly, but it is no less common that he is found fault with undeservedly. I am sure that the cases where the mal-practice is the patient's fault, are more numerous than where it is the doctor's. First, how often the patient demands impossibilities when it is out of the power of man to prolong his life, for the disease is incurable.

      There are many people who have inherited ill-health, or still suffer from the effect of some former illness; it is not owing to any defect in the doctor's skill that he can never get well, and is merely made more comfortable for a time.

      There are many cases where the disease is much involved and very difficult to understand, because the doctor does not see them as nature made them. Perhaps first, the man unsuccessfully tried to cure himself, and then went from one physician to another, not infrequently stopping longest at his door who promised most and knew least. If some man of real ability begins work on such a case as this, how does he know what is really the matter; what is constitutional and what may have resulted from unsuitable treatment. What could the best clock-maker in the world do, if you carried him a clock that had been worked over by dozens of people after it had been found mysteriously out of order. He looks it over and sees the works too much filed here, and badly balanced there, and would he not be likely to tell you that it will always go unevenly and unsteadily?

      In many instances people only need time for recovery, where we cannot trust wholly in any remedy but rest. Who would think of keeping a tired man awake all night to give him stimulating medicine after his hard day's work? Nothing can possibly take the place of the sleep he needs. So persons whose minds and bodies have been severely strained and taxed need a rest in proportion to the fatigue, yet they wonder that they do not get well before the first prescription has been half followed out, and then grow impatient. For one who needs absolute rest, five need rest merely from certain employments and interests that are wearing them out, and require change of scene and thought. I read a capital story years ago of one of Dr. Abernethy's prescriptions. A gentleman came to consult him, who could neither sleep nor eat and who was very nervous and depressed. The doctor said he could recommend nothing, but there was a physician in a small town in the north of Scotland, who had been wonderfully successful in such cases, to whom he would give him a letter. So the invalid, after some persuasion, left his business and started for Scotland, travelling very leisurely as was directed, and the end was that when he got to the end of his journey there was neither any such doctor there, nor need of him if there had been. There are women who have done the same things over and over again for years, whose tiresome life of housekeeping begins to wear them out, and what medicine will cure them with one dose?

      Some people will never get well until they cure themselves of worrying. Sometimes this comes from improper management of their religious nature; sometimes from useless thoughts of the past, and needless anticipations of the future. Often disappointment crushes a man and changes him for the rest of his life, mentally and physically.

      There are persons whose disease originated in overwork, but it is no less true that it comes from a lack of work as well. Employment would have cured some of our friends who are really dying, and will cure many who imagine they are dying from some mysterious nervous disease, which the doctors fail to cure, and do not seem to appreciate. They are persons qui l'écoutent vivre, as the French phrase has it; they watch themselves constantly, and the ailments of which another would be barely conscious, are to them sources of exquisite torture. If they would only find something else to do! The mind has so much control over the body if you only allow it a fair chance of taking the upper hand; but once give yourself up to watching for the time your head begins to be dizzy, and when the time comes your power of ignoring it has vanished; that slight feeling of dizziness is the controlling power of your existence. Expect to be better, not worse, and there is a great deal more chance for your doctor. For the doctor cannot make people happy and set their minds at rest, and it is often merely this that makes invalids of us. We may take all the medicine we please; where there is some family trouble, or business entanglement, we are wretched and hopeless and sad. Is it the doctor's fault, then, that we grow no better day by day? If we can be happy and interested, and throw off the weight that holds us down, his part of the cure is very slight.

      Can the doctor do much for us when, at the same time we carefully drink his medicine, we relentlessly follow the fashion of living that brought on the disease, and will still carry it on until we take leave altogether of the bad habit? [.]

      After the prescriptions are given and the management of a sick person wisely directed, the good results are often hindered by the stupid ignorance, and wilful neglect of the directions, and of the simple physical laws of life. To many people advice is uselessly given, for as Horace Walpole said: 'It is no use trying to cure some men of their follies, until you can first cure them of being fools.'

      Look at the localities which people make choice of for their houses, and still how often one hears of the family's being so weak and delicate, and so sadly afflicted by the deaths which have followed each other in quick succession. Then there is a reflection, perhaps, upon the mysterious dispensations of Providence. Doubtless nobody's death has ever taken Providence by surprise, and no one has gone away from this world till he was done with it, and his place ready in the next; but, for all that, one cannot encourage houses being built in swamps. And think of men's unfathomable ignorance of the plain truths of ventilation!

      And so people do just as they please with their minds and bodies, and when the inevitable results show themselves; when the minds show that they are growing useless, and things look different, and the sunshine seems to be going out of the world; when the bodies are worn out, then the doctor is considered capable of making up all the deficiencies. But his skill cannot counteract and supplement and fill out; or give us back the health and power we started with, and have lost, through neglect of ourselves. He cannot make us start out afresh and live right on again, as if we had been careful and sensible, and all these things had not been educating us for invalids. Perhaps we begin to be very ill some day and send for the doctor to cure our disease.

      But when we are ill it is not invariably like a fish-hook which an unlucky boy can have the surgeon take out of his hand, which soon recovers from the wound. It is we who are ill, and the part that is weakest gives out first. Did you ever know a farmer to try to doctor a branch of one of his apple trees that is growing yellow? When the tree is strong the leaves keep green enough.

      And besides all this, there is something else that makes your doctor appear noticeably inefficient, for he cannot cure old age. People are so often unjust and unappreciative in such questions as these, where the patient has either done nothing whatever for himself, when the cure is in his own hands, and where the cure, which the doctor might make, is hindered or made impossible.

      And so, finally, take the best care of yourself you possibly can. If you are ill, send for the best doctor you know and can get. Do just as he tells you, for the best doctors are not too good, and you must lift at your end of the log. And above all do not show yourself such a patient as those suggested by this witty old English rhyme:

      'God and the doctor, men alike adore,
      When on the brink of danger, not before;
      The danger past, they are alike requited,
      God is forgotten and the doctor slighted.'


Notes

"Doctors and Patients" originally appeared in The Tonic (Portland, ME, June 12, 1873, p. 3). The Tonic, edited by Mary S. Deering, existed from June 7 through June 19 of 1873 as a daily newspaper of the Maine General Hospital Fair in Portland, Maine. The text appears here courtesy of the collections of the Maine Historical Society, Portland, ME.  Errors in the text have been corrected and indicated with brackets.
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Le Sage certainly thought so. 'Death,' says he, 'has two wings; on one are painted war, plague, famine, fire, shipwreck, with all the miseries that present him at every instant with a new prey. On the other wing you behold a crowd of young physicians about to take their degree before him. Death, with a demon smile, dubs these doctors, having first made them swear never to alter in any way the established practice of physic': Alain René Lesage (1668-1747) was a French playwright and novelist, best known perhaps for his picaresque novel, Gil Blas (1715-1735).   Almost certainly Jewett's source is Fallacies of the Faculty (1861) by Samuel Dickson, Lecture 1, p. 4, which also contains a Moliere attribution in "Protoplasm and Housekeeping."    She quotes the Moliere passage almost directly.  See Google Books.

   
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Dr. Abernethy's prescriptions: In Memoirs of John Abernethy, F. R. S. (1853), George Macilwain, cautions that there are many legendary anecdotes repeated about John Abernethy (1764-1831), a London born physician and author on physiology. This particular story is not in the memoir, but similar stories do appear, Abernethy having a sense of humor as well as medical expertise.  Edgar Allan Poe's detective, Dupin, tells a humorous anecdote about Abernethy in "The Purloined Letter" (1844).
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Horace Walpole ...'It is no use trying to cure some men of their follies, until you can first cure them of being fools': Horace Walpole (1717-1797) was a British author, art historian, printer, politician, and wit. Cassandra Phillips, University of Saskatchewan, has identified the source of this quotation: "Letter 296 to John Pinkerton, Esq. Strawberry Hill, Sept. 30, 1785." Letters of Horace Walpole (1842), v. 4, p. 376," (schulers.com/books).
    In the letter, Walpole says, "Now that I am very old, I sit down with this lazy maxim; that, unless one could cure men of being fools, it is to no purpose to cure them of any folly, as it is only making room for some other. Self-interest is thought to govern every man, yet is it possible to be less governed by self-interest than men are in the aggregate?"
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Providence: The activities of God in the physical world.
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the plain truths of ventilation: In medicine, this refers to clearing the lungs and restoring normal breathing of patients in respiratory distress. However, it seems here that Jewett is referring to a less specialized knowledge about breathing or the circulation of air in buildings. Further information is welcome. (Research: Gabe Heller).
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witty old English rhyme: At GIGA-USA.COM, this epigram is credited to John Owen, "the British Martial" (1560-1622), and it is given in slightly different words:

      God and the Doctor we alike adore
      But only when in danger, not before;
      The danger o'er, both are alike requited,
      God is forgotten, and the Doctor slighted.
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Edited and annotated by Terry Heller, Coe College.


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