The Physician : Part 3

Doctor and Patient
by S. Weir Mitchell, M.D.

(Page 4 of 14)

My Dear Kinsman

The respectable age and character of your venerable patient leads me to regret that it is not in my power to suggest a remedy for the cure of the disorder you have described in her breast. I know nothing of the root that you mention as found in Carolina and Georgia, but, from a variety of inquiries and experiments, I am disposed to believe that there does not exist in the vegetable kingdom an antidote to cancers. All the vegetable remedies I have heard of are composed of some mineral caustics. The arsenic is the most powerful of any of them. It is the basis of Dr. Martin's powder.

I have used it in many cases with some success, but have failed in some. From your account of Mrs. Washington's breast, I am afraid no great good can be expected from the use of it. Perhaps it may cleanse it, and thereby retard its spreading. You may try it diluted in water. Continue the application of opium and camphor, and wash it frequently with a decoction of red clover. Give anodynes when necessary, and support the system with bark and wine. Under this treatment she may live comfortably many years, and finally die of old age."

He had here to deal with cancer, a disease which he knew to be incurable. His experience taught him, however, that in the very old this malady is slow and measured in its march, and that he could only aid and not cure. What he says might with slight change have been penned to-day. We have gone no further in helpfulness as regards this sad disease.

If what I write now is to have for the laity any value, it will be in correcting certain of their judgments as to physicians, and in suggesting to them some of the tests which will enable them to exercise a reasonable judgment as to those in whose hands they place so often without a thought the issues of life and death and the earthly fates of their dearest.

I began, somewhat discursively, by showing how much care the masters of my art gave even in past days to matters of diet and modes of life. This is still to-day a test of larger applicability. There are those of my profession who have a credulity about the action of drugs, a belief in their supreme control and exactness of effect which amounts to superstition, and fills many of us with amazement. This form of idolatry is at times the dull-witted child of laziness, or it is a queer form of self-esteem, which sets the idol of self-made opinion on too firm a base to be easily shaken by the rudeness of facts. But, if you watched these men, you would find them changing their idols. Such too profound belief in mere drugs is apt, especially in the lazy thinker, to give rise to neglect of more natural aids, and these tendencies are strengthened and helped by the dislike of most patients to follow a schedule of life, and by the comfort they seem to find in substituting three pills a day for a troublesome obedience to strict rules of diet, of exercise, and of work.

The doctor who gives much medicine and many medicines, who is continually changing them, and who does not insist with care on knowing all about your habits as to diet, mealtimes, sleep, modes of work, and hours of recreation, is, on the whole, one to avoid. The family doctor is most of all apt to fail as to these details, especially if he be an overworked victim of routine, and have not that habitual vigilance of duty which should be an essential part of his value. He is supposed to have some mysterious knowledge of your constitution, and yet may not have asked you a medical question in months or years.

Too much is taken for granted, and inefficient opinions are the outcome of carelessness. Every new case in a household should be dealt with as if it were a stranger's, and outside familiarity should not be allowed to breed contempt of caution in study or lead to half measures. Every consultant will agree with me that this kind of social nearness of the doctor to his patient is a common cause of inert advice, and nowhere more distinctly so than when unwise physicians attempt to practise in their own households on those they love.

There are very few instances of chronic ailments, however slight, which should not be met by advice as to modes of living, in the full breadth of this term; and only by a competent union of such, with reasonable use of drugs, can all be done most speedily that should be done. I have said "with use of drugs," for I am far from wishing to make any one believe that medicines are valueless. Nor do I think that the most extreme dosing employed nowadays by any one is as really hurtful as the neglect to urge efficiently the value of definite hygienic means. There are, indeed, diseases which can only be helped by heroic measures; but, in this case, were I the patient, I should like to be pretty certain as to the qualifications of my hero.

The popular view of the great hurtfulness of drugs is curiously fallacious. I have spoken above more of their relative usefulness, as compared to other means of relief, than with any desire to convince my readers that they are such terrible things as some kinds of practitioners would have us to believe. The dread of their employment is a relic of the time of reaction against the senseless and excessive dosing with calomel and strong purges, and nowadays, even as regards bleeding, once wholly abandoned, it is clear that it still has at times its uses, and valuable ones, too. As medicines are now employed, even by the thoughtless, it must be rarely that they give rise to permanent injury. Let any physician who reads these lines pause and reflect how many times in his life he has seen lasting or serious evil results from drugs.

Accidents happen, but they are the offspring of carelessness. Sometimes, also, unexpected and temporary extreme results surprise us, as when an opiate purges, or five grains of an iodide prove to be gravely poisonous. These occurrences are due to individual peculiarities, which we can as yet neither explain nor anticipate. One man can take opium with almost the impunity which belongs naturally to birds. Another is put to sleep by the dose you give a baby. All this teaches caution, but it is not a matter for blame when it gives rise to alarming consequences, and happily these cases of what we call idiosyncrasies are exceptionally uncommon.

About the Author

Silas Weir Mitchell was an American physician and writer. He studied at the University of Pennsylvania in that city, and received the degree of M.D. at Jefferson Medical College in 1850. During the Civil War he had charge of nervous injuries and maladies at Turners Lane Hospital, Philadelphia, and at the close of the war became a specialist in neurology.