Coming into Line.
If the rank and file of the profession were the dictators, the science of medicine, in the practical essentials, would be years in advance of its present position; prejudice would long ago have been forgotten, and dogmatism would be an unknown quantity in the profession. But every profession has its dictators. In the United States the editors of the medical journals and certain conspicuous men in the faculties of the prominent medical colleges, have dominated the profession for years.
It now looks as if the busy doctor was going to take the bits in his teeth; was going to do some thinking for himself, and was going to free himself from the domination of the dictators. The demands which the individual practitioner must meet, force him to this or, in therapeutics particularly, he will still be bound hand and foot, and dragged behind the band wagon, in which the liberal minded thinkers will ride.
At the head of medical dictation in the United States now, is The Journal of the American Medical Association. This journal controls the policy of the Journals of the State Associations. The time has come when the members of the faculty, so called, dare not speak, except the chief editor raises his hand. This domination has encouraged prejudice, has fostered dogmatism, has cherished narrowness, bitterness and rancor against everything that swung clear of their domination.
Most conspicuous, among the incongruities of this, in many things a great Journal, is the bitter fight it has waged this year against the only systematic effort that has ever been made, in the regular school, to teach the profession a rational and consistent method, of direct drug study, and direct drug action; one that has won so general approval. In my August number, I said, concerning Dr. Abbott and his work, "No man has so fully aroused the Regular profession to the importance of the exact study of disease indications and the adaption of exact, positive and reliable remedies to these indications; no man has produced so complete a change in the methods of study in his school, or has directed them more fully into a rational course, which means a perfect therapeutics for the entire profession. No man today is doing more to break down obnoxious sectarian barriers, and obliterate the bitter prejudices of the long past."
These things are what the profession need; these things are what the liberal spirit of the times demands; these things are what the busy doctor, in the sharp contention of the present day, is looking for and will have. The question then immediately arises, why does not this great Journal that claims to stand at the head of the greatest profession in the world, foster, encourage and support this essential demand? Why does this journal turn its entire battery of vituperation and contumely in probably the most vicious attack it has ever made upon any one person, upon this, the first great effort that has ever been made and accepted, to put the prescribing of the regular practitioner on a precise, exact, specific, rational and absolutely practical basis?
This is certainly hard to understand, but the truth is that the mass, the body of the profession will gradually slip away in practice, from this radical domination, and the impractical faculty will find themselves in an unpopular position, and without a following.
This dominating influence is undertaking also to obliterate all those medical journals that are not within its dominating influence and especially those that are friendly to the entire profession without regard to school. The fight against these journals is becoming very bitter.
In a recent editorial The Wisconsin Medical Journal says:
The Journal of the American Medical Association should be above such things. We as members of the Association protest against the critical, persecutory policy that has characterized the journal for the past two or three years. This policy is causing discord in the profession, and there is today more un-harmony, more suspicion, more backbiting, more bitterness in the medical profession than there has been at any time in the past twenty-five years. It may be true that we have a stronger organization, but it is the organization of the "machine."
Dr. G. Frank Lydston, one of the first physicians of Chicago, is among a band of prominent Regulars, among whom could be named Dr. Geo. F. Butler and others, who, with the rank and file, repudiate this dominating influence. Dr. Lydston in Dr. Daniel's Texas Medical Journal presents his sentiments in clear-cut, strong terms. The following are some of the things which the doctor, has to say:
The feature of the better class of independent journals that appeals most strongly to me is the mere fact of their independence in wearing no brand or collar. As matters medico-literary are now trending, the day is not far distant when the average practitioner of medicine will have no medium of expression, no literary representation and no literary pabulum of practical value within the comprehension of the average medical mind. I'm going to expatiate, enlarge, amplify, elucidate and—"conflagrate" this theme a bit, earnestly hoping that the multitudinous ultra-ethical self-labeled medico-literary perfecto will eventually be told what I have to say. Indeed, I'm sure he will, and, moreover, that he will stop browsing among the thistles of discontent just long enough to gather new notes for his raucous, discordant bray—that bray of narrow-minded, illogical protest wherewith alone he attracts the attention of the professional rank and file to himself, and incidentally, of course, to his literary holy of holies, choked to the brim with intellectual sweepings from other men's garrets.
Medicine is fast becoming so scientific, so turgid with "things that ain't so," or which are at least "under suspicion," that the main purpose of medicine, the healing of the sick, bids fair to be lost in the maze of laboratory experimentation and illogical deductions from mentally indigestible "facts"—scientific bricks without straw—from which none but a wizard could build an enduring fabric. What boots it to the practioner of the crossroads that there be opsonins and opsonic indices ? He has neither the technical training, the appliances nor the time to practically apply them in his daily work. Besides, who knows how soon the opsonins will be gathered to the snows of yester-year?
I fancy I hear the ultrascientific ones cry "Let the practitioner of the cross-roads and the hamlet hie him to the postgraduate school and cultivate—at so much a cultivate—'the optic sharp I ween that sees things which are not to be seen.' Let, also, the student of medicine be more thoroughly prepared in things scientific."
The postgraduate school often makes confusion worse confounded. Abdominal and other special surgeons "made while you wait," men who entered the mouth of the hungry P. G. school, passed immediately through its short, angleworm like prima viae with a special-course certificate in their hands, have not seldom out-heroded Herod —which means that where the haughty professor of the special P. G. course hath slain his dozens, some of his half-baked special students have slain their scores, aye, hundreds.
Our medical schools are responding with alacrity to the demand for ultrascientific training. The ultima thule of medical teaching in some quarters apparently is the manufacture of half-educated scientists, not trained physicians. Here is an illustration of some of the brilliant results. I recently had occasion to inquire into the knowledge of materia medica and therapeutics possessed by a recent graduate of a well-known school, who, by the way, was one of the ten "Honor Men" in his class:
Question— "What is the botanic name of the plant from which opium is derived?"
Answer— "Poppy, I think."
Q.— "What is papaver somniferum?"
A.— "Poke root."
Q.— "What are the alkaloids of opium?"
A.— "Morphine and atropine."
Q.— "What preparation of aconite would you ordinarily prescribe internally?"
A.— "Why, aconite."
I suggested that the tincture was an eligible preparation, and informed him that there were two tinctures.
Q.— "Which tincture would you give to a child?"
A.— "The tincture of the root, because it's the milder."
Q.— "What dose of the tincture of the root would you give to a child six months old?"
A.— "Oh, about one-half a dram every hour."
Q.— "Given the same child and a stimulating expectorant being indicated, what would you give?"
A.— "Carbonate of ammonia."
Q.— "In what dose?"
A.— "Oh, twenty grains every three hours."
Be it remarked that materia medica and therapeutics are taught in the sophomore year in the school from which this gentleman graduated. The treatment of disease is taught before the raison d' etre of treatment has dawned on the student's mind. But, this newly fledged graduate knows a lot about the embryology of the chick—he had watched it for weeks—the nervous anatomy of the frog, neurons, opsonins and things—which knowledge is not likely to save from massacre the first hapless infant he treats.
The independent medical journal meets the demand of the everyday practitioner who wants to know "what to do." The self-styled high-class medical journal—and there is really only one "high-class" journal, you know, which is climbing so high that its head looks from below very like that of a pin, often gives him a stone when he asks for bread. He seeks for light on the treatment of disease, and on looking over the menu card presented by the "most high," he finds such things as "My Last Thousand Cases of Excision of the Calamus Scriptorius," "My New Postural Method of Catheterizing the Iter e Tertio ad Quartum Ventriculam," "The Opsonic Index in the Care of the Second Bicuspid," etc.; and editorials in which the mantle of dignity conceals vast intellectual abysses.
In despair he turns to that cemetery in which so many fond therapeutic hopes lie blasted and buried under tons and tons of therapeutic nihilism—Osier's "Practice"— and still he finds no balm in Gilead. And then he turns to the independent journal and is consoled—which is a blessing, e'en though he be sometimes cajoled into belief in things unsubstantial. And the proof of the pudding is that thousands upon thousands of doctors buy and read the very journals upon which the "lily whites" of medical journalism frown so blackly.
The ultra-scientific one who does not overmuch believe in treatment and recognizes naught but the scalpel and hemostatic forceps sometimes marvels that anyone could condescend to read, much less contribute to, our independent journalistic media of medical expression. "Nothing in drugs," he wails; "send 'em to me and I'll cut 'em." He forgets that modern science has not yet conquered the lay aversion to the knife, nor the honest practitioner's belief, that, after all, the knife is often a confession of our limitations and weakness. And there is much in the training of the experienced practitioner which inspires him with therapeutic hope in a vast number of the ills of the flesh.
By drugs he can produce anesthesia, local or general, relieve pain, produce sleep, stimulate or depress the circulation, allay nervous irritability, aid digestion, relieve constipation and hepatic torpor, produce emesis, diaphoresis and diuresis, antidote malaria, and cure syphilis. What wonder that he has confidence in drugs per se while rather skeptical of our knowledge of them? "There must be a remedy. If I only knew" is a brow-contracting reflection familiar to the conscientious practitioner. And so long as there are sick ones to heal so long will he search for remedies—and so long will he read and believe in the literature that offers therapeutic hope.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.