Selected writings of John M. Scudder.
Symptoms are sign boards pointing to diseased conditions, and he who does not recognize them as disease expressions having a definite relation to drug force has little right to practice medicine. Dr. Scudder was discriminating as to symptoms, basing his specific indications upon prominent and unvarying symptoms as expressing definite pathologic wrongs.—Ed. Gleaner.
SYMPTOMS.—I am frequently met by the half interrogatory, "O, you prescribe for symptoms, do you?" Sometimes this is supplemented by, "I thought the science of medicine had so far advanced that physicians should prescribe for definite pathological conditions." I answer that I prescribe by symptoms; or if the inquirer is persistent, I will confess that I prescribe at symptoms, and that without "symptoms" I am nothing.
What so-called scientific physicians prescribe by or at the Lord only knows. It is probable that the minority in these latter days (who lay claim to be scientific) are prescribing at microbes. The majority are using the same old shot-gun pointed at the name of the disease, and hitting the patient quite frequently. All claim to be guided by standard authority, and want to be protected by the State against irregulars, who seem to be getting more than their proportion of the practice.
Confessing that I prescribe by or at symptoms, we will get at the matter better by having a definition of the word. Thomas defines symptom as, "a concurring circumstance happening simultaneously with the disease, and serving to point out its nature, character, and seat." He does not seem to be a doubting Thomas in this matter, and I shouldn't wonder if he also prescribed by symptoms.
Let us try Worcester, and see what educated men, other than doctors, think of the word: "A perceptible change in the body or its functions, which indicates disease. A sign or token: that which indicates the existence of something else."
How do we know things? Through our senses—sight, smell, hearing, touch, taste. Can we know them in any other way ? No; absolutely no. Symptoms then are the evidence of our senses. They are what we see, smell, hear, touch, taste, of disease. Deprive a doctor of these senses, and he is as absolutely worthless and knowledgeless as the chair he sits on. We understand that the senses may be educated, and that this education is the chief object of life. This is so in all pursuits; it is especially so in medicine. The man of educated sense is a good carpenter, shoemaker, farmer; the ones who have not this cultivation are wood-butchers, cobblers, and poverty breeders. The physician of well trained senses is likely to be a good doctor; the one! of no training is likely to be a politician, and a suppliant for boards of health.
You ask me then. Can we see disease? Can we hear disease? Can we smell disease? Can we taste disease? I answer, yea, verily, we can, and that is the way we know it. No man can claim that there is anything new or abstruse in this, or that it strikes a person suddenly like conversion, or that it requires a prophet. Our senses are the resultant of the use of all the people who have preceded us, plus the training that we have given them ourselves. I have great faith in being born well, and would rather have the heritage from an ancestry who have succeeded in mechanics and the industrial pursuits of the world, than from the most aristocratic blood of Europe. If we have the heritage of reasonably good senses we can so train them by use that we can recognize through them.
What can we see? We get the form, the color, some changes of structure, and to some extent a knowledge of the muscular capacity of the body. We get the form, color, and a knowledge of the adventitious material that makes the coatings of the tongue and mouth.
What can we smell? Stinks. Stinks that indicate disease of the blood, the stomach, the lungs, the bowels, the uterus. Stinks that talk to us of death.
What can we hear? Enough to tell us of many diseases of the respiratory apparatus, of diseases of the heart, of some diseases of the stomach and bowels; and lastly we can hear the patients story, supplemented by the history given by the nurse.
Can we touch disease? There is no one but what has heard of the evidence of the educated touch. We practice obstetrics by the touch. We diagnose many diseases of women by the touch. It tells us the condition of the tissues, and is the most reliable sense in the practice of surgery.
Can we taste disease? This sense is rather a personal one. We can taste our own disease—more rarely our neighbor's.
Symptoms! Yes, symptoms. I should like to know how we could get along without symptoms. The closer observer is likely to be the best doctor.—SCUDDER, Eclectic Medical Journal, 1888.