Do your own Thinking.
Selected writings of John M. Scudder.
This editorial shows Dr. Scudder's method of thinking along the lines of specific treatment of disease. A thinking physician is not very apt to be led away by so-called authority. His method of investigating materia medica is a good one—equally as good to-day as in 1875.—Ed. Gleaner.
DO YOUR OWN THINKING.—Yes, sir, you must do your own thinking, if you are to be a successful practitioner of medicine. You may obtain helps to right thinking from lectures, books, and journals, but you might as well expect to be nourished by letting some other person eat your meals for you, as to expect success by letting other people do your thinking.
It is well to recollect that the ability to think does not come by nature; it is the result of education. Just in proportion as the mind is trained to right thought, will be the ability to think right. It is possible that you may have the opinion that all action of the mind is thought. It is a very great mistake, for with many the severe labor of the brain is as barren of result as it would be in a confirmed case of insanity. There is a common English word that expresses the condition— "it wabbles."
I find in teaching that students are inclined to let the mind "wabble." When I ask them about one thing, they tell me of another. If the question directs the mind to the skin, the answer refers to the bowels; if to an internal remedy, they talk of a local application; if of the nervous system, they talk of the circulation— there is a singular perversity of the human mind to think of everything else but the special thing in hand.
Let us have in illustration a few examples of right thinking in diagnosis, and then we will complement them with some others in therapeutics. When, for instance, we examine a patient, it is well to have a clearly-defined method—the mind works methodically. What do we wish to determine first? Is it whether his "bowels are constipated," or he makes wind up or down, or whether he passes urine, or the long tedious history of his getting sick? Possibly we wish to know something of all this.
But we do want to know whether the disease is general or local. Now we propose to think—a general disease involves the entire body—is the entirety of the man affected? The general elements of life are found in its conditions, heat, formative force, electricity, in the circulation of the blood, and in the innervation—are these impaired? It might be that we desire to know first, whether the man is sick or well—what would be the process of thought? The healthy man is able to do a man's work, and do it pleasurably; the diseased man can not do a man's work, and suffers. How is it with this man?
What is the method of thought with reference to local disease— a part, when healthy, is able to do its work, and do it pleasurably; a part diseased does not perform its function well, and suffers— how is it with the various organs of this patient as we pass them under inspection ? Let us think first of the sensations experienced in a part diseased—they are always more or less unpleasant; corollary, if a part gives unpleasant sensations it is sick. Thus if a person complains of pain in the eyes, pain or uneasiness in the nose, in the throat, in the stomach, in the lungs, in the bladder, in the bowels, we feel confident there is disease of these parts. There is one exception to this rule, and that is where a part is sympathetically affected, as in the case of !gastric suffering and vomiting in pregnancy or uterine disease.
We have already learned that the body expresses pain, and that the suffering of individual parts is shown clearly in expressions that may be recognized by the educated senses, so that we are not forced to depend wholly upon the statements of the patient.
Now when the mind is directed to a part as the seat of disease, it at once thinks of the function, and makes the inquiry—is the function changed or impaired? Is it eyes, function sight, impaired or painful?—disease. Is it the respiratory apparatus— function respiration, impaired, difficult, or painful?—disease. Is it stomach—function digestion, impaired, painful?—disease. Is it urinary apparatus—function secretion and removal of urine,— impaired, difficult, painful?—disease. Is it brain—function sensibility, reason, emotion, volition—impaired, perverted, painful?— disease. When the mind is turned directly to the subject, it receives clear impressions, and reaches correct conclusions.
Then we recall the fact that many parts show disease by an effort to expel the cause of irritation, and we make examinations to detect this. Is it eyes?—there is the flow of tears to wash it away, and the continuous desire to remove it by rubbing. Is it nose?—there is the effort at removal by snuffing and blowing. Is it throat?—there is the effort at removal by hawking and short cough. Is it the bronchial tubes or lungs?—there is the effort at removal by cough. Is it stomach?—there is the sense of nausea, disgust, and effort of removal by vomiting. Is it of the bowels?— there is the effort at removal by diarrhoea and dysentery. Is it the urinary apparatus?—there is the effort at removal in urination. Even in parts where there is no anatomical arrangement for the removal of anything, and no physiological use requiring such removal, there is still the sense of need, and the feeling in the part that it would like to expel the cause of offense.
I name these expressions of disease as examples, rather than an examination of the physical condition of parts and organs, that we may have new studies. We have already recognized the value of an examination by our senses, and have studied the best methods of educating them for the work.
Now let us think for a moment of the object of this examination and this thought. It is hardly for our own gratification, the gratification of friends, or the satisfaction of the patient, or the absurd and wicked motive that theologians attribute to the Lord— "He doeth all things for His own glory." Evidently the object is to select the remedy or remedies which will cure the disease, i. e., restore health.
If a disease is general, we think of—what?—general remedies. If its chief factor is a wrong of the circulation—we think of remedies that exert a special influence upon the circulation. If of the blood—we think of remedies that specially influence the blood. If of the nervous system—we think of remedies that specially influence the nervous system. If of the temperature, excretion, or nutrition, we think of remedies that specially influence these. It is necessary that we hold this organ of thought in close subjection by the will to the work, for it is inclined to do everything else than the thing in hand, and to reach conclusions by the most absurd and devious ways.
If a disease is local, we think of—what?—local remedies— agents that have a special action upon the part affected. The reader will notice that this is logical, the method of common sense. If your watch is out of repair, you do not overhaul your wheelbarrow; if your cow wants milking, you do not accomplish the object by digging potatoes or reading a psalm. When the cart had stuck, Hercules advised the driver to put his shoulder to the wheel, and not to the nearest fence corner, or what was of about the same moment—mouth prayers to his deity. There are a good many lessons here besides the lesson of therapeutics which we desire to learn.
With this view of the subject, if we have localized disease of the eyes, we think of remedies that specially influence these. If we have localized the disease in the throat we think of remedies which exert a special influence here. If we have localized it in the bronchial tubes and lungs, we want remedies that exert a special influence upon bronchial tubes and lungs. If we have localized it in the stomach, small intestines or associate viscera, we want remedies that show an elective affinity for these parts. If we have localized it in the uterus or ovaries, we of course require remedies that influence specially the reproductive function and organs. Does not this seem more logical than—if my dog is sick I'll physic your cat.
The reader will notice that a good study of the Materia Medica, and a wise provision for the future, can be made by arranging the agents we employ in groups according to their local action. Do not take it for granted that everything must be done for you, that your mental food must be chewed and digested, leaving nothing but the work of the anus for you—that is not a very good position for a man. Take your note book, and King's Dispensatory, and go over the agents from A Z, and see what you know or can find out about each, and make your own groups. Don't tell me you have no time. I do more work than the majority, and have abundance of time for this and everything else.
What else may we think of? We may next attempt to classify our diseases by kind, and our remedies by kind of action. A very simple and yet a very valuable classification is to divide diseases into those with super-excitation, and those with want of excitation. We say, here is the normal standard of life that we measure from. Are the manifestations of life above or below this standard? The classification of remedies immediately follows: if the manifestations of life are above the normal standard we want remedies that are sedative—that remove irritation; if below the normal standard we want remedies that are stimulant—that increase the innervation and circulation of the part.
I flatter myself that I have shown the advantage of logical thought, whether I have shown the necessity of it or not. I concede that men may practice medicine without thinking, and that they may practice it with the most absurd thinking—this is continuously done. But every one should desire something better and higher, and it will only come by right observation and right thought.—SCUDDER, Eclectic Medical Journal, 1875.