Therapeutic Philosophy from Dr. Jos. R. Hawley
It occurs to me that our patients consult us for results—possibly I am wrong.
Therapeutic pessimism leads to nihilism. How unfortunate that this does not lead to ostracism.
The farther internal medicine advances in abstract theory the farther its textbooks recede in treatment—and Mrs. Eddy smiles.
Pseudo-psychiatry, under its many disguises, religious and irreligious, is the natural child of modern no-medicine medicine.
In top-rank medical journal contributions, non-surgical, the great guiding word is, be abstract, theorize, crowd the bibliography; therapeutic contributions received at writer's risk.
All patent medicines live on the credulity of laymen, and most proprietaries on the credulity of physicians—and the credulousness of both is largely the fault of the latter.
The highly qualified diagnostician who is not a thorough therapist, is a much more incompetent practitioner than the thorough therapist who is just an average diagnostician.
If it is true that the majority of practitioners are sadly weak in diagnostic skill, it is equally true that the majority of the remaining minority are criminally weak in treatment. There is an excuse for the former, but none for the latter.
Oh, for a medical Moses to lead us out of the wilderness of words into the land of deeds! The medical journals publish annually a verbose mass of abstract theory and hypothetical rot sufficient to confuse a medical giant—their original therapeutic contributions wouldn't confuse a medical gnat.
If our textbooks are right therapy has practically stood still since antitoxin in '93, and according to the most popular practice, Osler's, it has gone backward.
If the latter-day fashion of scorning clinical results, per se, as proof of an agents therapeutic value, had been universal formerly, we would now know nothing about the specifics and most of the other life savers. Practical experience always has been and for years must continue to be the parent of therapeutic progress.
In all professions, from religion to politics, the minority rules, that is, establishes precedents, organizations, interprets ethics, sets the pace—but in no profession does such a small minority rule as in the medical. Indisputably medicine of all professions is the most useful and indispensable, therefore, the greatest. Is it right that in the greatest profession the size of the ruling minority should be in inverse ratio to the relative utilitarian value of that profession?
There must soon be a renaissance of therapeutic enthusiasm and fairness. It is sure to come eventually, but for every year it is delayed many more years will be required to overcome the inroads on legitimate medicine and human credulity which have been and are to be made by those who, knowing nothing about disease, treat it with illogical verbiage based upon a sacrilege of the scriptures, and those who, knowing a little about disease, treat it with blatant sophistry based upon a sacrilege of sense.
Grand, old-time, general practitioner, you never had more than echo of adequate monetary compensation — your pay was largely genuine gratitude, respect, love. Overfilling of the profession, excessive specialism, and latter-day commercialism have greatly thinned your ranks, but you have left a great precept in the highest concept of medical practice. You have stood for the best in executive medicine and the best in potential citizenship. Your work was the concrete, you had to do, and in spite of inadequate, crude and largely empiric equipment, your results compare most favorably with those of today, and infinitely surpass those of the eminent agnostics who try to teach us treatment via the Great Abstract.
No science and no profession has made such radical revisions in its basic elements during any two centuries of its life as medicine has made in the last thirty years. During the same thirty years there has been a steadily increasing epidemic of therapeutic doubt. Unless they can discuss an absolute specific, such as antitoxin, or a theoretic mirage, such as the opsonic index, the leaders in internal medical literature are (outside of textbooks) practically silent on the end purpose of their art. The transformation of internal medicine into an actual if not absolute science logically necessitates theoretical as well as practical reconstruction and construction. But they must be correlated.—Editorial, Bulletin of Animal Therapy.