Present state of medical knowledge in England.

Date:
[1839]
Catalogue details

Licence: Public Domain Mark

Credit: Present state of medical knowledge in England. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [[JUNB PRESENT STATE ^’>!j^^J^^'^N<^VLEDGE IN I In our paper in No. XXII., upon Quacks and Quack Medicines, I we stated sufficient to account for the predilection of the English j people in favour of drugs and nostrums. There are, however, fur- : ther causes which maintain the ascendancy of quackery, and which also may be traced to the general defects of our medical system, as well as to professional example. We shall, therefore, devote I the present article to a rapid examination of the whole body of medical practitioners, in their several divisions of graduated physicians, operative surgeons, and apothecaries under the act of : parliament. The fee of the graduated physician is so enormous, in England, as to exceed the means not only of the lower but of the middle classes : his aid is therefore not demanded until the failure of the surgeon-apothecary, or, more correctly speaking, the physician- apothecary—for this practitioner perpetrates but little operative surgery beyond bleeding, drawing teeth, and puncturing purulent tumours when not dangerously situated. The physician, therefore, more commonly “ comes in at the death but when he does not, , his guinea visit of half-an-hour can give him no possible knowledge j of the patient’s idiosyncrasies. He is therefore obliged, in addition j to what he can discover at a glance, to rely upon the report of his ' general-practising predecessor, who will naturally make out a case to justify the nature and quantity of medicine he has inflicted. The physician, even though he should lie to his conscience, will approve of the previous treatment; because to the general prac- titioner he stands precisely in the same light as the barrister stands to the attorney. By such a cursory glance he can do but little good J he however lauds the skill of the apothecary, writes a pre- scription, receives his fee, and makes his bow. He perhaps calls a second time unasked, to see the effect of his prescription, and ' declines taking a fee, if offered. Such are the professional doings of the medical graduate among the most numerous classes of English society. But supposing the fee of the physician to come within the range of everybody’s purse, his qualifications form the next subject for examination. We beg here generally to disavow all personalities : it is with the system only that we find fault. We undervalue no man’s attainments ; and we repeat, with pride, that England can put forth names of living physicians who may vie with the most skilful and celebrated. The first obstacle to an improved state of medical science has resided in the London College of Physicians itself. No practi- tioners have hitherto been allowed to participate in its honours «cept those graduated at Oxford or Cambridge. Neither of these ‘iniversities has a school of medicine, or affords any facilities for Acquiring medical knowledge. The university lectures on any part of this branch of science, are mere idle ceremonies. They who take degrees there have no means, therefore, whilst in college, of qualifying themselves for practice. They are obliged to learn elsewhere healthy and morbid anatomy,—to acquire elsewhere all but very crude and general notions of the physiology of man and the signs of the diseases of which it is their avowed vocation to cure him, and which it is their duty to prevent as well as cure. To receive clinical or bed-side instruction, they are compelled to resort to other places where there are large hospitals. To study hygiene, and medical jurisprudence, they must leave the seat of I learning which professes to teach them and does not do so, but grants them a degree founded upon the acquisition of classical 1 learning or mathematical knowledge. These graduates constitute . the president and fellows of the Royal College of Physicians in London, whose doors remain closed a^nst the most distinguished and most gifted doctors in medicine belonging to other schools; though assuredly, with some few exceptions, those on the outside of the temple are the most worthy of seats of honour within. With the exception of the two infant schools of the London Universities, there is no real medical school in England. These are of such recent formation that there has not yet been time for any result, though we have no doubt that the good seed which has been sown in them, will, in due time, produce good fruit. Unfortunately it is no test of sterling talent that brings a phy- sician into the lucrative practice existing among the high-born and the wealthy. This may depend upon the mere caprice of fashion, aided by the sharpness and personal tact necessary to seize an opportunity. The patronage of an influential lady cured of an imaginary complaint, or whose weaknesses have been flattered, may create such an opportunity in favour of a man wholly in- efficient, who will retain his post by the exercise of other good qualities, and by becoming the depository of family secrets. There are two kinds of the fashionable physician : one possessing the utmost blandness and fascination of manner, great facility of speech, and the most exquisite polish ; the other pedantic, rude, and ill- mannered. Both maintain their ground by the same means ; and both are positive quacks in their practice. It is therefore very usual for such as can afford and pay the price of the best advice, to obtain the most questionable. Among our graduated practitioners generally, there is considerable deficiency in chemical as well as in pathological knowledge, to say nothing of real and comprehensive physiological philosophy. It follows, therefore, that besides the mistakes made in the nature of diseases, complicated compounds in the human body are provoked to the most dangerous exercise of the chemical affinities. We have now before us five prescriptions, written for as many patients, by a physician who resides at a fashionable place of summer resort. We know not to what diseases these remedies were opposed, but each contains, with a slight variation in tlie quantities, the same precise constituents. These are hydrocyanic acid, strychnia, sulphate of quinine, acetate of morphia, tartarized antimony, calomel, iodide of iron and camphor, with gum arabic, syrup, and water, as vehicles. Let any chemist fancy these substances, in frightfully large doses, obeying their chemical instincts in the human stomach. The quackery of this learned M.D., beyond the imposing appearance of so many items, is^of the speculative kind, no doubt: he most probably fancies that if one article fail, another may succeed in relieving the patient. But he overlooks the exer- cise of chemical attraction between the substances, and especially the energetic action upon each other of the liberated arch-elements oxygen, chlorine, and iodine, each of which is to be found in these prescriptions. If it be difficult, as every sound philosopher will admit, to ascertain the effect upon the human system of even two compound chemical bodies combined to form a medicine, the union of the several substances we have enumerated, upon a mere specu- lation of benefit, is an act of the absolute and reckless insanity of ignorance. An absurd piece of quackery general to the medical profession is the custom of continuing to write their prescriptions in a most execrable kind of Latin, instead of using the vernacular tongue. One of the reasons alleged in favour of this practice is, that could the uninformed read the prescription, they would have no con- fidence in the remedy. This is very probable, if they knew any- thing of medicine or chemistry,—not else ; and all who have such knowledge could read the Latin prescription. To the uninformed, the chemical names of the drugs expressed in English would be quite as unintelligible as if written in Latin, Another reason