The Public Looks at Pills

I

SOME years ago a society of distinguished physicians and surgeons invited a well-known journalist to speak to them on ‘The Doctor from the Layman’s Point of View.’ It was the chance of a lifetime, but the journalist made nothing of it. He filled his allotted hour with some appropriate display of scholarship (mainly Oriental), and a great many well-turned compliments. His audience, gratified but a trifle bored, expressed their sense of appreciation, and have had none but professional lecturers ever since.

In truth the layman’s point of view, as it has come down to us through the centuries, is one of mockery and derision. The French adage, ‘Never waken the sleeping doctor,’ is a little like ‘Never warm the frozen viper.’ The old Italian epitaph, ‘I was well: I wished to be better: I took medicine and died,’ turns up in divers tongues and in divers ages. Pausanias is said to have attributed his length of years to his avoidance of all drugs. English comedy, like French, rings with laughter at the expense of a profession from which so much was expected that a broad margin was left for discontent. George Colman’s sneer, —

is forced and mechanical alongside of Gay’s swinging lines: —

Dryden, more serious and assured, wrote decisively: —

which was being very much at home in Zion.

The layman, writing upon the science of medicine, has never drawn any wide distinction between a statement and a fact. He gave us in the past, as he gives us in the present, a great deal of interesting reading which, if false to circumstance, is apt to be exceedingly true to life. We learn from Robert Burton, who bravely quotes authority, that in the days of Jerusalem’s might and pride there lay open in the temple a great book written by King Solomon, and containing remedies for all manner of diseases. To this book the Jews had free access, and each man found in it the cure for his ailment. But Hezekiah caused it to be taken away, saying that it made the people secure, and that they forgot the need of calling upon God for help, because of their too great confidence in Solomon’s wisdom.

Burton himself was far ahead of his generation in sense and rational skepticism. His words are the words of wisdom. He makes plain the advisability of dieting, which all men hate, and the unadvisability of taking other people’s remedies, a habit dear to most men’s hearts. Neither does he think it well for laymen to read medical treatises, and draw their own conclusions. ‘No one should be too bold to practise upon himself without an approved physician’s consent, nor to try conclusions if he read a receipt in a book.'

Yet intelligence and monstrous erudition failed alike to eradicate from Burton’s heart a dim respect for ancient cures that had nothing but length of years to recommend them. There, for example, were the precious stones. How natural it seemed to him that their beauty and durability should have power to soothe the restless maladies of the mind. And there were other substances unknown to and unseen by him, yet whose existence and qualities he could not bring himself to deny: In the belly of a swallow there is a stone called chelidonius, which, if it be lapped in a fair cloth and tied to the right arm, will heal lunatics, and make madmen amiable and merry.’ And there were old wives’ cures in which he put no faith, but which had the warrant of usage and of error. ‘In my father’s house I first observed the amulet of a spider, lapped in silk in a nutshell, applied for an ague by my mother.’ This simple domestic remedy, though gravely recorded, is condemned by Burton as being ill-advised. His mother, he admits, was not the only practitioner. He has heard of divers cures wrought by spiders. But, after giving the matter due consideration, he ‘can see no warrant for them.’

Our world is a changing world, and the only durable thing in it is human nature. No longer do we put our faith in spiders, and the stone in the swallow’s belly has not even the poetic permanence of the jewel in the toad’s head. The diseases of the present have little in common with the diseases of the past save that we die of them. ‘Moral as well as natural maladies disappear in the progress of time.’ wrote Jane Austen flippantly to Cassandra, ‘and new ones take their place. Shyness and the sweating sickness have given way to confidence and paralytic complaints.’

Impenetrable Latin names have also replaced the deeply colored and dramatic words which told a terrorstricken people in what guise death was knocking at their door. The ‘Plague,’a strong and simple vocable, was bad enough; but think how the ‘Black Death’ must have numbed the heart with fright. The petty losses of perpetual warfare were trivial as compared with the blotting out of human life (one man out of every three in fourteenth-century England) when this dreadful pestilence swept the land. The Feu Ardent differed principally in name. We are told that the hands and feet of the infected turned ‘black as coals,’ and rotted away; and we know that in 1106 there was founded in Arras La Charité de Notre-Dame des Ardents, the members of which devoted themselves to nursing the sick until their turn came to die. Then there was the malady called, Heaven knows why, the ‘Purples.’ It was an afterthought in the way of epidemics, for it ravaged the town of Celle where Matilda, Queen of Denmark and sister of George the Third, was confined. The unhappy lady caught the disease from a page and died, to the great relief of those who wished her out of the reach of sympathy or succor. Even the ‘Sweating Sickness.’ about which Jane Austen jested, has an appalling sound which fits the horror that it bred. The Papal Nuncio, Chiericate, writing from London in 1520, says that it was so swift and sure that men riding through the streets reeled and fell dead from their horses.

Of what avail was physic against such tides of death? The world, ignorant and impotent, clung to words it could understand and feel, to remedies of childish simplicity, to the hope and consolation of prayer. Centuries passed, bringing rich gifts of knowledge, wisdom, and understanding. We seemed immeasurably remote from the helpless throngs to whom sanitation was unknown, and who stared wildeyed at the dying and the dead. Then in our own day a pestilence, urbanely called the Influenza, carried off (so say the latest statistics) twenty million people, outstripping all recorded epidemics because of the denser population of the civilized world, and because it traveled faster and farther than any of its predecessors. When sixty-eight thousand persons died of the Great Plague in London, Frenchmen walked the streets of Paris in comparative security. The Influenza leaped a sea as easily as it leaped a street. Britain and the Balkans, Russia and Rhode Island, were neighbors in misfortune, and each and all paid their heavy toll of death.

The changelessness of human nature, which progressive minds deny, is illustrated by man’s age-old inclination to escape from the orderly development, the ‘mapped lands and charted waters’ of science to byways, and short cuts, and the primrose paths of charlatanism. The same spirit which made the conservative Jews seek cures from Solomon’s pages impelled Londoners who lived through the terrible months that preceded the Annus Mirabilis to buy ‘anti-pestilential pills,’ and ‘the only true plague water,’ and mysterious remedies concocted by ‘ancient gentlewomen,’ familiar with the disease from childhood. Ambroise Pare fought a hard and, I fancy, a losing fight against the preposterous drugs of his day, the ever-popular mummy scrapings, and unicorn horns — a sovereign antidote to poison. The public was naturally incensed that a man who had risen from the despised ranks of barber surgeons should presume to depreciate such rare and costly medicines, to which only the wealthy could aspire.

II

The most amazing tale which the credulity of the world has ever furnished is the many-chaptercd history of touching for king’s evil. From the days of Edward the Confessor in England (this is a matter of tradition), from the days of Clovis in France, clear down to the days of profound skepticism and dawning revolution, men clung to the belief that scrofula was healed by the royal touch. ‘There is nothing that can cure the King’s Evill but a Prince,’ wrote Lyly in his Euphues; and the world, learned or ignorant, agreed with him. It was claimed that this mysterious power lay in the hands of French and English monarchs because they had been anointed with the sacred chrism; but Charles the Second, the most successful of royal practitioners, touched at Breda, Bruges, and Brussels before the Restoration; and devout believers crossed the Channel to be touched by the old Pretender — William the Third having sourly declined this prerogative of kingship.

Popularity, piety, profligacy, in no way affected the healing power. The people regarded their kings as Roman Catholics regard their priests. They were conduits through which flowed certain graces, irrespective of their own worthiness or unworthiness. Louis the Eleventh was fully as conscientious in touching as was Saint Louis, and Philippe de Comines warmly commends his fulfillment of this duty. ‘If other princes do not the same, they are highly to blame, for there are always numbers of sick people to be healed.’

There were indeed! Reading the records, we should be driven to conclude that unwholesome diet produced scrofula on a giant scale were it not for the fact that every kind of growth, or swelling, or eruption — diseases described by William Clowes as ‘repugnant to nature’—was classified as king’s evil when there was a chance for the patient to be touched. Clowes, whose office it was to examine the applicants for touching in the troubled reign of Charles the First, was a firm believer in, and a jealous guardian of, the monarch’s prerogative. He denounced and brought to justice an impostor named Leverett, who claimed to be a seventh son, which he was not, and to heal by touch. This man, a gardener by trade, had his followers, — what impostor has not! — and the evidence showed that he had ‘enticed lords and ladies to buy the sheets he had slept in’ — as unpleasant a remedy as the annals of healing record.

Henry the Fourth of France, who was a strong fighter but a weakling of a doctor, complained querulously to the Countess of Guiche that, when ill himself, he was compelled to touch two hundred and fifty sick on Easter Day. He should have been ashamed of his slackness. On the Easter of 1686 Louis the Fourteenth touched sixteen hundred people with little rest or respite, bearing himself as became ‘a healer and a king.’ The great monarch ranks next to the merry monarch in the number of his patients and the presumed efficacy of his treatment. It is estimated that at his coronation he touched two thousand sick; and from that day until his death fifty-six years later he frequently and patiently fulfilled this strange function of the crown. When he lay dying a number of afflicted children were brought to his bedside. He was nearing the end, and his dim eyes could not discern the wretched little objects about him. But two bishops guided his feeble hands to child after child, and repeated the brief formula, ‘The King touches. May God heal!’ which nobly resembled the everrepeated words of Paré, ‘I dressed him, and God healed.’

In England the ritual for the ceremony of touching was established by Henry the Seventh, who began the practice of crossing the sore with a gold ‘angel,’ which was subsequently hung about the patient’s neck. This custom obtained also in France, and we might be tempted to think that the coin was reason enough for seeking a cure were it not for the fact that after Charles the First had grown too poor to give it there were as many applicants as ever; and Charles the Second touched hundreds of sick before he had a spare piece of silver for himself, let alone gold for others. Pepys says that in the first four years of his reign he touched twenty-four thousand people; and it is calculated that he touched ninety-two thousand — some say two hundred thousand — before he died. Whatever he may have thought, he always played his part with becoming gravity. What disconcerted him — as well it might — was to find himself touching when he had not meant to — un médecin malgre lui. John Aubrey tells us that ‘a Mr. Avise Evans had a fungus nose, and said it was revealed to him that the King’s hand would cure him. So at the first coming of King Charles into St. James’s Park, he kissed the royal hand, and rubbed his nose with it. Which did disturb the King, but cured him.’

Of course it cured him! That is the certain end of the story. We read over and over again that some hundreds or some thousands of people were touched for king’s evil, and ‘all were cured.’ Now it was but natural that learned writers in the days of Queen Elizabeth should bravely assert that she healed her sick subjects. They would have been unwise to say anything else. But when it comes down to Queen Anne, who touched little Samuel Johnson, aged two and a half, we find the same repeated assurances of success. They are like the assurances of our friends to-day that they have been cured by patent medicines, by bottled waters, by colored lights, by deep-sea massage, by diets as alien as King Nebuchadnezzar’s, by the satisfaction of subconscious desires, and by being confidently told that they were well. It may even have been that some rustics felt themselves cured by the Scotch blacksmith whom Sir Walter Scott found practising medicine (by the pure light of reason) in Northumberland. Horrified, he remonstrated with the man, asking him if he never killed his patients, and received the memorable reply: ‘Whiles they die and whiles no. It is the will of Providence. Onyhow, your honour, it wad be lang ’til it makes up for Flodden.’

III

The age of credulity is every age the world has ever known. Men have always turned from the ascertained, which is limited and discouraging, to the dubious, which is unlimited and full of hope for everybody. To dream a few dreams after four years of world war was a pardonable weakness. To cultivate a few pleasant pretenses was almost a necessity. When Dr. Émile Coué unbottled his sunshine to warm us, we basked gratefully in its rays. Autosuggestion, so long as the suggestions were of the right kind, seemed a private path to Paradise. ‘ I am not a healer. You heal yourselves,’ said this delightful practitioner, and we made haste to believe him. Faith, hope, and confidence were remedies within reach of all. But after assimilating our little horde of persuasions, after repeating the Coué rosary until we were lapped in content, there would come now and then like a cold wind from the north the remembrance of words, stern and unequivocal, which we hoped we had forgotten: ‘Things are as they are, and the consequences of them will be what they will be. Why should we seek to deceive ourselves?’ And, shivering, we awoke to realities.

The delusions of the past seem fond and foolish. The delusions of the present seem subtle and sane. That the seventh son of a seventh son should have presumed to claim strange powers of healing, and that erysipelas (which was called the ‘Rose of Ireland,’ like one of Moore’s melodies) should have disappeared beneath his touch, was a manifest absurdity. So, too, was the dipping of smallpox patients in milk, and the wasteful swallowing of gold, which Chaucer held to be a sovereign cordial. An old Irish woman told me when I was a little girl that as a child she had been cured of mumps by being driven three times in a halter at daybreak through running water — a remedy which modern literary slang would call ‘colorful.’ But when a delegation of Quakers suggested that the College of the City of New York should establish a course of Peace Psychology, we lent them serious attention; and when an educational expert urged giving dolls to children as a preventive of race suicide, we did our best to follow her line of reasoning. Two hundred years ago doctors bled their patients to the doors of death. One hundred years ago twenty thousand leeches found congenial occupation in the hospitals of London. But some months ago a man struck by a motor in New Jersey suffered himself, and was suffered by his relatives, to bleed to death, because the tenets of what he called his religion forbade his summoning medical assistance.

The perilous candor of doctors in this candid age may have lessened their prestige with the average layman, who adores pretense and is always ready to credit what is loudly and persistently asserted. The iconoclastic jest of Dr. Oliver Wendell Holmes, ’I firmly believe that if the whole materia medica could be sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes,’ has been too often quoted by men who forget that it was spoken to the assured young students of the Harvard Medical School. Dr. Collins’s criticism of a practitioner, ’If automatons could have diseases, I should select him for their doctor,’ has a familiar ring. It wittily expresses a doubt and dissatisfaction common since the days of the Tudors. ‘Many physicians,’ grumbles Bacon, ‘are so regular in proceeding according to art for the disease, as they respect not sufficiently the condition of the patient.’

There was none of this professional plain speaking in the days when newspapers were unknown, and few men were so learned and so unwise as to read books. Doctors then kept their own counsel, and left the laity guessing at the nature of diseases of which all they knew was the end. When we read that king or noble died of ‘a surfeit,’ we may feel tolerably sure that the diagnosis was correct. A great many people die of it now, though the word does not appear on the physicians’ certificate. Philippe de Comines, who gathered the strangest kind of news from every available source, tells us that Mohammed the Second had ‘a swelling in his legs which every spring made them the size of a man’s waist (as I have heard from those who have seen them); and the swelling never broke, but dispersed of its own accord. No surgeon could tell what to make of it; but all agreed that hie gluttony was the occasion, though perhaps it was a judgment from Heaven.’

Gluttony or a judgment from Heaven? There were few maladies that could not be attributed to one or other of these causes, and occasionally to both. Charles the Bold, who was bold with caution, sought to stave off the threatened surfeit by having his six physicians sit behind his chair at table (so says the Burgundian chronicler, Olivier de la Marche), ‘and counsel him with their advice what viands were most profitable to him.’ They were compelled to agree, and agree quickly, with one another; but there is a story that one of them, or all of them, protested to the ducal cook that his dishes were unwholesome, to which that functionary replied, ‘My business is to feed my master; yours to cure him.’

IV

One quality has never been lacking in the long, noble, humorous annals of medicine, and it is the basic quality on which depends the worth of life — courage. The esprit de corps, which is unpopular on the same principle that nationalism is unpopular, has served as a fortress against fear. The heroism of the doctor who gives his life in searching for and experimenting with microbes is like the heroism of the explorer, the aviator, the sailor, the soldier, who all go out with high hearts to meet their duty and their death. The heroism of the doctor who gives his life in tending the pestilencestricken is something too holy for commendation. Not for him the overmastering curiosity of the scientist and investigator. Not for him the interest so keen that it obliterates panic. And not for him the supreme joy and lasting honors of discovery. Only a sombre pathway to death, and often to oblivion. Gui de Chauliac, Papal chamberlain at Avignon, and the first surgeon of his day, set the seal of glory upon his own name when he stuck to his post during the ravages of the Black Death in 1348. His Chirurgia Magna is the treasure of antiquarians, his admonition to physicians equals, if it does not surpass, the noble oath of Hippocrates. But because he practised what he preached, because he saw half the population of Avignon swept away, and stayed to heal the other half, his memory is honored of men, and his soul

In the winter of 1915 six English doctors obtained permission to visit the German prison camp at Wittenberg, and tend the prisoners who were rotting with typhus fever. These unfortunates had not seen a cake of soap, or felt the decency of clean linen, for two months. They were alive with vermin, and dead to everything but the consciousness of misery. Three of the six doctors died within five weeks; but to them and to their valiant successors hundreds of men owed a gleam of hope, a touch of compassion, and their lives. The heroisms of the World War were beyond count and beyond praise; but nowhere was grandeur nigher to our dust, and nowhere was God nearer to man, than in that prison camp.

The late Dr. Weir Mitchell once said to me that, in his opinion, neither English nor American fiction had ever produced a satisfactory portrait of a doctor. Sevier was sentimental; Lydgate a rather dull embodiment of excellence, Thorne unconvincing as a practitioner. He was by way of thinking that the. layman came no nearer to understanding the physician than to understanding medicine, though he had jested at both, railed at both, and sought help from both since the beginning of civilization. It is doubtful whether Dr. Mitchell, who was eminently fastidious, would have accepted with relish the up-to-date picture of Dr. Will Kennicott of Gopher Prairie, a plain person drawn with a firm rough touch which consistently denies him distinction. He is often obliterated from the canvas because his wife, the exacting and pretentious Carol, takes up so much room. But the unforced realism of the scene in the Morganroth farm, the amputation by night, the flickering lamp, the inflammable ether fumes, the matter-of-fact courage of a man accustomed to take chances — this is the kind of thing we like to know is within the possibilities of daily life. It makes for confidence in a world which has always produced, and still produces, ordinary men who do the work that lies at hand. Mr. Lewis has spared no profession from the shafts of his bitter ridicule. It is he who says that managing an epidemic with a board of health is like navigating a ship in a typhoon by means of a committee. But he has given us a physician in whom we believe, and whom, if we detach ourselves from sentimentalism, we can sincerely love.

The doctor of to-day must infinitely prefer abuse, which is harmless, and derision, which is world-worn, to the lofty patronage of the pseudo-scientist who renders profound homage to research, and eliminates the practising physician from the field of progress. ‘The fruitful study of disease,’ we have been told, ‘began with the investigations of Pasteur,’ which is partially true. But what of Lister, who ‘watching on the heights, and watching there alone,’ saw Pasteur like a star on the horizon? ‘The scientific use of the imagination,’ a great phrase and a great quality, has distinguished many a doctor who was content to heal his fellow men. We recognize it in the words of Dr. Keen, dean of American surgery, who has registered his hope that after death he may be permitted to know and rejoice in the discoveries of the future, in the forward leaps of ‘this great though little world.’

Hygiene is now the exalted idol of the public. There are none so learned and few so ignorant as to be without a set of rules which are unfortunately communicable. A writer in Harper’s Magazine warned us a few years ago that there was ‘no such thing as a science of medicine,’ and that the study of disease was a matter ‘distinctly apart from the art of healing.’ ‘Public health,’ he wrote, ‘becomes less and less an affair in which physicians should meddle. It demands rather a man of the temperament and clear-headedness of the engineer who is accustomed to think mathematically, and who dwells in a region where the landslides caused by his errors descend upon his own head.’

Do they so descend, I wonder? At least inevitably? Have there been no hecatombs of victims following the fatal weakness of wall, or roof, or bridge? It is doubtless true that ‘the great majority of men who enter medicine have no intention of making their métier the science of the study of disease.’ Somebody must serve as a medium through whom the discoveries of science, the fruits of knowledge, may be conveyed beneficially to the sick man whose eminently selfish desire is to get well. But it is a curious verdict which would forbid physicians to ‘meddle’ with public health. The health of the public is in their keeping. Why then should public health (a mere resetting of words) be outside their legitimate sphere?

A medical society in Chicago went so far as to issue a questionnaire, asking the laity, or at least sonic hundreds of laymen, if they preferred, and why they preferred, unprofessional to professional treatment. The answers received were with one exception — the high cost of keeping alive under the doctor’s care — inexpressibly futile. They showed a peevish discontent with the possible, and a colossal faith in the impossible, which are as old as humanity. Only in the event of ‘continuate and inexorable maladies,’ a terrible phrase of Burton’s, is this mental attitude of service. It may increase a man’s pain and shorten his life; but it fools him with hope until he dies.

After the World War was over, the Ladies’ Home Journal published a paper with this patronizing title: ‘The Returning Doctor: He can now become one of the most potent assets of American life.’ Can now become! How, I wonder, did the returning doctor feel if he read that encouraging assurance! How did the British Tommy feel if he read the peerless tribute to his services written by a thoughtful correspondent of the Times, and quoted with delight by André Maurois: ‘The life of a soldier is hard, and sometimes really dangerous.’

So it is that the public looks at machine guns and at pills.