DOCTORS AND PATIENTS.
IN his "Life and Death of Sir Matthew Hale, Kt.," Gilbert Burnett says that that celebrated Judge had " great skill in Physick, Anatomy, and Chyrurgery." From the bench "he would put such questions to Physitians or Chyrurgeons, that they have professed the College of Physicians could not do it more exactly." This was all very well ; but when Burnett goes on to inform us that "in sickness lie used to argue with his doctors about his distempers and the methods they took with them," we begin to wonder how the Physitians and Chyrurgeous liked it. What they thought of it, we are indirectly informed, for Burnett adds, though with entire simplicity, that "one of them told him" Sir Matthew "understood their own profession, as far as speculation without practice could carry him." The limitation was admirable. Speculative knowledge is, of course, good in itself, but the line between speculation and practice cannot be drawn absolutely. A pasha who had lost an eye ordered a glass one, and had it fitted in, showing transports of joy ; but when after a month's trial he found he could not see with it, he had the " chyrurgeon " bastinadoed and banished. Here there was a lack of " speculation " on the part of the pasha. But the too well-known case of the Indian prince and the seidlitz powders is doubtful. He first took the whole of the twelve blue powders dissolved in a punch-bowl, and then, not feeling much refreshed, took the twelve white ones also at one draught. It is a nice question whether speculation or practice was most wanted here, but it is certain that a portion of both is a good thing. It is notorious that the man who gives himself to the study of pathologi- cal books is apt to fancy he has all diseases at once, or by turns ; so much do " symptoms " resemble each other, or, in other words, so much is practice needed. The most experienced physician, when ill, goes to another physician—that is trite— and the two experts may reasonably " argue " with each other. But the best thing the uninitiated patient can do is to get a good doctor, and then mind him. There are illustrious examples in favour of this principle.
Mr. Gladstone, whose health and prospects of a vigorous old age were, in the spring of 1874, made the subject of a cheerful article in the Lancet, which gently rebuked him for talking of "my age," has more than justified the rebuke of his medical critic. He has shown not only staying power, but buoyancy. He has been betting ten to one, and praising the Burton ales as nectareous, if not nectar. He has been twice very seriously and once at least less seriously laid by, and has more than pulled through. And we have all heard—some of us with surprise, sensible people without any—that he minds what the doctor says, is a strictly obedient patient. But there is obedi- ence and obedience. Dickens treated unguaranteed prescriptions (of which he used to receive many hundreds) much as Lord Granville does, and he also minded his doctor. But there can be no doubt that he was a fractious patient, whose obedience was often but formal.
It must be admitted that it is sometimes difficult to obey a physician's orders. The late Dr. Eliotson once began some written directions (for a very young man, who had nothing par- ticular the matter with him) in the following terms :—" No wine, beer, tea, coffee, spirits, or tobacco. No churches, chapels, theatres, public meetings, lectures, or concerts," and so on. The patient might almost as well have become a Trappist, if he had heeded all this No doubt, such re- scripts are excused, on the ground that the patient will certainly break through the severest rules, and that the physician's only chance with him is to make them so strict that he will feel bound to keep a portion of them. But the patient knows that trick as well as the physician, and, if he is cynical, concludes that a doctor is a man who tells you some- thing about yourself that you would rather not hear, and gives you instructions which it is impossible to adhere to. Hence the attractions of Theodore Hook's "bold Buchaneer," or the amateur adviser who leaves you a margin. But this is far too serious a subject for a mere jest. It does not require the eye of a medical man to note that very large numbers of deaths, par- ticularly in acute diseases of the respiratory organs, occur from slight acts of disobedience to the doctor's commands. It would be painful, as well as hazardous, to say how many young children are lost by uneducated, inattentive, or conceited mothers, who think a slight difference in temperature cannot really matter.
It is often remarked that the position of the preacher has been made much more difficult of late years by the growth of culture ; we need. not repeat any of the platitudes about "the pulpit" and "the pew." But a similar thing might be said of doctors and patients, amongst the educated classes. True, the clergyman has often to encounter the conceit of the uneducated, as well as the criticism of the well-informed, for, under the in- fluence of a great Protestant superstition, every man thinks that in expounding the Bible his way is clear ; a fancy which the publication of the Revised Version of the New Testament must surely do much to shake, even in the most pig-headed "'come-outers " and blind leaders of the blind. But though the ordinary practitioner has it pretty much his own way with the pior, the number of more or less educated patients who can "argue" with the " physitian or chyrurgeon " is greatly in- creased. The chyrurgeon, indeed, has the whip-hand. If he decides to "do a little something" (as a great surgeon used to say, when he proposed to cut both your legs off, or do some such trifle), you can, indeed, say you will not submit to the opera- tion; but who would dispute with him about the way of per- forming it ? The physician does not stand on such a commanding eminence of superiority, except in cases where the patient is prostrated, or nearly so. He cannot see into your "inside," and the prejudice that you know more about it than he does, is not unnatural. Then, there is your " idiosyncrasy " ; has he really studied that, or does he take you "in a loomp " with other and inferior people ? The good-natured auctioneer in " Middlemarch " was so pleased at having his "symptoms watched," and so proud of having his "secretions studied," that he was enabled to resist the general • outcry for heroic treatment, and let Lydgate, the young doctor, do as he pleased with him. But then he called "Anne of Geier- stein" "Anne of Jeersteen," and had no opportunities of read- ing that hybrid, quasi-technical literature of physiology, pathology, and psychology which is now read by nearly every man who reads at all. Whether his reading it makes him more or less ready to " argue " with his " physitian " will depend upon himself. If he is himself an educated specialist in another line, he will probably have so alarming a sense of the gulf be- tween expert and non-expert in such matters as pathology and medicine, that he will be as good a patient as Mr. Gladstone. At the same time, a wise and cultivated physician will much rather have a patient who understands him than one who does not,—one who can anticipate questions, insinuate the idiosyn- crasy, and give the history of a chronic case, without going back to ancient history. But even "bold Buchaneers," and certainly sensible amateurs in sanatory and sanitary matters, have their use also.
Perhaps there would not be much risk in saying that the Medical profession, as a whole, is more alive than the Clerical tiO what is new in the conditions under which the work has to be done. A man can hardly be a good physician without hiving a considerable native share of scientific ability ; and he should also have much of the artist's sensibility to form, colour, and expressive motion. The physician, besides actual accom- plishments which he is likely enough to have quite outside his vocation, is often the most agreeable and well-informed man of the world in his very large circle. And everything conspires at present to compel or invite the widening of his horizon. To be a really good physician, a man must be a psychologist. This does not mean that, if he finds in a case of insomnia no obvious cause for the patient's disorder, he should ask the unfor- tunate man whether he has anything on his conscience, embezzle- ment, for instance. It is well known that Lord Eldon, when plain John Scott, eloped with the lady whom he married, and that they were lovers all their lives. While it was yet very early days with them, young Mrs. Scott fell ill in a strange village, and the local practitioner was sent for. Having, after the usual routine, failed to make out what was the matter with this beautiful lady, he said, "I'm afraid, ma'am, there is something on your mind? You are not happy with your husband ?" This was bad prac- tice. Mrs. Scott had much spirit and natural eloquence, and there was nothing the matter with Mr. Scott, who was both tall and athletic ; but the muse will not sing the dismissal of that doctor. The anecdote only illustrates, in passing, the sense in which the physician must not be a psychologist. Sir William Temple, two hundred years ago, wrote what is not indeed more true now than it was then, but more visibly and strikingly true. "It is certain," said he, "that the study of physic is not achieved in any eminent degree without very great advancements in other sciences ; so that, whatever the profes- sion is, the professors have been generally very much esteemed upon that account, as well as of their own art, as the most learned men of their ages, and thereby shared with the two other great professions in those advantages most commonly valued and eagerly pursued, whereof the divines seem to have had the most honour, the lawyers the most money, and the physi- cians the most learning." The last clause no longer holds, if we read the word " learning " fairly ; but generally, the remark is true. "Of what passed before the Flood," as Sir William Temple quaintly says, "we know little, except the length of men's lives." From some of his jests we may conclude that he would be surprised, if he were now living, to read, on the autho- rity of a physician (Dr. John Gardner), that "the changes in ageing are not beyond our reach, and it is probable that a rational and, scientific basis will be laid ere long for completely arresting them." Whatever may be done in the path of this tremendous speculation, will be done well, in proportion as medical men become true psychologists. This they will never do till they cease to "carve the living hound," and pursue their studies in the spirit indicated by the late James Hinton, in his lecture on "The Place of the Physician," whatever they may think of his crotchets or opinions :—
"The future shall be like the past. Of old, there stood before a Man, on the one hand, a law, forbidding him to labour on the Sabbath, enforced with all divine authority, as interpreted by the reputed wisdom and godliness of his age ; this law on the one hand, and on the other a poor lame man's sorrow. The Man before whom these two claims came—God's, as all men said, and his fellow's—chose which he would heed ; and he gave us a new law. He cured the body; and mankind, never ungrateful, never unknowing of their friends, have called him the physician of the soul. The needs of man interpret the laws of God, and who stands so close to the needs of man as you will, gentlemen, to whom, in their very direst need, all will cling ; to whose voice sick hearts will listen, as if it were the very voice of God, declaring judgment or mercy ; the very skirts of whose garments, if only a heart beats beneath them, faint hands will be raised to touch ? Closest to the very sources of the life of the human soul you will stand ; it is the physician's place. Of the highest law he is made interpreter. More than ever now the physician must have knowledge of the soul, must feel with finer senses, other pulses, and measure heats and chills which no thermometer can gauge."
And when this point is attained, there will be an end of at least one trouble between the doctor and the sufferer. Some physicians have complained of a cold shyness on the part of recovered patients, as if they did not like even the presence of the man who knew so much of their hour of humiliation. This is not a necessary condition of the case, and when the physician's work has become as much spiritualised as it is now rationalised, this complaint will be heard no more. The difference between men and women in this respect—a difference largely in favour of women—is a delicate subject to touch, but well worthy of a little respectful meditation.
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