The Present State of Medical Practice: A Suggested Remedy for Existing Abuses
BMJ (Clinical Research Edition)
Quack.s an(d Quackery.--Public Ignorance andl l'opular-Stiper-,stition.-HerbatlWt8.-Irsrb CheniL.,sa U.lul/e A8sgatants.-l'he " "hreepenny Doctor ."-Gener ol Pr}actitioners and ConZsultant.s. The Lack of L'nity anil I'i.raihil). -The Abu-8e of Hospitals, Disenaries, and Clubs. AT thle present time tlle medlical profession is confroiitede weith an evil of wliich the growtli during t}e latter lialf of t}lis centurY 118.8 been plienomenal. WVe can iio loiiger treat quackery wvit}l contempt, nor
... }l contempt, nor sliould we be doinlg our duty if we refrained from attempting to stamp out tllis evil, considering'ilOW great is tlle loss of life and liealtli t}lat is attendant upon the unlrestricted liberty accorded to it. Tlle sge of sootliing syrups alone is responsible for tlse deatlis of 15,000 cliildren Rer annum, and tlle number wliose lives and fortunes Iare ruined by tlle malpractices of the "1 nervous debility'. quacks must be very large, seeing l10W n}umerous th!e ar 1nl our big centres of industry. Not only are the rielh victimised by these birds of prey, but nio one is too poor or too suffering to escape their rapacious M.W8. For the credit of the niedical profession it is well that among the quacks there are but few medieal men, and tllese feware riglitly and deservedly despised and known at their true worth. England is t}le paradise of quacks, and in this partially enlightened 19th centuryw tllere is an enormous number of so-called educated people wlio are so simple as to be readily taken in byevgery loud-voiced and brazen-faced iInpostor that comes toile front. This is not to be wondered at, seeing tllat among all classes there exists the mo'st dense ignorance of tlle commonest elements of scientific knowledge, and such mediaeval ignorance demands some form of superstition. To such people rational medicine presents no charms; to tllem the body is a dark mystery, and disease some process not of N=ature which must be exo0rcised. The sequence of cause and effect is not -well defined in their minds and t}ley demand the miraculous in medical science, whicli we are not able to offer. Therefore, when tlle charlatan arrives with his bag. of tricks, tm&kin,g exrtravagant promises and assertions to which no one out of an imbecile ward could be expected to give credence, he finds; willing listeners and easy victims. From this form of quackery the medical profession does not lose to any very great extent, and our hostility to this method of swindling the public does not proceed from any ne¢essity to defend our professional interests. Herbalists, and other unqualified persons do a roarinlg trade among the lower middle and lower classes. 'The law or our apathy seems to allow a complete licence. to all and everyone to practise medicine and surgery without the necesity for a qualification of fitness. And although unqualifepersons cannot call themselvres doctors and labour under cranother slight disabilities, no check is placed upon them. Thne most serious diseases are treated by persons wl1o are even ignorant of the names of the diseases, and tlle most disRstrous results often follow. No punishment falls upon them, and beyond an occasional mild reproof from the coroner no n~otice is taken of tlseir misdeeds. The poor are not a class to differentiate between the various kinds of doctors, especially as the herbalists now put M.B. after tlleir names. The law safeguards property far more cariefully than the heath and liv-es of teco'mmunity? and exacts from the man who undertakes to na:vigate a sfiip a guarantc* that he is competent to do s0, and that he wil not.-through ignorance endanger the property entrusted to him; while it is careless as to te competency of the man who undertakes to pilot a siek man through the shoals and dangers of disease. True, We are so reproductive that a' life more or l-ess makes no aprciable difference to the c-ommunity, while a valuable shpand her cargo are not so easily replaced. Te third class of oultside com etition we havre to deal with is that of the ipibscirib-ing cemists. Although, I'am A paer eadat a metn fteEast Kent District of the784uth era Banchof the BishMdclAssociation,X held at.Ramsgate. r ' t H"AMAN^9 77 MAy 59 1894.1 A--THiE I'RESENT STATE OF AIEDIC.M t12 l'lsATICES. aware of the liariii tlat tiley perhlaps uiiwittinigly do in bulillidly W)esefibJing for ailmen lts tlley dIo not uiiderstand, yet of tlle tllree classes of uiiqualifiezd prati'tiC I liave a little sy iiipat}ly for tlle offenderls ill tSle tliirdl. The profits of thle 2'lielilist ar'e so cut by tlle unfalir compleztition of groeers and stores t}lat to iiiany it is a dilliculty to kiiow liow to make botli ends meet, and tlle chemllists c'aii also retort upon us tllat in dispeiising our inledichiles we trespass upon t}leir dlomain. As t}le interests of botli doct'or' aiid cliemist are after all idenltical, in time I believe some understanding will be ai-rived at, and eachl will agree to k;eep liis own businless. In tilis way we sliall be able to niieet t ie pubJlic thl.at waints80o iiucli atid is w illing to give so little. Tllat tlle zilaii wliose business it is to dispense drugsj sliouldl be tlierefore considered competenit to treat disease is a inatural sequence of reasoning in tlle unedueated mind. Drugs and treatnleiit liavre been so closely associated, that it requires a certaiii eflort to separate tllem in tliouglt, and the majority of persons are unequal to this effort. By the employment of unqualified assistants t}le medical profession 1ias enlcouraged tlliis belief in the competency of tlle pre, seribing clienlist, for tlle emplyment of an unqualified person must imply eitlier tllat th doctor employs Iiim to treat }iis poorer patients, knowing Iiim to be incompetent to treat disease, or tllat the doctor does not consider that a special train'ing is necessary for tlle diagnosis and treatment of serious maladies. The ipublie must concelude eitlier that the employer is not acting justly to Ihis poorer patients, or that at any rate for tlle slig iter ailments it does not matter to wliom they go for relief as long as some kind of medicine can be obtained. I am sure tllat the practice of em lyng unqualified assistants, now, fortunately for the good faeof tlle profession, rapidly dying out amonlg respectabe practitioners, lias been responsible for diverting a great deal of practice from Us to the clhemists. No other profession is so mlyopic as our own. We seem absolutely blind to our OWD interests, and the temporary'advantage gainedto-day prevents us from realising tlle liarm that will ensue at a subsequent period. If the public see tllat tlle doctors make a trade of thei'r profession, and are not in their practice superior to the chemist, they will go to the latter because his charges are lower; and altliough well-to-do persons seek advice from a chemist, yet Iiis practice lies pincirpally among the lower classes, and it is among this elass that doctors have lost the pos'ition and influence -they formerly held. T}lis is also due to the fact that certain myop'ic persons Itave engaged in a suicidal warfare of underselling one another, so that the half-crown fees of a few years back liave now sunk to a shillinlg, and in many places to sixrpence. Even the six enny man is being cut out in some poor neighbourhoods by the threepenny doctor. Men who work for these fees cannot pretend to practice the'ir profession, nor can they spend the time that is necessary for diagnosis. Such persons, wliose sole treatment consists in gving the patient medicine out of the nearest bottle on the shelf, simply make a farce of practice, and seeing that the lives of sick persons are at stake too often, it is to be feared the farce becomes a tragedy. The underselling whicli is now becoming so prevalent in the profession is causi g grievous harm, and it is a two-edged weapon apt to recoil upon the head of the user, a fact he very frequently forgets. Not only amoncr the liumble ranks of the general practitioners, but even among the lofty circles of the "1 consultants," is this fierce struggle for existence going on. In consequence of low fees the II consultant " is in competition with the general practitioner, and the latter comp ains that the "-consultant " sees his patients without communicating with Iiim.