RICHMOND EXAMINER. QUACKS, PHYSICIANS, AND THE PUBLIC.

[A short time since we had the pleasure of listening to a lecture publicly delivered at the Medical College of this place, by Dr. A. E. Peticolas, upon the uncertainty of medical success, and the causes of the popularity of the charlatan. As the subject was one of no small importance to the public at large, as well as to the Medical profession, we requested from the lecturer the copy of his address, which he has kindly furnished. After a few preliminary remarks, he thus opens his subject: --Eds. Ex.]

During the two years, gone slowly by, since I received that tremendous document in which the every aspiration of the medical student is concentrated; I have been a candidate for practice in the city of Richmond. When I make this statement, it is not intended that I have journeyed daily to the out-skirts of the town, to ride through suburban streets at the speed of the wild huntsman; for to speak the fact, I had no horse. Nor have I attended evening parties of political meetings, the theatre or the church, that my servant might call me out with anxious countenance and trembling tongue. This was impossible for I had no servant. Nor have I frequented drug-stores, the halls or hotels or the corners of the streets, to harangue upon the imperfect mode of treating the prevailing epidemic, and to publish the extraordinary success of my own peculiar practice. This role I could not play, for I had no patients. All that I have done has been to advertise through the newspapers that the blessings of our exalted art would be dispensed at the hands of Dr. Peticolas whenever the afflicted public should ask for them- stating the situation of his office, and adding that he could be found therein whenever called upon- a melancholy truth I had never occasion to contradict. These facts are not mentioned as relecting on the discrimination and intelligence of the community: for mine is no isolated case. The picture may be appropriated by hundreds of young graduates, by many middle-aged practitioners; and with the slight correction of no profitable patients, by many old ones also, who yet reap the barren reputation of an overburdened business. But it was the pinching of this most unpleasant shoe on my own foot which has led me to the observations and reflections I now offer for your attention; and it is therefore that I have dwelt on my own case, in preference to the common cause of my professional brethren. I would trace the influences which retard the progress of the regular physician, and which favor in an equal ratio the careers of the charlatan and the quack. I would ascertain why the men who apply the laws of Baconian philosophy to the knowledge of human disease- why the followers of Galen and Hippocrates, of Cullen and Cooper, Rush and Hunter, must linger for a quarter of a century in probationary semi-starvation, while Thompsonians and Homeopaths, Hydropaths and Chrono-Thermalists plunge without delay into the luxurious baths of wealth? These things are not without a cause. That cause I would ascertain.- The source of this most unreasonable of moral phenomena I would discover- even though I prove it beyond the reach of our art or of any other to heal its bitter waters.

It would be the simple theory of one unacquainted with the world and with science, that the tardy success of the young practitioner is owing to some radical defect in his medical education, to the correction of which the prime of his life must necessarily be devoted; that the studies of his collegiate course do naught but fill his mind with unavoidable errors, to the detection of which some twenty years must constitute a proper period, while the quack or medical charlatan starts from the goal with a microscopic discernment of disease inherent in the mind and which he has not enveloped in the fatal fog of acquired knowledge. But though this be the simplest resolution of the problem, it will scarcely satisfy the present audience. All rational and educated people of the present century admit in the abstract the advantage of study and training, however much their action in life may belie their convictions in the closet. Yet the quack, who manifests the grossest ignorance on all subjects whatever, besides a most peculiar and most amusing want of knowledge of disease, establishes himself without difficulty or delay in the public confidence. But if the quack is ignorant the public is equally so. Therefore his grandiloquent pretences can be palmed off as pure gold, which they are not; - while the modest promises of the young physician are only passed as German silver, or as honest pewter, which they are.

Success in medical practice, so far as the public is able to judge, is wholly problematical. The unlearned lawyer finds his first case in court the public pillory of his ignorance and imbecility. An incompetent engineer may deceive two. In these things results are certain and qualifications are manifest. But in medicine the results are uncertain, and the qualifications of the practitioner wholly unintelligible to the unlearned in medical science. There is no one subject in the whole range of arts and sciences, on which the world at large is so totally deprived of the first glimpse of light, as upon the principles which govern the regular practitioner in the treatment of disease. It is therefore incapable of judging between the medical merits of the two candidates for its custom. It must needs take the ipse dixit of each. He who promises the most wonderful results in the most incredible space of time, will consequently gain the day; and the man of real science has ever too much knowledge of his own ignorance and limited power to vie with the brazen numskull, even did he desire to do so.

The singular phenomenon I have set out to account for, may be traced to three principal causes. The complexity and admitted uncertainty of true medical science has already been adverted to as one of these. In fatal contrast stands the simplicity of quack theories, and the infallibility of quack practice. The two, when regarded in connection with the debilitated state of the understanding during all bodily afflictions, are amply sufficient to explain the paradoxical preference of the majority for the audacious charlatan over the learned and modest physician.

Proficiency in medicine, at the present day, involves the correct understanding of many distinct and separate departments of science- each one of them embraces a range of facts already little less than limitless; and their number is swelled by the labors of each succeeding week. To master these, to appreciate their relations towards each other and to disease, to deduce from their classified combination a code of stable and reliable principles to guide us in our practice, demands a long, earnest and entire devotion of whole intellect in its fullest vigor. A thorough acquaintance with the organism of the human frame, though itself a labor of Hercules, will serve the purpose of but a single stepping stone to the investigation of morbid conditions. Take as example a diseased liver. Of what value is it to know alone the form, size, situation, structure and relations of that organ? This information has been gained under circumstances not existing in the living man. For in the one instance we have been enabled to see, to handle, and to examine, the exposed viscus. In the patient laboring under Hepatic disease, a new method of interrogation must be adopted. Here everything is concealed from the eye and covered from the touch. Hypertrophy or displacement might be guessed at by inspection. But many most dangerous and malignant affections are altogether independent of alteration in size or of change in place. And as the mere anatomist can be no judge of disease in general, neither can he who in addition knows only the healthful functions of the various organs of the human body. Physiology teaches us that the liver is a deparating organ; that it eliminates certain elements of the blood whose permanent residence in that fluid are detrimental, and that it combines these to form a secretion requisite to perfect digestion. Careful observation has proved certain symptoms consequent on the failure of this office and the detention of carbonaceous material; but a class of these signs is by no means peculiar to torpor of the liver. Here it behooves the physician to call in much collateral evidence, that by its aid, and by excluding all the phenomena common to this and to other disorders, he may by degrees arrive at some distinctive point, and thus satisfy his mind that the liver, and the liver alone, is at fault. Again, however, there is a barrier to his progress- to know the organ affected is one thing, to appreciate the character of the offence another. A new series of observations must be instituted, a new course of reasoning must be called into play; nor should our enquiries cease, until the cause of disturbance, whatever it may be, has been fully established; for how shall we meet the onset of an enemy whose mode of warfare we know not, and of whose portal of ingress we are ignorant? But granting the possibility of just conclusions on all these points, nothing has yet been done for the relief of our patient. Should our information stop here, we can be of no service to him. Think you he will derive much comfort from being told the cause, the seat, the character or the danger of his disorder? Means have yet to be selected to arrest its invasions, and the manner of applying them is to be settled. Had each particular malady its specific antidote, whose administration would ensure a cure, much of the doubt and difficulty incident to the practice of physic would be at an end. There would be no hesitation as to the medicine to be employed- no disquietude as to the effects to be expected. Were is Pleurisy, Pertussis or Paralysis, Tetanus, Typhus or Phthisis, Catarrh, Colic or Coryza, past experience would at once supply the name of the required herb. But the truth is far, very far, otherwise. Two persons may be laboring under the same disease at the same time, yet the remedies needful in the one instance will differ in every particular from those given in the other- the first must be bled, cupped or leeched, must be starved and kept quiet, must take antimony or its equivalent. The other must be fed high, must take air and exercise, must have tonics and even stimulants. And it is not mere guessing which is to direct this most opposed plan of treatment. Careful investigation by one who is competent can alone decide it. The mere name of the disease is not the only consideration indicating the use of a particular class of remedial agents. The age, the temperament, the constitution, the idiosyncrasies of the patient, are to be held in view. The stage of the malady, the time of its continuance, the type of the prevailing epidemic, are also circumstances of importance to the estimate, and must all be carefully balanced before making choice from our Materia Medica. Again, the latter embraces a host of substances, each differing from the other, either as regards its particular effects, or with respect to the degree of power it exerts over the animal system; some have tendencies to special organs, others influence the whole economy; some are rapid and violent in their action, others mild and slow in manifesting their effects; some produce no change except in given bodily conditions; the administration of others is, under all circumstances, attended with the same result. To wield the powerful armament reasonably, to select or combine judiciously the elements of which it is composed, to aim them with accuracy at the end to be accomplished, require an intimate acquaintance with all their properties, physical and sensible, chemical and therapeutic.

But knowing all these; assuming that we have learned the name, the seat, the cause, the character, the stage of the disease, the previous history and present condition of the patient; allowing the facts and circumstances here enumerated have all been fully ascertained, and that after due deliberation the course of treatment most judicious has been decided on, does it follow that the invalid will be cured? Can this question be answered with mathematical certainty? Can we say to the afflicted parents, friends and relatives of the sufferer- cease your lamentation, for this sick man shall be made whole; be joyful, for this loved one shall be restored? We cannot. Our reply to all the queries which regard the ultimate issue, if honest and wise, must then be any thing but positive. There are a thousand sources of error, and a thousand causes for failure in all our calculations. The most learned and the most experienced can alone state the chances. The chances are in favor of life; the chances point to a happy termination; others have recovered from a similar situation; good nursing, chance of air, and nutritious diet, may restore health. These and such like doubtful expressions can alone be used with truth. But what are the sources of error? What the causes of this uncertainty? Can they not be traced to their origin? Cannot allowance be made for their existence? Cannot doubt be diminished? Yes. Their general character can be, and is, known. But little can be predicated as to the degree of power they may exert, and the difficulties presented by them are consequently the same as before. Many spring from the impossibility in some instances of obtaining the information already indicated as necessary to a complete understanding of the case. The patient or the persons in attendance either cannot or will not satistfy our enquiries. Many are to be referred to changes occurring during the course of the malady, the resistance opposed by the system to the invasions of disease causing us to confound the effects of remedies with the struggles of nature and many are to be sought in the workings of the much talked of, but little known, influence called sympathy. The majority of our difficulties may be traced to the fact that we are incapable of appreciating the nature and modus operandi of many of the causes of disease; that we are very far from having a thorough acquaintance with the extent of mental influences; and, lastly, that we are ignorant, totally ignorant, not only of the nature of the vital principle, but also of many of the laws governing its manifestation.

A child dies; the wretched parents mourn its loss; the friends and relatives collect; their sorrowful faces and garments of woe might lead us to suppose that they too had suffered a similar bereavement. These latter are said to sympathize with the former. Just so it is with the different organs of the human body. The heart, the stomach, or the brain, may be the seat of the disease, but all the viscera give evidences of disorder. One organ appears to suffer because the other is really affected. Thus, an infant is teething; it is fretful; cries from the slightest causes, or, apparently, from no cause; it refuses nourishment; its skin is hot; its face flushed; suddenly it falls into convulsions. Worms in the alimentary canal, irritating or indigestible food, may give rise to the same phenomena. There is no actual disease of the brain or spinal cord. Yet to the abnormal state of these organs the signs in question might with all propriety be referred. Again, a patient with liver disease suffers from pain in the shoulder, while the subject of coxalgia refers to his knees as the afflicted part, and numerous other instances might be cited to the same effect. But this so-called sympathy may not only produce apparent disease at a distance from the puctum saliens, but a true pathological condition may be set up in a part more important than the first, and of a kind more malignant. The child whose brain has sympathized with its stomach, may, by a continuance of the irritation, have a true inflammation of the cerebral tissue. Sympathy then may mask the simplicity of disease, and in a corresponding ratio increase the doubt of a favorable issue in two ways: first, by originating a train of morbid phenomena in a distant locality, thus leading off the physician, and inducing him to administer remedies of doubtful efficacy; or, secondly, by annulling the good he has done at one point by developing a worse malady in another. Now, if the confusion be great when the co-sufferers with the truly diseased region are in a state of health at the time of attack, a fortiori must it be greater when some, or many of them have been, or are still, in an unhealthy condition. The strictest research, the most thorough investigation, fails to discover the starting point of the evil. Strictly speaking, there may be no single starting point. Several organs may simultaneously, be equally or unequally, disordered; the symptoms due to one or the other predominating at different times, and presenting a complication impossible to unravel. The various phases of disease so unaccountable, so capricious, present almost unconquerable difficulties, the demand for interference first existing at one spot, then at another, and shifting to a third, fourth and fifth locality- so that it would seem to the observer as though “some tricky spirit were playing his pranks among the organs, now here, now there, eluding his search and escaping his grasp.”

Whenever men are ignorant of the nature and modus operandi of a cause, there will necessarily prevail a great variety of opinion upon the nature of the disease which is due to that cause, and an equal uncertainty relative to the best mode of arresting the affection this produced. Now, the ultimate causes of one half the diseases which medical men profess to treat, are beyond the grasp of medical science. What is more involved in mystery than the origin of periodical, continued, and exanthemaxtous fevers, or the influences producing epidemic cholera, or, indeed, any epidemic you may call to mind? We certainly do know that most of the fevers are in some way associated with want of local and personal cleanliness; but as to the particular mode in which accumulations of filth do act, we know not whether it be by the evolution of noxious gases, by the generation of myriads of fungi, or of shoals of animalculae, whose reception and distribution through the system produce or give an impulse to the production of characteristic symptoms- or whether any poison, either gaseous, animal, or vegetable, is absorbed- or, whether the phenomena seen are not merely the result of an impression made on highly sensitive parts, thereby determining a concatenated series of changes. I say, that whether the one or the other of these hypotheses be true, is matter of which we knew as much four thousand years ago as we do at this day. Each supposition has its fanatic, its prophet, and its devotees, who drag forth multitudes of facts in fortification of their peculiar views. Not only so. This difference of opinion is not confined to etiological doctrines. The pathology of many of these diseases is still a subject of grave discussion. Some argue the brain to be the chief disturber of the healthful equilibrium, its offence soon involving the whole economy in riot. We all know that Broussais and his followers have written octavos without number, to prove gastro enteritis the primary lesson in what we call general fevers; and although it may be suggested that these views are now obsolete, and that the theories of Clutterbuck and Broussais do not now concern us; that new facts and new investigations have declared fever to be a general and functional affection; that digestion, absorption, circulation, respiration, secretion all depart from the normal standard, while motionand sensation are perverted, and while intelligence is clouded; that we can find no central point for the disease; that fever may begin, may run its course, and terminate, without leaving a spot on which we can lay our finger and say, “Here didst thou lay concealed; in this corner didst thou lurk; here did thy devastations commence.” And we conclude from all this that fever does not originate from local inflammation, that fever may exist without it, that these local phlegmasiae are its concomitants and not its cause. Even though I grant this current theory to be true, it has not sufficient data for its foundation to prevent the subject from being still sub-judice. Not four weeks ago, it was argued in the Virginia Medical Society that Scarlet Fever is an essentially inflammatory disease. I have not the least intention of entering on that discussion; I allude to it simply for an illustration of our incapacity to settle the character of the commonest complaints. Such opposed opinions concerning cause and pathology, must necessarily result in corresponding discrepancies of treatment. If we believe a particular group of symptoms which all have agreed to represent by the name of Typhus, Typhoid, or Scarlet Fever, is consequent to the peculiar state of a singe oran, conventionally called inflammation; and it has also been established that a special class of remedies is at hand, whose efficiency in quelling inflammation if not to be doubted; it follows, as a rational conclusion, that our remedial efforts will be directed to the relief of the organ at fault, and that the agents known as anti-phlogistic will be used. On the other hand, if we put faith in the non-inflammatory theory, and we further grant the well-ascertained fact that the disease has a particular course to run which no effort on our part can curtail, and that there is no one class of remedies proper to every stage of the complaint, it is them quite obvious we will sit ourselves down by the bedside of the patient to watch carefully and to prescribe cautiously; that we will cool him when he is hot, warm him when he is cool, deplete and starve him when he is strong, nourish and stimulate him when he is debilitated, and thus endeavor by simply lending assistance to nature to support and strengthen the tendency to a favorable termination. But so long as our notions of the causation of disease are thus unsettled; so long as this contrariety of treatment prevails; there will necessarily be an equal uncertainty in the ultimate result of our labors. This humiliating deduction a quack can unblushingly deny, because his happy ignorance prevents him from drawing it; but no truthful physicians can avoid its discovery to others in every action and word of life. If a human being was a machine, all whose parts were cognizable to our sense, and within the reach of human intellect like a clock or a steam engine, then no matter how complex the combination of its screws and pulleys, of its wheels and wedges- no matter how much the well defined and certainly-known elements were multiplied and interwoven in its construction, there could be no difficulty in discerning an error in its action; no uncertainty as to the part at fault; no difference of opinion as to the modus of relief, nor the slightest hesitation in predicting a positive cure. The principles of mechanics are few and simple as those of all purely physical sciences; and, what is of far more importance, they are unerring and unalterable. But in the machine called Man, the principles of ordinary matter are not the only laws in operation. No ordinary combination of materials connect and move this magnificent framework of bone and cartilage; this intricate cordage of muscles and tendon; this wonderful nutrition apparatus, this strong yet simple heart, this beautiful correspondence of vein and artery; these ever-playing lungs, delicate as butterfly’s wings yet strong as the sails of a ship; this brain, that prince of organs, the temple of the will, the dome on which sensation and intellection sit, weaving their garlands. We know the elements of compounding these- chemistry has long since defined their nature and number; they can be obtained from almost every acre of ground in the world. The mechanical principles on which their action partially depends, are easy of apprehension. Their organized formation is perfectly apparent- they have been examined in every stage of their development; and this superb mass of tissues, this aggregation of organs, this poet, priest, hero, this orator and statesman, this lord of the world, is evolved from a simple cell, a thing no bigger than a wheel animalcule or a yeast plant, not a thousandth part the size of a glazier’s diamond. The prying eye of the microscope has shown us this, and the material phenomenon of its growth- but it has not shown the secret spring which moves the whole machine. It displays to us no synthetic process, whose means can build the cell from which all this comes forth. Prometheus and Frankenstein remain wild fables in the midst of all the Cuviers, and Hunters, and Owens. However perfect our knowledge of all the elements, the subtle method of their combination here mocks our baffled gaze.- There is something in this machine which we cannot see, or touch, or find at all. We veil our ignorance of it under the name of the vital principle;- but what it is, its nature and the process by which it selects and elaborates from the common materials of the earth a living, moving, sensitive being, is among the things known only to the Great Chemist of the Heavens. The science of medicine ends at this barrier. All departments of human knowledge are likewise bounded in one way or another, by things which human faculties cannot grasp. But the barrier which stops the career of our science allows us the least scope. It meets us everywhere. A few feet from the ground, and we beat our wings against the cage. This is the cause why medical is the least certain knowledge. This is why our actions are nearly all over unstable foundations. A calculation of probabilities is the most we can pretend to.

Having now taken a glance at the intricacy of true medical science, and having recognized the uncertain results of medical art as an attendant on its most earnest and honest endeavors, controlled as they are by influences entirely beyond our reach and ever likely to remain so- let us, for a few moments, view the contrast presented by empiric doctrines, connected with their broad assertions of infallibility. The more successful of these, and by success I mean with reference to popularity and the establishment of public confidence, set out with data easy to be understood- from whence are made deductions beautifully comprehensive and universal in their tendency. Two illustrations will suffice to show my meaning. They will be taken from Thomsonism and Homeopathy, and I warrant them fair samples of the whole cargo. Thomson, the founder of the former system, views the body of a man as a mere tenement of brick and mortar, provided for the earthly residence of the immortal spirit. The latter is a chilly creature, and needs the assurance of warm apartments to induce its long continuance in this terrestial house, a constant, never-failing supply of fuel and ever-burning fire must be provided. Man’s stomach is his fireplace; his food his ordinary fuel; digestion is the process of combustion. Should the fire burn dimly, and the rooms grow cool, the spirit threatens to seek other lodgings. The commotion of packing up, the preparations for removal, give the symptoms of disease. If the fire go out, the mansion gets cold; the soul leaves with a deep sigh; the man is dead. The only way to maintain life, to continue it to the limits of its widest span, is to keep up the warmth. To do this, the fuel must be good; must be put on at regular intervals; the fireplace must be kept clean, the chimneys clear.- The chimneys are numerous- the skin is the chief. If the food be nutritious and the stomach in proper repair, there is no residue of ash and cinder. It does sometimes happen, however, that the latter accumulate- soot and dust choke flues- the draught is arrested- the fire burns low- the cold makes its entrance- the soul trembles. What now is to be done? Why, simply what any one in his sober senses would do to an ordinary fire-place: clear away the ashes, sweep the chimney, and throw on the light wood. Lobelis is the hearth-brush and chimney sweep, No. 6, or some other combination of powerful stimuli, the light wood. Give your patient a touch of both, and who can doubt the result? ‘Tis as certain as any event can be- you may swear to a cure without the slightest hesitation. If two and two make four, your man will get well; - at least Dr. Thomson makes the declarations as true. His own words are, “they have often been proved so, and can be again if occasion occurs, to the satisfaction of every candid person, and at the hazard of any forfeiture the faculty may challenge.”

Now for Homeopathy. Hahnemann is less sublime than the Thomsonian charlatan. He offers no new ideas concerning the constitution of man; nor does he attempt to reduce disease to a unit. He grants you a man of bone, of muscle, and of nerve; admits disease to be manifold; that symptoms are varied; the causes of the disorder without limit. But he preaches from a text in Shakespeare:

“Tut man! One fire burns out another’s burning, One pain is lessended by another’s anguish; Turn giddy, and be helped by backward tuning; Our desperate grief cures with another languish: Take thou some new infection to thine eye, And the rank poison of the old will die.”

This he renders into Latin thus- Similia similibus eurantus- A hair of the dog is good for the bite; snow cures a frozen nose; fire, a burnt finger; thorn apple, insanity; Ipecac, nausea, and brandy delirium tremens. Ergo, the specific of every disease produces in the healthy body symptoms analagous to the malady it cures. Hahnemann discovers that this homogeniety of relation is the only true principle of medicine. Then what is plainer or easier to be understood than Hahnemann’s theory? The little child who has scorched his toes on the kitchen hearth, will testify to the doctrine; the cook will take oath on it; and the drunkard will hiccup with all due gravity; - there is no mistake about it. That which is evident to the understanding of infants, cooks and sotts, will not puzzle clearer intelligences.

In these illustrations, the principal elements favoring the reception of quackery are easily discovered. The foundation on which they operate, is the natural repugnance of the mind to rely on mere probabilities and possibilities; and its imperfect discrimination when under the influence of any great emotion or instinct. That there is no more controlling and all- absorbing instinct than that of self-preservation; no more paralyzing emotion than the fear of death, all will grant without any hesitation. That these two are decidedly in operation, to a greater or less degree during the invasion of disease, none can doubt. When, in addition, it is remembered that sickness itself has a tendency to cloud the perceptive faculties and to falsify the judgement, it is no longer theme for wonder that he will be preferred who can give simple, uncomplicated explanations of the condition of the sick man; can conscientiously promise relief to his misery, ease to his pain; can ensure the return of health without hesitation or prevarication; who has a panacea for all disease, or a specific for each variety of malady- to one who asks countless questions of his patient concerning apparently irrelevant matters; would know his age, his occupation, his habits, his mode of living, the diseases he has had; enquires of his family, his parents, his brothers and sisters; would ascertain his errors of diet, and the exposures to which he has been subjected; feels his pulse, examines his skin, his tongue, his face, his eyes; thumps his chest, kneads his body, tells him to take this position and then that; listens first on one side and then on the other; makes him talk, count, cough, spit; and after all this horrid inquisition, on being asked what he thinks of the case and will it get well? says, with melancholy face, that the case is very sick, and that he hopes it may recover;- that if his pills are swallowed, his draughts imbibed, if the regimen be curtailed, if the leeches bite, or the blisters draw, he may be better in the morning. To a doctor who will shave the head of one case of fever and surround it with ice bags, spunge its body, take blood from its arm, deny it food; who will envelope a second in blankets, cover it with mustard plasters, give it brandy and nourishment every hour of the night; who will treat one cough with alum or nitrate of silver; a second, with bleeding and tartrate of antimony, calomel and Dover’s powder; a third, with iron, cod liver oil, porter, and meat diet; will express hopes for the recovery of the two first, and will say the last never can get well. How in Heaven’s name, I ask, can the bewildered patient, or his anxious friends, reconcile such glaring contradictions, or be satisfied with such meagre attempts at consolation? Is it probable that they should be willing to place all that is near and dear to them in the hands of one who proposes such enigmatical doctrines; who administers opposed remedies for the cure of similar maladies; who gives the same medicine in different disorders; and who is yet much more inclined to yield the assurance that death will put an end to the sufferings of the sick man, than to promise that returning health shall relieve his fears? Is it wonderful that young medical men get little or nothing to do?- There is naught, save the authority of age and grey hairs, with the reputed learning and experience supposed to accompany them, which can give weight to the apparently mysterious enunciations of true medicine. Smooth-faced plausibility and cold lying, must always bear off the palm, when opposed to rugged truth and mere probability.

Gentlemen, I have given the outlines of a picture which my medical audience can easily fill up from their own experience. I have briefly traced the causes of a puzzling phenomenon. I have furnished the key to this paradox. The result of this analysis, the precipitate of our crucible is dreary in hue and bitter to the taste; but there is yet this consolation with it- that ours is the only side of truth and of honor. We cannot convince the ignorant public that they follow an ignis-fatuus; but we know our lamp, though small and dim, is all the light which the elements permit us to enjoy. Our position has been long ago defined in the gorgeous diction of Lord Verulam, while he wrote on a different theme: “Nevertheless,” says he, “I do not pretend, and I know it will be impossible for me, by any pleading of mine, to reverse the judgement, either of Aesop’s cock, that preferred the barley-corn to the diamond; or of Midas, who being chosen arbiter between Apollo, President of the Muses, and Pan, god of the flocks, decided for that Satyr who promised plenty; or of Paris, who judged for a smooth face before wisdom and power; or of Agrippina, occidot matream modo imperet- that would attain empire, with any condition, never so detestable; or of Ulysses, qui retulam pratudit immortaliteti; or of a number of like popular judgements, which are types of those who prefer present show and habit to all excellency- for these things must continue as they have been; but so will that also continue whereupon learning hath ever relied, and which faileth not: justificata est sapientia a filis suis.”

Thus much for ourselves. To the public at large I have in this discourse shadowed forth the size and strength of a monster who has long preyed and fastened on a credulous world, whose existence is dependant on elements which have ever been, which will ever be, in operation, and which can only be quelled by the strong arm of the law.

If a man sign the name of another he is sentenced as a forger; if he sells trash for goods he is arrested for swindling; if he meets his enemy in the road and shoots him through the head, he is hanged for murder; if he stabs him in a dark corner, he is execrated to violent death as an assassin; if he mingles arsenic with your cups his name is blotted from the books of humanity. The law lays an iron hand on all these. But he who announces himself to be a Doctor of Medicine, without authority, is de facto a forger; his charge for service is aggravated swindling; a murderer more efficient than he who discharges a rifle against your forehead, an assassin more certainly than he who thrusts a dirk through your breast while you sleep, and he gives you poison while you trust to his protection; and while he promises life; you quaff the bowl with a smile upon your lips, lay your money at his feet without a murmur, and never have for him a harsher epithet than quack!

Source: Richmond Semi-Weekly Examiner. 1 April 1851: 4 (Library of Virginia Archives)

Erin Bartels & Joe Essid prepared this typescript.