Nothing in his curriculum puzzled our embryo physician so much as the different methods of treatment advocated by his teachers. With many of them, it is only fair to say, the only treatment they advocated was the extension of the palmaris muscle in the hand, known to anatomists as the guinea muscle, for the purpose of receiving the fee. Men of the new school declared the only treatment necessary for any medical, as distinct from surgical disease, was a good warm bed, and discarded all drugs. As, however, these gentlemen lived by the practice of their profession, it was a question if they were not liable to be charged with obtaining money by false pretences, as they did nothing whatever to assist their client’s recovery.

Some, on the other hand, wrote great books on therapeutics, and gave you a list of some score or so of drugs, more or less deadly, for the cure of every complaint, real or imaginary, leaving the selection to the practitioner, as he, when he combined them, left Nature to take what she thought would best answer her purpose.

King James the First declared that the perusal of Hooker’s “Ecclesiastical Polity” (written as an apology for the Church of England) made him a Roman Catholic. How many students having heard at the hospitals the defence its professors have to make for it, and seen its practice in the wards, have retained any faith at all in the science of medicine? King James found that the arguments of Hooker did not go far enough. The student of medicine finds his teachers go a great deal too far; and becoming a medical sceptic when he has obtained his diploma, he generally adopts “the expectant treatment,” and leaves everything to the vis medicatrix naturÆ—in other words, he leaves his case exactly where he found it, and takes much scientific credit to himself for his non-interference.

You could always, if you liked, have the expectant treatment exhibited at St. Bernard’s; it was rather a favourite experiment. You got two cases as nearly as possible of the same type of the same disease, say typhoid fever, in exactly the same stage of development. You put the cases side by side in the same ward. With the one you adopted all the therapeutic routine which might just then be the fashion—for fashion in medicine is as variable as in ladies’ dress—and in the neighbouring case you gave no drugs at all, but water simply coloured with burnt sugar as a placebo, lest the patient should think himself neglected. You watched the progress of the malady, you adopted in each case the same diet, and at the end of three weeks or a month, both cases terminated by recovery as nearly as possible at the same time. Dr. Oliver Wendell Holmes said,“if all drugs were cast into the sea, it would be so much the better for men, and so much the worse for the fish.” They quite went in for this idea at St. Bernard’s, with an exception in favour of newly discovered drugs whose physiological actions were yet to be investigated, and till all was known of them which could be learned, they compelled their patients to swallow them. This was part of the expectant treatment. Mr. Micawber, it will be remembered, was somewhat of a disciple of this school. It is most unfair to argue that nobody got any good from this method, because many papers were produced for the medical journals on these new preparations; though, as an inquisitive lady reader once remarked, the cases all seemed to end with an autopsy.

But then, you see, a “P.M.” is like a lady’s P.S., quite the most important part of the whole concern. The drug bill at our hospital was a very heavy one, because all these new remedies at their first introduction are necessarily costly from their limited demand. Then all sorts of worthless articles of diet, much belauded by the journals which received large sums from the proprietors who advertised their wares in their columns, had to be tried. Poor wines, with high-sounding titles, at prices to match, were for mysterious reasons certified by the physicians of the place to be particularly “rich in phosphorus, and peculiarly suitable to invalids suffering from dyspepsia and want of nervous tone;” and were used in the hospital generally, in proof of the favour in which they were held, by Dr. Octavius Puffemup, M.R.C.P. (Lond.), Lecturer on Diseases of the Supra-Orbital Nerve at St. Bernard’s Hospital, London, Fellow of the Royal Society of Diana Lucina, and Member of the Royal Institution of Cynegetics, etc., etc., etc. All these much-belauded nostrums, like our little systems, “had their day and ceased to be;” they cost the charity a great deal of money, and served merely to advertise the members of the staff who demeaned themselves by praising them.

Did a member of the staff invent a new bed, a new inhaler, a new instrument, or a new kind of invalid’s clothing, it must be purchased, no matter what the cost, as often as he chose to order it for his patients. It served to keep his name before the public; it was one of the many ways in which the charity could recompense him for the time he devoted to its work.

A bookseller once declared, if his customers only purchased the books they were likely to read, he would not get bread and cheese. If only the pharmaceutical preparations were purchased which the patients really required, the makers of them would be in the same predicament. It is so easy to be liberal when you don’t have to pay. With proper conscientious management, directed for the patient’s benefit alone, the expenses of our great hospitals might easily be reduced one-half. But then there must be a good deal of self-sacrifice.