FAITH CURE AND GRAFT IN SURGERY.

I think we have enough before us to show why intelligent people become followers of fads. Seeing so many impositions and frauds, they forget all the patient research and beneficent discoveries of noble men who have devoted their lives to the work of giving humanity better health and longer life. They are ready at once to denounce the whole medical system as a fraud, and become victims of the first “new system” or healing fad that is plausibly presented to them.

And here a question arises that is puzzling to many. If these systems are fads and frauds, why do they so rapidly get and retain so large a following among intelligent people? The answer is not hard to find. The quacks of these fad schools get their cures, as every intelligent doctor of the old schools knows, in the same way and upon the same principle that is so important a factor in medical practice, i. e., faith cure—the psychic effect of the thing done, whether it be the giving of a dose of medicine, a Christian Science pow-wow, the laying on of hands, the “removal of a lesion” by an Osteopath, the “adjustment” of the spine by a Chiropractor, or what not.

The principles of mind or faith cure are legitimately used by the honest physician. Suggestive therapeutics is being systematically studied by many who want to use it with honesty and intelligence. They realize fully that abuse of this principle figures largely in the maintenance of the shysters in their own school, and it is the very foundation of all new schools and healing fads. The people must be made to know this, or fads will continue to flourish.

The honest physician would be glad to have the people know more than this. He would be glad to have them know enough about symptoms of diseases to have some idea when they really need the help of a physician. For he knows that if the people knew this much all quacks would be speedily put out of business.

I wonder how many doctors know that observing people are beginning to suspect that many physicians regulate the number of calls they make on a patient by motives other than the condition of the patient—size of pocketbook and the condition of the roads, for instance. I am aware that such imputation is an insult to any physician worthy of the name, but the sad fact is that there are so many, when we count the quacks of all schools, unworthy of the name.

The president of a St. Louis medical college once said to a large graduating class: “Young men, don’t go to your work with timidity and doubts of your ability to succeed. Look and act your part as physicians, and when you have doubts concerning your power over disease remember this, ninety-five out of every hundred people who send for you would get well just the same if they never took a drop of your medicine.” I have never mentioned this to a doctor who did not admit that it is perhaps true. If so, is there not enough in it alone to explain the apparent success of quacks?

Again I say there are many noble and brainy physicians, and these have made practically all the great discoveries, invented all the useful appliances, written all the great books for other schools to study, and they should have credit from the people for all this, and not be misrepresented by little pretenders. Their teachings should be applied as they gave them. The best of them to-day would have the people taught that a physician’s greatest work may be done in preventing rather than in curing disease. Physicians of the Osler type would like to have the people understand how little potency drugs have to cure many dangerous diseases when they have a firm hold on the system. They would have some of the responsibility removed from the shoulders of the physician by having the people understand how much they may do by hygienic living and common-sense use of natural remedies.

But the conscientious doctor too often has to compete with the pretender who wants the people to believe that he is their hope and their salvation, and in him they must trust. He wants them to believe that he has a specific remedy for every disease that will go “right to the spot” and have the desired effect. People who believe this, and believe that without doctoring the patient could never get well, will sometimes try, or see their neighbors try, a doctor of a “new school.” When they see about the same proportion of sick recover, they conclude, of course, that the doctor of the “new school” cured them, and is worthy to be forever after intrusted with every case of disease that may arise in their families.

This is often brought about by the shyster M.D. overreaching himself by diagnosing some simple affection as something very dangerous, in order to have the greater credit in curing it. But he at times overestimates the confidence of the family in his ability. They are ready to believe that the patient’s condition is critical, and in terror, wanting the help of everything that promises help, call in a doctor of some “new school” because neighbors told how he performed wonderful cures in their families. When the patient recovers speedily, as he would have done with no treatment of any kind, and just as the shyster M.D. thought he would, the glory and credit of curing a “bad case” of a “dangerous disease” go to the new system instead of redounding to the glory of Dr. Shyster, as he planned it would.

Is it any wonder true physicians sometimes get disgusted with their profession when they see a shyster come into the town where they have worked for years, patiently and conscientiously building up a legitimate practice that begins to promise a decent living, and by such quack methods as diagnosing cases of simple fever, such as might come from acute indigestion or too much play in children, as something dangerous, typhoid or “threatened typhoid,” or cases of congestion of the lungs as “lung fever,” and by “aborting” or “curing” these terrible diseases in short order and having his patients out in a few days, jumps into fame and (financial) success at a bound? Because the typhoid (real typhoid) patients of the honest doctor lingered for weeks and sometimes died, and because frequently he lost a case of real pneumonia, he made but a poor showing in comparison with the new doctor. “He’s just fresh from school, you know, from a post-graduate course in the East.” Or, “He’s been to the old country and knows something.” Just as if any physician, though he may have been out of school for many years, does not, or may not, know of all the curative agencies of demonstrated merit!

Would a medical journal fail to keep its readers posted concerning any new discovery in medicine, or helpful appliance that promises real good to the profession? Yet people speak of one doctor’s superior knowledge of the best treatment of a particular disease as if that doctor had access to some mysterious source of therapeutic knowledge unknown to other physicians. It is becoming less easy to work the “dangerous diagnosis” graft than formerly, for many people are learning that certain diseases must “run their course,” and that there are no medicines that have specific curative effects on them.

There is another graft now that is taking the place of the one just mentioned, to some extent at least. In the hands of a fellow with lots of nerve and little conscience it is the greatest of them all. This is the graft of the smart young fellow direct from a post-graduate course in the clinics of some great surgeon.

He comes to town with a great flourish of trumpets. Of course, he observes the ethics of the profession! The long accounts of his superior education and unusual experience with operative surgery are only legitimate items of news for the local papers. Certainly! It is only right that such an unusual doctor should have so much attention.

There is no “starving time” for him. No weary wait of years for patients to come. At one bound he leaps into fame and fortune by performing “big operations” right and left, when before his coming such cases were only occasionally found, and then taken to surgeons of known ability and experience. The reputable physician respects surgery, and would respect the bright young fellow fresh from contact with the latest approved methods who has nerve to undertake the responsibility of a dangerous operation when such an operation is really indicated. But when it comes to mutilating the human body by cutting away an appendix or an ovary because it is known that to remove them when neither they nor the victim are much diseased is a comparatively safe and very quick way to get a big reputation—that is the limit of quackery. And no wonder such a man is so cordially hated by his brethren. He not always hated because he mutilates humanity so much, as because his spectacular graft in surgery is sure to be taken as proof conclusive that he is superior in all other departments of therapeutics.

And it puzzles observing laymen sometimes to know why all the successful (?) operations are considered such desirable items of news, while the cases that are not flattering in their outcome pass unmentioned.

I find most complete corroboration of my contention in the president’s address, delivered before the Western Surgical and Gynecological Association at St. Louis, in 1907, by Charles W. Oviatt, M.D. This address was published in the Journal of the American Medical Association, and I herewith reprint it in part:

“The ambitious medical student does not usually get far into college work before he aspires to become a surgeon. He sees in the surgical clinics more definite and striking results than are discernible in other branches. Without being able to judge of his own relative fitness or whether he possesses the special aptitude so essential to success, he decides to become a surgeon. There will always be room for the young surgeon who, fitted by nature for the work, takes the time and opportunity to properly prepare himself. There is more good surgery being done to-day than ever before, and there are more good surgeons being educated to do the work. If, however, the surgeon of the future is to hold the high and honorable position our leaders have held in the past, there must be some standard of qualification established that shall protect the people against incompetency and dishonesty in surgeons.

“That there is much that passes under the name of surgery being done by ill-trained, incompetent men, will not be denied. What standard, then, should be established, and what requirement should be made before one should be permitted to do surgery? In his address as chairman of the Section on Surgery and Anatomy of the American Medical Association, at the Portland (1905) meeting, Dr. Maurice H. Richardson deals with this subject in such a forceful, clear-cut way, that I take the liberty to quote him at some length:

“While Dr. Richardson’s ideal may seem almost utopian, there being so wide a difference between the standard he would erect and the one generally established, we must all agree that however impossible of attainment under present conditions, such an ideal is none too high and its future realization not too much to hope for.

“While there is being done enough poor surgery that is honest and well intended, there is much being done that is useless, conscienceless, and done for purely commercial ends. This is truly a disagreeable and painful topic and one that I would gladly pass by, did I not feel that its importance demands some word of condemnation coming through such representative surgical organizations as this.

“The spirit of graft that has pervaded our ranks, especially here in the West, is doing much to lower the standard and undermine the morals and ethics of the profession. When fee-splitting and the paying of commissions for surgical work began to be heard of something like a decade ago, it seemed so palpably dishonest and wrong that it was believed that it would soon die out, or be at least confined to the few in whom the inherited commercial instinct was so strong that they could not get away from it. But it did not die; on the other hand, it has grown and flourished.

“In looking for an explanation for the existence of this evil, I think several factors must be taken into account, among them being certain changes in our social and economic conditions. This is an age of commercialism. We are known to the world as a nation of “dollar chasers,” where nearly everything that should contribute to right living is sacrificed to the Moloch of money. The mad rush for wealth which has characterized the business world, has in a way induced some medical men, whether rightfully or wrongfully, to adopt the same measures in self-protection. The patient or his friends too often insist on measuring the value of our services with a commercial yard-stick, the fee to be paid being the chief consideration. In this way the public must come in for its share of responsibility for existing conditions. So long as there are people who care so little who operates on them, just so long will there be cheap surgeons, cheap in every respect, to supply the demand. The demand for better physicians and surgeons must come in part from those who employ their services.

“Another source of the graft evil is the existence of low-grade, irregular and stock-company medical schools. In many of these schools the entrance requirements are not in evidence outside of their catalogues. With no standard of character or ethics, these schools turn out men who have gotten the little learning they possess in the very atmosphere of graft. The existence of these schools seems less excusable when we consider that our leading medical colleges rank with the best in the world and are ample for the needs of all who should enter the profession. Their constant aim is to still further elevate the standard and to admit as students only those who give unmistakable evidence of being morally and intellectually fit to become members of the profession.

“Enough men of character, however, are entering the field through these better schools to ensure the upholding of those lofty ideals that have characterized the profession in the past and which are essential to our continued progress. I think, therefore, that we may take a hopeful view of the future. The demand for better prepared physicians will eventually close many avenues that are now open to students, greatly to the benefit of all. With the curtailing of the number of students and a less fierce competition which this will bring, there will be less temptation, less necessity, if you will, on the part of general practitioners to ask for a division of fees. He will come to see that honest dealing on his part with the patient requiring special skill will in the long run be the best policy. He will make a just, open charge for the services he has rendered and not attempt to collect a surreptitious fee through a dishonest surgeon for services he has not rendered and could not render. Then, too, there will be less inducement and less opportunity for incompetent and conscienceless men to disgrace the art of surgery.

“The public mind is becoming especially active just at this time in combating graft in all forms, and is ready to aid in its destruction. The intelligent portion of the laity is becoming alive to the patent medicine evil. It is only a question of time when the people will demand that the secular papers which go into our homes shall not contain the vile, disgusting and suggestive quack advertisements that are found to-day. A campaign of reform is being instituted against dishonest politicians, financiers, railroad and insurance magnates, showing that their methods will be no longer tolerated. The moral standards set for professional men and men in public life are going to be higher in the future, and with the limelight of public opinion turned on the medical and surgical grafter, the evil will cease to exist. Hand in hand with this reform let us hope that there will come to be established a legal and moral standard of qualification for those who assume to do surgery.

“I feel sure that it is the wish of every member of this association to do everything possible to hasten the coming of this day and to aid in the uplifting of the art of surgery. Our individual effort in this direction must lie largely through the influence we exert over those who seek our advice before beginning the study of medicine, and over those who, having entered the work, are to follow in our immediate footsteps. To the young man who seeks our counsel as to the advisability of commencing the study of medicine, it is our duty to make a plain statement of what would be expected of him, of the cost in time and money, and an estimate of what he might reasonably expect as a reward for a life devoted to ceaseless study, toil and responsibility. If, from our knowledge of the character, attainments and qualifications of the young man we feel that at best he could make but a modicum of success in the work, we should endeavor to divert his ambition into some other channel.

“We should advise the ‘expectant surgeon’ in his preparation to follow as nearly as possible the line of study suggested by Richardson. Then I would add the advice of Senn, viz: ‘To do general practice for several years, return to laboratory work and surgical anatomy, attend the clinics of different operators, and never cease to be a physician. If this advice is followed there will be less unnecessary operating done in the future than has been the case in the past.’ The young man who enters special work without having had experience as a general practitioner, is seriously handicapped. In this age, when we have so frequently to deal with the so-called border-line cases, it is especially well never to cease being a physician.

“We would next have the young man assure himself that he is the possessor of a well-developed, healthy, working ‘surgical conscience.’ No matter how well qualified he may be, his enthusiasm in the earlier years of his work will lead him to do operations that he would refrain from in later life. This will be especially true of malignant disease. He knows that early and thorough radical measures alone hold out hope, and only by repeated unsuccessful efforts will he learn to temper his ambition by the judgment that comes of experience. Pirogoff, the noted surgeon, suffered from a malignant growth. Billroth refused to operate or advise operation. In writing to another surgeon friend he said: ‘I am not the bold operator whom you knew years ago in Zurich. Before deciding on the necessity of an operation, I always propose to myself this question: Would you permit such an operation as you intend performing on your patient to be done on yourself? Years and experience bring in their train a certain degree of hesitancy.’ This, coming from one who in his day was the most brilliant operator in the world, should be remembered by every surgeon, young and old.”