Dissertation on the best mode of Increasing and propagating Medical Knowledge in the State of Connecticut
To the Hon. President, the Vice President, and the other officers, fellows and members of the MEDICAL SOCIETY, in the State of Connecticut:
I have with much pleasure and satisfaction, observed your Questions proposed at your Annual Convention, in the city of Hartford, in October last; and am Happy in being informed, that there is so laudable an institution as a Medical Society, in the State of Connecticut; and that you are endeavouring to Increase and Propagate Medical Knowledge in your Republic.
I have not the Honour of being a Member of your Society, nor a Citizen of your State: but inasmuch as Physicians in other governments are permitted to answer your Questions, I take the Freedom of answering the first of the Two which are still held up for Discussion, viz. "What is the most elegible mode of increasing and propagating Medical Knowledge in the State of Connecticut."
The Clouds of Darkness and Ignorance which hover over the minds of many, who pretend to be Practitioners, in Physic, in consequence of the ridiculous Modes of Instruction in many parts of Our American Borders, makes your Question a Matter of very great Importance; and a rational Answer is a Subject highly worthy of the Attention of any Physician, who wishes to promote the Health and Happiness of his Fellow Mortals. I have travelled in some of the European Kingdoms, and in many parts of America: have been sundry times through Connecticut; but am not so well acquainted with your Modes of Instruction, and Methods of Practice, as I am with the Modes and Methods in some of the other American States, and European Countries; and am therefore not so capable, perhaps, of pointing out such things a may be agreeable to you, as those more acquainted with your internal Police. I shall, however, endeavour to Answer your Question according to the best of my capacity.
I beg leave, Gentleman, to mention,
First, The Qualifications necessary for a Physician.
Secondly, To describe the various Modes of Medical Instruction, and the methods used in introducing Imposters into the Practice of Physic in the country, and,
Thirdly, To Answer your Question.
First, I am then in the first Place to mention the Qualifications necessary for a Physician.
These Qualifications are,
All these Qualifications are necessary for an American Physician, and especially if he settles in a Country Township, where he will be obliged to officiate as a Physician, Surgeon, and Midwife; and sometimes as an Apothecary; for the Methods of compounding Medicines are so very different, precarious and uncertain amongst the Apothecaries, that every Judicious Practitioner, inclines to compound his own Medicines, rather than exhibit those whose Strength is unknown to the Purchaser. Now, how far short of the Qualifications I have described, many of our Practitioners come, will appear under the Subsequent Narration.
Having thus mentioned the Qualifications necessary for a Physician; I proceed to the Second thing proposed, viz. To describe the various modes of Medical Instruction, and the methods used in introducing Imposters into the Practice of Physic in this Country.
He that desires to become acquainted with any Art or Science, ought to avoid the Study of those Books, and the Instructions of those Masters that will lead him into Error; for if he takes a wrong Road in the beginning of his Journey, the further he goes, the greater will be his distance from the Right way, and the more difficult will it be for him to find it: and if he will not be convinced of his Error, by any Friend, who may endeavour to show him the Right Path, he will entirely miss the mark he was aiming at. Just so it is with those who attempt to become good Physicians; for if they set out wrong, and have Error infused into them, they miss of the Prize they intended to obtain.
I think it may not be improper to mention in this Place; that by reason of the late Discoveries and Improvements in Chymistry and other Branches of Medicine, the ancient Dispensatories, and other Medical books, now in Use in this Country, are found to be very Erroneous: that they contain many things which have impeded the progress of the Healing Art; and for that reason have therefore been justly expunged, not only from the late European Pharmacopoeias, but the late Books written upon the Practice of Physic. Many Medicines that were once in high repute in the cure of Diseases, are now laid aside, and the Methods of Practice, within the last twenty years, have been greatly altered in the European Countries, as well as in some Places in America: this Alteration has contributed much towards drawing the Practice of Physic into a smaller compass, the making of the Cure of Diseases more easy and certain and of course of raising the Medical Art to a higher Degree of Perfection. Now, wherever these Ancient Books are used by those who instruct Students in the noble Art of Medicine, both the Masters and the Pupils are led directly into Error; and when they have imbibed erroneous Opinions concerning the Administration, operation and Effects of Medicine upon the Human Body, they frequently augment, instead of alleviating the Distresses of their Fellow Mortals.
An Ignorant Physician is a dangerous Animal: He goes armed with the weapons of Life and Death; and if he is so much in the dark that he cannot distinguish the One from the other, or in other words, if he knows not the Nature of his Medicines, he will be as liable to usher Death and Destruction into the world, as the Preservation of Life and Restoration of Health.
But, alas! It is to be regretted that such swarms of Imposters are allowed to run about in the disguise of Regular bred Physicians, committing Slaughter and Depredation amongst their Ignorant Employers: And it is also to be regretted, that no regular System of Pharmacy, has ever been established in this country for a guide to the Apothecaries in the Preparing, and compounding their medicines: that they have been allowed to compound from Age to Age, as many different ways as there are different Methods prescribed in the different Dispensatories now in use: that many Medicines have been compounded and sold under One and the same Name that had different Degrees of Strength; and that from hence the most skillful Physicians have been greatly deceived, not only in the Administration of Proper Doses, but in the Operation and Effects of such Medicines amongst their Patients. This precarious mode of practice, has, perhaps, destroyed the Lives of thousands of the Americans!
Some prudent Practitioners have long been sensible of this Inconveniency, and have therefore compounded their medicines themselves; rather than expose their reputations, and the lives of their Patients by the Administration of Medicines whose strengths were unknown; and this has greatly diminished the Business of the Apothecaries: but who can blame them for compounding their Medicine so very different, when they have no Established Rule for a Guide; and there are such a variety of methods prescribed in the Different Dispensatories now in use.
A great variety of medicines are differently compounded; but as a Proof of my Assertions at this time, I shall only exhibit the different prescriptions for compounding but one medicine, viz. the Liquid Laudanum, which may be seen in the following Dispensatories, as,
1. The London Dispensatory.
- ℞ Gum Opii purify pun - ʒx
- Spirit vin tenu - ?
- Digere per Dies Deum, et cola.
2. The Edenburgh Dispensatory
- ℞ Opium, - ℥ij
- Aq. Cin. Spt. - ?
- Digere per Dies Quatuor, et cola.
3. Quinsey's Dispensatory
- ℞ Gum Opii crud. - ℥ij
- Croc. Anglican. - ℥j
- Aq. Aromat. vel cin. - ℥?
- Spt. Vin gallic. - ℥x
- Digere leni calore, et cola.
4. James's Dispensatory
- ℞ Gum Opii crud. - ℥ij
- Croc Anglican. - ℥j
- Aq. Aromat. vel cin. - ℥xx
- Digere leni calore, et cola.
5. Brookes's Dispensatory
- ℞ Gum Opii, - ℥ij
- Aq. Aromat. - ℥xx
- Digere leni calore, etc.
Thus we may see by preceeding prescriptions for compounding the Liquid Laudanum, how greatly that medicine varies in regard to its strength, and how liable a Physician is to be deluded in the Exhibition of Proper Doses; and in its Effects upon the human Body; and the same may be said of many of the other compounds.
I am apprehensive, that the Establishment of a Regular System of Pharmacy in America, would be of great utility to the Apothecaries; that it would increase their Business and diminish the troubles and care of those Physicians who compound their own Medicines.
In Europe there are certain Rules Established by law, for the Chusing, Preparing, Weighing, Measuring, Compounding, Distilling, Extracting, and Preserving of medicines; and if the Apothecaries do not strictly observe those Rules they are liable to punishment: they are, however, permitted to compound any other way if so ordered by some Learned Physicians for such Practitioners are allowed to order such Compositions for a Patient, as is thought most beneficial: and the same Rules and Regulations ought to be observed in this part of the world.
Another vanity has prevailed in this country, which has been the foundation of much discord amongst the Practitioners of physic: it arose from their being differently instructed in the Mysteries of the Medical Art. It has been customary for great Numbers of the Physicians to keep but one Dispensatory, hence, one has had an Ancient One of the London College; another has had one of that of Edenburgh; another has had Quinsey's etc. and as all of them give different Accounts of the Medical Properties of both the simple and compound Remedies; and as one Physician has been instructed according to one Dispensatory, and another according to another, so different Ideas have been imbibed concerning the Natures of Medicines; and from hence also, when Practitioners who have been thus Educated have met, to consult upon any difficult, or dangerous case, they could not agree about the prescription, administration, and Effects of Medicines; and from this difference of sentiment, much contention has ensued, as is obvious to every One who has been acquainted with the Practice of Physic in this part of the globe. But we must not, however, impute the grounds of this discord altogether to the Dispensatories, for there are other Books which tend to produce the same evil consequences, as well as the different Instructions given by the different Teachers of the Medical Art. But he who does not understand an Art or Science, is by no means fit to teach it to others; and therefore and Ignorant Physician is wholly unfit to become a Teacher, because he may lead his Pupils astray. But it is time for me to hasten from this Digression, and proceed to the thing I proposed, viz. to describe the various Modes of Medical Instruction, etc.
I find that these Modes are different in the different Parts of the United States. In the Cities of Philadelphia, and New York, they have Colleges of Physicians where Eminent Professors read Lectures upon the various Branches of Learning. Hospitals are also erected in those Cities, where a variety of dangerous cases may be inspected; and by these Advantages Students in Physic are Educated in a Regular way and manner.
In country places remote from those Colleges, the modes of Instruction are vastly different. For wherever a Physician has raised his fame by merit, or by Quackery, among the Ignorant multitudes of his Employers; some of them are commonly inclined to send their sons to him, to be instructed a year or two in the Medical Art: but if any of their other children are sent to learn to be carpenters, Taylors, or shoemakers: about seven years must be spent in learning the mysteries of those mechanical Arts.
Some young men are sent to learn to be Physicians, who have had some learning, and others are sent directly from the plough, who can scarcely read, or even write their own Names, and thus the Doctor becomes furnished with Pupils. His Library consists, perhaps, of Cheselden's Anatomy, an old Dispensatory, and Brooke's Practice of Physic; for I have been credibly informed that a very celebrated Practitioner, and eminent Doctor-Maker, keeps no other Books; though some of the other Doctor-Makers keep better Libraries, whilst others again may have those which are not so good.
Let us distinguish the Master from the Pupil, by calling the former Dr. Triumphant, and the latter Dr. Imposter, whilst we observe how the Learning goes on, etc.
The Pupil must of course Study theory before he enters upon Practice, and Dr. Triumphant presents Cheselden's Anatomy, which must be read through, and this being done, the old Dispensatory comes the next in succession, and afterwards Brookes's Practice. About a year is spent in these dry Studies. If the Pupil has not had learning before, this Study becomes very disagreeable: He does not understand the Technical terms, and, perhaps, has no body to Instruct him; for whether Dr. Triumphant is, or is not a man of Skill, he is very much hurried in his Business, being obliged to visit his Patients both Night and Day, and therefore cannot Instruct the Student.
When about a year is thus spent, the Pupil is permitted to ride upon Practice with his Master. Not a single Lecture has been delivered upon Botany, the Materia Medica, Chymistry, pharmacy, Pathology, Therapeutice, Anatomy, Surgery or any other Art, or Science; and the Pupil is almost as Ignorant as he was when he first entered upon his Medical Studies.
The Pupil is informed, whilst he rides with the Master, that Emetic Tartar will vomit; that Julap will Purge; that Opium will ease Pain, etc. and is often allowed to ride alone upon practice in Triumphant's absence.
Sometimes a year is spent in riding with the Master; but if he is to receive a certain sum of money for Instructing and Boarding the Pupil, he may perhaps, dismiss him sooner, under the pretence of his being duly qualified, although it is in reality with a design of accumulating some gain to himself by saving the Board, etc.
When the Pupil is dismissed, he receives a Recommendation from his Master: assumes the Title of Doctor, and launches out into the Ignorant World as a Practitioner in Physic, Surgery, Midwifery, etc. and now I think he may be legally styled, Doctor Imposter. Now is the time for playing the Hypocrite, for his Friends and Relations are employed to recommend him to the Public, as a man of wonderful skill! Great Humanity, and he soon finds Employment. If any Patient is murdered by his maleadministeration: he then Reports, that the Disease was so violent that it was impossible to conquer it by the most powerful medicines; and if by chance he cures a Patient ill of any dangerous Disorder, his fame rises immediately: he is highly extolled, and soon becomes very popular. He often rides out under the pretence of visiting the sick, when perhaps, nobody is ill; and goes from home one way, and returns by another. He rides very fast, and appears to be always in a hurry. He rails most bitterly against every Practitioner but himself, and Doctor Triumphant; whom he represents as a man of very extensive Abilities. At all Opportunities he crouds himself into the Company of the Patients of other Physicians, decrying the Remedies they have prescribed; telling what wonderful Cures he has wrought; How humane and charitable he has been to the necessitous; as he has often given his Advice to the Poor gratis, etc. He by the way offers his service, uttering a few high flown expressions; indulging himself in a variety of Nods and Significant Gestures, and emphatical Hmm's! and hahs! till he has excited the admiration of the Poor feeble Patients! who being desirous of Relief, employ the Imposter, and dismiss the regular bred Practitioners from their service. If he finds at any time that he is not in a likely way to perform a cure; and by a secret check of conscience, becomes doubtful of his own Abilities, he sends for Dr. Triumphant, to Assist him. If they cure the Patient, both of them are extolled as very eminent Physicians: but when the Imposter performs a cure alone, he has all the Praise to himself, and soon becomes so well established in his Profession, that he is esteemed fit to commence Doctor Maker, and in a few months is furnished by his Ignorant employers, with a Number of Pupils.
This has been the mode of Education, and method of introducing Imposters into the Practice of Physic in too many Places under the Sun; and of making them so very Popular in the World, that they have over-run Regular bred Physicians, to the disgrace of the Human Species, and destruction of their Health and Prosperity!
Many have been allowed to Practice Physic, who have had no learning, or at least have never been instructed by any Physician. This is evident by the great number of Quacks, who have raised their fame by imposing upon the Ignorant World with Nostrums, which have been recommended as a specific, for almost all kinds of Disorders; but on trial, have fell greatly short of the Encomiums that were given of them.
When an Imposter has once relieved a Patient by a Nostrum, he may be permitted to Administer other Remedies also, and so introduce himself into Practice by the Assistance of his Friends. In short the Practice has become so general that many of the Gossips are allowed to Practise, and interrupt that of the Regular bred Physicians.
Some People who are of a stingy Disposition, employ Imposters in the Medical Art, because they commonly practice cheaper than the Regular bred Physicians; and this is one thing that tends to introduce those devouring caterpillars into Practice. But it has been observed, however, that if these People stand in need of the Assistance of a Sawyer, Carpenter, Blacksmith or Taylor, they will be very careful in chusing a good workman. O foolish People, and unwise! Who hath bewitched you, or induced you not to chuse a good workman, when your lives are in imminent danger? Why do ye swallow the poisonous Doses prescribed by those Quacks and Imposters who know not the virtues of Medicines, the strength of your constitutions, nor the nature of your Diseases? Why do ye set a higher value upon your Money, than ye do upon your Lives? How can you be sure that such poisonous Remedies will not put an immediate end to your Existence? And is not the Employment of such Imposters almost as criminal as murder, and Suicide?
Lex naturae prohibit facere injuriam.
The Law of Nature forbids us to do injury.
Great Exertions have been made in divers Countries and Cities to Suppress Quackery. I was once in a large Country, when the Legislature enacted that a Committee should be appointed to examine all the Physicians, Surgeons, and midwives, in the government, who had not been graduated at a college, or University; or served as a Surgeon, on Board of a Man of War, or in the Army; and to licence all they found duly qualified; and if any Man or Woman, attempted after a certain Day, to Practise in any of the preceeding Professions without a Licence, He or She should pay for the first Offence, a fine of Fifty Pounds; and for the second Offence, double that sum, etc. if I mistake not.
I was also in a City, where a Law was passed, forbidding any Person to Practise, there, who had not been Graduated as a Doctor of Physic in some of the Universities within the limits of the United States or had passed an Examination, and been licensed in the same City. That if any attempted to practice without such qualifications, five pounds was to be paid for the first Offence, ten for the second, etc. And, I am preswaded, that the Legislatures would do well, if they made Laws in Every Government, for the Suppression of a Vice so very dangerous to the Lives of the Human Species.
It is a very extensive and laborious task, to learn to be a good Physician; for the requisite Arts and Sciences are so comprehensive, that much time must be spent before a Student can be properly Qualified. and although, many have spent but a year or two in Medical Studies, before they have entered into Practice, yet I am confident, that Seven years is not time enough for completing a work of such vast Magnitude and Importance. But some men of great natural Abilities, who have not had much Opportunity for acquiring Medical Knowledge whilst under the Care of their Masters, have afterwards, by procuring good Libraries and attending diligently to their Studies and Practice, become Skillful Practitioners whilst others again, who have had such an Education have, perhaps, by their Ignorance and neglect, destroyed the Lives of their fellow mortals!
Some Practitioners have had better Libraris than that kept by Dr. Triumphant; and they have spent more time in Instructing their Pupils; but when all this has been done, many things have been wanting, such as Anatomical Demonstrations, Chymical Experiments, etc. Although the Physicians in America commonly Practise Physic, Surgery, and Midwifery; and especially in Country Townships; yet they are considered in Europe, as distinct and separate Arts; and in some Places, he that Practises one of them, is not allowed to officiate in either of the other; and even the female midwives are obliged to live Seven years with some Experienced Practitioner, before they are permitted to Practise themselves. But in the Country, they commonly rush into Practice without the necessary Qualifications. These Regulations tend to make the Practisers more perfect in their several Professions, which is very commendable; for Quemque oportet esse peritum artis suxe. i.e. Every one ought to be skillful in his own trade: and if the same examples were more followed in this part of the world, it would raise the Medical Art to a higher Degree of Perfection.
Having thus Described the various Modes of medical instruction, and methods used in introducing Imposters into the Practice of Physic in this country; I now proceed Gentlemen to the Third thing proposed, that is, to Answer your Questions: viz.
"What is the most elegible mode of increasing and Propagating Medical Knowledge in the State of Connecticut?"
I beg leave to Recommend as the most elegible mode in My Opinion,
Thus Gentlemen, have I answered your Question according to the best of my capacity, and how far your Sentiments may correspond with mine, is at present unknown. I do not pretend to dictate, for you have a Right to Govern your own Affairs, as you in your Wisdom may see fit. The attending of Judicious Lectures upon every Branch of Medicine, is of very great utility to Students, as I know by my own Experience, which is the best School-Master; and, as but few Practitioners are able to furnish themselves with a suitable Apparatus; and as it is impossible for them to deliver a regular course of Lectures when they are crouded with other Employments, I thought fit to Recommend to your consideration, the Institution of a College of Physicians or Acadamy in your State, that young Gentlemen may be Educated in a regular manner for the future, and the country not so much incumbered with Imposters hereafter, as it has been heretofore.
I thank you for the communication of the Question I have attempted to answer; and hope that your endeavours to increase and propagate Medical Knowledge in your State will be crowned with Success; and after wishing your Health and Prosperity, Subscribe myself,
Dec. 19th. 1795.