Popular Science Monthly/Volume 22/February 1883/The Schools of Medicine

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By R. O. BEARD, M. D.

NOTHING is so popular as prejudice, and no prejudice so popular as that resting upon a supposed scientific basis, or backed by reputed scientific authority. Always obstructive to the spirit of progress, it is peculiarly so when related to a subject so closely concerning the interest of the people as the study and treatment of disease. In these physically degenerate days the avoidance or remedy of the thousand "ills which flesh is heir to" is a question of well-nigh universal import. The urgency of this common need offers a partial reason for the adoption and perpetuation, by the public mind, of the differences which are supposed to exist between the two great schools of medicine; while, at the same time, it measures the greatness of the misfortune of the fact.

Rooted in the professional ignorance and bigotry of almost a century ago, fostered by the bitter rivalries and exclusivism of opposing theorists, these differences have been taken up and fed by popular opinion, until they seriously embarrass the progress of medical knowledge, and tend to destroy all faith in the science and art of healing.

The medical fraternity at large, and of both schools alike, is responsible for this unfortunate condition of affairs. When professional men, who, supposably, represent the best phases of liberal thought and scientific culture, lend their names to the partisanship of mere theory, and array themselves under sectarian titles which signify their adherence to an exclusive dogma, it is small wonder that the laity should follow in their footsteps, and cast their views into the yet narrower mold of unreasoning prejudice.

And, as professional hands have sown this seed of error, it is they who must gather its barren harvest, and uproot the tares of false opinion from the popular mind.

The recent agitation within the ranks of the one school of medicine, of the question of establishing consulting relations with duly qualified members of the other, presents a good opportunity of offering to the general reader a few facts which may serve to illumine existing error, and prepare the way for the appreciation of some generally unrecognized truths.

It may be safely asserted that the chief obstacle which the profession has to encounter, in the attempt to harmonize the hitherto conflicting systems of medicine, is the existence of so violent a prejudice among the people in favor of one school or the other that the doctor's income is liable to suffer as an effect of any concession to his liberal convictions.

When an unknown physician appears in any community, and solicits a share of public patronage, what does the inquiring public first demand to know concerning him? Does society take the measure of his social standing, or estimate the quality of his moral character and training? Do his prospective patients seek evidence of his professional ability, his special acquirements, or his general scientific culture? No. They submit him to no such crucial tests as these. They content themselves with asking the one grave question, "Is he allopath or homoeopath?" and, having reply, assign him, according to their prejudices, to an immediate place in their mental register, as possibly useful or probably imbecile. What important principle, then, lies back of this oft-repeated query to account for its unfailing repetition? What significance is attached to these opposing terms, and whence is it derived?

In the first place, the words "homœopathy" and "allopathy" have a common authorship. The great founder and apostle of the homœopathic school, Dr. Hahnemann, was responsible for their coinage and introduction to the public. With the one, he proposed to christen the creed which embodied his own peculiar tenets; by the other, to throw into sharp contrast the system of the older and established school.

It is worthy of remark that his followers have, until recently, accepted, with singular uniformity, their leader's distinctive term, while his opponents have always, and with few exceptions, repudiated the name thus contemptuously bestowed upon them, and which has fastened itself to them through the influence of popular usage. The definition of these terms is somewhat obscure. Homœopathy does not now possess, in toto, its original significance. In its earlier day it represented a group of dogmas, which most of its younger disciples disown. Infinitesimal dosage, increased potency by means of dynamization, the unification of disease, etc., have ceased to be essential planks in the homoeopathic platform. According to more recent interpretation, it may be defined as a system of medicine based upon the one theory, "similia similibus curantur" or the doctrine of a similarity existing between the physiological and the curative action of drugs.

Allopathy, on the other hand, may be said to mean—in so far as it means anything—the application of medicine upon the principle "contraria contrariis curantur," or a system founded upon the belief in a certain antagonism discoverable between drug-action and disease.

Upon the face of these definitions, seemingly irreconcilable differences exist between the two leading schools of medicine; differences which, if borne out by the facts of to-day, furnish ample excuse for this persistently anxious query of the public. That the present status, however, of medical science affords no adequate support to this popular idea of a hopeless variance is clearly susceptible of proof.

When Hahnemann promulgated his new and remarkable dogmas, they certainly came into direct collision with the then accepted opinions and practice of the medical world. They were conceived and brought forth in an age of heroic measures in medicine; an age, too, in which the sthenic types of disease were largely predominant, and when the lancet and its auxiliary depletives were accounted the unfailing panaceas of all human ills in which failure was not a foreordained fact.

The homœopathic tenets rushed to the other extreme of theory, and, in practice, won the faint praise of doing at least no injury to human life. But, starting thus from widely separated points, the two schools have steadily traveled forward along paths set in inevitably convergent lines. The unbridged space which lay between them a century ago has been narrowed imperceptibly in their onward march, until men discover with surprise that to-day, across the intervening chasm, they can safely join their hands; and that, by mutual approaches, they may soon walk side by side, in common effort for the relief of humanity, and yet keep steadily "abreast of truth." Unconsciously receiving the impress of its opponent's teachings, the older school has learned, first, to lessen, and then to minimize its doses; to improve the preparation of its drugs, and to seek for better forms and methods in their administration. If it can boast the direct salvation of no greater number of lives, in consequence, it is at least responsible for fewer deaths. Its distinguishing characteristics have ever been an active spirit of investigation, and the consequent widening of the limits of its medical faith.

The homœopathy of to-day has also shaken from its feet the dust of more than one worthless theory. Although within its ranks are still numbered some so-called "high dilutionists," its leaders have long ceased to insist upon infinitesimal dosage as an essential principle of treatment. Not a few of its representative men administer many of their drugs in crude form, as the rule rather than the exception of practice. If it still clings to its central dogma, its principal adherents no longer claim for it the respect or merit of a universal law. That it serves as a good indication for the use of certain drugs, in the treatment of many conditions of disease, few careful students of materia medica and therapeutics will deny. Witness, as instances, the physiological as related to the curative action, in some particulars, of arsenic, ipecacuanha, turpentine, mix vomica and its alkaloid, strychnia, and camphor. Explain the action in any way we choose—as substitutive, as the primary differing from the secondary effects of the drug, etc.—the relationship of similarity, however problematical its value, still remains.

Not seldom has the reproach been cast upon homœopathy that it possesses no literature worthy of the name; that its followers can boast no valuable discoveries or original research. In the main, the criticism is just. But, in this one department of medical science, the profession has received at its hands an incalculable benefit. It claims, and for the most part rightly, the credit of advancing, directly or indirectly, the study of the physiological action of drugs, as related to the alleviation and cure of disease. The careful experiments thus set on foot have thrown a light upon the selection and intelligent use of remedies which has largely revised the old system of therapeutics. Homœopathy has, undoubtedly, given to the world the revelation of more than one valuable truth, and the profession and people alike owe to it, in the persons of its advanced thinkers, the gratitude of respect and recognition. In short, as "every student is a debtor to his whole profession," so the schools of medicine are mutually beholden to each other. The same influences which have modified the one sect have served to liberalize both. The practical result, as already manifest, is of greater interest to the public than are the steps by which it has been reached. A careful study of the course of treatment commonly pursued by leading practitioners, and recommended by the highest authorities in the two schools, reveals the fact that, in eighty selected forms of disease, representing maladies of every type and every stage, six tenths of the remedies employed by these supposedly rival schools are identically the same in kind, and differ only in respect of dose. The variance is no greater than probably exists between the respective methods of practice of any two physicians of either school. Were disease an entity, and its types invariable, we might look for the establishment of a universal law of therapeutics; but, considering all the varying conditions of age, sex, temperament, habit, hereditary tendency, personal idiosyncrasy, climate, and general surroundings, it is, in the nature of things, impossible. Between homoeopathic and "regular" physicians there is but one legitimate ground of quarrel—and herein the latter have sufficient cause of complaint—namely, the continuance, by their old-time opponents, of name and title suggestive of a rigid exclusivism, indicative of their supposed arrival at the ultima Thule of medical research, and their adherence to a universal dogma, to which, as such, they can no longer honestly adhere. Why should it not be possible for a guild of men, interested in so grand an object as the relief of suffering and the conservation of human life, to join cordial hands with their fellow-laborers in a common cause, and content themselves with the unequivocal name of physician, and the honored and honorable title of Doctors in Medicine? Let this once be un fait accompli, and we may rest assured that the good sense and mutual interests of the two great schools will speedily draw them together, in a process of mutual absorption, which will give a new impetus to the growth of medical science, and contribute immeasurably to a more successful, because more rational, treatment of disease.

The New York State Medical Society, representing the head and front of the profession in this country, has recently taken an initiatory step in this direction, by striking out and changing certain clauses of its ethical code which prohibited consultation with duly qualified homœopathic practitioners. Despite the unfortunate action of the American Association, in setting the stamp of their useless disapprobation upon this timely step, a thinking public must needs declare itself in approval of the New York Society. It has but constituted itself the vanguard of a movement which will soon be followed by all liberal men in the profession, and must ere long sweep away those petty obstacles to the progress of medicine, which, causing the disunion of its disciples, have limited its usefulness, weakened its experimental conclusions, and brought upon it the popular reproach of disagreement.

Many, it may be, of the older generation of physicians—minds which have crystallized unchangeably to the form of early ideas—must "pass away before these things are fulfilled," but they who are stepping forward to take their places in the great struggle with disease and death, will have their hands strengthened by a more conscious unity of work and purpose with their fellows, to which the profession of medicine has long been a stranger.

The principal barrier, let me repeat, to the attainment of this desired end lies, not within professional lines, but in the existence of this unfortunate prejudice among the people. When patients demand to be assured that a medical practitioner is not an "allopath" or a "homœopath," but—a reputable and well-educated physician, then will the folly of "exclusivism" be made manifest, not alone to the mind, but to the pocket of the profession; and then will Medicine, unembarrassed by the strife of schools, rise to her possible place as a successful and a more exact science.