TWO years ago the great surgeon, August Bier, wrote significantly in the Munch. Med. Woch: “I am a practicing physician and a professor of surgery,” in justification of the fact that he had occupied himself with homoeopathy and the medicinal treatment of disease, for which he had been blamed. This statement of Biers is of great importance for the future of medicine and should guide us medical men.
Everyone is aware that the tendency towards specialization, which has divided the healing art into countless departments, has produced much progress in the specialities cultivated. However, this tendency has very serious drawbacks, for it has produced the mechanization of the art of healing, and it has led to the introduction of many methods of treatment, which are superfluous and which are risky to the patient.
The horizon of specialists is apt to get narrowed. I have pleaded years ago that the art of healing should be placed once more on a broad basis, that general practitioners should once more guide the work of specialists.
Thirty years ago I was an enthusiastic student of surgery, but, although I was assistant to eminent surgeons, I looked upon many of their operations with grave misgivings. I was unable to adopt a purely mechanical view of the human body, and I believed that many of the operations performed were superfluous and could be replaced by simple, non-surgical treatment. My conscience oppressed me, but I did not find understanding for my views among the surgeons.
Twenty-five years ago I established myself and I acquired rapidly a very large surgical practice. However, my doubts remained. Wishing to clarify my views, I visited the greatest surgeons at every opportunity and did much reading. During the twenty-five years of my surgical activity. I have never operated if the indications for an operation were uncertain or were absent. When visiting other surgeons I saw the many operations, most brilliantly done from the technical point of view.
However, I noticed that out of ten large operations on the abdomen, often only one was really necessity. Besides, I found that there were surgeons who had written bulky and excellent volumes on the practice of surgery who failed utterly if they tried to operate themselves. When I attended medical congresses, I was surprised to find that few of the speakers used plain, intelligible language. I sat among the audience bewildered and dazed by a torrent of Latin and Greek verbiage.
I thought that possibly I lacked understanding of the healing art and attended the consulting rooms of the most successful medical practitioners, orthodox and unorthodox, professional and lay, and I was impressed by the multiplicity of methods whereby the sick can be made well. In the consulting room of one doctor I found a vast collection of apparatus, a veritable mechanical museum, with machines of which I had never heard the name. At another doctors I noticed that the consulting room contained no tools whatever, except a stethoscope.
The toolless doctor treated his patients with diet and with air and sun baths. He was a strict vegetarian, he had five magnificent children, and all five had among them not a single decayed tooth. I was impressed by the fact that his views were at least valuable for his children. After all, our patients ought to be our children. The third doctor whom I visited was a high authority on chemistry and pharmaceutics.
During a single day, while I watched him at work, I was made acquainted with numerous drugs and combinations, of which I had never heard. The man was an artist and he favoured powerfully acting remedies in large doses.
The fourth doctor was a homoeopath. I was permitted to be with him during his consulting hours and to accompany him on his visits to his patients. Hitherto I had had no belief in the infinitely small doses favoured by homoeopaths. I learned some thing new, and I saw methods from which every doctor can profit. I noticed that the homoeopath studied most carefully the whole of the constitution and the medical history of the patient and of his family, and that he took note of the most insignificant symptoms.
His object was not to treat “a textbook disease,”a mere abstraction, but a human individual with very individual complaints. When I saw him at his work, I could not help remembering the teachings of Hippocrates. The fifth doctor was a man of an unusual type. He was very intelligent, very experienced, and he studied the souls of his patients and tried to influence them. I was with him during his consulting hours. He wrote hardly any prescriptions. His principal means of action were the psychical persuasion of the patient, hypnotism and massage.
I have seen much massaging done by eminent experts, and I like being massaged, but I have never seen so scientific and so artistic a form of massage as in his instance. I was allowed to make the acquaintance of patients who had been vastly improved or cured by this treatment without medicine, who previously had been pronounced absolutely incurable by the highest authorities. I saw veritable miracles of healing.
If I were not afraid of tiring the reader, I would describe the activities of a physician who cures all his patients by hydropathy, I would describe the activities of a man who cures numerous and very serious diseases exclusively by operations on the nasal passages. I could tell of a man who cures the identical diseases by vibrating the sacrum, the lowest part of the back. I am, of course, aware that suggestion and auto-suggestion have vast importance in treating patients, but the successes which I have seen cannot be explained exclusively by the spiritual factor.
There is something which is not explicable in this way, and one is forced to conclude that there are numerous methods, totally different among themselves, whereby physical anomalies and mal-functionings, called disorders and diseases, may be cured. It is the true physicians duty to know all the methods employed, and to select that method which is safest and gentlest. The new monthly Hippocrates is intended to help medical men in making this selection.
The doctors of the time of Hippocrates were all-round physicians. They understood every branch of the healing art and they treated patients with medicine, surgery, diet, hydropathy, air and sun, gymnastics, massage, psycho-analysis, hypnosis, herbs, etc. In those times a doctor was also a surgeon, a gynaecologist, and a specialist for diseases of the eye, ear, etc. Let us remember that we have learned from Hippocrates many of the most important operations, such as tracheotomy.
We have now only a few men such as August Bier, who are physicians as well as surgeons and who dominate the whole of the healing art. Unfortunately the family doctor is dying out. He is being destroyed by the mechanization and specialization of the art of healing and by the panel system.
The patient consults a specialist who no longer knows anything of the body as a whole and its soul, but who has devoted his whole life and study to a single organ. Occasionally one finds that a surgeon has to look after 300 or 400 patients at an institution. In such a case there is no possibility of studying with sympathetic care the personal and the family history, the medical history, and the effect of occupation and of physical and mental occurrences upon the suffering individual.
Dr. Emil Schlegel wrote fifty-two years ago a book Innere Heilkunst bei sogenannten chirurgischen Krankheiten (Medicinal Treatment in So- called Surgical Diseases). That book should be re-issued in view of the senseless methods of sewing up abdominal organs which have been displaced and to cut out in large numbers ovaries and appendices because of some perfectly harmless abnormality.
As soon as an unnecessary but fashionable operation, such as the sewing up of floating kidneys, has been abandoned, some other useless operation becomes fashionable, such as the wholesale cutting out of tonsils, the exaggerated views regarding the effect of focal infections which we are told call for operations, etc. A patient of mine described to me the hospitals as institutions where patients are treated on Ford mass production principles, with factory-like rapidity by automatically working human machinery.
Medicinal treatment is as unsatisfactory as is surgical treatment. In his introductory lecture of 1931, Professor W. Heubner described a case of pneumonia, which was treated as follows. In twenty-four hours the patient was treated outwardly by painting the chest with iodine and applying a cold-water compress. Internally he was given three doses of Cardiazol, three doses of Digipurat, three doses of Codein, two doses of Ephetonin, one dose of Anastil, and he was given intra-muscular injections of Camphor oil, of Transpulmin, and of Quinine- Urethan.
Further he was given two intravenous injections of sugar in solution with Cardiazol and Digipurat. When one reads of such treatments, one cannot be surprised that nature cure, homoeopathy and other gentle forms of treatment are expanding rapidly. If the organism is flooded with medicines in this senseless manner, the value of medication is destroyed. But is such treatment scientific?
If I had pneumonia, I would rather be treated by a village doctor who would give me a cold compress and a cough medicine, with possibly digitalis thrown in, than with such polypharmacy.
While some patients are treated in hospital-factories on Ford mass production principles, there is an army of 32,000 panel doctors who fight for their daily bread, labouring hard in bitterness of soul. Two years ago an observer was sent to the waiting room of a busy panel doctor in Danzig, who “treated” 136 patients in two hours, giving each one less than one minute. Such treatment is no longer an art, it is not even a handicraft.
I have on purpose picked out a few extreme examples. I know, of course, that physicians do valuable work in hospitals and in general practice. I know, of course, that we cannot go back to the Hippocratic times when the doctor dominated the whole art of healing. Laboratories and medical mechanics are as necessary as are division of labour, railways, motor cars, electric light, etc.
However, we must regain the attitude of the great Greek physicians of antiquity. Doctors should imitate August Bier and be physicians, surgeons, gynaecologists, eye specialists, ear specialists, radiologists, homoeopaths, etc. At least that should be the doctors ideal, and the physician should always remember this ideal. He should have an open mind, desire to learn and apply criticism to his work. Men who are animated by this idea will lead the art of healing to a higher plane.