The Complete Essays (131 page)

– [A] ‘somebody opened a window’; ‘he has been lying on his left side’; ‘he has let painful thoughts run through his head’. In short a word, a, dream, a glance, all appear to be sufficient excuses for shrugging off the burden of responsibility.

Or when we get worse they take advantage of that too if they want to, profiting from another ploy which can never fail: when their poultices merely help to inflame the illness they palm us off with assertions that without their remedies things would have been even worse. They take a man with a bad cold, turn it into a recurrent fever, then claim that without them it would have been a continual fever. No need to worry that business should be bad: when an illness grows worse it means greater profits for them. They are certainly right to require their patients to favour them with their trust. It truly has to be trust – and a pliant trust too – to cling to notions so hard to believe.

[B] Plato put it well when he allowed freedom to lie to no one but doctors, since their promises are empty and vain but our health depends on them.
¹⁷

[A] Aesop is an author of the choicest excellence, though few people discover all his beauties; he agreeably portrays the tyrannous authority which doctors usurp over wretched souls weakened by sickness and prostrated by fear when he tells how a patient was asked by his doctor what effects he felt from a medicine he had given him: ‘I sweated a lot,’ said the patient. ‘Good,’ said the doctor. Another time he asked him how he had fared since then: ‘I felt extremely cold and shivery,’ he said. – ‘Good,’ replied the doctor. On a third occasion he again asked him how he felt: ‘All puffy and swollen up,’ he said, ‘as though I had dropsy.’ – ‘Excellent!’ said the doctor. Then one of the patient’s close friends came to ask how things were with him. ‘I am dying of good health, my friend,’ he replied.
¹⁸

They used to have a more equitable contract in Egypt: for the first three days the doctor took on the patient at the patient’s risk and peril: when the three days were up, the risks and perils were the doctor’s. Is it right that Aesculapius, the patron of medicine, should have been struck down by a thunderbolt for having brought the dead [’95] Hippolytus
¹⁹
[A] back to life –

[B]
Nam pater omnipotens, aliquem indignatus ab umbris
Mortalem infernis ad lumina surgere vitæ,
Ipse repertorem medicinæ talis et artis
Fulmine Phæbigenam stygias detrusit ad undas

[For the Father Almighty, angry that a mortal should rise from the Shades of the Underworld to the light of the living, struck down the discoverer of the Art of Medicine, the son of Apollo, and with his thunderbolt cast him into the waters of Styx]

– [A] while his followers who send so many souls from life to death find absolution! [B] A doctor was boasting to Nicocles that his Art had great prestige. Nicocles retorted: ‘It must indeed be so, if you can kill so many people with impunity.’

[A] Meanwhile if they had asked my advice I would have rendered their teachings even more mysterious and awesome. They began well but did not keep it up to the end. A good start that, making gods and
daemons
the authors of their doctrines and then adopting a specialized language and style of writing – [C] even though Philosophy may think that it is madness to give a man good counsel which is unintelligible:
‘Ut si quis medicus imperat ut sumat: “Terrigenam, herbigradam, domiportam, sanguine cassant”…’
[As though a doctor’s prescription for a diet should say: ‘Take terrigenous herbigressive autodomiciled desanguinated gasteropods…’]
²⁰

[A] It has proved a rule good for the Art (found in all vain fantastical supernatural arts) that the patient must first trust in the remedy with firm hope and assurance before it can work effectively. They cling to that rule so far as to hold that a bad doctor whom a patient trusts is better than the most experienced one whom he does not know.

The very constituents selected for their remedies recall mystery and sorcery: the left foot of a tortoise, the urine of a lizard, the droppings of an elephant, the liver of a mole, blood drawn from under the right wing of a white pigeon; and for those of us with colic paroxysms (so contemptuously do they abuse our wretchedness) triturated rat-shit and similar apish trickery which look more like magic spells than solid knowledge. I will not even mention pills to be taken in odd numbers; the designation of particular days and festivals as ominous; the prescribing of specific times for gathering the herbs for their ingredients; and the severe, solemn expression on doctors’ faces which even Pliny laughs at.

Where doctors went wrong (I mean after such a good start) is that they did not also make their assemblies more religious and their deliberations
more secret: no profane layman ought to have access to them, no more than to the secret ceremonies of Aesculapius. Because of this error their uncertainties and the feebleness of their arguments, of their guesswork and of their premises, as well as the bitterness of their disagreements (full of hatred, of envy and personal considerations), have all been revealed to everybody, so that a man must be wondrously blind if he does not feel at risk in their hands.

Did you ever find a doctor taking over a colleague’s prescription without putting in something extra or cutting something out? That gives their Art away and reveals that they are more concerned with their own reputation (and therefore with their fee) than with the well-being of their patients. The wisest of them all was he who decreed that each patient should be treated by only one doctor:
²¹
for if he does no good the failure of one single man would be no great reproach to the whole Art of medicine, but if on the contrary he does strike lucky, then great is the glory; whereas when many are involved, they discredit their trade at every turn, especially since they normally manage to do more harm than good. They ought to have remained satisfied with the constant disagreements to be found among the opinions of the great masters and ancient authorities of their Art – only the bookish know about those – without letting everybody know of their controversies and the intellectual inconsistencies which they still foster and prolong among themselves.

Do we want to see an example of medical disagreement among the Ancients? Hierophilus locates the original cause of illness in the humours; Erasistratus, in arterial blood; Asclepiades, in invisible atoms flowing through the pores; Alcmaeon, in the exuberancy or deficiency of bodily strength; Diocles, in the imbalance of our corporeal elements and the balance of the air that we breathe; Strato, in the quantity, crudity and decomposition of the food we eat; and Hippocrates locates it in our spirits.
²²

A friend of the doctors, whom they know better than I do, exclaims in this connection that it is a great misfortune that the most important of all the sciences we use, the one with responsibility for our health and preservation, should be the most uncertain, the most unstable and the one shaken by the most changes.

There is no great harm done if we miscalculate the height of the sun or
the fractions in some astronomical computation: but here, when it is a matter of the whole of our being, there is no wisdom in abandoning ourselves to the mercy of so many contrary gales.

Nothing much was heard of this science before the Peloponnesian War. It was brought into repute by Hippocrates. Everything he established was overturned by Chrysippus; everything Chrysippus wrote was then overturned by Erasistratus, the grandson of Aristotle. After that lot there came the Empirics who in their Art adopted a method quite different from the Ancients; when their reputation began to grow shaky, Herophilus succeeded in getting a new kind of medicine accepted, which Asclepiades came and attacked, destroying it in his turn. Then successively the opinions of Themison gained authority, then Musa’s, then later still those of Vexius Valens (the doctor famous for his intimacy with Messalina). At the time of Nero, the empire (of medicine) fell to Thessalus, who condemned and destroyed everything taught before him. His teachings were subsequently struck down by Crinas of Massilia, whose new contribution was to regulate all the workings of medicines by ephemerides and astral movements, making men eat, sleep and drink at the times which suited the Moon or Mercury. His authority was soon supplanted by that of Charinus, also a doctor in Massilia; he not only fought against Ancient medicine but also against the centuries-old public institution of hot baths. He made his patients take cold baths even in winter, immersing the sick in streams of fresh-water.

Before Pliny’s time no Roman had ever condescended to practise medicine; that was done by Greeks and foreigners – as among us French it is practised by spouters of Latin. As a very great doctor has said, we do not easily accept treatments we can understand, any more than we [C] trust the simples we ourselves gather.
²³
[A] If those nations where we find our guaiacum, sarsaparilla and china-root have doctors of their own, just think how exoticism and costliness must make them esteem our cabbages and our parsley: who would dare to despise plants sought in such distant lands at the risk of long and perilous journeys!

Since those medical upheavals among the Ancients there have been innumerable others up to our own times, mostly total fundamental revolutions
like those recently produced by Paracelsus, Fioravanti and Argenterius; I am told that they do not only change the odd prescription but the woof and web and the government of the medical corpus, accusing those who professed it before them of being ignorant charlatans.
²⁴

I leave you to imagine where that leaves the wretched patient.

If we could only be sure that their mistakes did us no harm even if they did no good it would be a reasonable bet to chance gaining something without risk of losing everything. [B] But Aesop tells how a man bought a Moorish slave and thought that his colour was incidental, brought on by ill-treatment from his former master; so he had him carefully physicked with baths and medical concoctions. As a result the Moor was not cured of swarthiness but he did lose his good health. [A] How often have we found doctors blaming each other for the deaths of their patients! I remember the local epidemic a few years ago: it was fatally dangerous. When the storm was over (having swept away innumerable people) one of the most celebrated doctors in the land published a booklet on the subject in which he regretted having prescribed bloodletting, admitting that it was one of the principal sources of the harm that was done.
²⁵

Moreover their authors maintain that there is no medicine without harmful side-effects: if those which do us some good do us some harm as well, what must the other ones do when applied to us quite abusively?

As for those who loathe the taste of medicine, I personally feel that, even if for no other reason, it would be dangerous and harmful for them to make themselves force it down at so inappropriate a time: just when they need rest it constitutes, I think, an unacceptable assay of their strength. Besides when I consider the factors which are said to occasion our illnesses I find them so slight and so specific that I am forced to conclude that even a tiny error in the prescribed dosage could do us great harm.

Now things go very bad indeed for us if our doctor’s mistake is a dangerous one, for it is difficult for him not to go on falling into yet more errors. To aim at the right target his treatment must embrace very many
factors, circumstances and elements: he must know his patient’s complexion, his temperament, his humours, his inclinations, his actions, even his thoughts and his ideas; he must take into account external circumstances such as the nature of the locality, the condition of the air and the weather, the position of the planets and their influences; then he must know what causes the illness, its symptoms and their effects and the day when the crisis is reached. Where the drugs themselves are concerned he must know their dosage and their strength, their country of origin, appearance and maturity as well as the right prescription. And then he must know how to combine those elements together in the right proportions so as to produce a perfect balance. If he gets any one of them slightly wrong, or if one of his principles is slightly awry, that is enough to undo us. Only God knows how difficult it is to understand most of these elements; for example, how can a doctor discover the proper symptoms of your illness when each illness can comport an infinite number of them? How many hesitations and disputes do they have over the analysis of urines? Otherwise, how could we explain their ceaseless wranglings over their diagnoses? How else could we excuse their ‘mistaking sables for foxes’ – the fault they fall into so often? In such illnesses that I have had, as soon as there was the slightest complication I never found three doctors to agree.

I am most impressed by the examples which could affect me.

Recently there was a nobleman in Paris who was cut on doctor’s orders: the surgeon found he no more had a stone in his bladder than in the palm of his hand.

Then there was a close friend of mine, a bishop; most of the doctors he consulted urgently pressed him to be cut; trusting in the others, I too joined in the persuasion; once he was dead they opened him up and found he only had vague kidney trouble. They have less excuse in the case of the stone, which, to some extent, can be felt by probing. That is why surgery always seems to me to be more exact: it sees and feels its way along; there is less conjecture and guesswork: medicine has no vaginal prod which can open up the passages of our brains, our lungs or our livers.