Introductory Address Delivered Before the Senior Students.
of the Hahnemann Medical College, Philadelphia.
G. HARLAN WELLS, M.D., F.A.C.P., PROFESSOR OF MEDICINE
You gentlemen are about to start your work in internal medicine in the Medical Wards of the Hahnemann Hospital. I think that I am justified in saying that this is the most important work that you have to do in your career as medical students. The kind of work that you do at beside of patient will determine whether or not you are fit to be a doctor.
Some of you will be surgeons, and I hope good ones, some, obstetricians, and a few will be nose and throat specialities, but all of you should have a basic training and a basic experience in general medicine; and it is here in the Wards that you must get that experience.
I think that it is important for us to consider first, “What is the duty of a doctor ?” Well, that has been very clearly defined for us by Hahnemann in the opening chapter of the Organon, when he said very concisely, “The duty of the doctor is to heal the sick”. Later there has been added “and to prevent disease”. In these two statements are contained “all the law and all the prophets” as far as the duty of the doctor is concerned.
The care of the sick is one of the greatest problems that has confronted the human race since its very beginning. There have always been sick people. Even among primitive people there are those who are injured by accidents of various sorts, bitten by snakes, or who contract infections and so from the very beginning of the human race this problem of taking care of sick people has been an important one.
Lucretius, describing the sick of his day, states that “with cries and gestures they taught with broken words that it is right for all men to have pity on the weak.” Dr. Osler quotes the well- known medical historian Dr. Payne saying “The basis of medicine is sympathy and the desire to help others and whatever is done with this end in view must be called medicine.”.
You have heard a great deal about the medical sciences, but I want to say definitely to you now, what I have said many times before, there is no such thing as the science of medicine. The practice of medicine is an art. There are medical scientists, but they are not doctors, in the sense that Hahnemann had in mind when he described the duty of a physician. The doctor is not only a medical scientist, but also a keen and sympathetic student of human nature, with the ability to apply the practical facts of science to the needs of the individual patient for the sake of getting him well or of relieving his distress.
The problem of the doctor is a much more difficult one than that of the medical scientist. The medical scientist deals in the main with chemical, anatomical, and pathological problems. The doctor deals with human problems. The doctor does not treat diseases. He treats people who have diseases.
Unless he has an understanding of people, unless he is able to impress with his sincerity and with his sympathy for their suffering he will never succeed in the practice of medicine. He may know all that there is to be known about the science of chemistry, of anatomy or of pathology, but he will never be a successful doctor, “The physician,” said Socrates, “must treat the whole man, body, mind and soul.”.
If you want to know what the average patient expects of you, as a doctor, all you have to do is to get a good old fashioned bellyache. Your one desire is to get relief. You dont want a doctor who is going to make a diagnosis, and then perform a post- mortem examination on you to see whether he is right. You want somebody who will relieve your bellyache. Now what you want is what every other sick man wants, and he is only interested in diagnosis in diagnosis in so far as that helps you to get him well or to relieve him of his symptoms.
In internal medicine, we have a certain technique or plan in order to attain this ultimate purpose of medicine, which is the healing of the sick, and we being by what we know as diagnosis. Diagnosis, of course, in the broad sense is an attempt to evaluate the physical condition of the patient for the purpose of determining why he is ill. It is much more than labelling a disease by a specific name.
It isnt necessary for me to spend much time impressing on you the importance of diagnosis. In the first place, diagnosis is necessary from a legal standpoint. People with diphtheria, small- pox, and with similar diseases are not allowed to roam the streets because they are a menace to the community. Therefore, the law places upon the doctor the responsibility of making a diagnosis for the purpose of protecting the community.
Secondly, diagnosis is important in order that you may be able to give intelligent answers to the patient and his family. One of the first questions that you will be asked when you enter a sickroom is, “Doctor, is Mary going to get well ?”
Or you may be asked, “How long is she likely to be sick ?” Now, if you dont know whether Mary has “a cold,” or ordinary bronchitis, or influenza, or tuberculosis, or typhoid fever, how are you going to answer those questions intelligently ? You cant. Therefore, in order that the patient may be given satisfactory answers and may have some confidence in your experience and ability, it is necessary for you make a diagnosis.
And lastly and very important, a diagnosis is necessary in order to apply proper treatment. It is true that we sometimes get people well, or people get well, when the doctor has no idea of the nature of their malady, but in the majority of cases, a proper diagnosis is an important step in the application of proper treatment.
I recall a boy some years ago who was brought here with a discharge from the nose. The doctor had prescribed very carefully for him, but the boy did not improve and finally he was examined by one of our rhinologists who found a sand-burr in his nose, This boy was from Jersey, as you may have suspected. When the sand-burr was pulled out of his nose, the indicated remedy worked, but until you got the sand-burr out of his nose, you might have prescribed all the medicine in the world with no effect.
We have heard in the past that a homoeopath doesnt need to make a diagnosis. He simply prescribes the remedy, and the patient gets well. Well. I wont waste much time in discussing that problem because a man who makes that statement knows very little about medicine and very little about homoeopathy.
Hahnemann told us that it is necessary for us to know what is curable in disease before prescribing a drug. That applies not only to homoeopathy, but on all kinds of therapy. If you dont know what the disease is, how are you going to determine what is curable about it ? So it is just as necessary for a homoeopathic prescriber to make a diagnosis as it is for a surgeon or any other therapeutist.
Very properly diagnosis is the first step that we must take in the handling of sick people. There are doctors who say, “When I make a diagnosis, I make a diagnosis, I have no further interest in the case.” That kind of doctor never will get very far, because the patients interest only begins at that point. It is folly for me to tell you, if you are suffering from an acute biliary colic, that you have gallstones, and then walk out of the house.
You want to get relief from the pain and, therefore, the diagnosis in important to you only in so far as it leads me to determine what should be done to relieve you, If I dont relieve you, and you are an intelligent person, you will get somebody else who will.
The influence of doctors, in any community, depends upon the fact that they bear in mind they are there primarily to help sick people; and whenever doctors forget their true function people lose confidence in them. They seek the help of people who are not scientific physicians at all, because these people at least try to do, or promise they will do, that which the doctor neglects.
The doctor who loses interest in the case when he has made a diagnosis isnt a doctor at all, he is merely a medical dilettante.
When we come to the question of therapy, we must bear in mind that there are a great many methods of healing sick people, and all of these methods have their proper place. We have been condemned by some, especially in the past, because, they said, “You dont teach enough homoeopathy at Hahnemann.” There was a time when almost the entire practice of medicine consisted in the administration of drugs. A physician was a person who gave drugs, and the bulk of medical care centered around the administration of drugs.
That time has passed. Drug therapy of any type today occupies a more or less secondary place in the treatment of disease, and we have to utilize in the care of the sick, any method of therapy that is likely to help. As a matter of fact, I believe we teach a broader range of therapy in this institution than is taught in most of the medical schools in this Country, because we have for years endeavored to teach every method of medical therapeutics, as well as any other methods of therapeutics, that has proved to be of value.
