Moore first points out that “the art of medicine itself is uncertain and conjectural.”4 In his opinion, medicine consists of a mostly unsubstantiated body of knowledge based on assumptions. He feels it is necessary to make this clear to “a sensible and unprejudiced reader who may find this notion disagreeable but has to accept it.” Moore is suspicious of “physicians who imagine they fully understand the nature of every disease, have high and enthusiastic notions of the powers of medicine and are never disturbed with doubts.” In contrast, those who “understand character imagine that those of the above description are commonly found among the weak, the ostentatious and superficial, and seldom or never among the acute and intelligent.” He also warns physicians against getting all their knowledge from books. Moore preaches that “learning from experience is essential.” The motto for his book is, “Caecus iter monstrare” (By experience taught):
There was never a greater absurdity…than to suppose that a man of an uncommon weak understanding can be a good physician; he may indeed have a great deal of experience; he may possibly be even a man of learning, but without natural acuteness and good sense there never was a good physician since the world began.
Moore stresses that a physician must be on his guard against too much skepticism “even if it is less dangerous than implicit faith in any particular system, or an eager belief in facts, without repeated experience, and the most cautious examination.” Still he favors studies of earlier schools of medicine and writes, “we discover what led men of great sagacity into error; such discoveries serve as beacons to prevent us from steering the same course.” But he also points out that ”many useful hints and observations may be found; for it often happened that the practice was good, even when the reasoning was founded on false principles.”
Moore looks upon the effect of most medicines with skepticism: “acute reflection and experience will tell us that many so-called effects of medicine are actually…the work of nature only…which should moderate our faith in the miraculous powers of medicines.” He also explains that effective medicines are seldom made “by men of science after study and reflection.” Some are made by “mere accident, others by ignorant savages, and others we owe to the chymical enthusiasm of a credulous age, which, hot in pursuit of the philosophers stone, stumbled on discoveries in medicine…far more beneficial to mankind than the object they pursued.”
Overmedicating in conditions with good prognoses seems to have been as common then as it is now. To Moore, doing nothing is often the better alternative. “The difference between a good physician and a bad one is certainly great; but the difference between a good physician and no physician at all, in many cases, is very little.” He adds: “It is astonishing how exceedingly apt medical practitioners of every denomination are to impute to drugs that salutary effect which proceeds from universal influence of another cause.”
When writing about fevers Moore seems less inspired. The measurement of body temperature at the time was cumbersome and not widely used; fevers were usually diagnosed by assessing skin temperature and pulse. In his book, he describes contemporary thinking on fevers, but makes few comments. Perhaps he sensed that the “fever school” was on its way out.
He does, however, give a fine description of depression: “The patient, when apparently in good health, and perhaps in the most opulent and desirable of circumstances, is gradually invaded by a languor and dejection of spirits, which renders him averse to every kind of exertion of body or mind…everything appears to him dark and dismal.” He calls it “the melancholy complaint” and rightly assumes that it “certainly depends on some affection of the origin of all the nerves.” After consulting many doctors, who are often quacks, the patient “either sinks into fixed melancholy…or, his good genius having whispered in his ear, ‘fuge medicos et medicamina’…he tries a new climate, consults no practitioners of any country, sex, or denomination; and forms a fixed resolution to swallow no more drugs, from which…he has the best chance of dating his recovery.”
Moore´s views on contemporary medicine and physicians reflect his common sense just as his travel books do. He would like to see physicians use a combination of knowledge and personal experience in the care of patients. Thus, he is an early proponent of what, more than 200 years later, gains popularity in the medical arena as EBM (Evidence Based Medicine). His main message is that the physician must take into serious account ”the constant tendency, so often mentioned, in diseased nature to restore itself.”
- Moore, John. A view of society and manners in France, Switzerland and Germany. London, Strahan and Cadell, 1779.
- Moore, John. A view of society and manners in Italy. London, Strahan and Cadell, 1780.
- Moore, John. Medical Sketches. London, Strahan and Cadell, 1786.
- All the quotes cited in this essay come from John Moore’s Medical Sketches.
EINAR PERMAN, MD, PhD is a retired physician living in Stockholm, Sweden. He is a member of our international editorial board.
He has written two other articles regarding Dr. Moore:
- Perman, Einar. John Moore M.D. Physician, Travel Writer, and Social Commentator. Hektoen International, Vol.3, April 2009.
- Perman, Einar. Doctor Moore in Italy. Hektoen International, Vol.5, November 2009.
Highlighted in Frontispiece Spring 2010 – Volume 2, Issue 2