Mark Twain and Medicine: Any Mummery Will Cure (review)

K. Patrick Ober's volume is a carefully researched and thoroughly documented exploration of Samuel Clemens's relationship to medical practice and medical practitioners in the "Gilded Age" of post–Civil War America. On the surface, it is a wonderfully readable chronicle of Clemens's often amusing and frequently biting observations on doctors, patients, and treatments. In the course of his presentation, Ober also paints a clear picture of the spectrum of fads, cults, and theories of practice in the era that immediately preceded Abraham Flexner's study. Finally, the work inevitably contains Ober's own reflections on the art of medicine, worthy of careful study in their own right.

Samuel Clemens is perhaps the most highly dosed, dunked, doused, mobilized, and magnetized writer in American literary history. Clemens's childhood encounters with measles, scarlet fever, and cholera were terrible in their own right, but the diseases were only slightly more deadly than the purgation, bloodletting, cold water cures, and patent medicines used as preventives or treatments. Later in life, dissatisfaction with conventional treatment of his own gouty arthritis and the chronic illnesses of his wife and children caused Clemens to seek aid from healers of every persuasion. He lost no opportunity to express his opinions on his experiences in his commentaries and fictions.

Clemens lived in the era of Jacksonian democracy, when individual choice and the wisdom of the common man were the guiding principles for Americans. The do-it-yourself attitude of the nineteenth century applied to health care as well. Americans moved from one medical theory to another, alternately encouraged by early success and discouraged by inevitable failure. The Clemens family was different than others only in the amount of treatment they could afford.

Traditional medicine had changed little over the centuries. Clemens suggested that if Galen himself had come to administer medical care when he was a boy, he would have found little difference between the medical treatments of Missouri in the nineteenth century and the medicine Galen had practiced almost 2,000 years before. Americans wanted better results and enthusiastically embraced all varieties of cure. The era gave birth to patent medicines, hydrotherapy, electrotherapy, magnetic therapy, rest cures, diet cures, faith cures, homeopathy, and osteopathy. Within sects there were purists and eclectics; allopathic practitioners were no different than others. Quoting Dr. Thomas Nichols, a contemporary of Clemens, Ober notes: "There are allopaths of every class . . . homeopaths of high and low dilutions; hydropaths mild and heroic . . . ; spiritualists with healing gifts, and I know not what besides. What is worse is that there is no standard, no real science of medicine, no absolute or acknowledged authority" (p. 199).

Ober's use of Clemens's experiences and commentary to present the state of medical practice is engaging and informative. Traditional practitioners fare no better than cultists under Clemens's inspection. Although it is tempting for the modern reader to dismiss the accounts as romantic nostalgia of another era, one must remember that the events described took place only slightly more than 100 years ago. Although some of the individuals were bald-faced opportunists, others were well respected and ethical practitioners, firmly convinced of the scientific basis of their practice. Are we also on occasion blinded by certainty?

Ober has made a careful study of Clemens, and in the course of it, one suspects that he has found a like-minded soul. Although honesty is the foundation of medical ethics, Ober, like Clemens, believes that too much honesty can be harmful. Clemens learned the distinction between disease and illness. Both travel together, but they demand different treatments. Diseases are treated with drugs, surgery, and modalities, which may or may not affect a cure. Illness is treated with compassion, caring, and hope, which always heal. As Ober notes, truth can take away hope, and there is evidence that hope itself can improve a patient's prognosis. Clemens ultimately concluded that the ability to give hope to the suffering...