Both Mark Twain and his alter ego, Samuel Langhorne Clemens (1835-1910), had opinions about everything; they certainly had a lot to say about American medicine as it was practiced from the mid-19th century into the early 20th century. (Figure) In this fine book, K. Patrick Ober relates Samuel Clemens's personal experiences with illness, his reflections on the failings of traditional allopathic medicine, and his encounters with diverse and competing medical therapies, including patent medicines, hydrotherapy, electrotherapy, mind cure, osteopathy, homeopathy, and faith healing. Ober then integrates those accounts with Clemens's jocular and often sharp critiques of doctors and medicine as voiced through the fictional public persona of Mark Twain in a number of excerpts from his stories, editorials, commentaries, and speeches. Ober traces the medical history of the Clemens family over two generations, beginning with Samuel's childhood illnesses, the family's anxieties about epidemics of scarlet fever, cholera, and measles, and his sadness about the deaths of three of his six siblings before the age of 10. Suspicious of the efficacy of allopathic therapies, the Clemens family often experimented with such unconventional alternatives as Davis's Pain-Killer, composed mostly of alcohol and tasting like "fire in liquid form," and a cooler "water cure." As an adult, Clemens researched and experimented with alternative therapies for his family's many health problems; he even toyed with patenting his own "cures" for his gout, bronchitis, rheumatism, carbuncles, and occasional colds. Each of these family stories of sickness is placed in a historical context. Ober evenhandedly delineates the concerns of practitioners (and patients) with traditional allopathic treatments after midcentury and explains the development and theoretical underpinnings of each alternative therapy. In this context, Clemens's enthusiasm for every new therapy makes sense. With each new approach, he was hopeful. And for a time, each therapy did indeed seem to have a curative effect, either for him or for his family members. Inevitably, the water cure, the mind cure, the rest cure, the electric cure, and other promising therapies brought disappointment. The supposed "cure" did not last, and the symptoms returned. Yet he persisted in trying them all. How did Clemens come to understand the efficacy of these therapies? As he voiced his opinion through Mark Twain in A Connecticut Yankee in King Arthur's Court, "Any mummery will cure, if the patient's faith is strong in it." This is, in fact, Clemens's central insight about healing. In a letter to his physician, Wilberforce Baldwin, in 1904, Clemens remarked that "medicine has its office, it does its share and does it well; but without hope back of it, its forces are crippled and only the physician's verdict can create that hope when the facts refuse to create it." Clemens's insights resonate with Ober's central assertion that "the intersection of faith and healing and hope and medical care is a tricky one, but it was a central feature of Mark Twain's medical world just as it is essential to medical practice of the 21st century." In the last section of the book and in the afterword, Ober reflects on the conflicts inherent in contemporary medicine: hope and truth telling, cure and care, mind and body, and traditional and alternative medical systems. He argues provocatively that there "is no such thing as alternative medicine. There is only proven medicine, which is supported by scientific evidence, or unproven medicine, which lacks the scientific evidence needed to support its use. Even so, patients can derive some benefit from simply having something to believe in, and this may be the greatest contribution of nontraditional medical approaches." Citing Howard Spiro, Ober argues that physicians practice within two conflicting worlds: the world of science, which provides them with their knowledge of disease, and the world of people with instincts, pain, suffering, hope, and joy. The first is the realm of physics; the second is the realm of the poet. Clemens understood that neither the world of hard science nor that of soft humanitarianism could provide every answer for every problem. The boundary between science and art is not distinct, and the world of medicine exists at the border. Mark Twain quipped that any mummery could work if the patient had sufficient faith in it. And if it works, Ober speculates, perhaps it is not really mummery at all.
Stephanie Brown Clark, M.D., Ph.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
