Quackery

QUACKERY, the practice of treatment by persons without appropriate scientific medical training, using means and methods not based on the data of medical science, but drawn for the most part from the oral traditions of so-called folk medicine. The quack is a self-taught healer. The group of quacks includes both persons sincerely convinced of the healing power of their therapeutic remedies and even applying their knowledge free of charge ("for the salvation of the soul," "for God"), and those for whom quackery is a profession. The quack should be distinguished from the charlatan. "The latter consciously fools people; he understands nothing about the business, only charlatanizes, and the gullible pay extra for his charlatanism" (Dal). History of quackery takes its origin from teurgic (religious) medicine, when the belief in the demonic origin of diseases dominated: evil spirits were attributed the ability to send misfortunes, diseases, death, and to possess people in order to torment and torture them more severely ("the possessed"). Only ministers of religion—priests—could fight evil spirits; in this epoch, temples were the natural center of healing activity, and priests were the first quacks. Healing by mysterious means partly passed from the priests into the popular masses and created groups of quacks outside the temple. These were often persons capable of convincing the surrounding naive, unenlightened mass that they could enter into communication with the invisible world (sorcerers), subjugate evil spirits, send diseases to people through them, and drive evil spirits out of the sick (magicians). Magicians—healers who operated with the help of "devilish power"—possessed the "ability to hear the whisper of mother earth"; "all the secrets" of nature were open to them; they "distinguished" the rustle and speech of herbs; "knew and were able" to find "good" and "evil" herbs, prepared corresponding infusions from them, and thus reinforced the action of conspiracies ("spells," "love incantations") with a definite "potion." Amidst the endless variety and diversity of life phenomena in a pathological state of the organism, individual observers from the people managed to notice certain general features in individual pictures of the disease and approximate indications of the causal connection of phenomena. These observations thus served as the basis for popular ideas about pathological processes and the starting point for their treatment; in this stage of its development, folk medicine began to study the action of herbs and through slow and unconscious experience arrived at the treatment of various symptom complexes with certain means of the plant world, gradually accumulating disparate observations and passing them down from generation to generation. Self-taught healers of a new formation appeared who, although they healed "in the name of God," resorted to the help of the cross, prayer, and conspiracies, but transferred these mystical procedures of their predecessors from the main method of treatment to an auxiliary one, bringing to the fore a diverse arsenal of medicinal agents and influences. The contingent of quacks also gradually changed: if initially it was composed predominantly of experienced persons who had wandered around the world, of persons close to nature (shepherds), then veterinarians and blacksmiths experienced in the treatment of animals entered here, and—significantly later—persons already from so-called scientific medicine (former hospital attendants, especially from soldiers), and then outright exploiters of the sick person under the guise of a quack knowing the secrets of folk medicine, with the methods of a charlatan well-versed in the psychology of the consumer. With the passage of time, the nature of the applied means also changes: along with herbs collected on certain days (mainly on the day of Ivan Kupala), at special hours, in precisely indicated places, such potent means as, for example, vitriol, sublimate, fumigation with sulfur, cinnabar are used; surgical methods of treatment, primitive balneotherapy, and rubbing—"massage"—are applied. The causes of quackery are as diverse as its forms in different countries and at different times; but one thing is characteristic—precisely now, just at the time when the successes of scientific medicine have reached such a high level, quackery has raised its head particularly high and spread widely in countries distinguished by their culture (in Germany, England, the USA). Especially characteristic is the history of quackery in Germany, where the main impetus for its development was given in 1869, when a law was passed on the right of unhindered treatment (but with the obligation not to call oneself a doctor). Despite the constant discrediting of free healers (the criminal chronicle gives a rather accurate idea of their moral level), the growth of quackery caused the organization in Germany of a special society to combat this evil, the organization of special exhibitions, and the introduction of a draft special law against quackery in the Reichstag (not adopted). In the Palatinate, for example, doctors published an appeal to the population in which they refused to provide medical aid in those families whose members first applied to a doctor for injuries and then, eliminating the latter, continued treatment with quacks (help by doctors is provided then only in emergency cases). In England, quackery and charlatanism also flourish strongly, and various secret remedies, about which publications are made in newspapers, have a huge sale. The causes of quackery, despite their diversity, are rooted to a certain extent in lack of culture, especially in sanitary illiteracy of broad strata of the population; primitive ideas about the essence of diseases, about the interaction between health and disease are also based on prejudices passed down from generation to generation; blind faith in him pushes one to the quack. The growth of quackery is associated with a lack of trust in scientific medicine and insufficient knowledge of its basic principles, as well as with the inadequacy of the medical and sanitary network. The intensive popularization of medical knowledge does not always satisfy this goal: giving many fragmentary pieces of information on pathology and therapy, it does not illuminate systematicity in modern biological and medical knowledge, often bears a "catechism" character, and generates a multitude of perplexed questions, often even contributing to a skeptical attitude toward the conquests of scientific medicine. At present, medicine is liberating itself from the exaggeration of the significance of the individual and his individual talents; therapy is acquiring solid scientific foundations, becoming knowledge. The veil is being torn from the mysterious and miraculous. The progress of science and technology increases medical possibilities, but at the same time diminishes the prestige of the personal skill of the doctor. Medicine is in constant development; much in science is still controversial, and disagreements exist among scientists. Meanwhile, the quack is alien to doubt; his treatment methods are allegedly based on what is still hidden from science, what cannot be explained, what one can only believe in. The quack possesses completely accessible means that can be applied in the everyday environment of the patient; for him, against every disease, there is a special medicine acting "magically." Connected with the entire structure of concepts and way of life of the poorly cultured patient, quack treatment grips his psyche more strongly and acts as suggestion. Scientific medicine, although it speaks of psychological impact, of treating the whole person as a whole, including his psyche, has nevertheless devoted comparatively little attention to this issue until now. Systematic psychotherapy has still penetrated general medicine far too little. Often the patient feels that a cursory examination with only a subsequent prescribing of a therapeutic procedure or prescription without reassuring the patient and arousing his hopes is not yet medical aid, and this does not dispose him in favor of scientific medicine. Meanwhile, the quack is often won over by individual attentiveness to each individual patient and his disease; it is the picture of the patient's experiences that the quack makes the soil for his successes. The quack unconsciously hypnotizes. Such, in basic outline, are those psychological foundations that push unstable minds incapable of critical analysis toward the quack, sometimes draw even cultural strata of the population into the worship of quackery, and are the causes of the growth of quackery. These psychological factors create the fact that quackery exists and sometimes even flourishes in a cultural environment where, it would seem, there is no soil for it whatsoever. In addition to all this, among the conditions contributing to the growth of quackery must be attributed the comparatively insufficient accessibility of medical assistance, then the infatuation with patented remedies existing in scientific medicine, which supports in the population the idea of the presence of unconditionally specific remedies, and especially the support of the unfounded belief in the presence in so-called folk medicine of yet unraveled secrets. The forms of quackery are different in each country, they are in mutual correspondence with those ideas that the people have about the origin of disease, and therefore change depending on the level of culture, the literacy of the population, its prejudices, the material standard of living, and the nature of the morbidity of the population associated with it.

Poverty and the meagerness of knowledge among the peasantry of Russia, who for centuries were deprived of qualified medical assistance due to historical conditions, provided wide scope for the development in our countryside of primitive forms of quackery, which has survived in its integrity to a significant degree even at the present time. And to this day, popular theories about the causes of diseases are almost entirely based on superstitions, on supernatural causes, on the origin of diseases from God or unclean forces. The so-called real causes are represented very little: they are ancient and one-sided: a cold ("caught a cold", "chilled the gut"), labor ("overstrained", "hurting from strain", "ruptured the navel"). Such etiology also created a corresponding diagnostics: spoilage, "infliction upon the heart", the evil eye, words, fright, from a bad wind. The methods of diagnostics are divination on water, a mirror, cards, etc. In accordance with the diagnosis, a wide variety of therapy is used. Against "unclesan forces", incantations act first of all. Knowledge of incantations for one or another simpler cases of life is quite widespread among the people in general, and many experienced people who have lived long enough in the world possess knowledge of them, even those who do not bear the loud name of quacks. However, the ability to apply incantations, to sort them out in relation to more complex diseases is possessed only by real male and female quacks, "guess-women", "locheyki", "sorceresses", "whisperers", and "fortune-tellers". Rarely does a quack possess incantations for all diseases; for the most part, a quack chooses one incantation specialty, thanks to which he becomes especially famous: some cast spells on teeth and headaches, others on blood, still others against snake bites, etc. The incantations that quacks possess are usually hidden from patients (if one tells anyone the word of an incantation, it will lose its power); according to the peasants' belief, incantations are transmitted only on the deathbed, in private, in strict secrecy. The main feature of quack therapy, taking into account the patient's worldview, is to introduce peace into his psyche. This purpose is served by the method of pronouncing incantations, resembling the technique of hypnotizing (in a whisper, in a monotonous and measured tone), their content (listing a number of saints, which corresponds to the beliefs of certain patients), tautology in content, the setting in which the incantations are carried out (the demand for silence in the hut, mysterious manipulations with the objects of the incantations), and finally the concluding chord (washing and blowing on the patient). The impression of monotony and a feeling of fatigue are necessary elements of the action of all incantations. Such treatment, bearing the character of a kind of sacred rite, has one goal—to affect the psyche of the patient, and this effect is stronger and deeper the more complex and mysterious the techniques, the more authoritative from the peasant's point of view the person pronouncing the incantation, and the more the incantation can "touch the soul".—The most necessary element in all incantations and quack manipulations is wat er: water, after it has been "incantated", "passed through a door hinge", combined during appropriate manipulations "with coals from the stove", acquires miraculous power and the ability to remove any disease; water is given internally, the patient is sprinkled with water ("washing the patient"), "washing of the eye" is performed with water (by special specialists—"washers"); water is used to treat "fright", to treat "shock". Finally, all sorts of herbs and medicinal substances are given in water.—In folk practice, besides external treatment (applying plasters of red wax and sulfur, flour with honey, cottage cheese with dough, dusting wounds with soot, ash, tobacco, crushed sugar), massage and rubbing of patients in steam in stoves and baths are widely used (with radish, olive oil, kerosene, wine, red honey, etc.); all this is done by specialists ("trikhi" or "steamers") accompanied by prayers and incantations. External therapy must also include the treatment of eye diseases by licking with the tongue when foreign bodies get into the eyes, rubbing the eyeballs through open eyelids for corneal ulcers. Quack bloodletters let blood (some "venous", others "cupping" or "horn", still others from the "sokolok"—the vein on the thumb); quack bone-setters reduce dislocations, help with bone fractures, apply primitive bandages (comparatively rarely bandages made of bast, birch bark, etc.); quack adjusters treat strain and rupture when a person has "ruptured the navel", in order to "direct" it by throwing a pot (the character of a dry cupping glass), "wrapping the navel", "tugging the navel", "pinching the navel". There are quacks whose specialty is talking alcoholics out of it. Among the multitude of charlatans who gathered at the Nizhny Novgorod fair, there were also "healers from binge drinking". Incantations are read by themselves, or their pronunciation is accompanied by various hand actions, or a "therapeutic" remedy is added—repulsive substances that cause nausea and vomiting: in delirium tremens, they give internally three bugs or an infusion of vodka on two live pikes, or warm water until strong sweating and urine excretion begin.—A special development was received by treatment with various herbs; the material formed gradually, which quacks use, made it possible to collect entire collections and manuals—"herbals" and "flower gardens". Measures to combat quackery must proceed along the line of analyzing the producing causes. As diverse as the forms of quackery in the countryside and the city are, as diverse as the roots nourishing quackery in various countries and localities are, so diverse must be the measures undertaken to combat quackery in different places and at different times. Only a thorough analysis of the causes and the involvement of the entire population in an active, conscious struggle against quackery can yield tangible and comparatively rapid results in this regard. But for this, first of all, it must be realized that quackery is not an expired dead formula, but an evil that has deeply penetrated the life of the people, and this evil is a huge brake not only in the matter of restoring the health of individuals, but chiefly in improving the health of everyday life. Therefore, a serious, planned, persistent struggle must be waged against quackery. For the success of this struggle, it is necessary, as already said, to abandon the infatuation with folk medicine in all its varieties and to set as the main task the fight against the unscientific worldview in the field of the causes of origin and course of diseases. Scientific medicine in all its justifications must become folk medicine in the best sense of the word, must enter into the flesh and blood of folk culture. The progress of medical science by itself is not in a condition to either eradicate or significantly limit quackery. Scientific qualification when applied in medical practice must organically bind the provided medical assistance with the everyday life of the people, must permeate the approach to the disease by taking into account the everyday characteristics of the patient as a product of a certain environment. Blind faith in the doctor and his actions must be replaced by firm trust in scientific medicine; this is the main direction of the fight against quackery. Zemsky medicine, despite the brevity of its existence compared to the thousand-year life of the people, exerted an undeniable influence on it, changing somewhat the views on treatment and some contagious diseases; but it did not influence the development of general reasonable views on health and disease, did not influence the worldview of the people (chiefly the peasantry) as a whole. The huge shift that has occurred in this regard since the October Revolution should significantly facilitate the fight against quackery, but the struggle must be waged by the collective efforts of the population itself. Legislation in the fight against quackery essentially plays only a subsidiary role: with a certain cultural development of the population, prohibitive measures will not succeed in suppressing either quackery or charlatanism; the fight against quacks and charlatans is not yet the fight against quackery and charlatanism. However, the free practice of treatment by persons who do not have systematic medical education is not in the interests of protecting the health of the population. In Germany in 1869, with the introduction of the trade tax, the freedom of medical practice was established, but even here subsequent legitimations introduced a number of restrictions. The right to perform official functions, the right to vaccinations, and the issuance of medical certificates is granted only to approved doctors; unapproved persons engaged in medical practice have been subject to mandatory registration since 1902; these persons do not have the right to announce reception hours anywhere outside their home; pharmacies are prohibited from dispensing potent remedies to unapproved persons. German judicial practice uses the article of the criminal code on fraud to combat charlatanism if it can be proved that the person engaged in treatment promised the patient a successful cure. In Russia, although legislation established that none of the Russian subjects or foreigners has the right to engage in any branch of medical practice if he does not have a Russian medical diploma, at the same time, according to Article 226 of the Criminal Code, "persons who, out of philanthropy, gratuitously help patients with their advice and treatment methods known to them are not subject to punishment for illegal medical practice."

Numerous Senate clarifications revealed that "healing for a fee can be considered illegal only in cases where poisonous and potent substances were used." In the USSR, all persons who do not possess duly certified medical education and engage in treatment as a profession are subject to unconditional liability under Article 109 (fraud), Article 145 (negligent bodily injury), or Article 139 of the Criminal Code (negligent homicide). However, it must be acknowledged that the existence of this law has not yet stopped the spread of quackery and charlatanism in villages, cities, and even capitals.