THE SACRED WHOLE OF MAN.
So ignorant of man’s whole,
Of bodily organs plain to see—
So sage and certain, frank and free,
About what’s under lock and key—
Man’s soul!—_Browning._
He alone is an acute observer who can observe minutely without
being observed.—_Lavater._
When the students enter the wards of the hospitals for regular work
with the staff, they have to devote a considerable portion of their
time to the business of minutely recording the family history, physical
signs and symptoms, and the treatment of each patient allotted to them.
These records are valuable for reference, and still more so for the
education of the pupils. They accustom the student to habits of careful
observation; and as clinical work is by far the most important factor
in his training, the man who does most of this stands the best chance
of thoroughly learning his business. Elsworth found his account in
sticking to the bedside, and often learned from conversing with his
patients many things which helped him to understand how they came to be
patients at all. Indeed, he found so much imprudence and ignorance in
the habits of the people, that he wondered how it was they were ever
free from disease. All the industrious men were great note-takers in
the wards; they found that to understand the disease one must
understand the subject of it. The practice introduced them to the
habits of the working classes as nothing else could have done so
perfectly. The expert note-taker learned more of human nature in thus
recording these histories than he could have acquired from reading any
number of books. Some startling revelations as to the amount of drink
the British workman can absorb were often made in this way. There were
several great breweries in the neighbourhood, and the men employed
assured the doctors they usually drank about two gallons of beer a day.
These men were always awkward persons to treat; their flesh healed
badly, and they were liable to many complications which abstemious
persons would escape. Many artisans, whose weekly wages would average
twenty-eight to thirty shillings, owned to spending ten shillings on
their own liquor—a sum which, given to their wives, would have often
made all the difference between poverty and decent comfort. Many of the
accidents that were brought in could be traced to unsteadiness of brain
caused by alcohol. When men are working in dangerous situations, it is
perilous in the extreme for them to indulge in stimulants. It was not
surprising that men who drank two gallons of strong beer a day should
fall into the vats or down trap-doors; the wonder was they could walk
at all.
One man confessed to having taken on an average forty two-pennyworths
of rum a day. He was a Jew dealer in metals, and made a good deal of
money at times; but his liver could not stand the alcohol, and he was
the subject of a good pathological address on cirrhosis when he died.
This drink-madness was often found to be hereditary, as were many other
maladies. Very often the taking of the family history involved the
collection of very curious facts from the patients’ relatives when they
came to visit their sick friends. Idiosyncrasies were often traced
several generations back, odd deformities and bodily peculiarities
persisted in families as explained by Darwin, and illustrated the fact
that a man thinks and reasons in certain grooves wherein have run the
wheels of thought of hosts of his ancestors. A descendant of a Huguenot
refugee remarked lately that his nerves had not yet got rid of the
terror infused into them by the hair-breadth escapes his progenitors
endured hundreds of years ago. It is said the whole world feels the
effect of the stamp of one’s foot on the ground; not less is it true
that our habits and work will influence the minds of untold generations
of our successors.
True psychological medicine is less understood in the present age of
science by our doctors than it was in the East thousands of years
since. It will scarcely be credited that the great, the overwhelming
majority of medical men can and do obtain their diplomas to practise,
and attain to all the honours of their profession, without ever having
heard a lecture on mental diseases, seen the inside of a lunatic
asylum, or examined a person of unsound mind, except in connection with
some physical signs indicating bodily disease, as in the delirium of
fevers. In connection with some medical schools facilities are
offered to the students to visit a neighbouring asylum for clinical
observation, but it is extremely rare for them to avail themselves of
the privilege. One may pass half a score of examinations at the various
boards which have the power of licensing the practitioner who is to be
charged with the duty of aiding by his counsel the families amongst
which he will practise in a hundred forms of mental affliction, without
having ever been asked a single question bearing upon psychological
medicine. The student will be required to state with the minutest
accuracy the stages of great operations which there are ten thousand
chances to one he will never have the chance of performing, and a still
remoter probability that he would have either the knowledge or the
nerve to perform if he had the opportunity. He will be minutely
cross-examined over obscure and rare complaints which it is extremely
likely he will never see in his own practice if he live to Methuselah’s
age; yet he will not be required to diagnose the difference between
melancholia and hysteria. At the same time it is quite true, if he be
an industrious man, he may learn a good deal about these mental
maladies if he attend the lectures of the physicians who make them
their speciality, but this is optional; he does not get any credit for
it in his schedules; he will not be advancing his chances of a “pass”
by so doing, and there is much temptation if, amongst so many things
which a student of medicine _must_ know, he holds in light esteem some
things about which he may or may not trouble himself at his discretion.
The study of mental phenomena occupies the attention, then, of but few,
and those only the most cultivated and thoughtful of the students. To
the Sawbones it is like cuneiform inscriptions or the domestic economy
of the Hittites. Is not this a scandalous blot on our system of medical
education? Yet every half-educated, idle, and beer-boozing young man
who can get one foot on the medical register, and write L.S.A. after
his name (implying that he has the licence of the Apothecaries’
Society, Blackfriars), has the legal power to sign a lunacy certificate
which may consign anyone of us to the walls of a mad-house! Would this
be tolerated were it understood? It is recorded of Garibaldi that in
the war against the Austrians in Lombardy, he was seized with the marsh
fever in the midst of one of his campaigns. The malady soon turned to
typhus, and he was given over by his physicians. Lying at Lerino at the
point of death, he heard the wild shout—“The Austrians!” The enemy had
suddenly come down upon the little town, and the slaughter of his
followers had begun. Springing from his bed with an infusion of new
life in his veins, he buckled on his sword, and led his troops,
inspired by his own wonderful personality, to conflict and victory.
What was the influence of the mind in effecting this cure? Ah! that is
no part of a medical curriculum. Mesmerists, spiritualists, theologians
may deal with that as best they may—it is beneath the notice of the
colleges.
A fact like this is surprising only to those medical men who have never
studied psychological medicine.
The miracles of Lourdes and of hundreds of other Catholic shrines need
not be denied altogether as unworthy of credence. There is abundant
evidence that some cases of cure do really occur in connection with
faith healing. Those who have made a study of mesmerism have adduced
instances of healing by its means which it would be foolish to deny. So
much charlatanism and fraud have always been mixed up with these things
that it is not perhaps matter of much surprise that they are held in
low esteem by men of science. Still, as there are undoubted phenomena
in connection with them worthy of patient examination, it is surprising
that so prominent a field of inquiry should be so completely neglected
by our doctors, while it is considered necessary to know precisely how
long a dog covered with varnish would live, and how many degrees of
heat a rabbit can tolerate before succumbing to its agony. A young lady
of hysterical temperament, who had been humoured to the top of her bent
by her medical man, had, after a few months of gynæcological treatment,
become so enfeebled in mind that she imagined she had lost the use of
her lower extremities, and even succeeded in inducing her doctor to
believe that she really was unable to walk. She was advised to consult
a well-known hospital physician, who was chiefly celebrated as a true
mind doctor. When he took his seat by the couch of the invalid he soon
diagnosed her malady, and, finding she was of high intellectual
culture, asked permission to read to her. The doctor was an admirable
reader, and his rendering of a long and soul-stirring passage from one
of the great poets _made_ the girl forget her ailment so completely
that she sprang from her couch with energy as he paced the room
declaiming the poem, and exclaimed, “Is not that magnificent?” At that
moment the deluded woman found the complete use of her limbs, and a few
more readings cured her without other medicine. They don’t teach this
sort of things in hospitals,—not the curative part, at least.
Examiners at the colleges would “plough” the man who ventured to
propose readings from Shakespeare three times a week with dramatic
action as a remedy for hysteria. What they want is—
R. Tinct. Valer. Am. dr. j; Potass. Brom. gr. x.
Aq. Dest. oz. j; ter die sumend.
You see, it has been discovered by physiologists that if a solution of
the bromide of potassium is applied locally to a rabbit’s heart, it
produces instantly marked lessening of its action,[3] and if applied to
the muscle of the frog it throws it into tetanic spasm.[4] On the nerve
trunks it acts as a paralyzing poison;[5] in fact, if you inject it in
the vicinity of a living dog’s heart, “cardiac arrest always occurs.”
So that you see how easily the physiologist can demonstrate how bromide
of potassium quiets the excited nervous system of the hysterical
ladies. You do not quite follow the reasoning? Well, do not tell the
examiners that, because they declare it is quite plain to them, and
helps to prove the value of experiment. Now, as there are no instances
given in any books of physiology known to us, detailing any effects
produced on the hearts or brains of any mammals by the dramatic reading
of poetry, it would be manifestly unscientific to treat lady patients
by any such method. Moreover, as it is of no use to cure anybody if you
cannot demonstrate precisely _how_ you cure him, it is better to let
him alone.
The mind specialist who effected these remarkable results was answered
by his colleagues who went in for the rabbit and dog theories that in
the first place the patient wasn’t ill at all; secondly, that
consequently she was not cured; and thirdly, that she was still as ill
as ever. But the good physician still holds on his course, speaks with
growing disrespect of the Pharmacopœia, _studies_ Nature, but does not
“put her to the question,” and takes hints from old women, birds, trees
and flowers; and like another Paracelsus, is ridiculed by his
professional brethren in proportion to his success in unorthodox
methods.
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Footnote 3:
Virchow’s Archiv., xli. 101.
Footnote 4:
Dublin Journal, xlvii. 325.
Footnote 5:
Bull. Therap., lxxiii. 253. 290.