Mat 1, 1886.] 



♦ KNOWLEDGE 



221 



made an impression, it became necessary to keep it up. 

 This was done by I'epeated visits, at all hours of the day 

 and night, and by expressing on these occasions the most 

 intense anxiety as to the effect of the very powerful and 

 dangerous medicaments. This was not a case in wliich a 

 sudden effect could be expected to be produced, whatever 

 might be the means employed. Symptoms of disease existed 

 which bore too close a resemblance to tliose of an organic 

 order to admit of hope of a sudden, if even of tardy, re- 

 lief." (It vdU be seen presently that unmistakable evi- 

 dence was afterwards obtained of the existence of such 

 organic mischief as the surgeon at this time feared.) 

 " Hence the pills (bread, of course) were given every sixth 

 hour only. Within twenty-four hours the man's sufferings 

 were decidedly less. Within four days he was almost free 

 from pain. On the sixth day he was quite so ; his pills were 

 omitted : and at the end of a fortnight he was again at duty 

 with a clear eye, a health}- skin, and was rajjidly regaining 

 his flesh. Here, as in most cases where this method has 

 been tried, the diet and drink have been left unrestricted. 

 Occasionally, however, it became necessary to taboo some 

 article, lest its coming in contact with the remedy might 

 prove most destructive ; in other words, articles were 

 occasionally forbidden when the mind seemed to be inclined 

 to lose sight of what must be made the all-important subject 

 of thought by night and day. The wonderful improvement 

 in this man's state was frequently commented on by both 

 officei-s and men, who of course were, and still aie, as little 

 acquainted with the means employed as the patient himself 

 was." 



This case is so remarkable that we might well be disposed 

 to consider that the man's cui-e was not in reality affected by 

 the means to which the surgeon attributed it. Might not 

 the illness, for instance, have been on the point of yielding 

 to the remedies used before the mental method was tried 1 

 Or may there not have been some other cause at work ? for 

 to mention no other, a patient on board ship may have 

 changes of climate unlike those ordinarily experienced by 

 the patient on land. One feels disposed at a first view of 

 the case to prefer an explanation based on the possibility 

 of some such causes as these having acted, than one which 

 in reality requires us to believe that a man (and one too, 

 be it remembered, not specially trained, like some Eastern 

 devotees, to fix his attention constantly on his interior), by 

 thinking constantly about the good effects of a supposed 

 medicine upon his stomach and intestines, could actually 

 cause organic changes to take place in these viscera. The 

 case would then be a singular introversion of the state of 

 things desci-ibed by Macbeth. He says, •' Canst thou not 

 minister to a mind diseased 1 " But here the physician 

 throws his physic on one side, not because he cannot 

 minister to a mind diseased, but because he believes a 

 healthy mind has the power of ministering to a dise;ised 

 body when physic has altogether failed. The memorv (of 

 bread pills and of their imagined potency) was here trusted 

 to pluck from the intestines a rooted trouble, the brain was 

 called upon to raze out the written troubles of the stomach. 

 For it appeared afterwards that these troubles n'ere written 

 (at least, in the poetic sense in which iShakespeare uses the 

 word). They had, at any rate, made their mark. Let the 

 rest of the story be carefully noted. •• It may be said," pro- 

 ceeds the narrator, " that this case, as above given, goes for 

 nothing, in so far as it does not show that the pains were 

 anything but casual ; in which case any mode of treatment, 

 or very likely no mode at all " (doubtless the reader has 

 already thought of the possibility that the medicines made 

 most of the mischief), "would have been equally successfid ; 

 or it may be again, as it has before been said, that it " (the 

 disease presumably) '• was altogether feigned, and that the 



commanding officer would have made a better and quicker 

 cme. I think not; and for the following reasons : the man's 

 flesh had wasted : his eye became sunken ; his skin sickly 

 in hue, as well as in feeling ; his sleep, when he had any, 

 was of the most distui-bed character. But more than all, 

 the pain after some weeks returned, and the other bad 

 symptoms followed in its wake; yet both it and they were 

 relieved a second time by the same means. While suffering 

 from a thii-d attack he was sent to the Royal Xaval Hospital 

 at Malta, and there, after much suffering, he brought up by 

 vomiting a portion of the mucous membrane of one of the 

 small intestines "... clearly recognisable by a well-ti-ained 

 medical eye. " I am distinctly assured," says our author, 

 " by one of the ofiicers of the establishment, that he most 

 carefully examined the ejected matter, and that its characters 

 were so marked that there could loe no room for a doubt a,s 

 to what it was. This being so, we have pretty clear proof 

 that disease existed long before this slough was thrown off; 

 and that even this organic disease was suspended, on two 

 occasions, by mental influence only." 



The question how far it is a legitimate medical practice 

 to deceive a patient in such a case as the above has been 

 raised hy Dr. Todd, and is answered by him in a way which 

 seems open to objection. " Nothing," he says, " can justify 

 our asserting what is not true in order to gain the patient's 

 confidence." And elsewhere, " in regard to misleading 

 patients generally, even causa scientice, one of the pi'actical 

 diflSculties the investigation into the influence of the ima- 

 gination presents is certainly the unseemliness of making 

 experiments of this nature, and the danger of sullying that 

 strict honour which by no profession is more prized or main- 

 tained than by the professors of the medical art." If the 

 cause were that of science alone, this emphatic opposition to 

 the misleading of a patient might be regarded as justified. 

 But there certainly seems an excess of strictness in objecting 

 to the deception of a patient for his own good. K a doctor 

 is perfectly satisfied that a jiatient will not recover without 

 a strong mental effort, and that this effort will certainly not 

 be made unless the patient is misled with regard to the 

 nature of the treatment, the doctor might fairly consider it 

 his duty to "assert what is not true to gain the patient's 

 confidence." An adherence to veracity so scrupulous as to 

 outweigh the life of a fellow-creature may appear deserving 

 of admiration when dealt with in a treatise on morals, but 

 in actual life would be altogether objectionable. If it be 

 urged that liberty to deviate in some such cases from strict 

 truth might be open to abuse, it may at once be answered 

 that so also would liberty to select the strictly veracious 

 coiu^e (under any circumstances) be open to abuse. Con- 

 sider, for instance, the following case, which is by no means 

 an imaginary one. A man is lying prostrate under a very 

 dangerous illness, and it is known to all who attend on him 

 that any severe mental shock must inevitably pi-ove fatal to 

 him, but that if for a few days he can be kept free from 

 mental disturbance he will recover. He sends a messenger 

 to inquire about the health of a beloved relative, whom he 

 knows to be in a critical condition, or exposed perhaps to 

 some special form of danger distinct from illness. The 

 messenger, when he reaches that relative's house, is informed 

 that death has been there before him. Shall he retui-n and 

 tell the patient the truth, thereby certainly killing him 2 

 Let it be assumed that he must at any rate take some 

 message back : protracted anxiety being, let us suppose, as 

 dangerous for the patient as the sudden shock of illness. 

 He can do only one of two things : tell the truth and kill, 

 or a.ssert what is not true and spare the patient's life. Few 

 will question what he ought to do. But the question may 

 be raised, is he to be regarded even as free to choose ? He 

 holds for the time being the patient's life in his hands ; he 



