It may be objected that the above failures in perception of differences (a much more difficult thing than perception of similarities[7]) was occasioned solely by the speed with which the observations were made. I entertained a contrary belief, and my belief was confirmed by the following example of my own capacity for disgraceful blundering.
Shortly after the publication of “The Massage Case,” a friend asked me how I could have made such a mistake as to attribute to Elfie during her convalescence the strength to walk twenty miles in one day. I asked her to show me the passage wherein I had erred. She did so; and I read that Elfie really did walk twenty miles in the desert. I was amazed at my own stupidity, for, considering the length of time required for complete recovery from severe nervous exhaustion, it is evident that even the charm of Dr. Risedale’s society could not be expected to inspire her even temporarily with nerve-power for such a feat. I had looked steadily at the passage for a few seconds before the idea occurred to me that I might be seeing wrong. Then I scrutinised each word by the light of this suspicion, and having hit upon a correct theory, I found out the truth. It turned out that Elfie walked in the desert for twenty minutes, not miles. An erroneous impression had been conveyed to my brain through the ear; and by its disproportionate tenacity—disproportionate to my perceptive power at the moment—had prevented my receiving a new and truer impression through the eye.
I was overdone at the time, and took the warning; that is to say, I rested. But many of our doctors and nurses, whose observations are of the extremest importance, are supposed to do their work in a fatigued condition, and are considered fit objects of abuse if they do it badly. Why then do they overwork themselves? The answer to this question is that they are underpaid. The butcher and the baker must always receive the reward of their labours; the doctor and the nurse must often toil for nothing, though we are aware that, in order to obtain efficiency in any profession, it is essential that that profession should be well paid. The community may object that it cannot afford to pay more than it pays at present. Can it then afford to be kept ill or made ill by ignorant interference or by erroneous notions? It would surely be cheaper in the long-run to pay to get well or to learn how not to get ill.
To be dogmatic about that which is least known would appear to be an ineradicable characteristic of human nature in its present imperfect state. “Fools rush in where angels fear to tread” is still a true saying. In the treatment of nervous disease it is amply exemplified. Where we are most ignorant, there we are most uncompromising in our dealings. When we understood absolutely nothing of insanity, seeing little connection between madness and disease, we resorted to the whip and the chain. On waking to some conception of nervous disorder, we perceive similarities more readily than differences, and proceed to lump together all diseases of the nerves in the earlier stages under the name of “hysteria.” Having already some vague foolish fixed idea in our heads about “hysteria” being synonymous with idleness and general depravity, we drag our patients about, beat them with wet towels, give them frightful shocks, galvanic or otherwise, and then get rid of them as quickly as possible, so as not to have the burden of remote consequences.
But when more serious mischief is set up, what then? Why, then comes tardily a perception of differences, and we divide nervous disorders into hard and fast diseases, concluding that all had been different from the very first. The later perception of underlying similarity has as yet scarcely dawned. Some of these maladies are considered curable; others, without rhyme or reason, are considered incurable.
With regard to the curability of nervous disease, let us consider what happens when we travel by train from Eastbourne to London, and again from Eastbourne to Brighton. In each case we pass through Willingdon and Polegate, and stop at Lewes. We can get out at Lewes or at either of the previous stations and return to Eastbourne, but if we proceed as far as Lewes, our return journey will be longer than if we had got out at Polegate. In the same way nervous disease is more quickly cured in the early stages than in the later stages. Now, suppose that we are in a train which does not stop between Lewes and London. It is evident in this case that, if we have missed our chance of alighting at Lewes, we must go on to the final goal; no return being possible. Thus, there is a point in certain nervous diseases beyond which recovery is impossible. On the other hand, in travelling from Eastbourne to Brighton, we have several chances of retracing our steps even after leaving Lewes, where the ways diverge; and so we find that, in some cases of nervous disease, incurability is reached sooner than in others. And just as we must be content to take longer to return from Lewes than from Polegate, so we must be content with a slow cure in advanced nervous disorders, and remember that, in administering nerve-tonics, the weaker the patient, the weaker should be the dose; all attempts to hurry the cure being fatal to success. Moreover, just as, in journeying from Eastbourne to London, and from Eastbourne to Brighton, we travel along the same road as far as Lewes, so all nervous diseases have a common origin in nerve-deterioration which may be repaired.
Defective powers of observation bring with them this great evil,—we not only fail to reduce a terrible malady to a minimum, but we mete out unjust censure to those who seem to be responsible for the failure. Whereas the really responsible party is the community at large—in short, ourselves. We blame the doctor; but doctors are after all a small minority, and the minority can only expand and take shape in the direction in which the least pressure is put upon it by the majority. The grotesque modes of treatment resorted to in past times evidently gave satisfaction to all but the enlightened few, just as bad Governments have been tolerated in the countries fitted only to be governed badly.
But to be dissatisfied, to mete out blame, to expect a cure, are healthier symptoms than a passive acceptance of the evil and a lazy belief in incurability.
Medical science is unlimited. The law of our universe is progress.