Doctor and Patient

by S. Weir Mitchell

Diseases such as typhoid fever, or a sharp local lung-trouble like pneumonia, really do make these minute changes approximate in abruptness to death. You weigh, let us say, one hundred and eighty pounds, and you drop in three weeks of a fever to one hundred and thirty pounds. The rest of you is dead. You have lost, as men say, fifty pounds, but your debt to disease, or to the blunders of civilization, for it is a case of creditor behind creditor, is paid. Your capital is much diminished, but you have come out of the trial with an amazing renovation of energy. This is the happy convalescence of the wholesome man. The other, the unlucky, fellow, does not get as safely through the cleansing bankruptcy of disease. The vicious, unlucky, or gouty grandfather appears on the books of that court in mysterious ways; his sins are pathologically visited on his child's child in this time of testing strain.

In the happy rush towards useful health, of a convalescence undisturbed by drawbacks, it is pleasant to think, as one lies mending, of the good day to come when my friend, recovering from typhoid or smallpox, shall send for his legal adviser and desire him as usual to bring suit against the city for damages and loss of time.

A little girl coughed in my face a hideous breath of membraneous decay. I felt at once a conviction of having been hit. Two days later I was down with her malady. She herself and two more of her family owed their disease to the overflow of a neighbor's cesspool, and to them—poor, careless folk—Death dealt out a yet sterner retribution. There was a semi-civilized community beyond both. Should one go to law about it and test the matter of ultimate responsibility?

The amiability of convalescence is against it. One feels at peace with all the world, and so lies still, and reflects, "like souls that balance joy and pain," as to whether, on the whole, the matter has not had its valuable side. Certainly it has brought experiences not otherwise attainable.

Of the deeper and more serious insights a man gathers in the close approach of death and the swift, delicious return to safety and enlarging powers I hardly care to speak. To a physician, it is simply invaluable to have known in his own person pain, and to have been at close quarters with his constant enemy, and come off only wounded from the contest. In the anxiety about you is read anew what you look upon in other households every day, and perhaps with a too accustomed eye. And as to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated. It were easy to dwell on this aspect of convalescence, but the mental state of one on the way to health is not favorable to connected thought. It is more grateful to lie in the sun, at the window, and watch the snow-birds on the ice-clad maples across the way, and now and then, day after day, to jot down the thoughts that hop about one's brain like the friendly birds on the mail-clad twigs.

I make no apology for the disconnectedness of my reflections, but turn gladly to my records of the joyous and less grave observations which the passing hours brought me. Much as I have seen of disease and recoveries in all manner of men and women, the chance to observe them in my own person presented me with many little novel facts of interest. I find in my brief notes of this well-remembered time many records of the extraordinary acuteness won for a while by the senses.

Not dubious, but, alas! brief, is the gain which the sensorium acquires in this delightfully instructive passage out of death's shadow into certain sunshine. In my own case there was a rapid exfoliation, as we call it, of the skin, a loss and renewal of the outer layer of the cuticle. As a result of this, the sense of touch became for a while more acute, and was at times unpleasantly delicate. This seemed to me, as I first thought of its cause, a mere mechanical result, but I incline to suspect now that it was in a measure due to a true increase in capacity to feel, because I found also that the sister sense of pain was heightened. Slight things hurt me, and a rather gentle pinch gave undue discomfort. No doubt a part of this was owing to my having taken a good deal of opium, and then abruptly laid it aside. As I have elsewhere stated, this is apt to leave the nerves oversensitive for a season. The sense of hearing seemed to me to be less wide awake. I did not hear better, but high notes were for a while most unpleasant. The sense of taste grew singularly appreciative for a time, and made every meal a joyful occasion. The simplest food had distinct flavors. As for a glass of old Madeira,—a demijohned veteran of many ripening summers,—I recall to this day with astonishment the wonderful thing it was, and how it went over the tongue in a sort of procession of tastes, and what changeful bouquets it left in my mouth,—a strange variety of varying impressions, like the play of colors. In these days of more unspiritual health and coarser sense I am almost ashamed to say what pleasure I found in a dish of terrapin.

The function of smell became for me a source both of annoyance and, later on, of pleasure. I smelt things no one else could, and more things than I now can. The spring came early, and once out of doors the swiftly-flitting hours of sensory acuteness brought to me on every breeze nameless odors which have no being to the common sense,—a sweet, faint confusion of scents, some slight, some too intense,—a gamut of odors. Usually I have an imperfect capacity to apprehend smells, unless they are very positive, and it was a curious lesson to learn how intense for the time a not perfect function may become. Recent researches have shown that a drug like mercaptan may be used to test the limit of olfactory appreciation. We have thus come to know that the capacity to perceive an odor is more delicate than our ability to recognize light. Probably it is an inconceivable delicacy of the sense of smell more than anything else which enables animals to find their way in the manner which seems to us so utterly mysterious. Yet, even in human beings, and not alone in a fortunate convalescence, do we see startling illustrations of the possibilities of this form of sensorial acuteness. I know of a woman who can by the smell at once tell the worn gloves of the several people with whom she is most familiar, and I also recall a clever choreic lad of fourteen who could distinguish when blindfold the handkerchiefs of his mother, his father, or himself, just after they have been washed and ironed. This test has been made over and over, to my satisfaction and surprise.

If a man could possess in the highest degree and in combination all of the possible extremes of sensory appreciativeness seen in disease, in hysteria, and in the hypnotic state, we should have a being of extraordinary capacities for observation. Taylor, in his "Physical Theory of Another World," a singular and half-forgotten book, has set this forth as conceivable of the beings of a world to come, and dwelt upon it in an ingenious and interesting way. For a long time even the inhalation of tobacco-smoke from a friend's cigar disturbed my heart, but one day, and it was, I fear, long before my physician, and he was wise, thought it prudent, I suddenly fell a prey to our lady Nicotia. I had been reading listlessly a cruel essay in the Atlantic on the wickedness of smoking, and was presently seized with a desire to look at King James's famous "counterblast" against the weed. One is like a spoiled child at these times, and I sent off at once for the royal fulmination, which I found dull enough. It led to results the monarch could not have dreamed of. I got a full-flavored cigar, and had a half-hour of worshipful incense-product at the shrine of the brown-cheeked lady,—a thing to remember,—and which I had leisure enough to repent of in the sleepless night it cost me.

This new keenness of perception, of taste and touch, of smell and sound, belongs also, in the splendid rally which the body makes toward health, to the intellectual and imaginative sphere of activities. Something of the lost gifts of the fairy-land of childhood returns to us in fresh aptitude for strange, sweet castle-building, as we lie open-eyed, or in power to see, as the child sees, what we will when the eyes are closed,—