Doctor and Patient

by S. Weir Mitchell

The mother at the sick-bed of her young child is, however, a being quite often as difficult to manage as her child. All her instinctive maternity is up in arms. Deep in the heart of many mothers there is an unconfessed and half-smothered sense of wrath at the attack which sickness has made on her dear one. Then nothing is too much to give; no sacrifice of herself or others too great to grant or demand. The irritability and feebleness of convalescence makes claims upon her love of self-sacrifice, and her prodigality of tenderness as positive and yet more baneful. That in most cases she may and does go too far, and loses for her child what it is hard to recover in health, is a thing likely enough, yet to talk to her at such times of the wrong she does the child is almost to insult her. Nevertheless the unwisdom of a course of reckless yielding to all a child's whims is plain enough, for if the little one be long ill or weak, it learns with sad swiftness to exact more and more, and to yield less and less, so that it becomes increasingly hard to do for it the many little unpleasant things which sickness demands. Character comes strongly out in the maladies of the child, as it does even less distinctly in the sickness of the adult. The spoiled, over-indulged child is a doubly unmanageable invalid, and when in illness the foolish petting of the mother continues, the doctor, at least, is to be pitied.

The ductility of childhood has its dangerous side. This is seen very well in cases which, fortunately, are rather rare, and, for some reason, are less frequent in girls than in boys. These little ones observe sharply the faces and obvious motives of those about their sick-beds, and more readily than adults are led to humor the doubts they hear expressed by the doctor or their elders as to their capacity to do this or that. Too frequent queries as to their feelings are perilously suggestive, and out of it all arises, in children of nervous or imaginative temperaments, an inexplicable tendency to fulfil the predictions they have heard, or actively to humor the ideas they acquire as to their own ailments and disabilities.

There is something profoundly human in this. With careless, unthoughtful people, who have trained a child to know that illness means absolute indulgence, and who pour out unguardedly their own fears and expectations at the bedside, the result for the child is in some cases past belief. The little one gets worse and worse. It accepts automatically the situation, with all the bribes to do so made larger by feebleness, and at last gains that extreme belief in its own inability to rise or move about which absolute convictions of this nature impose on child or man.

There is a further and worse stage possible. The child's claims increase. Its complaints gather force, and alarm those about it. Gratified in all its whims, it develops perverted tastes, or refuses all food but what it fancies. At last it becomes violent if opposed, and rules at will a scared circle of over-affectionate relatives. When all else fails, it exaggerates or invents symptoms, and so goes on, until some resolute physician sees the truth and opens the eyes of an amazed family.

Certain physicians explain these cases as due to hysteria, and in a small number of instances there are signs which justify such an explanation. But in the larger proportion the mode of origin is complex, and depends on the coincidence of a variety of evils, none of which are of hysterical character. I am not here concerned so much with the exact nature of these troubles as I am with the avoidable errors in the management of sick childhood. If I can make the mother more thoughtfully alert, less disposed to terror and exaggeration, less liable to be led by her emotions, I shall have fulfilled my purpose without such discussion as is out of place in essays like these.

To make clear, however, the possibility of the disasters I have briefly described, an illustration may answer better than any length of generalized statements. A little fellow of nine once came under my care, and was said to have inflammation of the coverings of the brain. There was a long story, which I may sum up in a few sentences. An only child; feeble in youth; indulgence to almost any degree; at the age of eight, a fall, not at all grave, but followed by some days of headache; long rest in bed, by order of a physician; much pity; many questions; half-whispered, anxious discussions at the bedside; yet more excessive indulgence, because every denial seemed to increase or cause headache. At last the slightest annoyance became cause for tears, and finally for blame, all of which a gentle, fearful mother bore as if it were part of the natural trials of disease. It took but a few months of complete non-restraint to make of a shrewd, bright, half-educated, spoiled boy a little brute, as to whose sanity there seemed to be some doubt. He was easily made well, and has lived to thank the sternness which won back the health of mind and body his parents had so foolishly helped to lose for him.

A single example may suffice, nor have I any fear that it may lead any one, least of all nature's gentlest creation, a mother, to be more severe than is reasonable. She it is who is really most responsible. She is ever beside the child when the little actor is off guard. She may have the cleverness to see through the deceit or she may not. The physician comes and goes, and must take for granted much that he has no chance to see, and for which he has to trust the more constant attendant. Moreover, the rarity of these cases is apt to help to deceive him quite as much as does the mother's affectionate trust. Nevertheless, it is his fault if soon or late he fail to see the truth; but he may well be careful how he states his doubt. The mother at the sick-bed but too often resents as a wrong any hint at the true state of the case.

Children are singularly imitative, and more or less prone to suffer from this tendency. Hence the curious cases in which a child simulates, I do not say dissimulates, the malady it sees constantly before it, as when one child has attacks of false epilepsy, owing to having seen the real attack in a sister or brother, or when St. Vitus's dance runs through a school or an asylum.

To sum up, we credit these little ones with a simplicity of moral organization which forbids us to believe that the causes which are active for mischief in their elders are not as potent for evil in them. The popular and reasonable creed of moral education, which teaches us to ask from a well child self-control, self-restraint, truth of statement, reasonable endurance of the unavoidable, good temper, is not too lightly or too entirely to be laid aside when sickness softens the rule of health and all our hearts go out in pity to the little sufferer.

Certain of the nervous and other maladies of children sometimes keep them a long while under treatments which are annoying, painful, or disabling. They often end by leaving them as strong as their fellows, but crippled, lame, disfigured, or with troubles that attract remark, or, at least, notice. Thus, a child may have hip-disease, and, after years of treatment, get well, and although vigorous enough to do all that is required in life, be more or less lame. In another case, there is disease of the bones of the spine. After a wearying treatment, it is well, but the little one has a distorted spine,—is humpbacked. Again, we have the common malady, palsy of childhood, and here, too, most probably, there is left a residue of disability, or, at all events, some loss of power.