Doctor and Patient

by S. Weir Mitchell

It would be easy, and in some sense valuable, could a man of large experience and intelligent sympathies write a book for women, in which he would treat plainly of the normal circle of their physiological lives; but this would be a method of dealing with the whole matter which would be open to criticism, and for me, at least, a task difficult to the verge of the impossible. I propose a more superficial plan as on the whole the most useful. The man who desires to write in a popular way of nervous women and of her who is to be taught how not to become that sorrowful thing, a nervous woman, must acknowledge, like the Anglo-Saxon novelist, certain reputable limitations. The best readers are, however, in a measure co-operative authors, and may be left to interpolate the unsaid. A true book is the author, the book and the reader. And this is so not only as to what is left for the reader to fill in, but also has larger applications. All this may be commonplace enough, but naturally comes back to one who is making personal appeals without the aid of personal presence.

Because what I shall write is meant for popular use rather than for my own profession, I have made my statements as simple as possible. Scarcely a fact I state, or a piece of advice I give, might not be explained or justified by physiological reasoning which would carry me far beyond the depth of those for whom I wrote. All this I have sedulously avoided.

What I shall have to say in these pages will trench but little on the mooted ground of the differences between men and women. I take women as they are to my experience. For me the grave significance of sexual difference controls the whole question, and, if I say little of it in words, I cannot exclude it from my thought of them and their difficulties. The woman's desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics. She is physiologically other than the man. I am concerned with her now as she is, only desiring to help her in my small way to be in wiser and more healthful fashion what I believe her Maker meant her to be, and to teach her how not to be that with which her physiological construction and the strong ordeals of her sexual life threaten her as no contingencies of man's career threaten in like measure or like number the feeblest of the masculine sex.

THE PHYSICIAN.

I have long had in mind to write from a physician's point of view something in regard to the way in which the well-trained man of my profession does his work. My inclination to justify the labors and sentiments of an often misunderstood body of men was lately reinforced by remarks made to me by a very intelligent patient. I found him, when I entered my room, standing before an admirable copy of the famous portrait of the great William Harvey, the original of which is in the Royal College of Physicians. After asking of whom it was a likeness, he said, "I should be a little curious to know how he would have treated my case."

I had to confess that of Harvey's modes of practice we know little, but I took down from a shelf those odd and most interesting letters of Howell's, clerk of council to James I., and turned to his account of having consulted Harvey on returning home from Spain. Only too briefly he tells what was done for him, but was naturally most concerned about himself and thus missed a chance for us, because it so happens that we know little of Harvey. At this page of Howelliana was a yellow paper-marker. Once the book was Walpole's, and after him was Thackeray's, and I like to fancy that Walpole left the marker, and that Thackeray saw it and left it, too, as I did.

My patient, who liked books, was interested, and went on to say that he had seen several physicians in Europe and America. That in France they always advised spas and water-cure, and that at least three physicians in America and one in London had told him there was nothing the matter with him, and that finally a shrewd country doctor had remarked bluntly that he would not give him any medicine, because he was overdosed already with work and worries, which was true.

At last he came back to Harvey. "He looks ill," he said, which is true. His honestly-painted knuckles make diagnosis easy. My friend thought that this great man would probably have dosed him well, and, as he added, would not have bothered him about too much sugar, nor forbidden champágne. I had to reply that whatever ills were in the England of that day,—and there was much dyspepsia and much gout,—sugar was the luxury of the rich, and anything but as abundant as it is to-day, when we consume annually fifty-six pounds per head or per stomach. I told him that in all ages the best of us would have dwelt most on diet and habits of living, and that Harvey was little likely to have been less wise than his peers, and he has had but few. Then he said it would be curious to put on paper a case, and to add just what a doctor in each century would have ordered. The idea struck me as ingenious and fertile. I could wish that some one would do this thing. It would, I think, be found that the best men of every time were most apt to consider with care the general habits of their patients as to exercise and diet, and to rely less than others on mere use of drugs. As to this matter, one learns more from men's lives than from their books, but nowadays care as to matters of hygiene has become in a valuable degree the common wisdom of a large part of my profession. Surveying our vast gains, we are a little apt to undervalue the men of older days, and no lesson is wiser than sometimes to go back and see how the best of them thought and acted amidst the embarrassments of imperfect knowledge.

There is a charming life by Henry Morley, of Cardan, the great Italian physician and algebraist, which gives us in accurate detail the daily routine of a doctor's days in the sixteenth century. In it is an account of Cardan's professional visit in 1551 to John Hamilton, archbishop of St. Andrew's, Scotland, and practically the ruler of that turbulent realm. Cardan's scientific opinion as to his patient is queer enough, but, as Morley remarks, it is probably not more amusing to us than will be our opinion in a like case to the smiling brother of our guild who may chance to read it at some remote future day. The physician of whom I now write was one who already dreaded bleeding, thought less of medicines than his fellows, and was, in fact, exceptionally acute. He did some droll things for the sick prelate, and had reasons yet more droll for what he did, but his practice was, as may happen on the whole, wiser than his reasons for its use. His patient was a man once bulky, but now thin, overworked, worried, subject to asthma, troubled with a bad stomach, prone to eat largely of coarse food, but indisposed to physical exercise. Cardan advised that the full, heated head, of which his patient much complained, should be washed night and morning with hot water in a warm room, and then subjected to a cold shower-bath. Next was to come a thorough dry rubbing, and rest for two hours. As to his asthma, he forbade him to subject himself to night air or rainy weather. He must sleep on silk, not feathers, and use a dry pillow of chopped straw or sea-weed, but by no means of feathers. He forbade suppers if too late, and asked the reverend lord to sleep ten hours, and even to take time from study or business and give it to bed. He was to avoid purgatives, to breakfast lightly, and to drink slowly at intervals four pints a day of new asses' milk. As to other matters, he was to walk some time in the shade at an early hour, and, discussing the time for the fullest meal, Cardan remarks that established habits as to this point are not to be lightly considered. His directions as to diet are many, reasonable, and careful. His patient, once stout, had become perilously thin. Turtle-soup and snail-broth would help him. Cardan insisted also on the sternest rules as to hours of work, need for complete rest, daily exercise, and was lucky enough to restore his patient to health and vigor. The great churchman was grateful, and seems to have well understood the unusual mental qualities of his physician. Nothing on the whole could be better than the advice Cardan gave, and the story is well worth reading as an illustration of the way in which a man of genius rises above the level of the routine of his day.

I might go farther back in time, and show by examples that the great fathers of medicine have usually possessed a like capacity, and learned much from experience of that which, emphasized by larger use and explained by scientific knowledge, has found its way into the text-books of our own day and become common property.