Physician and patient

by Worthington Hooker

As an illustration of these remarks, I will introduce a case, showing the influence of the irritation of passion upon a diseased body. I refer to the death of John Hunter, who has been often called the greatest anatomist and physiologist of his age. “On October 16, 1793,” says his biographer, “when in his usual state of health, he went to St. George’s hospital, and, unexpectedly meeting with some things that ruffled his temper, he allowed himself to give way to passion; the heart became overloaded with blood, the ossified aorta, not yielding to the effort of the heart, the countenance became dark, angina pectoris immediately ensued, and turning round to Dr. Robertson, one of the physicians of the hospital, he was incapable of utterance, and died.”

This, it is true, is an extraordinary case; but the result of mental irritation in common cases of disease, though not as great and as palpable as in this case, is nevertheless as real. While it caused in the case of John Hunter a sudden and final suspension of the heart’s action, it would, in a man suffering from some inflammation, aggravate that disease, by driving the blood too forcibly into the inflamed part, and by making its irritable nerves partake of the general excitement of the system. The effect might not be at any moment very powerful, but if the irritation be repeated or continued, although it may be vastly less in amount than it was in the case of Hunter, the accumulative effect of the excitement upon the disease would at length become very great, perhaps destructive. And in certain low states of disease, when, in the midst of great weakness, the nervous system is in an extremely agitated condition—a condition, in which little causes may produce powerful effects—a comparatively slight irritation induced in the mind, connected as it is with every trembling filament of that nervous system, may overwhelm the very powers of life as certainly, if not as suddenly, as did the strong passion of Hunter, in overloading his diseased heart, and thus stopping its action.

But withholding irritation, and securing rest and quiet, do not comprise all the physician’s duty in relation to the mind, any more than they do in relation to the body of the patient. He is sometimes to excite the mind to positive action, for the same reasons that exciting medicines are sometimes administered to the body; and he may thus often exert, through the mind, a very happy influence upon disease. This remedy, as I have already hinted, is to be applied with discretion, according to the nature of each case, and so as not to interfere with that rest, which I have shown to be so necessary to the mind in the treatment of disease. The excitement must, with some few exceptions, be agreeable in character, in order that it may produce a genial influence upon the nervous system. The mode, the time and the degree of its application require the exercise of discrimination, as much as the dose, and form, and time of any stimulant or other medicine that is given to the patient. The judgment and tact of the physician are never more needed than upon such points as these. Tissot, a French physician, relates an amusing case, showing the utility of discrimination in regard to the kind of mental stimulation to be applied. A lady was affected with a lethargy, and many applications were used to rouse her, but to no purpose. At length a person, who knew that the love of money was the ruling passion of her soul, put some French crowns into her hand. After a few minutes she opened her eyes, and was soon entirely aroused from her stupor.

The influence of the imagination upon the body is familiar to every one. I will mention a few cases to show its power.

Beddoes, an English physician of great enthusiasm, had imbibed, among other new ideas, the notion that palsy could be cured by inhaling nitrous oxide gas. He requested that eminent chemist, Sir Humphrey Davy, to administer the gas to one of his patients, and sent him to him for that purpose. Sir Humphrey put the bulb of a thermometer under the tongue of the paralytic, to ascertain the temperature of the body, so that he might see whether it would be at all affected by the inhalation of the gas. The sick man, filled with faith from the assurances of the ardent Dr. Beddoes, and supposing that the thermometer was the remedy, declared at once that he felt better. Davy, desirous of seeing how much imagination would do in such a case, then told him that enough had been done for that time, and directed him to come the next day. The application of the thermometer was made from day to day in the same way, and in a fortnight the man was cured.

When Perkins’ tractors were in vogue, Dr. Haygarth of Bath, as I have stated in another chapter, had a pair of wooden ones made of precisely the same shape with the orthodox metallic ones, and contrived to color them so that the deception should not be discovered. He then applied them to quite a number of patients, with the same results that followed the use of the genuine tractors, which cost five guineas a pair. Pain was relieved as if by magic, and the lame were made to walk. Their operation in these cases is of course to be accounted for in the same way with the operation of the thermometer in the case just related.

Some medical students determined to try the influence of imagination upon a countryman who was going into town to market. They met him one after the other, each telling him how pale and sick he looked. At first, as he felt perfectly well, he paid no regard to it, but after two or three had thus accosted him, he began to think there must be something the matter with him. By the influence of imagination he soon began to feel badly, and to look really pale. And as he still continued to meet persons, who declared themselves struck with his peculiarly sickly and ghastly appearance, he grew worse, and the result was that he sickened and died.

I could cite numerous cases illustrative of the influence of the imagination upon the condition of the body, but these will suffice.

The physician has constant opportunities for making use of the influence of mental association to much advantage in the management of the sick. He does this almost insensibly in his daily intercourse with his patients, exciting trains of agreeable associations in their minds, varied to suit the mental and moral character of each, thus aiding materially the operation of his remedies.

Dr. Rush gives a striking instance of the influence of association, which I will relate in his own words: “During the time,” says he, “that I passed in a country school in Cecil county, in Maryland, I often went on a holiday with my schoolmates to see an eagle’s nest, upon the summit of a dead tree in the neighborhood of the school, during the time of the incubation of that bird. The daughter of the farmer in whose field this tree stood, and with whom I became acquainted, married and settled in this city about forty years ago. In our occasional interviews, we now and then spoke of the innocent haunts and rural pleasures of our youth, and, among other things, of the eagle’s nest in her father’s field. A few years ago I was called to visit this woman, in consultation with a young physician, in the lowest stage of a typhus fever. Upon entering the room I caught her eye, and with a cheerful tone of voice said only, the eagle’s nest. She seized my hand without being able to speak, and discovered strong emotions of pleasure in her countenance, probably from a sudden association of all her early domestic connections and enjoyments with the words I had uttered. From that time she began to recover. She is now living, and seldom fails, when we meet, to salute me with the echo of the eagle’s nest.”