Physician and patient

by Worthington Hooker

It is important in the treatment of disease, to remove all causes which awaken disagreeable associations in the minds of the sick, for they often retard, and sometimes prevent the recovery of the patient. It is as clearly the duty of the physician to detect the causes of such associations, and to remove them if possible, as it is to detect and remove the material causes of any irritation or inflammation.

Dr. Rush mentions a case that came under his observation, in which the influence of disagreeable associations hindered the recovery of the patient. “A gentleman in this city,” he says, “contracted a violent and dangerous fever by gunning. After being cured of it, he did not get well. His gun stood in the corner of his room, and being constantly in sight, kept up in his mind the distressing remembrance of his sickness and danger. Upon removing it out of his room he soon recovered.”

Some are much more readily affected by mental associations than others. A gentleman in a stage coach was observed to keep his cloak lying by his side, while he was shivering with the cold. He was asked by one of his fellow travellers why he did not put it on. He replied, ‘I have just returned from a voyage, in which I was very sea-sick, and while so I lay with that cloak wrapped around me. Foolish as it may seem, I cannot put it on without renewing the nausea.’

The various degrees and modes in which mental associations appear in the sick room, require of course the exercise of discretion and tact, in managing them to good purpose. There is often much injury done by failure in this respect. If, for example, the patient have great irritability of stomach, and if some medicine which has been doing him good, at length become exceedingly offensive to him, the continuance of that medicine might do him essential harm, by the mere influence of mental association; though, aside from this, it may be still an exceedingly appropriate remedy for his disease. Under such circumstances a change must be made, or the patient will be injured, it may be fatally. It will not do to call the patient whimsical, and to go right on with the course. The mental association connected with the medicine is practically one of the ingredients in it, and as such has so modified its nature as to render it inappropriate to the case.

The physician can often do much in curing disease by diverting the mind of his patient. Disease is frequently broken up by producing a new action in the system. This is a principle in medical practice which is familiar to others, as well as to the physician. And this change may sometimes be brought about in the system, by a corresponding change effected in the mind, especially in those cases where the state of the mind is particularly influenced by the disease. The husband of a poor woman, who in a feeble state of health had fallen into a settled melancholy, broke his thigh. The whole current of her thoughts and feelings was now diverted into another channel, from her own sorrows to the care of him and the relief of his pains, and she recovered her sanity, and with it, for the most part, her health, long before the fracture was united. The misfortune of her husband was a severe remedy, but an effectual one.

A physician of my acquaintance some years since became thoroughly impressed with the idea, that some symptoms which he had, indicated the existence of an organic disease which was certain to end fatally. At his request I made a full examination of his case, and found the symptoms to be purely of a nervous character. The expression of my opinion relieved him for the time of his anxiety. But as he brooded over his feelings when alone, the same idea returned again. I examined him repeatedly with the same result, but the comfort which he received from me was only temporary. Knowing that he was paying his addresses to a lady who was not only cheerful herself, but who had the power of making every body else cheerful about her, I recommended to him to be married at once, and told him that if he would be, we never should hear any more about his aneurism. My prescription was followed, and was entirely successful. The idea, which had so long haunted him like an evil spirit, was cast out never to return.

Every one is familiar with the fact, to which I have already alluded, that dyspepsia has a depressing influence upon the mind. And as the mental depression reacting upon the disease aggravates it, anything which tends to remove this depression assists materially in curing the disease. Diversion of the mind from its habitual gloomy ideas to cheerful thoughts and efforts, often exerts a great influence in such cases. I will mention a single case illustrative of this remark. A gentleman of high intellectual character, who was sadly afflicted with the dyspepsia, visited his friend Dr. Ives of New Haven, and placed himself under his care. The Doctor saw at once that medicines would do but little good in his case, so long as his mind remained in the same condition, and occupied with the same thoughts; and that a change there would go far to effect a corresponding one in his bodily condition. He determined to produce this change without the patient’s being aware of his intention, as it in this way would be more effectually accomplished. In one of his rides with him they alighted to pick some wild flowers. He adroitly excited his friend’s curiosity in regard to the structure and growth of the flowers, and leading his mind on step by step, he did not stop till he had fairly made him a student of botany without his knowing it. The result was that he engaged in the study with great enthusiasm, and followed it up for some time. He was changed at once from a gloomy self-tormentor into an ardent and cheerful seeker after knowledge in one of its richest and fairest fields, and this change made his recovery a rapid and easy one.

But it is not only in those cases in which the mind is obviously affected, that the physician is to apply the principle of which we have just been speaking. He can make use of it with much profit in ordinary cases of disease, in his intercourse with his patients from day to day. The sick are prone to brood over their own complaints, and to watch their sensations, and they need to have the mind diverted to other subjects.

In this connection I will notice very briefly the influence of change of scene upon the invalid. When the same objects are seen by him from day to day, and he has the same subjects of thought and conversation, these all act as so many fastenings, or points of attachment, tending to hold the disease in the same unvarying condition. But take him away from them all, and set him free from this discouraging and burdensome sameness, and let his thoughts and feelings flow into other channels, and the change of course favors the introduction of a new state of things, bodily as well as mentally. The new objects that he sees not only take off his attention from his diseased sensations, but the new excitement that he feels, as he sees them one after another, diffuses a refreshing and invigorating influence throughout his system. And imagination lends her aid in producing this effect. It seems to him that everything is better than it was where he was so lately shut up with the feeling almost of a prisoner—that the air is more pure, the grass more green, the foliage of the trees more dense and rich, and even the sun more cheerfully bright. Something, it is true, is to be attributed to change of air under such circumstances, but much less commonly than to the influence of change of scene upon the mind.

The sick room, as every physician has frequent occasion to witness, acquires after a time a monotony that is dreary and painful to the confined invalid. Day after day he sees the same furniture and same walls, every irregularity of whose surface he becomes acquainted with, and he is forced to seek for some variety even in the most trivial circumstances. “There, Doctor,” said an invalid playfully, “I have made a little change, to-day. I have had the rocking-chair put the other side of the fire-place, and the bureau moved to that corner, and those phials on the shelf, you see, have changed their places. My friends, Cologne and Camphor, have gone to the other side of that vase, and those drops (which, by the way, Doctor, I think that I have taken so long that some change would be well) have their station now quite at the other end of the shelf. And my good grandmother, you see, looks down upon me from the other side of the room. Variety is pleasing, Doctor, even within a few yards square, when one can not get any farther.”