- Email: [email protected]
MINISTERING TO THE SICK
MINISTERING TO THE SICK.-WILLIAM B. COLEY
able to hear the voices of her friends on the telephone-a pleasure previously denied her for very many years. The amplifying equipment is contained in a small cabinet which can easily be accommodated in any out-of-the-way position near the telephone, and the instrument can be fitted on any installation served by an automatic exchange, or by a manual exchange of the type provided in the more populous areas, at an extra charge of 10s. a
she is
now
auarter. MINISTERING TO THE SICK
THERE can be no sharp line drawn across the map of medical treatment which attempts to allot provinces on the one side to exact therapeutics and on the other to the various attentions on physical and moral well-being of patients such as fall under the headings of religious support, mental guidance, sympathy in family troubles, or the provision of diversions. The doctor’s work may be assisted by the priest, almoner, and hospital visitor, and the medical profession knows very well the wide influence for good and the favourable impulses towards restoration that follow upon the intelligent aid of sympathetic persons outside the professional rank. And the priest may occupy the honourable and peculiar position of adjutant in the direct medical treatment. In domiciliary medicine this can be well observed where the patient belongs to the priest’s flock, but in the hospital where the patient is personally unknown to the priest the value of religious ministration has been much debated. To many his presence round the bedside appears to be nothing but a nuisance. He is needed, they would say, neither in diagnosis nor treatment, and being no expert in many social difficulties it cannot be expected that his cooperation can be of any practical value. Dr. Richard Cabot and the Rev. Russell Dicks, B.D., have written an interesting book setting out the claims of the minister to be present in the sick-room, paying regard to the limitations of his knowledge, while pointing to the unlimited value which spiritual assistance may be to the patient.l The authors believe profoundly in the value of cooperation between the doctor and the minister in hospital work-they only consider in any detail the patient in the institution-and they propose to show that the aims which will call the minister to the bedside are to counteract the evils of specialism, and to give devotion and spiritual care such as only religion can inspire. By the words counteraction of specialism it is implied that medical treatment, however broad, is of a special character, while social and spiritual diagnosis in the presence of disease require qualities which no doctor, unless by accident, can attempt to offer. Criticism of a work written with deep sincerity is made difficult because it is not possible to assess devotional belief as a method of treatment in the same sort of way in which therapeutic procedures and operative methods can be submitted to judgment. One does not know how far such belief is present in any given case of improvement or recovery. The dual treatment, as suggested in the book, comes into play mainly in institutional treatment, where it may be thought to be of less value than in the home, and where the circumstances of environment are so favourable to moral as well as physical change that the actual cause of any alteration for good must always be uncertain. The part allotted by the authors to the minister is magnificent, and brings 1 The Art of Ministering to the Sick. By Richard C. Cabot, L. Dicks, B.D. London : Macmillan and Co., 1936. Pp. 384. 12s. 6d.
M.D., and Russell Ltd.
963
about with it the discharge of difficult and ungrateful duties : to discharge them he must be an extraordinarily endowed person, possessing faith, intuition, delicate tact, broad sympathy, scriptural knowledge, familiarity with topical literature. All these qualities are in the examples of religious treatments set out, and as we are apt to endow the ideal doctor in talking of him with many of them, we must not grudge them to the ideal priest. Each may hope to display them, and in their exhibition may find as a result physical and moral betterment of the patient in accordance with the wellknown influence of mind on body. But the authors suggest that in institutional life the priest would find a proper role in supervising the amenities of the institution in a way that in this country would bring him into collision with the heads of the managerial and nursing departments. Every doctor knows the store that is set by many patients upon the ministrations of the clergyman and knows also their value from the therapeutic point of view in certain cases, even while unable to assess that value in any exact terms or predict its display in any particular case. But it seems highly doubtful if either the medical staff or the lay management would regard the visiting clergyman as a fitting mediator in staff troubles. If the secretary of the hospital and the superintendent of the nurses chose to consult him on points of difficulty no doubt they might benefit by his advice, but to interfere in these departments is not comparable to helping the sick ; it is comparable to advising the doctor as to medical treatment, and that we do not commend. But we can commend the book to which we are referring as one dealing with questions that are often before the medical profession in this country, if not in exactly the same form in which they have presented themselves to the able and sincere American writers. WILLIAM B. COLEY THE death in New York on April 16th of William Bradley Coley at the age of 75 years removes a forceful figure from American surgical life. In this country his name is chiefly associated with a fluid for the relief of inoperable cancer. Moved by Paget’s observation that malignant tumours occasionally diminish or disappear after an attack of erysipelas Coley worked assiduously on the action of living streptococci in sarcoma and 45 years ago he published an extensive series of cases of inoperable sarcoma which had shown benefit after injection of the combined toxins of B. prodigiosus and Strept. erysipelatis. Other surgeons had like experience of benefit in 2 to 4 per cent. of such cases, and in 1910 Coley’s fluid was included in the list of nonofficial remedies compiled by the American Council on Pharmacy and Chemistry. Coley never ceased to develop this treatment and ten years ago he and his brother recorded the completed story of 55 cases of sarcoma in which the diagnosis had been confirmed by well-known pathologists. A few months back the Council on Pharmacy in reviewing the whole of the evidence concluded that the combined toxins of erysipelas and prodigiosus may play a significant role in preventing or retarding malignant recurrence or metastasis, and on occasion may be curative in hopelessly inoperable neoplasms. But Coley was not a man of one idea. He held the chair of clinical cancer research at Cornell and was always His own papers are models of a seeker after truth. clinical presentation and so fully documented as to command attention from other workers in the same field. He was on the staff of the Hospital for Ruptured
able to hear the voices of her friends on the telephone-a pleasure previously denied her for very many years. The amplifying equipment is contained in a small cabinet which can easily be accommodated in any out-of-the-way position near the telephone, and the instrument can be fitted on any installation served by an automatic exchange, or by a manual exchange of the type provided in the more populous areas, at an extra charge of 10s. a
she is
now
auarter. MINISTERING TO THE SICK
THERE can be no sharp line drawn across the map of medical treatment which attempts to allot provinces on the one side to exact therapeutics and on the other to the various attentions on physical and moral well-being of patients such as fall under the headings of religious support, mental guidance, sympathy in family troubles, or the provision of diversions. The doctor’s work may be assisted by the priest, almoner, and hospital visitor, and the medical profession knows very well the wide influence for good and the favourable impulses towards restoration that follow upon the intelligent aid of sympathetic persons outside the professional rank. And the priest may occupy the honourable and peculiar position of adjutant in the direct medical treatment. In domiciliary medicine this can be well observed where the patient belongs to the priest’s flock, but in the hospital where the patient is personally unknown to the priest the value of religious ministration has been much debated. To many his presence round the bedside appears to be nothing but a nuisance. He is needed, they would say, neither in diagnosis nor treatment, and being no expert in many social difficulties it cannot be expected that his cooperation can be of any practical value. Dr. Richard Cabot and the Rev. Russell Dicks, B.D., have written an interesting book setting out the claims of the minister to be present in the sick-room, paying regard to the limitations of his knowledge, while pointing to the unlimited value which spiritual assistance may be to the patient.l The authors believe profoundly in the value of cooperation between the doctor and the minister in hospital work-they only consider in any detail the patient in the institution-and they propose to show that the aims which will call the minister to the bedside are to counteract the evils of specialism, and to give devotion and spiritual care such as only religion can inspire. By the words counteraction of specialism it is implied that medical treatment, however broad, is of a special character, while social and spiritual diagnosis in the presence of disease require qualities which no doctor, unless by accident, can attempt to offer. Criticism of a work written with deep sincerity is made difficult because it is not possible to assess devotional belief as a method of treatment in the same sort of way in which therapeutic procedures and operative methods can be submitted to judgment. One does not know how far such belief is present in any given case of improvement or recovery. The dual treatment, as suggested in the book, comes into play mainly in institutional treatment, where it may be thought to be of less value than in the home, and where the circumstances of environment are so favourable to moral as well as physical change that the actual cause of any alteration for good must always be uncertain. The part allotted by the authors to the minister is magnificent, and brings 1 The Art of Ministering to the Sick. By Richard C. Cabot, L. Dicks, B.D. London : Macmillan and Co., 1936. Pp. 384. 12s. 6d.
M.D., and Russell Ltd.
963
about with it the discharge of difficult and ungrateful duties : to discharge them he must be an extraordinarily endowed person, possessing faith, intuition, delicate tact, broad sympathy, scriptural knowledge, familiarity with topical literature. All these qualities are in the examples of religious treatments set out, and as we are apt to endow the ideal doctor in talking of him with many of them, we must not grudge them to the ideal priest. Each may hope to display them, and in their exhibition may find as a result physical and moral betterment of the patient in accordance with the wellknown influence of mind on body. But the authors suggest that in institutional life the priest would find a proper role in supervising the amenities of the institution in a way that in this country would bring him into collision with the heads of the managerial and nursing departments. Every doctor knows the store that is set by many patients upon the ministrations of the clergyman and knows also their value from the therapeutic point of view in certain cases, even while unable to assess that value in any exact terms or predict its display in any particular case. But it seems highly doubtful if either the medical staff or the lay management would regard the visiting clergyman as a fitting mediator in staff troubles. If the secretary of the hospital and the superintendent of the nurses chose to consult him on points of difficulty no doubt they might benefit by his advice, but to interfere in these departments is not comparable to helping the sick ; it is comparable to advising the doctor as to medical treatment, and that we do not commend. But we can commend the book to which we are referring as one dealing with questions that are often before the medical profession in this country, if not in exactly the same form in which they have presented themselves to the able and sincere American writers. WILLIAM B. COLEY THE death in New York on April 16th of William Bradley Coley at the age of 75 years removes a forceful figure from American surgical life. In this country his name is chiefly associated with a fluid for the relief of inoperable cancer. Moved by Paget’s observation that malignant tumours occasionally diminish or disappear after an attack of erysipelas Coley worked assiduously on the action of living streptococci in sarcoma and 45 years ago he published an extensive series of cases of inoperable sarcoma which had shown benefit after injection of the combined toxins of B. prodigiosus and Strept. erysipelatis. Other surgeons had like experience of benefit in 2 to 4 per cent. of such cases, and in 1910 Coley’s fluid was included in the list of nonofficial remedies compiled by the American Council on Pharmacy and Chemistry. Coley never ceased to develop this treatment and ten years ago he and his brother recorded the completed story of 55 cases of sarcoma in which the diagnosis had been confirmed by well-known pathologists. A few months back the Council on Pharmacy in reviewing the whole of the evidence concluded that the combined toxins of erysipelas and prodigiosus may play a significant role in preventing or retarding malignant recurrence or metastasis, and on occasion may be curative in hopelessly inoperable neoplasms. But Coley was not a man of one idea. He held the chair of clinical cancer research at Cornell and was always His own papers are models of a seeker after truth. clinical presentation and so fully documented as to command attention from other workers in the same field. He was on the staff of the Hospital for Ruptured