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THE INFLUENCE OF MIND AS A THERAPEUTIC AGENT.
1540 Willcox to the Belfast meeting of the British Medical AssoIn this ciation on the Vaccine Treatment of Pneumonia. paper Dr. Willcox also makes a reference to lung puncture for purposes of diagnosis, and suggests the injection of a little sterile broth into the lung before withdrawal of the I am, Sir, yours faithfully, lung juice. THOMAS J. HORDER. Harley-street, W., Nov. 13th, 1909.
agent, although the induction of such a condition by suggestion, were it possible, would scarcely be proposed as a benefi-
cent measure1 For example, a case was brought to my notice some years ago in which a lady suffering from heart disease and subjected to much domestic unhappiness lost compensation, had progressive cardiac failure, became dropsical, and was at the point of death. At this stage she lost her reason and became oblivious to her sorrow, soon afterwards recovering cardiac force, when all the evidences of her circulatory failure disappeared. The disturbing mental factor had APPENDICITIS WITH HÆMATURIA. been tragically eliminated and some of its consequences To the Editor of THE LANCET. vanished. But the sweet oblivious antidote"was in this SIR,-Your notice of this condition in THE LANCET of case obtained at terrible cost. The tragedy, however, some Nov. 6th, and the subsequent letter of Mr. W. B. Cosens in hypnotists would say, might have been avoided. For the last week’s issue, have interested me considerably, as the " rooted sorrow " of an unfaithful husband might have been association of hæmaturia with appendicitis has been noted by plucked from the poor lady’s memory and left her heartme on several occasions, and, indeed, I have referred to its whole, smiling on Lothario. I understand that amnesia may possibility in discussing the diagnosis of appendicitis in the be permanently limited by suggestion. Surely a most fifth edition of Rose and Carless’s "Manual of Surgeryissued beneficent power in a world of regrettable incidents, even in 1905. I am able to call to mind two patients who were lying though one live thereafter in a hypnotic and hypothetical in adjacent beds in hospital suffering from appendicitis who paradise t Reference was from time to time made in the discussion bothhad developed hæmaturia; one was a lad with a recent attack, the other a man who had sustained many attacks and to the prejudice entertained by the profession against the whose appendix was enclosed in a dense mass of adhesions suggestive or hypnotic treatment of disease. I confess, Sir, which on operation rendered its removal impossible. I that I number myself with those who regard this prejudice believe the source of the trouble is usually to be attributed to as altogether wholesome, and trust I may still regard myself the fact that in these cases the appendix is adherent to the as not singular. There are doubtless a large number of posterior abdominal wall over the line of the ureter, and I neurotic persons of somewhat unstable mental equilibrium attribute the hæmaturia to a ureteral source and not to the whose stability may in addition have been rendered still kidney. In support of this idea I might mention a case more unsteady by drugs, drunkenness, or excess of other which occurred to me some years back. I was called one kinds, and who may thus become, for the time at all events, evening to see an adult woman who was suffering from incapable of listening to and being influenced by reason. There had Where emotions are concerned reason is not always in the the most typical and intense renal colic. been a previous history of pain on the right side, ascendant. If such persons, under the spell of the stronger which might have been of renal, biliary, or appen- personality of the suggester-a factor to which some importFor this she was treated, and the ance appeared to be attributed-are capable of being restored dicular origin. passage of some gravel seemed to alleviate the symptoms. to greater equanimity and good conduct, I presume no one The attack therefore seemed probably due to the impac- can offer any objection to the employment of such beneficent tion of a calculus in the ureter, but the most careful investi- suggestions, whatever form they may take, and whether gation was made with a view to inclusion or exclusion of the induced by means of the hand of the operator laid on the appendix as the source of the trouble. Radiography was pit of the stomach, as one of the speakers said was his wont, not existent at that time, and finally I cut down on the or without any such manoeuvre. But, Sir, there are many cases, even among the unstable, kidney to find a healthy organ with no sign of calculous disease and a pervious normal ureter. The pain continued which benefit by the plain if sympathetic inculcation of subsequently and the patient died a week later from perfora- common sense, the inspiration of righteous conduct, and, tion of an appendix abscess, the appendix being located in above all, of courage to face and to accept whatever betide: the back of the abdomen and just hanging down over the " Felix qui potuit rerum cognoscere causas ; pelvic brim in the situation of the ureter. Atque metus omnes, et inexorabile fatum Subjecit pedibus, strepitumque Acherontis avari ! I am, Sir, yours faithfully, ALBERT CARLESS. CARLESS. Some years ago I had occasion to see a lady who suffered Upper Wimpole-street, W., Nov. 16th, 1909. ALBERT from time to time from severe fits of a hystero-epileptic character for which I could do little until I discovered that the underlying cause of her disturbance was the sufficient THE INFLUENCE OF MIND AS A THERAfact that she loved one man and had been persuaded to eonPEUTIC AGENT. tract what was regarded as an advantageous marriage with I then pointed out to her the alternatives to another. To the Editor of THE LANCET. the situation with resignation as an honourable accepting SIR,-I have read with interest your special article on the woman, and was struck by her telling me, ten years later, above subject in THE LANCET of Nov. 6th, reporting Dr. that she had never had a fit since the conversation which I Claye Shaw’s address and the subsequent discussion. I held with her, when her position and duty became more was also present at the Harveian Society when the address clear to her. was given and the discussion took place. The address itself Whether ’tis nobler in the mind to suffer was comprehensive, philosophical, and suggestive of many The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles trains of thought which might have been developed. The And by opposing end them," little if I contained discussion philosophy, may express myself so without offence, but was certainly very ’’practical." is a quandary in which the patient often finds himself, and That is to say, it sufficiently demonstrated the fact that some not an unhopeful mood for the physician to find him in, propractitioners had found that, by soothing some nervous vided he can induce him, according as his condition is inpatients with and without a certain amount of manual curable or curable, to do the one or the other with open-eyed mystery, annoying and painful symptoms had in some cases courage and a full appreciation of the circumstances. He been relieved and bad habits in some instances corrected. may then be placed in the way to establish that equanimity The thesis, however, that the mind has a therapeutic or insouciance which brings in its train, sometimes slowly, but influence under certain circumstances scarcely required often surely, quietude, normal sleep, refreshment, and in a full-dress debate for the establishment of a fact so the case of functional disorder frequently " cure," while in the commonly observed and, I had thought, so generally case of incurable disease he is thus placed in as favourable admitted. For, surely, the acknowledged fact that a position as possible; and, if in pain, he may gain ease emotional disturbances have a morbific influence in- by that which produces sleep, not hypnosis. But it is by the volves as a corollary that the removal of emotional straightforward exercise of sympathy, common-sense, reason, disturbance has a therapeutic influence. It was generally and knowledge that we can best foster such recuperation, agreed that suggestion was of little value in the treatment of aided, it may be, in the case of those addicted to drugs or insane patients. But it was not pointed out that the super- drunkenness, by a period of self-imposed incarceration under vention of insanity might itself be on occasion a therapeutic circumstances in which the exercise of a besetting propensity .
"
"
1541 is difficult, and this without a lunatic conception of what may be a beverage of extremely good vintage, or at the expense of the reputation of a very useful drug. That in these days of specialism the fostering of health-giving mental impulses should be erected into a speciality is not surprising, but I would submit that such specialisation is quite uncalled for, as some who took part in the debate on Dr. Claye Shaw’s address fully recognised. In some cases, I imagine, not even a physician is necessary, and perhaps, after a preliminary examination by a competent medical man, a certain number of cases might be relegated to the "Christian Scientists" for treatment as a change from the once more popular nursing homes for neurasthenics. But your leading article in THE LANCET of Nov. 6th sufficiently indicates that a preliminary consultation with the faculty should take place before the patient is placed, as Mr. Stephen Paget seems to suggest he might in some instances be, on the list for Christian Scientist "treatment," if the patient have a bias towards that mode of therapeutic effort or consolation. So much might perhaps in the present day be conceded to poor souls shaken for the time in a steadying faith by that too iconoclastic materialism preached so blatantly by some aggressive physicists of the nineteenth century, whose11 cocksureness " the opening twentieth century is inclined to regard as somewhat premature and which it will probably, as it grows older, be glad to forget, like Huxley’s "Bathybion Haeckeli" on the strength of which scientific error Strauss died an atheist. In his broad consideration of the whole subject, one the importance of which I in no way desire to depreciate and myself emphasised in an address on the Place of Metaphysics in Medicine, on which you at the time commented in THE LANCET, Dr. Claye Shaw has touched, on the one hand, on the foundations of religious faith and, on the other, on the practical application of suggested belief in the treatment of disease. Much as one is tempted to follow him into the former sphere the pages of a medical journal are scarcely suited for discussing the questions involved. I, therefore, refrain from doing so, merely remarking that the foundations of religious belief are nothing if not historical, and that the Way and the Life are alike uninteresting if divorced from the simple and I unvarnished Truth, whether suggested or entertained. imagine the same criterion should determine what is and what is not permissible in therapeutic methods. The whole purpose of this letter is to question alike the desirability of, or necessity for, the employment of make-believe, or placebo, in the treatment of disease under any circumstances, except, perhaps, in our dealings with some lunatics and the obsessed by a notion, when the physician may be compelled, distastefully to himself, to use argument on the mental plane of the afflicted or adopt subterfuge to effect goodin other words, in the portico of the lunatic asylum. Finally some remarks were made in the discussion on the suggestive nature of the action of drugs. There have been, and no doubt are, some drugs in use the direct potency of which for therapeutic purposes is not great. But, surely, it is not necessary to insist that a large proportion of the most useful drugs are as potent for evil as for good unless used with a skill which it is open to all to acquire, and in securing the beneficial results of which the mental processes of the patient have little share. I had written so much of these remarks when THE LANCET of Nov. 13th reached me, in which I observe your leading article on the Therapeutics of Suggestion and Dr. Mercier’s paper on Brain and Mind, both of which bear upon the subject. I am glad to read in the former that a preference appears to be expressed for that better way in which no part of the patient’s personality is suppressed or placed in abeyance, but an appeal is made to the crowning function of all the functions-namely, the mind by careful methods of rational persuasion ......" (p. 1447). For such I have contended in this letter and confess that, to my mind, to support and form the character of a humanity, which has to face the many insoluble problems of an infinite universe as well as the vicissitudes of life in health and in disease, more is to be gained even from the hopeless but brave attitude of the Stoic who exclaimed, "Thou canst not rob me of death !" than from the position occupied by those who are lulled into peace by any species of make-believe, and under such circumstances necessarily live with some part of their being in abeyance, notwithstanding argument to the contrary. ......
"
But were we to accept Dr. Mercier’s conception of the relation of mind to brain possibly there might be less objection to suggestive therapeutics. So far as I can gather his meaning, the mind as an I I epiphenomenon " has ceased to have material connexion with the cells from which it sprang, and the rearrangement of its processes by hypnosis would only be to play among immaterial atoms. I do not know in how far such a view will be acceptable to the majority of present.day physiologists and psychologists. But it is because I believe now, as I did when I delivered my lectures on the Relation of the Nervous System to Disease and Disorder in the Viscera in Edinburgh in 1898, " whether the registration of memory be in the cell or merely rendered possible through the instrumentality of the cell...... that it would be impossible without the cell, and that the passage of impressions through the cell influences the organic conditions of the latter " (p. 49), that I conceive there is objection to methods which tend to cause us to look on matters not as they are but as they are not. Hypnotists tell us that this may be brought about without detriment to the mental organism. Can it occur without change in the mental organ ? And if not, is such change desirable or safe ? Sir, it is because I venture to question this that I look upon the therapeutic trilogy of "Christian Science," Hypnotism, and the isolation Nursing Home as in the same category, and of these upon hypnotism as the most objectionable. The "Christian Scientist,’’ so to speak, hypnotises himself or attempts to do so, the Somnambule is hypnotised, the Segrey6, to coin a convenient term if it is not already in use, is advised to regard vacuity and frequently to overeat himself, which latter has the merit at times of recalling him to earth by dyspepsia if by no other means. The full influence for good of the mind upon the body may, however, I maintain, be procured by fostering the courageous outlook of the open-eyed whole man upon all that can befall him and by the aid of agencies which import no spurious or supposititious conditions. But the task of those who take this view is not rendered easier by the creation of therapeutic sandheaps such as those discussed, in which distressed humanity is invited to bury its head like the ostrich, and thus to escape at least the vision of danger. I am, Nov.
14th, 1909.
Sir, yours faithfully, ALEXANDER MORISON, M.D. M.D., F.R.C.P.
DARWINISM AND MEDICINE. 10 the Editor
of THE LANCET.
SIR,-In his recent Bradshaw lecture Professor J. A. Lindsay, to the changes which are taking place in the jaws and teeth of civilised man, says: "Apparently the diminution in the size of the jaws has outrun the diminution in the size or number of the teeth, and hence the overcrowded state of the jaws which we know to be so common." May I say that I have not been able to obtain any evidence in support of such a conclusion ? In the absence of malformation of the jaws (e.g., from adenoids) overcrowding of the teeth is always, in my experience, due, not to any raoial diminution in the size of the jaws, but to arrested development of the jaws from disuse in the individual. In other words, provided the young human is brought up on food which demands a due exercise of the muscles of mastication overcrowding (with the exception mentioned) never occurs. And now I would like to refer to a subject which is of the utmost importance to biologists. Professor Lindsay very truly remarks that " man is not subject to the unrestrained operation of natural selection." He does not, I am interested to note, maintain that this process has ceased to operate on civilised man. Yet this is what many leading biologists are now doing. So careful a thinker as Professor Arthur Thomson in his philosophical Bross lectures (1907)1 writes : "We can never resume the yoke of natural selection which even early man began to wriggle out of, which man has been more and In more effectively throwing off as the ages have passed." of view he to cite Professor this proceeds Ray support Lankester: "The mental qualities which have developed in man have to a large extent, if not entirely, cut him off from the general operation of that process of natural selection and survival of the fittest which up to their appearance has been the law of the living world....... Nature’s
referring
......
1
The Bible of Nature.
Charles Scribner’s Sons, New York, 1908.
agent, although the induction of such a condition by suggestion, were it possible, would scarcely be proposed as a benefi-
cent measure1 For example, a case was brought to my notice some years ago in which a lady suffering from heart disease and subjected to much domestic unhappiness lost compensation, had progressive cardiac failure, became dropsical, and was at the point of death. At this stage she lost her reason and became oblivious to her sorrow, soon afterwards recovering cardiac force, when all the evidences of her circulatory failure disappeared. The disturbing mental factor had APPENDICITIS WITH HÆMATURIA. been tragically eliminated and some of its consequences To the Editor of THE LANCET. vanished. But the sweet oblivious antidote"was in this SIR,-Your notice of this condition in THE LANCET of case obtained at terrible cost. The tragedy, however, some Nov. 6th, and the subsequent letter of Mr. W. B. Cosens in hypnotists would say, might have been avoided. For the last week’s issue, have interested me considerably, as the " rooted sorrow " of an unfaithful husband might have been association of hæmaturia with appendicitis has been noted by plucked from the poor lady’s memory and left her heartme on several occasions, and, indeed, I have referred to its whole, smiling on Lothario. I understand that amnesia may possibility in discussing the diagnosis of appendicitis in the be permanently limited by suggestion. Surely a most fifth edition of Rose and Carless’s "Manual of Surgeryissued beneficent power in a world of regrettable incidents, even in 1905. I am able to call to mind two patients who were lying though one live thereafter in a hypnotic and hypothetical in adjacent beds in hospital suffering from appendicitis who paradise t Reference was from time to time made in the discussion bothhad developed hæmaturia; one was a lad with a recent attack, the other a man who had sustained many attacks and to the prejudice entertained by the profession against the whose appendix was enclosed in a dense mass of adhesions suggestive or hypnotic treatment of disease. I confess, Sir, which on operation rendered its removal impossible. I that I number myself with those who regard this prejudice believe the source of the trouble is usually to be attributed to as altogether wholesome, and trust I may still regard myself the fact that in these cases the appendix is adherent to the as not singular. There are doubtless a large number of posterior abdominal wall over the line of the ureter, and I neurotic persons of somewhat unstable mental equilibrium attribute the hæmaturia to a ureteral source and not to the whose stability may in addition have been rendered still kidney. In support of this idea I might mention a case more unsteady by drugs, drunkenness, or excess of other which occurred to me some years back. I was called one kinds, and who may thus become, for the time at all events, evening to see an adult woman who was suffering from incapable of listening to and being influenced by reason. There had Where emotions are concerned reason is not always in the the most typical and intense renal colic. been a previous history of pain on the right side, ascendant. If such persons, under the spell of the stronger which might have been of renal, biliary, or appen- personality of the suggester-a factor to which some importFor this she was treated, and the ance appeared to be attributed-are capable of being restored dicular origin. passage of some gravel seemed to alleviate the symptoms. to greater equanimity and good conduct, I presume no one The attack therefore seemed probably due to the impac- can offer any objection to the employment of such beneficent tion of a calculus in the ureter, but the most careful investi- suggestions, whatever form they may take, and whether gation was made with a view to inclusion or exclusion of the induced by means of the hand of the operator laid on the appendix as the source of the trouble. Radiography was pit of the stomach, as one of the speakers said was his wont, not existent at that time, and finally I cut down on the or without any such manoeuvre. But, Sir, there are many cases, even among the unstable, kidney to find a healthy organ with no sign of calculous disease and a pervious normal ureter. The pain continued which benefit by the plain if sympathetic inculcation of subsequently and the patient died a week later from perfora- common sense, the inspiration of righteous conduct, and, tion of an appendix abscess, the appendix being located in above all, of courage to face and to accept whatever betide: the back of the abdomen and just hanging down over the " Felix qui potuit rerum cognoscere causas ; pelvic brim in the situation of the ureter. Atque metus omnes, et inexorabile fatum Subjecit pedibus, strepitumque Acherontis avari ! I am, Sir, yours faithfully, ALBERT CARLESS. CARLESS. Some years ago I had occasion to see a lady who suffered Upper Wimpole-street, W., Nov. 16th, 1909. ALBERT from time to time from severe fits of a hystero-epileptic character for which I could do little until I discovered that the underlying cause of her disturbance was the sufficient THE INFLUENCE OF MIND AS A THERAfact that she loved one man and had been persuaded to eonPEUTIC AGENT. tract what was regarded as an advantageous marriage with I then pointed out to her the alternatives to another. To the Editor of THE LANCET. the situation with resignation as an honourable accepting SIR,-I have read with interest your special article on the woman, and was struck by her telling me, ten years later, above subject in THE LANCET of Nov. 6th, reporting Dr. that she had never had a fit since the conversation which I Claye Shaw’s address and the subsequent discussion. I held with her, when her position and duty became more was also present at the Harveian Society when the address clear to her. was given and the discussion took place. The address itself Whether ’tis nobler in the mind to suffer was comprehensive, philosophical, and suggestive of many The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles trains of thought which might have been developed. The And by opposing end them," little if I contained discussion philosophy, may express myself so without offence, but was certainly very ’’practical." is a quandary in which the patient often finds himself, and That is to say, it sufficiently demonstrated the fact that some not an unhopeful mood for the physician to find him in, propractitioners had found that, by soothing some nervous vided he can induce him, according as his condition is inpatients with and without a certain amount of manual curable or curable, to do the one or the other with open-eyed mystery, annoying and painful symptoms had in some cases courage and a full appreciation of the circumstances. He been relieved and bad habits in some instances corrected. may then be placed in the way to establish that equanimity The thesis, however, that the mind has a therapeutic or insouciance which brings in its train, sometimes slowly, but influence under certain circumstances scarcely required often surely, quietude, normal sleep, refreshment, and in a full-dress debate for the establishment of a fact so the case of functional disorder frequently " cure," while in the commonly observed and, I had thought, so generally case of incurable disease he is thus placed in as favourable admitted. For, surely, the acknowledged fact that a position as possible; and, if in pain, he may gain ease emotional disturbances have a morbific influence in- by that which produces sleep, not hypnosis. But it is by the volves as a corollary that the removal of emotional straightforward exercise of sympathy, common-sense, reason, disturbance has a therapeutic influence. It was generally and knowledge that we can best foster such recuperation, agreed that suggestion was of little value in the treatment of aided, it may be, in the case of those addicted to drugs or insane patients. But it was not pointed out that the super- drunkenness, by a period of self-imposed incarceration under vention of insanity might itself be on occasion a therapeutic circumstances in which the exercise of a besetting propensity .
"
"
1541 is difficult, and this without a lunatic conception of what may be a beverage of extremely good vintage, or at the expense of the reputation of a very useful drug. That in these days of specialism the fostering of health-giving mental impulses should be erected into a speciality is not surprising, but I would submit that such specialisation is quite uncalled for, as some who took part in the debate on Dr. Claye Shaw’s address fully recognised. In some cases, I imagine, not even a physician is necessary, and perhaps, after a preliminary examination by a competent medical man, a certain number of cases might be relegated to the "Christian Scientists" for treatment as a change from the once more popular nursing homes for neurasthenics. But your leading article in THE LANCET of Nov. 6th sufficiently indicates that a preliminary consultation with the faculty should take place before the patient is placed, as Mr. Stephen Paget seems to suggest he might in some instances be, on the list for Christian Scientist "treatment," if the patient have a bias towards that mode of therapeutic effort or consolation. So much might perhaps in the present day be conceded to poor souls shaken for the time in a steadying faith by that too iconoclastic materialism preached so blatantly by some aggressive physicists of the nineteenth century, whose11 cocksureness " the opening twentieth century is inclined to regard as somewhat premature and which it will probably, as it grows older, be glad to forget, like Huxley’s "Bathybion Haeckeli" on the strength of which scientific error Strauss died an atheist. In his broad consideration of the whole subject, one the importance of which I in no way desire to depreciate and myself emphasised in an address on the Place of Metaphysics in Medicine, on which you at the time commented in THE LANCET, Dr. Claye Shaw has touched, on the one hand, on the foundations of religious faith and, on the other, on the practical application of suggested belief in the treatment of disease. Much as one is tempted to follow him into the former sphere the pages of a medical journal are scarcely suited for discussing the questions involved. I, therefore, refrain from doing so, merely remarking that the foundations of religious belief are nothing if not historical, and that the Way and the Life are alike uninteresting if divorced from the simple and I unvarnished Truth, whether suggested or entertained. imagine the same criterion should determine what is and what is not permissible in therapeutic methods. The whole purpose of this letter is to question alike the desirability of, or necessity for, the employment of make-believe, or placebo, in the treatment of disease under any circumstances, except, perhaps, in our dealings with some lunatics and the obsessed by a notion, when the physician may be compelled, distastefully to himself, to use argument on the mental plane of the afflicted or adopt subterfuge to effect goodin other words, in the portico of the lunatic asylum. Finally some remarks were made in the discussion on the suggestive nature of the action of drugs. There have been, and no doubt are, some drugs in use the direct potency of which for therapeutic purposes is not great. But, surely, it is not necessary to insist that a large proportion of the most useful drugs are as potent for evil as for good unless used with a skill which it is open to all to acquire, and in securing the beneficial results of which the mental processes of the patient have little share. I had written so much of these remarks when THE LANCET of Nov. 13th reached me, in which I observe your leading article on the Therapeutics of Suggestion and Dr. Mercier’s paper on Brain and Mind, both of which bear upon the subject. I am glad to read in the former that a preference appears to be expressed for that better way in which no part of the patient’s personality is suppressed or placed in abeyance, but an appeal is made to the crowning function of all the functions-namely, the mind by careful methods of rational persuasion ......" (p. 1447). For such I have contended in this letter and confess that, to my mind, to support and form the character of a humanity, which has to face the many insoluble problems of an infinite universe as well as the vicissitudes of life in health and in disease, more is to be gained even from the hopeless but brave attitude of the Stoic who exclaimed, "Thou canst not rob me of death !" than from the position occupied by those who are lulled into peace by any species of make-believe, and under such circumstances necessarily live with some part of their being in abeyance, notwithstanding argument to the contrary. ......
"
But were we to accept Dr. Mercier’s conception of the relation of mind to brain possibly there might be less objection to suggestive therapeutics. So far as I can gather his meaning, the mind as an I I epiphenomenon " has ceased to have material connexion with the cells from which it sprang, and the rearrangement of its processes by hypnosis would only be to play among immaterial atoms. I do not know in how far such a view will be acceptable to the majority of present.day physiologists and psychologists. But it is because I believe now, as I did when I delivered my lectures on the Relation of the Nervous System to Disease and Disorder in the Viscera in Edinburgh in 1898, " whether the registration of memory be in the cell or merely rendered possible through the instrumentality of the cell...... that it would be impossible without the cell, and that the passage of impressions through the cell influences the organic conditions of the latter " (p. 49), that I conceive there is objection to methods which tend to cause us to look on matters not as they are but as they are not. Hypnotists tell us that this may be brought about without detriment to the mental organism. Can it occur without change in the mental organ ? And if not, is such change desirable or safe ? Sir, it is because I venture to question this that I look upon the therapeutic trilogy of "Christian Science," Hypnotism, and the isolation Nursing Home as in the same category, and of these upon hypnotism as the most objectionable. The "Christian Scientist,’’ so to speak, hypnotises himself or attempts to do so, the Somnambule is hypnotised, the Segrey6, to coin a convenient term if it is not already in use, is advised to regard vacuity and frequently to overeat himself, which latter has the merit at times of recalling him to earth by dyspepsia if by no other means. The full influence for good of the mind upon the body may, however, I maintain, be procured by fostering the courageous outlook of the open-eyed whole man upon all that can befall him and by the aid of agencies which import no spurious or supposititious conditions. But the task of those who take this view is not rendered easier by the creation of therapeutic sandheaps such as those discussed, in which distressed humanity is invited to bury its head like the ostrich, and thus to escape at least the vision of danger. I am, Nov.
14th, 1909.
Sir, yours faithfully, ALEXANDER MORISON, M.D. M.D., F.R.C.P.
DARWINISM AND MEDICINE. 10 the Editor
of THE LANCET.
SIR,-In his recent Bradshaw lecture Professor J. A. Lindsay, to the changes which are taking place in the jaws and teeth of civilised man, says: "Apparently the diminution in the size of the jaws has outrun the diminution in the size or number of the teeth, and hence the overcrowded state of the jaws which we know to be so common." May I say that I have not been able to obtain any evidence in support of such a conclusion ? In the absence of malformation of the jaws (e.g., from adenoids) overcrowding of the teeth is always, in my experience, due, not to any raoial diminution in the size of the jaws, but to arrested development of the jaws from disuse in the individual. In other words, provided the young human is brought up on food which demands a due exercise of the muscles of mastication overcrowding (with the exception mentioned) never occurs. And now I would like to refer to a subject which is of the utmost importance to biologists. Professor Lindsay very truly remarks that " man is not subject to the unrestrained operation of natural selection." He does not, I am interested to note, maintain that this process has ceased to operate on civilised man. Yet this is what many leading biologists are now doing. So careful a thinker as Professor Arthur Thomson in his philosophical Bross lectures (1907)1 writes : "We can never resume the yoke of natural selection which even early man began to wriggle out of, which man has been more and In more effectively throwing off as the ages have passed." of view he to cite Professor this proceeds Ray support Lankester: "The mental qualities which have developed in man have to a large extent, if not entirely, cut him off from the general operation of that process of natural selection and survival of the fittest which up to their appearance has been the law of the living world....... Nature’s
referring
......
1
The Bible of Nature.
Charles Scribner’s Sons, New York, 1908.