The Therapeutics of Suggestion.

1446 and zeal for efficiency he conveniences upon the presence of which he must not acknowledges his indebtedness for the facilities which he reckon elsewhere, and the more important it is that has had for acquiring knowledge of the best materials and he should be taught the principles of asepticism and and to whose

progressive spirit

completed by a the possibilities of securing it under externally adverse series of appendices subjects related conditions. We cordially sympathise with the view that the to its main purpose, such as with the requirements in hospitals should afford every possible security and advantage the way of apparatus, instruments, linen, cutlery, crockery, to all who are treated in them ; but we also feel that the and so forth, for award unit of specified size ; an "analysis students should be rendered, as far as possible, independent of the arrangements for nurses at the Toronto Hospital for of institutional facilities, and should be taught to consider Sick Children, which are described as being of especial how the absence of these facilities should be encountered in excellence ; and an account of the conditions of medical and the private house and in the conditions of daily life. In the surgical appointments ana or nursing service in tne principal metropolis and in other great cities provision more or less hospitals of the United Kingdom. It is, in fact, little less analogous to that afforded by hospitals is furnished by than an encyclopaedia of hospital construction and manage- nursing homes and other arrangements ; but in rural districts ment, and deals with every related subject except the actual the practitioner is constantly called upon to be his own treatment of the patients. The forms for books and sanitary officer, and it is of the first importance to his registers and the suggestions for inquiries touching the success that he should have been effectively trained in this means of applicants for relief, appear to be specially worthy department of his work. methods of construction.

The book is dealing with various

"

of attention. But in striving to realise by the mental vision the picture The of of a perfect and perfectly equipped hospital which Dr. THE history of the medical profession, amidst much that MACKINTOSH has drawn for our instruction, we have more is to which it would than once been led to question the position encouraging to the men of our own day, discloses also be entitled as an educational instrument. A young medical that which is disappointing and calculated to make us pause

Therapeutics

Suggestion.

entering upon practice is called upon to treat patients as we discourse on the progress of science in general and of in a variety of circumstances, many of them extremely our art in particular. Of therapeutics this is more especially adverse to health; and, if he has been taught his pro- the case. The practitioner of a generation or two back, as fession under the highly artificial conditions described he left the schools, was in the first place a therapist and only by Dr. MACKINTOSH, it would scarcely be a matter for very secondarily a pathologist and diagnostician. To-day he surprise if he were unable to adapt himself to more is better able to discover the site of a disease and to ordinary ones, and if he were to fail in doing the best I classify it when found, but he has exchanged the therapeutic that was possible in the cottage of the workman, or confidence of his forbears in medicine for a scepticism which is sometimes paralysing to his efforts. For centuries even in the ordinary residences of middle-class people. It is obvious that the aggregation of patients in a single civilised communities bore, as Sir JOHN FORBES wrote in building involves risks which hardly present themselves in 1857, ’’ the evils of polypharmacy and of that meddlesome the case of one sick person in a private house ; but and perturbative practice" which was still so prevalent the conditions of the private house are constantly and in his day. Polypharmacy still prevails, but at its side take in high degrees unfavourable, and they have regularly to ranik meti2ocis wmcn at tneir introduction were vauntea as be encountered and overcome in practice. We greatly ques- opening up more certain roads to health. Hydrotherapy, tion whether the conditions of the pattern hospital would not Mechano-Therapeutics, Hypnotism, Therapy in connexion have some tendency to disqualify the student who had been with the coal-tar products, with many another method of trained among them ; they might be to him somewhat of the more recent date, have been announced to the world in terms nature of leading strings, or of corks or bladders to one who of the warmest commendation, have been as warmly was learning to swim. Such conditions protect both the denounced as futile or even dangerous, and with the lapse learner and the patients in hospital against dangers from of time have found a place in our armamentarium which which in private practice he would have to find, is neither particularly base nor particularly distinguished. One who had been associated with this Journal for nearly and often to extemporise, methods of protection for himself. We are here reminded of an old exa- 40 years wrote in 1874: "There is no chapter in the history mination story about two students who were respec- of medicine more astounding and bewildering than the tively asked to deal with a foreign body in the episode of 1837-38, when for a time animal magnetism or auditory meatus of a cadaver. One of them asked to be mesmerism engrossecl the attention ot the protession and the supplied with the aural speculum, the methods of illumina- public." In a lecture delivered by Dr. ELLIOTSON in August, tion, and the pattern of forceps which had been designed by 1837, and reported in THE LANCET, we find the words,"There the lecturer upon aural surgery at the school at which he can be no disgrace in taking the trouble to inquire into had been taught. The other picked up a bit of wire that was the effects of mesmerism-not, of course, going into anything lying at hand, twisted it into a snare, and removed the supernatural, but only as to its production of such effects as offending substance in a moment. The better the hospital, we have observed in other cases, such as sleep, coma, sleepand the more complete its appliances at which the walking, loss of power and sensation in the limbs, &c. ; these student has been educated, the more necessary will it become we often saw." The experiments which followed seem to have that he should learn to regard these appliances as artificial been carried on in an atmosphere which must have made man

1447 scientific inquiry difficult. In the public discussion of the patient himself, it is sought to beneficially influence the subject invective and vituperation worthy of a political plat- disordered functions of the body. In the words of form formed the chief weapons of the respective sides, and Dr. T. CLAYE SHAW, who opened the discussion at the ultimately Dr. ELLIOTSON, as a result of a resolution passed Harveian Society, psycho-therapeutics postulates "thy by the Council of University College to the effect "that existence of conative processes, such as Will, Faith, the hospital committee be instructed to take such steps as Power of Attention, treating these as actual entities shall deem most advisable

to

prevent

the

practice which

be influenced

by being strengthened when magnetism in future within weak or called into energy when dormant."1 It is, we the hospital," resigned his position as physician to venture to think, one of the most extraordinary paradoxes of the hospital. From this time mesmerism ceased seriously our time that though the modern school of psychology is, as to exercise the minds of members of the profession in this Dr. SHAW points out, usually materialistic in its teaching, country. It is true that BRAID, working in 1841 and for insisting that will, attention, and conative processes are long after, suggested the term hypnotism and gave to the results not causes, and that there are no such things as world admirable accounts of the phenomena of that con- primitive faculties in the direction of compelling forces, yet dition, but it was left to foreign scientists to elaborate his that the latest remedial measures put forward as of extreme work and to speculate as to the physiological or pathological validity involve an appeal to that very will and attention foundations of the states observed. Dr. G. H. SAVAGE, in whose existence, in the laboratory, is strenuously denied. the Harveian Oration for this year, selected hypnotism as Monistic materialism may be our creed, but if so, it is a the central theme of his oration, not, as it would appear, creed which must be disregarded in practice. We publish altogether without misgiving as to its dangerous character. this week an interesting article by Dr. CHARLES MERCIER, The subject has, doubtless, a sinister connotation both for written with characteristic directness from a more metathe public at large and for the medical profession physical point of view than we are accustomed to find in a in particular. The word carries suggestions of the medical psychologist. We commend the perusal of this public platform and of a disgraceful charlatanism which short article to our readers. Dr. MERCIER points to the holds its loathsome exhibitions to satisfy a morbid impossibility of picturing the neurons of the brain as containand ignorant curiosity. There is no more justification for ing or producing a sound of high C or an emotion of anger. the platform performance of hypnotism than for the plat- These mental states are not in the brain, they are in the form performance of surgical operations. Exhibitions of mind. "There is no community of nature between the this character are alike degrading to the hypnotiser, the vibrations of molecules in the neurons of the brain and the hypnotised, and the public who witness them ; nor is the thoughts, passions; and volitions that occupy the mind. induction of hypnotism likely to be without mental harm There is utter separation: between the mental and the to the unfortunates who for a few shillings submit them- material there is a gulf that no imagination can bridge." We selves to useless and unskilled experimentation. Hypnotism recall that Dr. MERCIER, in his presidential address at the as a therapeutic agent of value is no new thing. It has annual meeting of the Medico-Psychological Association been used for years on the Continent in the judicial school last year, laid stress upon the importance of preserving the It has passed inescapable responsibility of each individual for his acts. It of CHARCOT, his associates and followers. of enthusiastic a support, through is to that sense of responsibility that whoever practises through stage exuberantly a stage of chilling criticism, and at length occupies a fairly psycho-therapy, whether consciously or not, makes appeal ; defined place. It is not a panacea. It is useful here and and where the physician finds it absent the feebleness of

they

of mesmerism

useless there.

or

can

animal

As with most remedies which

have not

his remedial

measures

is most

apparent.

been mere fashions of the passing hour, it may produce sometimes results which are little less than miraculous and at others results which are positively harmful, and it is for the physician, as a man of science, carefully to select the "Ne quid nimis." cases which may be benefited, and not, as the charlatan, indiscriminately to dose all his patients with the same THE LANCET REPORT ON THE STANDARDISATION medicament. OF DISINFECTANTS. Closely following upon the Harveian Oration a discussion WE have pleasure in submitting to our readers this week took place at a meeting of the Harveian Society upon the first part of a report by a Special Commission of Inquiry, " suggestion"in the treatment of morbid conditions. In the appointed by us, upon the Standardisation of Disinfectants. continental school, which has in the past practised hypnotism For some years past we have had abundant evidence before an unsatisfactory position. very extensively, there has grown up an opinion that while us that the whole question was in and independent attention at the careful It has received suggestion, used either with or without the induction of the hands of several scientific observers who set themselves the hypnotic trance, is of considerable value, there yet remains a task of determining whether any method could be trusted to simple method which is its superior and which seeks to represent the actual germ-killing capacity of a given disproduce its results with the help of persuasion. No part of infectant. No recognised method appears to have received the patient’s personality is suppressed or placed in abeyance, an absolute consensus of opinion in its favour. Either there but an appeal is made to the crowning function of all the was something wrong in regard to the conditions under

Annotations.

functions-namely, rational

persuasion

to the mind.

careful methods of and with the active cooperation of the

By

which the

experiments 1

were

made

or

the deductions

See THE LANCET, Nov. 6th, 1909, p. 1369.

were