CHAPTER II In the later eighties, I had about determined to make my (Part 4)

his fellow generically in order to carry persistently what is named per- sonal magnetism. Hypnotism and suggestion are more or less synonymous, and it is impossible to make a definition showing a point at which ordinary external impression and hypnotism have lines of demarcation between them. When I entered the field of medicine, hypnotism was being given a great deal of attention on the part of students of the subject. Many books were being written, describing its value as a resource to be deliberately applied for service to our patients. At the present time it has been relegated to a position among the curiosities of practice, although here and there we find a reputable physician who is convinced of the value of hypnotism as part of our armamen- tarium. Most of us. perhaps, have come to feel that hypnotism is as dangerous as any other powerful resource, and should be employed with that degree of caution which we observe when giving poisonous drugs. Such at least is my own con- viction. I studied some of the methods of hypnotism, as did most of the younger men at that time, and found that it was not difficult to hypnotize a fair proportion of patients accord- ing to any one of three or four established methods. The method which I chose was that of tiring the eyes by directing the subject to give close attention to a small brilliant diamond moved slowly and rhythmically back and forth. When eyes became sufficiently tired and brain tire followed consequence, the patients were then sufficiently receptive lona _ /hen i d in I e to m 82 TO-MORROW'S TOPICS Dpt the suggestion of drowsiness. Having accepted tli they were ready for varied further suggestions. It was some- times possible to do tninor surgical operations and such pain- ful work as reduction of dislocated joints, while the patients were under hypnotic influence. These patients, having once accepted suggestion from nie, seemed always ready to adopt any other suggestion later. Such uncanny relationship was one of which I did not approve, feeling that people are gener- ally much safer if they fight with me, instead of agreeing with me upon any subject. From my own experience with the employment of hypnotism I am obliged to feel that the subjects of all hypnotists must act similarly, and therefore that it is extremely dangerous for an individual to surrender the will to any other individual, no matter for what purpose or how good the excuse. It seems to me that a will which has been weakened through the power of any other will is apt to remain weakened against the will of many others. As memliers of a responsible profession, and as responsible members of society, we are doing a wrong in thus lessening that resistance which is necessary on the part of every individual for playing a role in the stability of society. Nurses at the hospitals say that patients are hke their physicians, and they have sometimes totd me they could observe without much difficulty which physician had charge of certain cases. One physician will have a set of patients who are in a state of unrest, showing disquietude continually, finding fault both with their physician and with their sur- roundings, apprehensive, and running stormy courses as patients. Another group of patients under another physician, other circumstances being similar, will all be quiet peaceable, and devoted to kindly thoughts of their nurses and in harmony with their surroundings. This is all the result of suggestion. Patients when restored to good health resist external imprcs- TO-MORROW'S TOPICS 83 sions habitually and live in their own ways according to their methods of adaptation to environment, but when they are ill they are particularly receptive to suggestion that is carried in the manner, words, and bearing of the one upon whom they are chiefly dependent for the time being. This explains very well why the various religious and other healing movements carry their crowd of followers with so much ease, when people of healthier minds clearly perceive the fallacies which may belong to such movements. In our professional work many temptations to take advan- tage of human nature must be rigorously guarded against. People may be easily alarmed by anyone whom they believe to be responsible. Some years ago when called out of town to see a case in consultation I went about with the physician on subsequent calls before train time. He suggested the danger of a "touch of diphtheria" in four different cases of throat trouble in which there was nothing more than a prev- alent tonsilitis. I noted the alarm which his suggestion called forth and which insured for him continued and frequent calls upon these patients. Nothing could have been more repugnant and repulsive to me, and I have never ceased to think of this doctor as a monster in the profession. This was many years ago and a wide experience with members of the profession leads me to believe that very few indeed are willing to turn human nature to their own account in this way. The tendency is rather in the other direction, and good doctors are prone to err on the side of making light of really serious troubles. They have a tendency to make too little of the importance of cases, and to give passing superficial attention only to matters which really require close and continued observation. There is a good-natured desire to "let the patient off easy." One helpful qualification for a surgeon is a kind of deluding hopefulness, and a persistence even to the degree self- I ree of H 84 TO-MORROW'S TOPICS obstinacy. There is a certain comparison in definitions which reads like this: "Firmness is will power, and obstinacy is won't power." The surgeon who is stupidly obstinate to the point that he won't let the patient die. — regardless of any deeper insight, — may be really carrying a suggestion which is immensely helpful to the patient. The eagerness with which a patient watches the doctor's face means that the doctor's doubts instantly become the patient's doubts, particularly if the patient is a woman. If the surgeon has in mind a question about her recovery, she recognizes it "quicker than lightning." If he puts aside the doubt by an effort of the will until he is out of her presence, remaining in a fool's paradise while at her bedside, it will give her courage to live. I have never forgotten one case of a great fibroid tumor in which the patient was nearly dead from hemorrhage in advance of the operation. On the following morning she was barely living. Speaking in a low whisper she said, as I bent over close to catch her words. "Doctor, I am dying." She really was dying, but I replied: "Oh, you must not think that, for it will spoil my statistics." This was not heartless levity. It was giving her something to grasp quickly, at a moment when a tear drop in sympathy might have been as fata! as a bullet in its effect. Some months after her recovery, shs said one day, "Do you know what saved my life? On the morning when I was barely holding on and everything was nearly a blank, you said if I died it would spoil your statistics, and I determined to make one last effort to live for the sake of your statistics. I was too far gone to care anything about myself,— in fact really wanted to die and end it all." This matter of thought- fuhiess for others is characteristic of woman. It does not always have the effect of saving her life however. We are apt to look upon it rather as one of her dangers. It is very unsafe to make the diagnosis of "a moribund con- TO-MORROW'S TOPICS 85 dition/' Not unfrequently a case is abandoned in the belief that the patient is moribund, and yet we see now and then a startling recovery from the application of last-resort resources. There is no doubt that death after an operation brings dis- credit to surgery because people in general do not distinguish between cases. On these grounds some surgeons have held that it is not best to operate when a patient is almost certain to die as a result of his condition, with or without operation. There is good ground for their argument but personally I have never been able to bring myself to adopt this point of view. It seems to me that we must give the last chance to everyone, even if the whole profession of surgery goes to the dogs in consequence. There is always a natural tendency to make "surgical judgment" favor one's own reputation a bit. In the actual practice of surgery one needs to employ many other things beside science. On one occasion there was a call to a distance for an operation upon a man suffering with stone in the bladder. He was an aged man of wealth, with a young wife. On arriving in the town I found the man in a seriously septic condition, and knew that an operation would give him the only possible chance for life. His physicians were present and had everything ready for operation, but the young wife said quite firmly to me, "We have decided not to have an operation done. He cannot stand it." It was evident that by "we" the wife was speaking editorially. I awaited an opportunity to speak with her aside and then said quietly: "Now, madam, if your husband dies without operation, and you are known to have opposed it, you may imagine what the neighbors will say." "Mercy!" she replied. "What do you mean?" "Madam," said I, "if you do not know what was meant, you would not have exclaimed 'Mercy !' " "Dear me !" said she, "I guess you had better go ahead with the operation." The man's life was saved. 86 TO-MORROW'S TOPICS On another occasion when called to a case of appendicitis with abscess, it was apparent that the doctors and members of the family were all being domineered by an elderly maiden aunt, and I was informed "aside" that she had set herself against the idea of an operation upon her nephew. In fact, while we were examining the patient she took occasion to absent herself, and stood in the adjoining room all alone looking out of the window in an attitude of lack of interest. I knew what would be forthcoming, having been warned. Stepping out to her, I said, "We have decided upon imme- diate operation, and we are a little short of help. Judging from your face you are a woman of great determination and plenty of nerve, and you can stand right up and help us with- out flinching." A complete change of bearing ensued. She looked highly pleased, came straight out, and practically directed the whole arrangement of the room in preparation for the operation. She really was a masterful woman, but had not previously been convinced about the need for opera- tion in the case. There is indeed much more to surgery than surgical work. For instance, one case comes to mind in which an extremely nervous man of the race horse type, occupying a high ex- ecutive position and accustomed to dictate, required an operation for ulcer of the stomach. He was suffering from the depression and mental vagaries commonly belonging to that condition. His wife, who was closely devoted, was almost erratic in her belief in her duties toward him. He threatened to commit suicide rather than submit to an opera- >n, and would not go to the hospital at first, but through the fe's insistence finally went. At the time of the operation, h assistants and everything ready, and all of the machinery )reparation in order for conducting an important operation, patient refused to take the anesthetic until after much TO-MORROWS TOPICS 87 argument. A moment later he jumped off from the table and decided that he would not have the operation done on that day, but at some other time. We all knew too well what that meant, and it was a question if we had the right to use force. A consultation was at once held in an adjoining room between the various doctors and the good wife who was on the point of collapse. We decided that it would be morally wrong not to use force, because the patient was likely to do himself some injury on finding that his will had given way at the last mo- ment. The orderlies and assistants were consequently given instructions to take the violently protesting patient by force. on the ground that he had inhaled a certain amount of anaes- thetic and was not quite rational. The operation was per- formed without unusual difficulty and on the following morn- ing the patient said nothing whatsoever about our having used force. After the operation the good wife felt that she must remain by his side constantly day and night. This always affects the work of trained nurses and they object to it seriously, because their every movement and attitude is apt to be criticized by one who is over-solicitous. The two ex- cellent nurses at once objected to fanciful requirements that ; insisted upon by the good wife, along with demands on the part of the patient which were more or less unreasonable, but which were complied with, — in the midst of a spirit of general opposition between all parties. The hospital house- staff felt that the surgeon should stand by the nurses, and re- quest the devoted wife to remain away. On the other hand, she was the only one who had exercised power sufficient for getting her husband to the hospital, and it was she who had permitted us to use force at the time of the operation. Beside ^L that the patient was continually calling for her. There soon ^B came the anticipated demand for a change of nurses, — always a ^1 serious matter, because it includes the idea of incompetency on I 88 TO-MORROWS TOPICS the part of the ones who are in diarge. We surmised that new ones would not be any more satisfactory under the ocmditions, but a change of one nurse was made, and the other remained unwillingly. After three or four days of unceasing irruption on the part of everybody connected with the case the patient made a sudden impatient movement at night, sitting up in bed to get a drink. He pulled apart the abdominal sutures, and it resulted in his death a few hours later. If instead of having disturbances so complicated and continuous, the patient had simply entered the hospital quietly in an ordinary way, secured nurses in an ordinary way, and undergone operation in an ordinary way, the surgeon would have had very little anxiety, and the patient would undoubtedly have made an ordinary recovery. This case is quoted merely as an illustra- tion of what some of you will have to meet when leaving the simple surroundings of plain scientific work at the hospital, and entering the field of practice in which people, rather than cases, have to be managed. How happy a great many people would be if we could only cut their heads off! That is the only part that makes trouble for themselves and for us. We have to be diplomatic in our conduct with patients. Not long ago an operation had been planned for a middle- aged young woman. She came from the West to New York and was to pay a good fee. Everything was all arranged, and just as she was leaving my office for the hospital I re- marked, "You will gain fifteen or twenty pounds in weight after this operation." She instantly asked: "Do you mean that?" I replied, "Yes." "Then," said she, "I am not going to have it," and back home she went. It cost me twenty-five hundred dollars to make that unnecessary statement to her. Once on a train a stranger opened conversation on the subject of a goitre which needed removal, and asked me what New York surgeon he should consult. I told him to TO-MORROWS TOPICS go and talk with Dr. Coley who happened to be on the same train, — as he was just the man to do it. The man replied that he had already talked with Dr. Coley, and it was he who had sent him over to my seat. Neither one of us ever saw the man afterward, and the chances are that he thought neither one of us really wanted to care for him, when in fact it was such a promising case for a satisfactory resuh that we each had to use some nicety of taste in order to refer him to the other. Whenever a new operation is devised there will always be some surgeons who find too many cases for its application and who do too much of that sort of work, while others do too little of it. Between these extremes there are surgeons who use good judgment, careful methods in diagnosis, and the maintenance of a good sense of propriety in selection of cases. As one becomes older in the profession there is always a certain pause, a hesitation, before doing any surgical work which is not distinctly necessary, There are many distressing results from meddlesome surgery. A young man commonly requires no further incentive to action than the mere finding of surgical conditions. An unimportant lipoma, a mulberry ovary, an old joint dislocation with good enough function remaining — "these are clearly surgical conditions," he says in surprise, when a policy of conservatism is suggested in council- After a while he begins to consider surgical cases in a comparative way. What is the comparative danger be- tween neglect and action ? What is the comparative benefit