He alone is an acute observer who can observe minutely without being observed.—Lavater.

When the students enter the wards of the hospitals for regular work with the staff, they have to devote a considerable portion of their time to the business of minutely recording the family history, physical signs and symptoms, and the treatment of each patient allotted to them. These records are valuable for reference, and still more so for the education of the pupils. They accustom the student to habits of careful observation; and as clinical work is by far the most important factor in his training, the man who does most of this stands the best chance of thoroughly learning his business. Elsworth found his account in sticking to the bedside, and often learned from conversing with his patients many things which helped him to understand how they came to be patients at all. Indeed, he found so much imprudence and ignorance in the habits of the people, that he wondered how it was they were ever free from disease. All the industrious men were great note-takers in the wards; they found that to understand the disease one must understand the subject of it. The practice introduced them to the habits of the working classes as nothing else could have done so perfectly. The expert note-taker learned more of human nature in thus recording these histories than he could have acquired from reading any number of books. Some startling revelations as to the amount of drink the British workman can absorb were often made in this way. There were several great breweries in the neighbourhood, and the men employed assured the doctors they usually drank about two gallons of beer a day. These men were always awkward persons to treat; their flesh healed badly, and they were liable to many complications which abstemious persons would escape. Many artisans, whose weekly wages would average twenty-eight to thirty shillings, owned to spending ten shillings on their own liquor—a sum which, given to their wives, would have often made all the difference between poverty and decent comfort. Many of the accidents that were brought in could be traced to unsteadiness of brain caused by alcohol. When men are working in dangerous situations, it is perilous in the extreme for them to indulge in stimulants. It was not surprising that men who drank two gallons of strong beer a day should fall into the vats or down trap-doors; the wonder was they could walk at all.

One man confessed to having taken on an average forty two-pennyworths of rum a day. He was a Jew dealer in metals, and made a good deal of money at times; but his liver could not stand the alcohol, and he was the subject of a good pathological address on cirrhosis when he died.

This drink-madness was often found to be hereditary, as were many other maladies. Very often the taking of the family history involved the collection of very curious facts from the patients’ relatives when they came to visit their sick friends. Idiosyncrasies were often traced several generations back, odd deformities and bodily peculiarities persisted in families as explained by Darwin, and illustrated the fact that a man thinks and reasons in certain grooves wherein have run the wheels of thought of hosts of his ancestors. A descendant of a Huguenot refugee remarked lately that his nerves had not yet got rid of the terror infused into them by the hair-breadth escapes his progenitors endured hundreds of years ago. It is said the whole world feels the effect of the stamp of one’s foot on the ground; not less is it true that our habits and work will influence the minds of untold generations of our successors.

True psychological medicine is less understood in the present age of science by our doctors than it was in the East thousands of years since. It will scarcely be credited that the great, the overwhelming majority of medical men can and do obtain their diplomas to practise, and attain to all the honours of their profession, without ever having heard a lecture on mental diseases, seen the inside of a lunatic asylum, or examined a person of unsound mind, except in connection with some physical signs indicating bodily disease, as in the delirium of fevers. In connection with some medical schools facilities are offered to the students to visit a neighbouring asylum for clinical observation, but it is extremely rare for them to avail themselves of the privilege. One may pass half a score of examinations at the various boards which have the power of licensing the practitioner who is to be charged with the duty of aiding by his counsel the families amongst which he will practise in a hundred forms of mental affliction, without having ever been asked a single question bearing upon psychological medicine. The student will be required to state with the minutest accuracy the stages of great operations which there are ten thousand chances to one he will never have the chance of performing, and a still remoter probability that he would have either the knowledge or the nerve to perform if he had the opportunity. He will be minutely cross-examined over obscure and rare complaints which it is extremely likely he will never see in his own practice if he live to Methuselah’s age; yet he will not be required to diagnose the difference between melancholia and hysteria. At the same time it is quite true, if he be an industrious man, he may learn a good deal about these mental maladies if he attend the lectures of the physicians who make them their speciality, but this is optional; he does not get any credit for it in his schedules; he will not be advancing his chances of a “pass” by so doing, and there is much temptation if, amongst so many things which a student of medicine must know, he holds in light esteem some things about which he may or may not trouble himself at his discretion. The study of mental phenomena occupies the attention, then, of but few, and those only the most cultivated and thoughtful of the students. To the Sawbones it is like cuneiform inscriptions or the domestic economy of the Hittites. Is not this a scandalous blot on our system of medical education? Yet every half-educated, idle, and beer-boozing young man who can get one foot on the medical register, and write L.S.A. after his name (implying that he has the licence of the Apothecaries’ Society, Blackfriars), has the legal power to sign a lunacy certificate which may consign anyone of us to the walls of a mad-house! Would this be tolerated were it understood? It is recorded of Garibaldi that in the war against the Austrians in Lombardy, he was seized with the marsh fever in the midst of one of his campaigns. The malady soon turned to typhus, and he was given over by his physicians. Lying at Lerino at the point of death, he heard the wild shout—“The Austrians!” The enemy had suddenly come down upon the little town, and the slaughter of his followers had begun. Springing from his bed with an infusion of new life in his veins, he buckled on his sword, and led his troops, inspired by his own wonderful personality, to conflict and victory. What was the influence of the mind in effecting this cure? Ah! that is no part of a medical curriculum. Mesmerists, spiritualists, theologians may deal with that as best they may—it is beneath the notice of the colleges.

A fact like this is surprising only to those medical men who have never studied psychological medicine.

The miracles of Lourdes and of hundreds of other Catholic shrines need not be denied altogether as unworthy of credence. There is abundant evidence that some cases of cure do really occur in connection with faith healing. Those who have made a study of mesmerism have adduced instances of healing by its means which it would be foolish to deny. So much charlatanism and fraud have always been mixed up with these things that it is not perhaps matter of much surprise that they are held in low esteem by men of science. Still, as there are undoubted phenomena in connection with them worthy of patient examination, it is surprising that so prominent a field of inquiry should be so completely neglected by our doctors, while it is considered necessary to know precisely how long a dog covered with varnish would live, and how many degrees of heat a rabbit can tolerate before succumbing to its agony. A young lady of hysterical temperament, who had been humoured to the top of her bent by her medical man, had, after a few months of gynÆcological treatment, become so enfeebled in mind that she imagined she had lost the use of her lower extremities, and even succeeded in inducing her doctor to believe that she really was unable to walk. She was advised to consult a well-known hospital physician, who was chiefly celebrated as a true mind doctor. When he took his seat by the couch of the invalid he soon diagnosed her malady, and, finding she was of high intellectual culture, asked permission to read to her. The doctor was an admirable reader, and his rendering of a long and soul-stirring passage from one of the great poets made the girl forget her ailment so completely that she sprang from her couch with energy as he paced the room declaiming the poem, and exclaimed, “Is not that magnificent?” At that moment the deluded woman found the complete use of her limbs, and a few more readings cured her without other medicine. They don’t teach this sort of things in hospitals,—not the curative part, at least. Examiners at the colleges would “plough” the man who ventured to propose readings from Shakespeare three times a week with dramatic action as a remedy for hysteria. What they want is—

You see, it has been discovered by physiologists that if a solution of the bromide of potassium is applied locally to a rabbit’s heart, it produces instantly marked lessening of its action,^[3] and if applied to the muscle of the frog it throws it into tetanic spasm.^[4] On the nerve trunks it acts as a paralyzing poison;^[5] in fact, if you inject it in the vicinity of a living dog’s heart, “cardiac arrest always occurs.” So that you see how easily the physiologist can demonstrate how bromide of potassium quiets the excited nervous system of the hysterical ladies. You do not quite follow the reasoning? Well, do not tell the examiners that, because they declare it is quite plain to them, and helps to prove the value of experiment. Now, as there are no instances given in any books of physiology known to us, detailing any effects produced on the hearts or brains of any mammals by the dramatic reading of poetry, it would be manifestly unscientific to treat lady patients by any such method. Moreover, as it is of no use to cure anybody if you cannot demonstrate precisely how you cure him, it is better to let him alone.

The mind specialist who effected these remarkable results was answered by his colleagues who went in for the rabbit and dog theories that in the first place the patient wasn’t ill at all; secondly, that consequently she was not cured; and thirdly, that she was still as ill as ever. But the good physician still holds on his course, speaks with growing disrespect of the Pharmacopoeia, studies Nature, but does not “put her to the question,” and takes hints from old women, birds, trees and flowers; and like another Paracelsus, is ridiculed by his professional brethren in proportion to his success in unorthodox methods.