ARTICLE XXXIX.

MIND CURES FROM THE STANDPOINT

OF THE

GENERAL PRACTITIONER.

BY ROBERT T. EDES, M.D.

OF READING.

READ JUNE 8, 1904.

MIND CURES FROM THE STANDPOINT OF THE GENERAL PRACTITIONER.

If one wished to ascertain the general trend of opinion in the community relative to the progress of medicine in recent years, and with this object in view were to glance over the table of contents of a large number of medical journals from cover to cover, he might infer that leaving out surgery and obstetrics there was a sort of polarization going on in which one set of opinions grouped themselves around mental, psychical, and even miracle cures, as represented by all sorts of 'pathies, 'ologies and sects, religious and otherwise, and at the other extreme around a condition of polypharmacy such as the world has never before seen; where if we believe half of what we read on one side the wonder is that any one dies, if at all, before he reaches one hundred; or, if we believe another set of writers, that any one ever lives to grow up.

It may seem absurd, or at least disrespectful, to suppose that The Massachusetts Medical Society goes to either of these extremes. As a matter of fact I don't think it does,not as a society-but a little experience showed me that one of these poles is not without its attractions for some of the members, and it is not an unfair inference that the other is drawing to itself some adherents by the fact that such a subject as that upon which I have been asked to say a few words finds a place upon the programme.

I had occasion to send to a good many of the Fellows some years ago a circular letter of inquiry as to the drugs which it was thought desirable to reject as useless from the U. S.

Phamacopoeia, and what should be added. I received some answers somewhat as follows: "What is the use of putting in a lot of trash such as is now there? Give us something practical and useful."

Then would follow a list in which the influence chiefly to be noticed was evidently the latest advertising pages in the Journals. When one looks over pharmacopeias and works on therapeutics (and by the way I know of little more instructive reading on the subject than Stille's Materia Medica compiled when the learned author was a young man, studied side by side with the last edition of the American Dispensatory of which the therapeutic part was written by the same author after many years of evidently well digested experi ence) and if he notes the changing lists of drugs which have, many of them, been vaunted just as highly and on apparently the same basis as those now produced in such bewildering rapidity by the coal tar chemists, and when he recalls the varied and often contradictory theories which have controlled the practice of medicine, many of them being, according to our present knowledge of pathology, absolutely groundless; he is obliged to acknowledge the vigor of the vis medicatrix naturæ.

But when we find that in spite of mistakes and contradictions, which the critics and satirists are not slow to perceive nor reluctant to remind us of, that the physician is still sought for in sickness as a helper and not merely as a sort of sanitary adviser, in order to promote recovery or at least to witness it, we have evidently to reckon with some kind of constant and permanent usefulness which has comparatively little to do with therapeutics as laid down in books, but which has been a part of the physician's armentarium ever since there were physicians.

This moral support or encouragement, the relief from responsibility, the substitution of decision for doubt, even a masterly inactivity when there are no active steps to be

taken, has long been recognized by the laity and by those literateurs who are fond of doctors but not of drugs, although it is apt to be somewhat slightingly spoken of by those who want something to be done promptly.

We are all familiar with the story, which I presume continues to go down from one generation to the next, and which in one form or another is told to us by gentlemen of other professions who wish to pat us physicians on the back on public occasions, of the doctor's smile which was supposed to be worth so many hundreds or thousands per annum, according to the social stratum to which he administered. The market for this commodity, however, varies greatly. While a lady fatigued with what she is pleased to term her social duties may be very willing to pay quite a liberal fee for his smile to the fashionable practitioner who "does not believe in drugging," which is the proper name to apply to the administration of all medicines except those which you happen to fancy, and which does not exclude in the case supposed "just a little sleeping powder" or "just an occasional nerve tonic," there are others who begrudge even a small one for the moral support of an equally competent physician unless they get something with it which they can taste or feel. But this sort of comfort is hardly therapeutics in the strict sense, and it certainly does not work wonderful cures. there are any, they are discounted in advance and supposed to be in the ordinary way of business, unless perhaps they find commendation in the doctor's obituary.

If

Considering the very prominent position which psychic treatment in one form or another occupies in the public mind and the extravagant claims made for it, and hence its necessary importance in the professional consciousness, it is worth while to consider what morbid processes can be beneficially affected by mental action. Of course we do not expect or admit any influence of outside or foreign mind or spirit or nerve function upon the bodily processes of any patient