WHATEVER grave doubts reason and experience may teach us to entertain in regard to medicine as a science, none can deny its position as an art. And it must be understood that medicine is a great deal more than the simple art of gaining time for the recuperative forces of nature to exert themselves. It does much besides occupy the mind. It directs the mind, and, through the mind, the body. It is to the body, in fact, what rhetoric is to the understanding, — a force that compels by persuading. Its plane of action is among the voluntary powers of man, where, making use of the imagination and the will, it constrains the obscure and reflex forces of the soul, and through them controls and persuades the involuntary functions of the body. Thus it happens that the doctor wields such a tremendous power in the world, and men obey him implicitly, whether he be the fashionable doctor of our cities, elegant and dainty, with a soft finger to feel pulses, and a soft voice to mollify nerves ; or the rude, terrible witch-doctor, who, by the reedy rivers of Africa, carelessly dispenses life and death to the shuddering children of the Fetish.
Camus, a scientific amateur, in 1753 wrote a rather fanciful sort of book which he styled Médicine de l’ Esprit, a system of healing by which the mind was made to cure the body. What Camus sought to gather into a co-ordinate method had, however, long before been observed in detail by the philosophers, and practised in detail by the quacks, who have always had a subdued and bewildered sort of consciousness that the chief part of their profits and their influence is due to the power which the mind exercises over the body.
It needeth a “ Delian diver,” says Lord Bacon, rightly to pursue the study of the imagination in disease. For, as Sterne has most acutely figured it, a man’s body and his mind are exactly like a jerkin and a jerkin’s lining ; rumple the one, you rumple the other. Fortis imaginatio generat casum, was the old caution of the medical schools to their acolytes. A frequent cougher in a church sets nearly the whole congregation to coughing. The scars of Saint Dagobert, Saint Francis, Saint Theresa; the raptures of the Seeress of Delphos and the Seeress of Prevorst can all of them be rationally interpreted by an accurate comprehension of this action of the mind upon the body. The books are full of cases of abnormal circumstances and corporal miracles produced by this sort of action. I need not repeat them here. I once saw a strong and very hearty man grow weak and faint, so that he was forced to go to bed, under the apprehensions produced in him by the distant, muffled drumming of some pheasants, which he heard while ploughing his field, and of which he mistook the dull, regular throb, not knowing what it was, for palpitations of his own heart.
In effect, it has been very rightly said that the senses are five porches by means of which the physician gets access to the body through the mind. Nor does it much matter by which one of these porches the skilful doctor enters. He can make his way as deeply and as readily by the porch of hearing or the porch of sight as he can by the porch of touch or the porch of taste. It was in recognition of this fact that the ancients laid such stress upon what they called medical music, whereby, flattering the ear, absorbing the attention, fascinating the soul and soothing the irritated nerves, they had the greatest success in the cure of the toothache, sciatica, gout, and diseases of an acute and violent character. Buretti and others sought to systematize this mode of treatment, and not without success. It is indeed a mode of acting upon nervous disease that is ancient as the harp of David and the lyre of Orpheus. At that subtle touch of harmony the clouds rolled away from the moody spirit of Saul, and the grim soul of Pluto waxed benignant. Varro commends the efficacy of music in the paroxysms of gout, while Theophrastus claimed that it was good as an antidote against the bite of serpents and the sting of the tarantula. Vigneul de Marville, seeing all these effects, and unwilling to believe that the spiritual part of man could so directly influence the physical, fancied a mechanical and Cartesian sort of action of the sound waves, whereby they harmonized the circulation of the blood, and, by relaxing the vessels of the body, afforded a freer exit to obstructed and nefarious vapors.
“The imagination,” as Lord Bacon said, “is next akin to miracle-working faith.” There is no doctor who would not rather contend with serious and even vital maladies, than with the thousand and one diseased conceits and hypochondriacal fancies of the malade imaginaire, who, aggrieved by dyspepsia and with his mind all awry, demands to be treated for every disease under heaven but the one mental lesion that makes him such a thorough nuisance. He has, indeed, no mortal malady; but does not his imagination give just as real and actual a twist to the nervous currents of his body as the magnet gives to the course of the compass ? It is in nervous conditions like this — and all sickness is accompanied with more or less general disturbance of the nerves — that the doctor and the quack equally find their opportunity, and establish their prestige, by working upon the excited and despondent or expectant feelings. The force of sympathy, even, can work a miracle, if the mind be in this state.
And even habit — by blinding the fancy to what the muscles are called upon to do, as was the case with her who carried the bull because she had carried the calf, and was only half conscious of its growth—has virtually a miraculous operation.
There are some very striking instances on record of the imagination doing the work which physic is fancied to be alone able to perform. When the Reformation appeared in Lithuania, Prince Radzivil went to Rome in person to give the Pope assurance of his devotion to the cause of orthodoxy. On his departure, the Holy Father presented him with a box of precious relics. Having come home, the relics were made use of by the monks for the cure of a demoniac who had hitherto successfully held out against every kind of exorcism. The success was instantaneous and complete, — a miracle was performed coram populo, and the virtues of the relics established beyond debate. The prince was confirmed in his faith, yet he was not so enthusiastic but he saw a supercilious smile on the face of the young man who had been keeper of the relics. “ Upon inquiry as to the meaning of sneers upon so solemn and awful an occasion, and pardon being promised, the prince learned to his disgust that, the genuine relics having been lost upon the way, the keeper had supplied their place with bones collected how he could, and put into a box the fac-simile of that which was lost.” This lot of rubbish, the bones of cats and dogs, picked from the highway, it was that had performed the miracle ! The legend says the prince became a Protestant straightway. I trust he did not suspect either the monks or the demoniac of deceiving him, for, so far as they were concerned, the miracle was beyond doubt a genuine one, working a bona fide cure of a bona fide affliction through the simple force of the expectant and excited imagination. And it is in this way precisely, nine times out of ten, that medicine works its cures, and especially that sort of cure most triumphantly adduced in proof of its surpassing efficacy.
Here, likewise, we have the solution of the actual and appalling power of witchcraft, and of the wonderful force of magic, with its charms, spells, amulets, and other devices for most thoroughly reaching the imagination through the senses. Among our American negroes, almost as much as among the African negroes, witchcraft exercises a despotic power. I have myself known an instance of a very kindly, brisk, and quite clever negress, one reared among intelligent people, and afforded opportunities enough to know far better, who, made melancholy perhaps by an accession of dyspepsia, fancied herself bewitched, resorted to innumerable ways of having herself exorcised without avail, and finally pined, languished, and died, without any lesion that was discoverable, and in spite of the skill of the best physicians. An enemy had “ put a spell upon her,” she said, and there was no escape for her from the doom of death. As her fancy wrought, so her body wrought.
Wherever magic has been able to retain its hold upon the imagination, its charms and amulets have worked as powerfully in the cause of health as physic. It is only when we cease to believe in sorcery and sortilegy — and we never do quite let go our faith in magic and our proclivity to superstition — that we demand of physic to furnish us a substitute, and, as Comte says, advance from the dominion of feticism to the regency of metaphysical notions. Magical medicine is probably as old as the world. The savages of those prehistoric days, who dwelt in caves and gnawed bones, naked and miserable as they were, must have had their witch-masters and their workers of spells, their sorcerers and their makers of amulets. Homer tells us how the wound of Ulysses was cured by the healing touch of the sons of Autolycus. The Ephesiœ literœ of Diana were a right famous amulet with the ancients, among whom, indeed, medicine was always half magical, half sacerdotal, and always more or less practised by the priests, who, as go-betweens from the gods to the people, were conceded to have an authority over disease not to be exercised by common men. After the oracles grew dumb and Pan’s reputation had grown to be a thing of the past, Christian superstitions easily substituted themselves for the old ethnic superstition. A famous mediaeval charm was that by means of the names of the three kings of Cologne, hung about the neck upon a piece of parchment, with the general legend, “Caspar brings myrrh, Melchior incense, Balthasar gold,” and a special entreaty that they would have in charge to heal the particular disease under which the patient was suffering. This charm was particularly efficacious in epilepsy, which as a mysterious disease, — the Greeks called it the sacred disease, — and one that seemed most certainly to proceed from the stroke of the higher powers, was naturally one for the relief of which supernatural aid would be solicited. After the priests, there was still a sort of Levitical family to whom the province of healing belonged of right, as the green turban among Islamites is the hereditament of the descendants of the Prophet. The seventh son of a seventh son was a physician by destiny, and always had a preternatural proclivity for setting disease at naught. I have noticed the advertisements of such seventh sons very lately in the newspapers, and as they can afford to advertise, it is fair to suppose they are patronized. The curative power possessed by another branch of these proscriptive physicians, the magnetists, is something which can neither be explained nor denied. The evidence is too strong for us to reject the almost miraculous cures performed by Baptista Porta, Cardan, Kircher, Gasner, Valentine Graterakes, Mesmer, Cagliostro, etc.
Old Robert Burton, the naive and learned anatomist of melancholy, gives us most ingenuously an excellent instance of the manner in which a faith in amulets may get possession of a mind that ought to be capable of rejecting such things entirely, or rather of accepting them for what they are really worth. Speaking of the use of spiders for ague, — and the spider’s web is an excellent remedy for the chronic form of that troublesome disease, by the way, — Burton says : “ I first observed this amulet of a spider in a nutshell lapped in silk, etc., so applied for an ague by my mother ; whom, although I knew to have excellent skill in chirurgery, sore eyes, aches, and such experimental medicines, .... yet among all other experiments, this, methought, was most absurd and ridiculous. I could see no warrant of it. Quid aranea cum febre? For what antipathy? Till at length, rambling among authors (as I often do), I found this very medicine in Dioscorides, approved by Matthiolus, repeated by Aldrovandus, etc. I began to have a better opinion of it, and to give more credit to amulets, when I saw it in some parties answer to experience.” So the scholar was led by Dioscorides to accept what his reason and common-sense had encouraged him to reject.
The key-note to all these facts is part of the rationale of human nature. The relations between medicine and psychology are in fact much closer than is generally conceded. It was an old doctrine of Plato, and a true one probably, that a man must have a natural disposition towards a thing if he would become that thing. To be virtuous, be must have an innate proclivity to virtue ; and education has no power to supply the defect in temperament. In other words, what we take from without must be, through some correspondent sense or feeling, already in ourselves. Where the organ is not, the sense is not. From this notion, and entirely over and above the conceded divine origin of the healing art, it came to be supposed that the healer himself must have a supernatural efficacy in his touch, congenerous with his election to perform the healer’s functions. “ The physician chosen of God,” says Van Helmont, “is accompanied by many signs and wonders for the schools. Compassion will be his guide. His heart will possess truth, and his intellect science. Love will be his sister ; and the truth of the Lord will illuminate his path. He will invoke the grace of God, and will not be overcome by the desire of gain.” This, a truly noble character, is so genuinely the nature of the medical enthusiast, that in mere self-defence even the most abandoned quacks have been constrained to assume it ; and there is not a mountebank of them all who, in making up his newspaper column of bad grammar and bosh, but gives some space to establishing his claims to rank as a benefactor of the human race and friend and free doctor to the poor.
Medicine, then, in this view of the case, is principally a physical effect produced in one’s body by means of faith wrought upon by imagination. The doctor and the drug are the instruments of the imagination and the impulses to faith. When we are ill, desire inclines us to hope ; the manner of the physician, the ceremony of his charm, or the name of his prescription, dispose us to believe ; immediately, the mind puts forth its influence upon the body, the body reacts, and the effect is produced that the case demands or the doctor wishes. Observation, experience, reason, all go for nothing in such cases, because, where one is strongly inclined, reason becomes lop-sided, and experience and observation act as mechanically as a child that gets his lesson by rote. Just so Saint Theresa, by force of longing and imagining, actually produced in her palms the stigmata of the suffering Christ which had so long and so vividly been imprinted upon her fancy. Paracelsus said very plainly — and knew it to be true, although he missed the application of it — that the incredible might be performed at any time, through the combined agencies of imagination and faith ; and he used this as an argument for astrology, as if faith had external as well as internal jurisdiction, and could actually influence the stars and move the mountains instead of simply making the mind believe in such powers. Very noticeable is his language: “If the command be combined with faith, the magically divine spirit in us has a superhuman sphere of action, which extends itself as wide as our thoughts, our imagination, and our faith.”
Baron Dimsdale has quoted the explanation of an old shoemaker, accused of witchcraft, of the means by which he cured the ague. “ I cure people,” said he, “ by pretending to cure them. People say that I can cure the ague ; and when they come to me I say that I can cure them, and then I go into my garden and bid them wait until my return ; I cut a twig off some tree, cut nine notches in it, and then I bury it in the garden, and tell the patient I bury the ague with it. I obtain confidence on account of the charm which people think I possess ; and by performing these and other ceremonies it generally succeeds so well that the individual has no return of his ague.” It will be noticed here that the worthy shoemaker, though not able to say why, had a certain faith in the validity of his curative powers, without which faith he would have practised in vain ; for, as John Damascenus said, no medicine is efficacious unless given, as well as taken, in faith. Here, again, the doctor is like the orator, and the secret of his sway is a counterpart of the si vis me flere of the rhetoricians. It was Galen’s maxim, that hope and confidence outvalued the drug : perhaps the latter science of medicine will decide that where hope and confidence are, the drug may be quite dispensed with.
The real process by which this action is procured of the mind upon the body, while not precisely identical with what Camus had laid down, is not very different from it. The process is, briefly, that of a reciprocal action. Medicines, having no real effect upon disease, yet act forcibly by indirection, by deceiving the senses, and notably the sight and taste. The nerves of the stomach are credulous, and the nerves of the eye are credulous. A mesmerist can persuade the eye that black is white, and he can persuade the stomach that sweet is bitter. The doctor can do quite as much as the mesmerist. The mind, being thus susceptible, is to be taught, by means of faith, imagination, and sympathy, that the body is curable, and the process in hand the right one. This done, all that is needed is to restore the body actually by right regimen, when the mind regains its stamina, and the cure, already prefigured and made operative in the imagination, is completed in fact. The deceptio visus is a particularly strong force in medicine. The mysterious presence of the doctor, the mysterious manipulation of his drugs, his manner, his apparent confidence, his touch of pulse and sight of tongue, how far do all these go to work the cure for which his skill gets all the credit? The imposing ceremony of the royal touch for king’s evil, although it could not break down a strumous diathesis, nor remove the constitutional taint, must yet have been very efficacious in bracing up the minds and spirits of the afflicted, and concentrating their recuperative energies. I do not doubt, could the data be obtained, it would be found that the proportion of those healed regularly diminished as the people begin to have less exalted opinions of royalty and of “the divinity that doth hedge a king” ; and that the percentage of cures to cases in Anne’s reign was not one tenth so great as in the time of the Plantagenets and Tudors.
The legitimate and necessary inference from all this is, that the successful doctor owes more to his manner than to his matter ; that he works deeper by his presence than by his drug ; and that a sturdy and impudent quack, ignorant, pretentious, false, and greedy, may still be a distinguished and excellent physician. For the physician’s office is to heal the sick, and it is no matter how he does this. The cure is not for the doctor to work, but for his patient. But the power over that patient which impels him to work out his own salvation is still in the doctor. So long as man is liable to disease, therefore, although he may learn to dispense with physic, he will not be able to dispense with the physician. That presence, that influence, that power, will still be demanded by the imperative craving of poor human nature, which, whenever misadventure, disease, or calamity come upon it, dares not to trust in itself, but cries for strength and comfort, support and reassurance, to come to it from without. But that we know it is impossible, we should demand to take our doctors with us even across the bridge of Mirza, and until we are safely arrived at the mysterious regions beyond. For these reasons it is of the first importance to us to understand how the doctor actually works, and what is the real quality of the influence he wields.
The doctor operates by skill of character, rather than by skill of knowledge. It is the active, not the speculative, part of his mind that wins him professional eminence. Not in his science, but in his personality, is the secret of his power. His insight is sympathetic much more than diagnostic. It is his office to touch the springs of hope and confidence, to soothe the chafed nerve, to quiet the secret fear, and revive the fainting heart. This he may do in two ways : by delicate and intuitive insight, and sympathetic feeling for character ; or by the crushing, overbearing, arrogant, but irresistible force of aggressive self-confidence and vanity. In the first case, we have the perfect doctor ; in the second case, we have the quack : in both cases what is demanded,—a healer of men. Now, in neither of these cases does science appear to be the main thing. Science is not the main thing, indeed. In fact, so uncertain is medicine, so fallacious, so utterly incompetent to grapple with serious disease, that the patient turns from drug to doctor, as the drowning man grasps at straws.
Now, the real vindication of the quack lies in this, and in the further fact that the physician’s confidence in his own powers, as a rule, is the measure of the patient’s reliance upon those powers, and consequently is a measure of the efficacy of the treatment. If the afflicted fancy his doctor predestinated to heal him, he will be healed. But this feeling of confidence must originate for the doctor in his consciousness of power, — not power of diagnosis to determine the malady, not skill of judgment to determine the remedy, but consciousness of mastery in himself, in the recondite forces of his personal nature, to meet and overcome and dissipate all kinds of disease. “ The real sorcerer,” says Grimm, “is the upwardstriving man..... The original cause of all sorcery must have proceeded from the very bosom of the holiest, the united wisdom of all heathenism, operating on the worship of the gods, and the art of poetry. Sacrifices and singing passed over into representations of magic ; priests and poets, men admitted into the confidence of the gods, and participants of divine inspiration, soon merged into the diviner and sorcerer.” Thus, then, all the beginnings of quackery were profoundly sincere, and the first impulses of every quack lead him to entertain an acute and living sense of his powers of working good to man. It is only after repeated success — success that, by proving itself to be lodged in his presence and indifferent to his mood, intoxicates him — that he becomes careless and indifferent in his means. He has discovered the fallibility of human judgment, the narrowness of human reason, the boundless scope of human imagination, upon which he can play at will. Then, indeed, “ by the side of his health-bringing practice, a pernicious one develops itself.” As is the case with the orator, the poet, the enthusiast of every class, his trick is the sign of his degeneracy, his first success is the fruit of the power of faith that is in him.
It was the doctrine of the Rosicrucians, that the true physician had only to look upon his patient to heal him ; and this was likewise the doctrine of Kircher, Cagliostro, Mesmer, — quacks all of them, but only so by the second intention of relapse and degeneracy out of an original state of pure enthusiasm. In this sense Mohammed was a quack, and Savonarola. “ There is a secret of curative art in which consists the genius of healing,” says a thoughtful writer ; “ it is that union of sympathy with intelligence, and of moral energy with magnetic gifts, whereby the tides of life are swayed, and one can really minister to a mind diseased.” But this perfect physician can scarcely exist. It is the foible of humanity that strong self-consciousness tends always to become overweening ; that power destroys modesty and breeds pride ; that he who can cure by manner will trust to manner alone, and give science and more reputable art their dismissal. Hence, every true healer, by the mere force of nature, gravitates into dogmatism, into self-determination, into quackery. He does what suits himself, and is no longer sedulous to inquire what may suit his patient.
This is a mental condition in the doctor and the quack which is loudly reprehended in the world, but which, for my own part, I cannot find occasion to condemn very sharply. Looking at the matter dispassionately, I can see no reason why the physician should not be dogmatic, if that dogmatism be a necessity to the successful discharge of his functions as a professor of healing. The dogmatist is merely one who stands like a rock upon the foothold of his own experience, and it is a maxim in medicine that a grain of experience is more worth than many tons of reasoning. No one can tell how the curative process works ; if the dogmatist’s own way works well, he has the right to pursue it, and the right to decline to explain it. Nor am I inclined to repudiate dogmatism in the abstract, though I confess there are few things more disagreeable than to come into personal collision with the harsh edges of one of those models of self-sufficiency who practise it as the art of their lives. All great men, all men, at least, great in active life, have been dogmatists. Caesar, Mohammed, Cromwell, Mirabeau, Napoleon, are examples of the class. The dogmatist, briefly defined, does not inquire into means, but seeks ends. He does not ask why or wherefore, but how and what. He does not wait for reason to convince him, but obeys and acts by intuition and impulse. He speaks ex cathedra, as one having license in the depths of his own consciousness. He has neither time nor disposition to argue and explain.
From all these things we begin to discover the doctor’s right place and real importance in the economy of society. His work is not to be done by means of drug or knife, but by means of his counsels, and, above all, by force of his manner. He enters into the very life of the invalid in his struggle with disease, sustains him, and holds up for him his languishing right hand until the victory is decided, as Aaron and Hur held up the right hand of Moses when Israel fought against Amalek. It is the doctor cures us, not the doctor’s physic ; and the quack has very often valid reason against the scornful repudiation he gets from the physician, since his mere manner very often effects that which all the science of the other has failed to accomplish.