Place of Personal Influence.—When the antitoxins and directly curative serums seemed about to make for themselves a place in therapeusis, it looked for a time as though this personal element might be entirely superseded. It seemed that all other therapeutic factors must give way to definitely accurate doses of antitoxic principles, directly opposed to the toxins of disease and capable of conquering it. With the success of diphtheria serum, the prospects for scientific therapeutics from the biological standpoint became very promising. Unfortunately, our further experience with antitoxins and therapeutic sera of various kinds has not been satisfactory, and now the medical world is looking elsewhere for progress in therapeutics.
This throws us back once more on the old-time therapeutics, and we have to learn to use all their elements. One of the most important of these, if not, as we have suggested, absolutely the most important, the one that in all the many variations of therapeusis has maintained itself, is the personal influence of the physician by which he is able to soothe the patient's fears, allay his anxieties, make him face the situation calmly so that he may not use up any of his vital force in useless worry, but on the contrary employ all his available psychic energy in helping nature to overcome whatever disturbance there is within the organism. This personal influence was for several centuries spoken of as personal magnetism, not merely in the figurative sense in which we now employ that term, but in a literal sense. The implication was that some men possessed within themselves a reservoir of superfluous energy, vital in character, but thought to be related to the force exhibited by the magnet, when it attracted bodies to itself, and made metals for a time magnetic like itself, and which actually passed over from the physician to his patient. We have gotten away from the idea of any physical force flowing from physician to patient, but we know very well that certain physicians are much more capable than others of arousing the vital energies of the patient, sometimes to the extent of making him feel, after treatment, that he has more force than before. The patient feels that something must have been added to his natural powers, though he has only been brought into a state of mind where he can better use his own powers.
It is the men whose presence created this impression in patients, an impression that is justified by the fact that somehow he enabled them to vitalize themselves better than before, who have been most successful in the treatment of patients. In all ages the men of reputation for healing have had this. A careful study of their lives shows that this counted for more in many of the experiences of their healing than the drugs and remedies which they employed. The men who have been the most sought by patients have not as a rule left us great therapeutic secrets; on the contrary, they have only employed the conventional remedies of their times with reasonable common-sense and have added to them their own personal influences. On the other hand, the men who have made discoveries in therapeutics, and in medicine, have not always been popular as physicians. They have known too much of their own lack of knowledge to be quite confident in their use of remedies, and this has hurt something of their personal influence over patients.
IMPRESSIVE PERSONALITY
As a matter of fact, it is easy to comprehend, even from the comparatively scanty details that we have of habits and methods of the great physicians, that their effect upon their patients was always largely a matter of impressive personality. Any one who, from a pharmaceutical standpoint, knows how inefficient were many of the remedies that great physicians depended on, yet how effective they seemed to be to their patients, and even to themselves, will appreciate the factor of personal magnetism that entered into their employment. It is not alone in the olden time that great physicians have been almost worshiped. For their patients they have at all times been men of exalted knowledge, masters of secrets and comforters of the afflicted, just as was the first great physician of whom we have any account, I-em-Hetep, in Egypt nearly six thousand years ago. Such men as Hippocrates, as Galen, as Sydenham and Boerhaave, and Van Swieten, accomplished curative results far beyond the therapeutics of their time. The loving admiration of patients and of their disciples shows how strong were their personalities and gives us, almost better than the writings they have left to us, the secret of their successes as practitioners of medicine.
A Great Modern Physician's Influence.—It is interesting to study in the lives of great physicians the details which illustrate their personal influence, their consciousness of it and how deliberately they used it. A typical example very close to us, whose reputation was still fresh while I was at the University of Paris, was Professor Charcot. He had made great discoveries in nervous pathology. To a great extent he had revolutionized our knowledge of nervous diseases and added many new chapters to this rather obscure department of medicine. Far from making the treatment of nervous diseases easier than before, or giving more assurance to the physician who dealt with them, his discoveries, however, had just the opposite effect. His work emphasized that practically all of the so-called nervous diseases were due to degenerations in the central nervous system, which no medicine could be expected to relieve in any way, and which nothing short of the impossible re-creation of damaged parts could ever cure. His studies included organic degenerations of other organs, and in his treatise on "Diseases of the Old" it is made clear that many of the symptoms of old age are due to organic lesions for which no cure can ever be expected. This would seem to discourage treatment, yet somehow Charcot became a great practicing physician as well as a medical scientist and pathologist.
His success was due to his personal influence over his patients. In spite of the unfavorable prognosis that he had to give in so many cases, he was able by suggestion to help many patients with regard to their course of life, and to reassure them, so that many adventitious neurotic symptoms not due to their underlying nervous disease, but to their solicitude about themselves, disappeared. Very few people who came to him went away without feeling that his advice had been very valuable to them and without experiencing, as a rule, after they had followed his advice, that they were much better than they had been before. It was for the neurotic conditions associated with nervous affections that Charcot's personal influence over patients was of the greatest therapeutic significance.
He himself recognized this and did not hesitate to use it to its fullest extent. Towards the end of his life, the method by which his patients were presented to him was calculated to make their relation to him, above all, a very personal one, and to give his influence the fullest weight. Nervous patients who came to see him, were each in his turn invited from the general waiting-room into a small ante-room just outside of Charcot's office and there, in silence and dim light, asked to await the summons of the physician himself. When the time came for him to call them in, the folding doors between the rooms opened and he stood in a blaze of light inviting them to enter. Many a neurotic patient despairing of relief for symptoms that had lasted long in spite of the treatment of many other physicians, felt at once that here, in this kindly, gentle-voiced man standing so prominently in the light, was surely the long looked-for physician who would heal whatever ills there were. They came fully impressed with his power to heal, and all the valuable influence of auto-suggestion was enlisted on the side of their physician.
What is true in the regular practice of medicine can be seen much more clearly in the history of those who were not physicians, but who, nevertheless, by personal magnetism, succeeded in curing various ills, or at least in lifting up patients so that they used their own natural powers of recovery to much better advantage than would have been possible if left unaided.
Every successful healer has had this same personal influence, personal magnetism, call it what we will, which his patients have thought helpful to them through some direct communication, but which he himself, if he seriously studied it, and which every other thorough student of the question must realize, was due only to his power to call out the latent vitality of his patients. The mystery is not one of teledynamics, a transfer of energy from the operator, but one of awakening dormant faculties in the subject. Just why they should be dormant, since the patient so much wants to use them if he only could, is hard to understand. They do, however, lie dormant until the call of another strong personality wakens them to activity. Many people are so constituted that they cannot do effective work except under the direction of others. They lack initiative, though they may fill secondary places very well, indeed, much better often than the man of initiative