Essays In Pastoral Medicine Part 12

Often when in such cases there is no definite history of harelip, it is found that in either one of the parents there is a very high arched palate and a thin upper lip, showing that the normal occlusion of the cleft which exists here during foetal development is not quite perfect, and this peculiarity may be traced for several generations back, with an occasional occurrence of harelip as an exaggerated example of the faulty tendency not to produce sufficient tissue in this neighbourhood for the proper closure of the embryonic cleft.

An even more striking manifestation of a physical anomaly, as a family trait, is the condition known as hemophilia. This {124} tendency to bleed easily, so that a slight scratch, or the pulling of a tooth, may give rise to fatal hemorrhage, occurs, as a rule, only in males, but is transmitted through the female line. It is in the mother's male relatives that the history of its previous occurrence is found, and the tendency usually can be traced through several generations, until it is lost in vague tradition. It is no wonder, with such examples before them as six-toedness, harelip, and hemophilia, that physicians have been ready to accept heredity of qualities in the moral order, traits of character and disposition, and pathological tendencies to crime or pa.s.sion or indulgence.

One of the most frequently discussed conditions of supposed pathological inheritance of this order is dipsomania. Everyone has heard it said, "Poor fellow, how can he help it; his father was a drunkard before him." As we have already said, in such direct cases inheritance is absolutely unproven. An alcoholic father may transmit a very weak physical const.i.tution to his children, and this may prove inadequate to enable them to withstand the emotional strain and worry of modern great city life, and, as a consequence, they may take to alcohol for consolation until the habit is formed, and then the craving for stimulants supplies the place of any hereditary influence that may be supposed to be needed.

Of course there are cases of the drink habit in which, after a number of generations of family history of alcoholism, an individual seems to have the craving for stimulants born in him. In such cases it is not unusual to find that the patient, for such he must be considered, is able to avoid indulgence in liquor entirely, except at certain times.

Every physician of any large experience has had under his care dipsomaniacs who had no difficulty in keeping away from liquor for weeks, or even months, but who had regularly recurring periods, sometimes as far apart as every three months, when they had an irresistible craving for stimulants come over them. The regularity of the interval in these cases is often very remarkable. Here, of course, we may be in the presence of some as yet not well-understood periodical law of cell life, with consequent depression, and then the irresistible craving for stimulation. {125} As a rule, however, it would seem that in most of these cases suggestion has great influence.

As we have said elsewhere, with regard to suicide, when a man has constantly before his mind's eye the fact that a father, perhaps a grandfather, or other members of the family, have committed suicide, he is likely to be much more easily led to the thought of this way of escaping hard conditions in life than are other individuals. The man who knows that the fact that his father indulged too freely in stimulants will be looked upon by many as an excuse for his deviations in this matter is likely to be more easily led to take an occasional drink at moments of depression, or for friendship's sake, though he realises that it so weakens his will power over himself that he is likely to take too much before he stops.

The pa.s.sage in _Julius Caesar_ (Act. I. sc. 2) in which Ca.s.sius says:

"The fault, dear Brutus, is not in our stars, but in ourselves,"

ill.u.s.trates one phase of the subject. There are, of course, many other things besides the drink habit, with regard to which men are p.r.o.ne to find excuses in heredity, and to consider that somehow their ancestral tendencies make them not quite responsible for actions commonly considered the result of malice or pa.s.sion, rather than hereditary influence, and our great English poet, knowing men so well, has stated the truth forcibly.

In _King Lear_ there is an often quoted pa.s.sage which properly stigmatises the opinion in this matter held by those who would find excuses for wrong-doing in hereditary qualities:

"This is the excellent foppery of the world, that, when we are sick in fortune,--often the surfeit of our own behaviour,--we make guilty of our disasters the sun, the moon, and the stars; as if we were villains by necessity; fools by heavenly compulsion; knaves, thieves, and treachers by spherical predominance; drunkards, liars, and adulterers by an enforced obedience of planetary influence; and all that we are evil in, by a divine thrusting on; an admirable evasion of wh.o.r.e-master man, to lay his goatish disposition to the charge of a star!"

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One phase of the question of hereditary tendencies to inebriety is extremely interesting from a physiological and sociological point of view. As the result of carefully gathered statistics, there seems to be no doubt now that when children are conceived while the parents, or either of them, is in a state of drunkenness, the offspring is very likely to be of low-grade physical const.i.tution and often of very neurotic tendencies. In France, particularly in the case of a number of insane children and idiots, histories of this nature have been obtained in confirmation of this unfortunate factor as an element in degeneracy. In general it may be said that about one-third of the admissions to homes for children of low intelligence, as well as to insane asylums, are due to this cause.

There is in this, of course, an added motive for temperance, and it would seem that parents should be warned of the danger to which they are subjecting their offspring by excessive indulgence in alcohol, when it may be followed by such serious and lasting results to the beings on whom their love and affection will be expended in the future. This phase of alcoholic excess has never been taught as insistently as its importance would demand, perhaps because of the delicacy of the subjects which it involves; but it is too significant a factor in making or marring progress in the development of the race to allow any pusillanimous motives to prevent the spread of precious knowledge. [Footnote 3]

[Footnote 3: The present conditions that obtain with regard to the celebration of marriages are very p.r.o.ne to have a certain amount of intoxication as their result. Perhaps, then, it is a fortunate thing, as has often been said, that the first child is not born until some considerable time after it might normally be expected. It has been said more than once, however, that first children are a little more likely to have certain degenerative defects than are others, and a connection has been found between certain abuses of stimulants and incidental exhaustion to account for this. One of the most amusing things to Li Hung Chang, on his travels through our country, was the curious publicity we give to everything connected with marriage, while presumably our Christian ideas should rather counsel a veiling of the mysteries, religious and physical, connected with it. Certain it is that the present tendency towards farewell dinners at clubs, and other festivities of various kinds, are not at all likely to result in benefit to the presumably hoped-for offspring.]

The only real light that has been thrown on the puzzling details of heredity has come from work in the same field in which Mendel made his ground-breaking observations. {127} De Vries, the professor of botany at the University of Amsterdam, has succeeded in showing that new species of plants may be made to arise by careful attention to certain anomalous plants which occur from generation to generation. These plants breed true, that is, maintain their own peculiarities. To begin with, they are quite different from the parent plants, and the difference is perpetuated by inbreeding.

So far the problem of the origin of species has been supposed to depend upon the normal variation that is noticed in plants and animals. All living things differ from one another, even though they may belong to the same species, and differ sometimes in remarkable degrees. This continuous variation was supposed to account for the origin of new species when it became excessive. It has become well recognised now, however, that such differences gradually disappear in the course of the normal multiplication of plants and animals. The tendency is much more towards the disappearance than the maintenance of peculiarities.

There are certain discontinuous variations, however--sports, as they are called--in plants which differ very markedly in some quality from others, and these have the tendency to perpetuate themselves. Just why these sports occur is not known, nor how. They occur in a certain small percentage of all normal plants, but may die out, though it takes but little encouragement to succeed in helping them to maintain themselves. It is this that De Vries has done, and thus has succeeded in raising what would be called new species of plants.

This same thing would seem to occur in human beings. Some definite variation occurs as a consequence of a peculiar embryologic process.

This becomes stamped upon the genital material and appears in the subsequent generations. It does not occur as a consequence of pathological changes nor of mere embryonic faults; it is almost as if it were something introduced from without. Once having found an entrance, however, it affects the germinal material and thus perpetuates itself.

With regard to plants, it has been suggested that the only explanation available for the occurrence of sports is that there is a purposeful introduction of them as the result of the laws of nature, and that it is thus that evolution is intentionally {128} brought about. This is, of course, a scientific reversion to teleology once more, but the question of teleological influences has been discussed more seriously in the last few years in biological circles than ever before.

Unfortunately for the coincident evolution argument involved in human beings, the peculiarities introduced, which become the subject of inheritance, do not make for the development, but rather for the degeneracy, of the race. Even such peculiarities as six toes can scarcely be said to add any special feature of advantage to man in his struggle against his environment.

It is agreed by many of our best authorities in biology, zoology, and botany, by such men as Professor Wilson of Columbia University, Professor Thomas Hunt Morgan of Bryn Mawr, Professor Castle of Harvard University, Professor Bailly of Cornell University, Professor Michael Guyer of the University of Cincinnati, Professor Spillmann, who is the Agrostologtst of the United States Government, and Professor Bateson of the University of Cambridge, England, that these principles of heredity enunciated by Father Mendel will undoubtedly revolutionise the modern knowledge of the subject. In the meantime, however, all the old theories are in abeyance. Darwin's work and Weissmann's brilliant theories and observations must give way, while the application of these new laws is being worked out to their fullest extent. While the influence of heredity can not be denied, there is undoubtedly a tendency to overestimate the influence on the physical being of the power of hereditary transmission, and, on the other hand, to underestimate the influence of this same force as regards disposition and character. There is no doubt now that the physical basis influences the exercise of the will, and that consequently responsibility is not infrequently modified by the hampering influence of unfortunate physical qualities. This truth makes for that larger charity in the judgment of the actions of others which enables physicians to realise how much men are to be pitied, while its failure of recognition by the "unco guid" not only causes suffering, but in the end adds to the amount of evil.

JAMES J. WALSH.

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X

HYPNOTISM, SUGGESTION, AND CRIME

In recent years a quasi-unconscious state, induced by suggestion and called the hypnotic trance, has come to occupy a very important place in the popular mind. Hypnotism, as the general consideration of this state is known, has attracted not a little attention, as well from physicians as from those interested in psychology. The hypnotic (Greek, [Greek text], sleep) trance is a condition in which voluntary brain activity is almost completely in abeyance, though the mind is able pa.s.sively to receive many impressions from the external world.

There are very curious limitations in the effect of the hypnotic state upon the various senses. While visual sensations, and, as a rule also, impressions from the tactile sense, lose their significance, or are translated according to the will of the person active in producing the hypnotic state, or of some person present making suggestions, auditory sensations are quite normally perceived. The patient has all the appearance of being asleep, though motions, and even locomotion, are often possible, and are performed as if the patient were walking in sleep.

The hypnotic state is a partial sleep, then, of the motor side of the nervous system and of portions of the sensory nervous system. Certain of the higher intellectual powers, however, are entirely awake, and capable of being impressed through the hearing, and thus hypnotic suggestion has a place. For a time, under the influence of Charcot and his disciples, there was a very generally accepted opinion that the hypnotic trance was a pathological condition, somewhat allied to the cataleptic phase of major hysteria. It is well known that persons suffering from severe attacks of hysteria {130} may, while apparently unconscious, yet receive suggestions through the hearing. On the other hand, the production of cataleptic and other strained att.i.tudes, in the maintenance of which fatigue seems to play no part, is possible by means of hypnotic suggestion in susceptible individuals.

Further investigation, however, seems to have shown that the hypnotic state is rather to be considered as a quasi-physiological condition, somewhat related to sleep, all the mystery of which is not as yet understood. This is not surprising when we realise that such a normal and absolutely physiological condition as healthy sleep is yet without a satisfactory explanation on the part of physiologists. Hypnotism is recognised now as having a certain limited power for good, though the benefit derived from it is apt to be temporary, and the operator loses his power after a time,--not so much failing to produce the hypnotic condition, as failing to have his suggestions favourably accepted by the subject While the Nancy school of hypnotism insisted that most people were susceptible to the hypnotic trance, it is now generally considered that something less than 40 per centum of ordinary individuals can be brought under its influence.

Much has been said of the dangers of hypnotism. There seems no doubt that very nervous persons are likely to be hurt by repeated recourse to the hypnotic condition. After a time they are likely to live most of their lives in a half-dreamy condition, in which initiative and spontaneous activity becomes more difficult than before. Where persons have been hypnotised by means of the flash of a bright object, or by some other special means, it sometimes happens that accidentally some similar object may send them into hypnotic trance. After a time, too, auto-hypnotism becomes possible, and much of the individual's waking time is occupied with efforts to keep himself from going into the hypnotic trance. These are, however, very extreme cases, likely to occur only in those who are not of strong mentality in the beginning.

Unfortunately these are the individuals who are most likely to be made the subjects of repeated and prolonged hypnotic experimentation on the part of unscrupulous charlatans.

For the great majority of those that are susceptible to the {131} hypnotic condition, there is very little danger. We now have on record the experiences of men who have seriously devoted many years to the study of hypnotic phenomena. There is entire agreement among these men that the possible dangers of hypnotism have been exaggerated. Indeed, it may be as well to say at once that most of what has been written with regard to the dangers of hypnotism has come from those who have least practical experience with the condition. Dr. Milne Bramwell, who, for a quarter of a century, has had a very extensive experience with hypnotism in its many phases, in his recent book on hypnotism, deliberately speaks of the "so-called dangers" of hypnotism. He has never seen any evil effects, though he has been practising hypnotism very freely on all kinds of patients for over twenty years.

It is on the experience of such serious, disinterested observers that we must rely for our ultimate conclusions as to hypnotism, rather than on the claims of pseudo-experts who like to magnify their own powers, or on popular magazine articles, or still less the Sunday newspapers, the writers for which are mainly interested in producing a sensation.

It seems probable that in the next few years hypnotism will occupy a less prominent place in popular interest than it has in the recent past. Interest in hypnotism runs in cycles, reaching a maximum about once a generation, and we are on the downward swing of the last wave of popular attention to this subject.

A subject that has attracted much attention, whenever hypnotism has been under discussion, has been the possibility of crime being committed under the influence of hypnotic suggestion. The best authorities in hypnotism seem to be agreed that subjects can not be brought by hypnotic influence to perform actions that are directly contrary to their own feeling of right and wrong. The supposed exceptions to this rule are rather newspaper sensations than real compelled crimes. There is no doubt, however, that a tendency to the performance of certain wrong actions, so that the normal disinclination to their performance becomes much less than before, may be cultivated by a series of hypnotic as well as by waking suggestions. Where the individual influenced is {132} already characterised by weakness of will in certain directions, the added weight of the motives furnished by hypnotic suggestion may prove sufficient to turn the scale of responsibility. It is probably because of such influence that a recent case in France has attracted world-wide attention.

In general, however, it may be said that normal individuals can not be brought to the commission of crime by hypnotic suggestion, and the plea of irresponsibility, for this reason, is not worthy of consideration. There are phases of this important problem, however, which require further careful study. Undoubtedly some of the so-called inherited tendencies to the commission of crime are really instances of the influence of auto-suggestion that has kept the possibility of some criminal act constantly before the mind. Some of the cases of hereditary dipsomania are almost surely of this character. Persons whose parents have been the subject of inebriety lose something of their own will power to keep away from intoxicating drink by the reflection that it is hopeless for them to struggle against an inherited tendency.

A series of cases have been reported in which suicide has occurred in successive generations in the same family at about the same time of life. There seems no doubt that suggestion must have great influence in such cases. In one well-authenticated report, mentioned in the chapter on suicides, the members of the family were officers in the German army, and the eldest son, the family representative, committed suicide within the same five years of life, in four successive generations. The last member of the family had refused to marry, because of this doom hanging over the house, and had often referred to the possibility of suicide in his own case. In his early years he seemed to have the idea that he might escape the family fate, but after middle life he settled down irretrievably to the persuasion that he would inevitably go like the others.

Here, in America, a rather striking example of this has recently been the subject of sensational newspaper reports. A notorious gambler, whose career had seen many ups and downs, finally found himself in a condition where, strange as it may seem, legal restriction made it impossible for him to {133} continue his usually lucrative profession.

Three members of his immediate family, two brothers and his mother, had committed suicide. To friends he had sometimes spoken of this sad history of family self-murder, but always with a calm rationality which seemed to indicate that he hoped to avoid any such fate. When well on in years, however, with his means of livelihood taken from him, he, too, took the family path out of difficulties and shot himself at the door of the man who had been most instrumental in taking away from him his occupation. It seems not unlikely, from the circ.u.mstances of the case, that a double crime, homicide, as well as suicide would have been reported, only for the fortuitous circ.u.mstance that the other man was not in at a time when usually he was to be found at his office.

In such cases as these it seems reasonably clear that long-continued familiarity with a given idea produces an auto-suggestion which finally overcomes the natural abhorrence even of suicide. Something can be done for such unfortunates by suggestion in the opposite direction, and by taking care that as far as possible they are not allowed to brood over the fate they consider impending. At times of stress and emotional strain, relatives and friends must be particularly careful in their watch over them. It is never advisable that they should take up such professions as those of broker or politician, or speculator, since the emotional states connected with such occupations are likely to prove too much for their mental equilibrium.

Practically all physicians that have given any attention to the subject are convinced that not a few of the suicides, which are now so alarmingly on the increase in this country, are due to the frequent reading in newspapers of the accounts of suicides. As we have said elsewhere, brooding over the details of these is very likely to lessen the natural abhorrence of self-murder in persons that are predisposed, by melancholic dispositions, to such an act. The publication of cases of suicide can do no possible good, while it undoubtedly does, in this way, work incalculable harm. This is especially true with regard to suicides among young people, that is, individuals under twenty-five years of age. The saddest feature of recent {134} statistics with regard to suicide is that this crime has become proportionately much more frequent among young men and young girls, and even children, than it was two or three decades ago. It has been noted, too, in many cases that a previous suicide in the family seems to have familiarised the young mind with the idea of self-destruction and thus suggested its commission.

On the other hand, among young people especially, it has been noted that there is frequently an imitative element in suicides. Three or four suicides, practically with the same details, will occur, within a few days of each other. Suicides at all ages are especially likely to occur in groups, and are often cited to exemplify the truth of the old axiom that evils never come singly. It is especially among young people, however, that this relationship to previous suicides can be traced, and there is no doubt that it is the unfortunate publicity given to suicide, with the consequent suggestive influence, which const.i.tutes the most important factor in these cases. All the influence that clergymen can exert, then, must be wielded to suppress this, as well as the many other evils which flow from sensational journalism.

JAMES J. WALSH.

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XI

UNEXPECTED DEATH

Unexpected death and its problems const.i.tute the princ.i.p.al reason why there should be a pastoral medicine, and why the clergyman must keep himself in close touch with advances in medicine. To have an ailing member of a congregation die unexpectedly, that is, without the rites of the Church, when perhaps there has been some warning as to the possibility of such an accident, can not but be a source of the gravest concern in pastoral work. Sudden death can be antic.i.p.ated in many diseases that are acute, while in chronic forms of disease the sufferer can be prepared for its possibility by the administration of the sacraments at regular intervals. There is, however, an old proverb which says that death always comes unexpectedly; and even with all the modern advance in medicine, this still contains a modic.u.m of truth. As an unprepared death is an occasion of the most poignant regret to the friends of the deceased and to the attending clergyman, it is with the idea of furnishing some data by which the occurrence of death without due antic.i.p.ation may be rendered more infrequent, that the following medical points on the possibilities of a fatal termination in certain diseases have been brought together. Unfortunately, even with all our progress in modern medicine, they must be far from adequate for all cases.

Needless to say, the only rational standpoint in this matter must be that it is better to be sure than to be sorry. The impression is very prevalent now that at least the sacraments of Penance and the Holy Eucharist should be administered to the sick whenever there is even the possibility of a fatal termination of the illness. Extreme Unction is more usually delayed until there is some positive sign of {136} approaching dissolution. Delay in its administration, however, not infrequently leads to this sacrament being given when the patient is unable to appreciate its significance. This would seem to be very far from the intention of the Church. The idea has been constantly kept in mind, then, so to advise the clergyman with regard to the liability of a fatal termination as to secure, if possible, the administration of Extreme Unction while the patient is still in the full possession of his senses.

a.s.sured prognosis, that is, positive foresight as to the course of any disease, is the most difficult problem in medicine. Nearly 2400 years ago, when Hippocrates wrote his chapter on the progress of diseases, he stated that the hardest question to answer in the practice of medicine is, will the patient live? That special chapter of his book remains, according to our best authorities, down even to our own day, a valuable doc.u.ment in medical literature. It can be read by young or old in medical practice with profit. While our knowledge of the course of disease has advanced very much, the wise old Greek physician antic.i.p.ated most of the principles on which our present knowledge of prognosis is founded. This fact in itself will serve to show how unsatisfactory must be any absolute conclusion as to the termination of any given disease. Our forecasts are founded on empirical data,--that is, they are the result of a series of observations,--and the underlying basis of all the phenomena is the individual human being, whose const.i.tution it is impossible to know adequately, and whose reaction to disease it is impossible, therefore, to state with absolute certainty.

With this warning as to the element of doubt that exists in all prognosis, we may proceed to the consideration of certain organic affections which make sudden death frequent.