Relation of the Exceptional Child to Exceptional Mental ConditionsBy John P. Cronin......

69

73

The Bath Room and Habit Formation-Adrenalin and Anesthetics

105

REFRACTION

106

N. F. Pepsin Preparations.

The Pupil in Health and Disease.

Effect of Tilting the Lens- Mental Interpretation of the Retinal Image... 108 Correction of Hyperopia...

MEDICAL PHARMACY

An Old-Fashioned Liniment..

109

111

112

A Creosote and Phenol Pill.

118

An Automatic Filter.

114

Bacteriology of Toothbrushes-A New Medicine-Dropper Clip. ELECTRO-THERAPY

115

Electro-Chemical Treatment in Gynecology-By Samuel Sloan.. X-Ray in Staticus Lymphaticus-Electrification in Varicocele... THERAPEUTIC BRIEFS.

NOTES AND MISCELLANY.

116

125

127

128

Vol. XL.

A Monthly Journal of Practical Medicine.

St. Louis, Mo., March, 1912.

EDITORIALS.

No. 3.

A

AN UNCONSIDered stumblING-BLOCK In expert testimony. FTER all, the real element of weakness in the expert-witness situation does not, we think, lie in the aspects of the matter which are most frequently discussed the ex parte attitude of the witnesses themselves, as determined by their enormous fees, the spectacular fencing of the opposing attorneys, designed to foil rather than to bring out the truth, and the general effect of confusion in the minds of the jury as to the real issues in the case. These things, in our opinion, are given rather exaggerated exploitation. They pertain only to the occasional case, which, like the rare case in medicine, while it attracts a great deal of attention, is not really representative of any prevailing state of affairs.

In the course of his professional career the writer has had quite frequent occasion to appear in court as an expert medical witness; never, he admits, in anything that could be regarded as a cause célébre, which, as we have said, is representative of nothing, but in several ordinary cases, such as are on the docket every day, and in which the testimony of the medical man is continually being given without any flourish of trumpets or startingly big fees. It has been the writer's uniform experience, contrary to the impression generally to be gained from current discussions of the subject, that the attorneys on both sides were courteous and conscientious men, who were, in the main, interested in getting at the truth, at least so far as the medical testimony was concerned; that every latitude was given the expert witness to enable him to make clear, in his own way, just what he wished to convey; and that the net result of the expert testimony thus elicited and given has usually been to generally illumine the issue.

But in the course of this experience, the writer has encountered, almost universally in his engagements with examining attorneys, and in his contact with the law in general, a stumbling-block which he regards as of far more practical importance than the occasional glaring objections referred to above-a stumblingblock of which, so far as we are aware, no one has ever made mention in discussing the expert witness and his relations. It intrudes itself upon the smallest, no less than upon the biggest, medico-legal questions, and blocks the way to an intelligent understanding between the witness and the court. It consists in this, that lawyer and physician are regarding the subject in hand from entirely different angles, and the great majority of the questions asked by the former in terms of his viewpoint are inherently unanswerable by the latter in terms of his viewpoint.

An instance will serve to illustrate the point. The question, let us say, is one of the suspected insanity of one of the parties to the suit. Asked as to the grounds for his opinion upon the individual's mental condition, the physician replies that he made careful inquiries of those who were in daily contact with the party, in

addition to a personal examination, and that they severally made certain statements about the suspected individual which led him to a decision. Attorney promptly moves that all this be stricken from the record, and taken from the jury, because it is mere hearsay-conversation had in the absence of the party at interest. And there you are. As a medical man, one is perfectly justified in taking-nay, one is obliged to take the statements of other people in making a diagnosis and directing treatment, as, for instance, the statement of the nurse as to whether a patient slept is much more valuable than that of the patient himself; but in law second-hand statements are worthless.

Only recently the writer testified in a divorce suit where he had previously, and without any knowledge at that time of a projected divorce suit, examined the woman and pronounced her a paranoiac and recommended an inquiry into her sanity. The inquiry was never had, but she was placed in the observation ward of the public hospital for a week or so and then discharged. The woman's counsela most conscientious and able man-put the question to the writer: "Would you still, in view of the fact that she has been under observation in the hospital and discharged, adjudge this woman insane?" Replying to which, the writer was obliged to remind the attorney that physicians do not "adjudge persons insane;" that that was the business of the probate court; that physicians, sheerly in their capacity as medical advisers, and with no legal relations whatever, make a diagnosis on the symptoms and circumstances; that in so doing they are justified in considering every kind of data, without regard to its legal value; and that in the case in question there had been sufficient data, both physical and circumstantial, to warrant advising an inquiry.

Here, we believe, is a real occasion of stumbling and misunderstanding, as between the expert witness and the court. Perhaps the illustrations we have cited are not as luminous as they might be, but at least they will serve to set forth the fact that the viewpoints of the lawyer and the physician are widely different, and that each is talking in terms of his own viewpoint. Is there any way of translating one into the other, or of reaching a common ground of neutrality, where neither viewpoint intrudes itself?

S

THE COMMON SENSE OF PSYCHO-THERAPY.

OME years ago—not so very many, either-in the city of Chicago, a professor of psychiatry, one Parkyn by name, used to conduct a post-graduate school in psycho-therapy. We believe that Dr. Parkyn afterward went into the real estate business, and exercised his suggestive influence upon prospective purchasers of improved property, from which he doubtless realized more material profit than he ever did from the teaching of suggestive therapeutics. Be it understood, however, that this is said in no spirit of satire or cynicism-except in so far as it implies satire or cynicism upon the obtuseness of a profession which was, in the main, utterly unable to appreciate the keenness of Dr. Parkyn's doctrines for there is not the slightest doubt in our minds that of all the theories and systems of psychotherapy ever promulgated for the benefit of medical men, his teachings contained the greatest modicum of common sense and practical truth.

To a certain extent, of course, a suggestive therapeutist is born, not made. Hence it is extremely unlikely that any of Dr. Parkyn's pupils in suggestive treatment could ever have achieved his success. He was one of those temperaments which naturally bend and shape others to their own will-not by bluster or mass force,

but as the warmth of the sun, in the old fable, compelled the traveler to remove his cloak. But the power which he wielded and taught was not altogether a natural gift. A great deal of it was nothing but the recognition and utilization of a very commonplace truth concerning sickness and human nature, such as anyone might, by the exercise of a little ordinary sense and tact, equally recognize and utilize.

Those who remember Dr. Parkyn's regnum, and especially those who were fortunate enough to attend his course (among whom, by the way, are included some of our most eminent physicians and surgeons), will recall the enormous range of cases that he treated, not only in matter of numbers, but, what is more to the point, in the matter of variety. From chronic constipation to infantile paralysis; from cold in the head to locomotor ataxia. They will remember that, whatever element of mystery there may have been in his treatment and its effects to the patients who benefited by it, or even to the physicians who witnessed and tried to profit by it in their own practice, he himself made no mystery out of it at all. Indeed, we are inclined to believe that the frankness and simplicity of his theory and practice were more or less of a stumbling block in the way of its more general acceptance. "If the prophet had bid thee do some great thing, would'st thou not have done it?"

He met with criticism and hostility, of course, from the powers that were; and the chief ground of such criticism and hostility consisted in the very aspect of the matter which ought to have demonstrated just where the real crux of his success lay, namely, that he extended his method of treatment (successfully, of course, for nobody bothers to fight unsuccessful practices) to diseases which, by all the canons of medical science, ought to be beyond its reach. We do not mean to say that he cured, or even half cured, but he improved such conditions as locomotor ataxia, hemiplegia, infantile paralysis, and the like. It was quite explicable, of course, and excusable, that he should benefit with his suggestion such neurotic conditions as neurasthenia, hysteria, and even habitual constipation; but that he should benefit organic diseases was both inexplicable and inexcusable. Yet here, as we have said, lay the whole secret of his suggestive philosophy— and it is an open secret that he who runs may read and profit by. It is simply this, that in every disease, functional or organic, there is always a certain percentage of the symptomatology, a certain proportion of the disability, which is superadded to the actual physical pathology by the mind of the patient; and this proportion is always subject to the influence of suggestion. Not only does this hold just as good for hopeless organic troubles such as we have cited above as for less serious disorders, but it applies even more emphatically to them; for the sheer knowledge that a disease is hopeless is sufficient to bring about in the patient a corresponding utterness of surrender which immediately adds its quota of helplessness to the condition. It is this mental complement, so to speak, which in our opinion constitutes the crux of all suggestive therapy. At all events it offers a place for the application of psycho-therapy in practically every diseased condition with which the physician has to do, and one which is easily and readily amenable to every practitioner who is possessed of only the most ordinary sensibility and tact.

In our department of "The Doctor Himself," in this issue, we are abstracting a very excellent article from the Lancet upon this very subject-the psychology of the every-day treatment of patients-which we earnestly commend to the thoughtful perusal of our readers, and also to their conscientious adoption. It will be found, we think, that the article in question bears out the principle which we have deduced in this editorial, and which we have ventured to illustrate by a reminiscent review of Dr. Parkyn and his system.