On common neuroses, or, The neurotic element in disease and its rational treatment.

  • Goodhart, James F. (James Frederic), Sir, 1845-1916.
Date:
1894
    a-going. There is nothing in such a train of reason- ing that is anywhere outside irreproachable doctrine, and, in my opinion, nothing that is not highly probable. If this is so, what is the use of stimulating the liver ? And although such a practice is endorsed by ages of custom, if we retire into ourselves and think the matter out for ourselves by the light of our experience, can we say for certain that the blue pill, the podophyllin, the salines, the Carlsbad salts, and so on, have accomplished the work that we entrusted to their care ? I think that, were it so, we should know more than we do of the why and the how of the formation of these concretions ; whereas, in truth, we know nothing of these two points, and we must fain confess that as yet we have not got behind the most obvious symptom of some disease of which we still remain in absolute ignorance. I may add here a few words on the subject of sick- headache or migraine; because, although it more fittingly belongs to the group of cerebral neuroses treated of in the first lecture, it more often, or at any rate very often, comes before me as a disease that is supposed to be due to a sluggish liver, or perhaps is the effect of an excess of uric acid in the blood. Either way, the patient is too apt to diet himself strictly, and to make his diet list sparer—and yet more spare— and that is not the way to cure most migraines. It would be more true to say that this disease is never due to those supposed partial abrogations of function
    on the part of the liver, than that it is ; for although it is often associated with such conditions, neither the one nor the other—" the liver " nor the uric acid —is the substantive disease: they and the headache are alike due to some deeper-lying causes. Migrainous subjects mostly come from the ranks of temperate livers—who very often work their brains to exhaustion. Within the limits of wholesome food they require to live well, while the remedies that do them good are such as have a distinct effect upon the cerebral hemispheres and the nutrition of the nerve elements—viz., sleep, rest, tea ; guarana, cannabis indica, antipyrin, and so on. While of remedies that do something to control the frequency of the attack are such brain foods as cod-liver oil and alcohol, and nerve tonics such as arsenic, strychnine, phosphorus and iron. And now I have done. In taking leave of my subject, let me reassert what has been the aim in these lectures. It was, in giving a clinical exposition of the common neuroses, to lay stress on the very certain fact that there are limits to the treatment of this class of diseases by drugs and operations, and that there are many conditions in which the cure must^come mainly from within, our function in chief being to call out this dormant power. I have endeavoured to insist, because I am sure at the present day we are too likely to forget, that the highest position we can take is to cure people by 9
    G advice rather than by drugs, to make the public pay for the use of our brains, and not for a prescription of so many ounces of physic. Drugs have their own field, but they are our instruments only ; of them- selves they have no vitality, and a sound-common sense—may I say a robust physiology ?—has a larger mission even than they in the treatment of disease. There is a time to give drugs, and even to give them with a free hand, but there is equally a time when advice only is needed, and not physic—shall I stop there ? no, when to give drugs is quackery! Yes, there are times when to give medicine is to give poison, for it sends the poor patient on a hunt for health which no physic will procure, and it lets slip the opportunity—in the exigencies of human pain, and of suffering of all kinds, too seldom fit—of pointing the ignorant to a future of medicine which both for them and for us is an ideal to be hoped for, to be striven for. I am not one of those who think that if we could conceive of a future for Medicine in which drugs should bear no part the function of the doctor would be gone. Rather do I hold that as the level of health of a community is permanently raised, so is he emancipated for a sphere of larger use, of still more liberal aims, of nobler purpose. But that is a subject for a future Harveian lecturer. For me it must be enough to press the conviction I hold that the large class of ailments that has formed the subject of these lectures admits of treatment, and
    ought to be treated, with a minimum of drugs ; and that if we could but prevail on the neurotic to see and to believe this, there is many a one who is now passing a life of aimless and too often hopeless invalidism to whom we might certainly promise, in language that many of them know too well,— " Soon will come the great awaking, Soon the rending of the tomb, Then the lessening of all shadows, And the end of toil and gloom.'' But that end is not yet. Will it ever be ? I must sorrowfully confess that the prosaic side of life suggests a couplet from another source :— '' But when you see that blessed day, Then order your ascension robe." None the less we still can say, " Come from the four winds, O breath, and breathe upon these slain that they may live."
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