Mr. President, Ladies and Gentlemen,
Firstly, I wish to express my thanks and appreciation for the great honour, of which I am quite unworthy, entailed in the privilege of addressing this Congress.
My interest in the importance of psychological factors in the aetiology of skin disease was aroused initially by a conversation with Dr. J.L. Halliday in the course of which he described his findings in three consecutive cases of dermatitis. All three were men in late middle life. None had a history of dermatitis. In each the onset had been dramatic in the rapidity with which the eruption had spread over the body surface and the failure of the methods of treatment hitherto employed to bring about alleviation.
The characters or personalities of these three patients contained similar features, and their experiences prior to the outbreak of illness were strikingly alike. They were upright and good – living men keenly conscious of their own virtue and rectitude; the skin disease followed closely some disaster; and, in the belief that their misfortunes were utterly undeserved, they harboured an acute sense of injustice. Halliday approached the problem by applying the principles of aetiology now associated with his name, and later labelled the condition, “Jobs Dermatitis”.
Many of you will no doubt be familiar with these principles and their value as a guide to the student of cause and effect. They contain these questions to be answered by the diagnostician who concerns himself with aetiology.
1. What kind of person is this?
2. Why did he take ill when he did?
3. When did he take ill how he did?
4. What purpose does the illness serve?
5. What is the prevalence of the illness?
This association of ideas – Job and dermatitis – was brought back to his memory when some months later I encountered the following persons.
A Jewish storekeeper, aged 66, had had extensive “eczema” for three years. Almost the whole of his skin had been involved at one time or another. The onset had been sudden and the dermatitis had spread rapidly, accompanied by intolerable itching. In the first year he had consulted his family doctor and three or four dermatologists. In the past two years he had attended weekly at an outpatient department.
He was living alone in a single apartment, Twenty – five years ago at the age of 41, he had married a beautiful girl aged 17, an orphan without dowry. Five months after the marriage she had given birth to a daughter – not his child. He had forgiven her and brought up the child as his own. He had lavished kindness and money on both wife and daughter.
He had been successful in business and owned two retail shops besides having an interest in a wholesale establishment. Except for a few hundred pounds, he had placed all his assets, including his business, in his wifes name. Five years ago, when he was 61, she, then aged 37, had formed an attachment with another man, is possessed her husband of his entire fortune, and sacked him from his own business, Litigation had followed and dragged on for two years. His capital has been exhausted, which prevented him from contesting the matter further. At this point his skin eruption had made its first appearance.
As he related his story, he repeatedly emphasized his goodness to his wife and the rectitude of his past life. He seemed also to link his past business and material success with his righteous way of living.
In the course of discussion I said to him, “You will no doubt have heard of Job?” He replied, “Doctor, I was born and brought up in Russia. I knew the book of Job almost by heart before I was 14 years old.” I said, “Then you will remember that he was the most prosperous man in the land and that he regarded his great wealth as no more than a just reward for his righteousness? And you will remember how thieves and robbers stole his flocks and herds and burned his crops, and how a whirlwind destroyed his seven sons and three daughters.
You will remember also how his soul was torn in pieces. It was beyond his comprehension how such disaster could befall a man so good as he, who believed the tall of his riches was the measure of his righteousness. You will remember what happened to him. His body itched and oozed intolerably. so has yours.”
He was greatly moved and said nothing for a few minutes. Then with tears in his eyes he informed me that I was the first person to give him some inkling into the real nature of his trouble.
Late in the evening of the day on which this interview occurred, his friend, who had sent me to him and who vouched for the truth of his story, in a state of great agitation and indignation, informed me, that an hour or so after my visit, two psychiatrists, sent by the patients wife, had called, certified him insane and removed him to a mental institution. This step was taken because of his behaviour on the previous day when he had hurled a brick through the plate glass window of one of the furrier shops formerly owned by him and where his wife was then attending to customers.