NEGLECTED PSYCHOLOGICAL AND HYGIENIC FACTORS IN SURGICAL CASES


That the coarse-grained, heavily muscled, show-moving, dull- minded individual will react very differently, from the sensitive, high-strung, nervous, quick-moving, intellectual individual is probably known to every one. There are many intermediate types; but how often do even these most extreme differences enter into the diagnostic procedure and conclusions of the physician or surgeon when considering a case ?.


The death of Rudolph Valentino on August 23d, a few days after he was operated upon for gastric ulcer and appendicitis, gives rise to feelings that become more and more poignant as the published reports are reviewed. Sadness over the untimely taking off in the flower of his young manhood of a player of engaging personality and international popularity, is succeeded by regret, then humiliation, and finally by indignation and wrath that there should be medical men in charge of such cases who are apparently so blind, so prejudiced, so lacking in discrimination, so oblivious of the physiological, limitations and susceptibilities of the human organism, and so negligent of the simplest natural measures for conserving vital energy as the published reports of this and many other cases shown them to be.

Inasmuch, however, as the treatment of Valentino accorded with current practice in such cases, responsibility for his death and the death of many others must be shared by the entire medical body, saving and excepting only the homoeopathic member of it, which they hate and would destroy for its rebellion against and rejection of such therapeutic methods; and saving also those professionally despised independent bodies and “cults” who treat the sick, more or less successfully, without any medication whatever.

Valentinos death vividly recalls the still more poignant case of Caruso, his great compatriot, whose tragical death under very similar treatment a few years ago is still fresh in the public memory.

Both of these men were victims of a cruelly false and pernicious philosophy medical treatment. Their lives were sacrificed on the altar of a false god.

“Whom the gods would destroy they first make mad.” They who are mad are devoid of ordinary reason and judgment, are infatuated, rash, reckless. Was ordinary reason and judgment shown in submitting a man who was debilitated by the strain of the hard work, excitement, emotional stress, late hours, irregular and injudicious dietetic habits incidental to his temperament, vocation and environment to the additional strain and shock of one, (some say two,) of the most serious operations in surgery without a long period of rest and recuperation under the most careful and conservative hygienic and dietetic treatment?.

Valentino appears to have been a man of a highly sensitive, passionate, romantic nature; erotic, emotional and impulsive; enjoying or suffering intensely, physically strong but a spendthrift to energy. He had long been suffering from the pains of gastric and intestinal disturbance, but was too proud to complain. It is reported that when he did mention them to some of his friends, or his manager, he was either laughed at, or told to “go and see a doctor or else shut up and forget it.” Imagine the effect of such flippancy upon one of his temperament. Instead of the sympathy, consideration and sound advice due him, he received ridicule and a rebuff. Young, inexperienced, and lacking knowledge in such matters, the knew nothing better to do than to wallow rebuff and force himself to go as he had been going.

For several weeks before the beginning of the end, Valentino had been undergoing to pangs of anger, humiliation and the desire for vengeance in the painful, if silly, episode which was widely exploited in the newspapers. The vulgar public was regaled with accounts of his challenges to personal combat with the editor who had ridiculed and insulted him, and descriptions of the preparations he was making, or was supposed to be making, to carry out his threats of vengeance and prove his valor.

All very silly and disgusting to sensible, people, of course, but tragical in its physical results for nothing more rapidly and profoundly saps vitality, wastes energy and disturbs normal physiological functions than such indulgence of evil passions.

The facts as reported tend to show that he was already in that irritable, overwrought, weakened condition of the nervous system which portends a breakdown.

He was not himself. He was a sick man. And the things he did, the course he pursued, in the absence, probably, of sound and kindly advice, constantly aggravated and hastened the further progress of his disease.

When the breakdown came and Valentino fell into the hands of the doctors, were these elements and particularly the psychic factors of the case taken into consideration? Presumably his clinical history was taken and routine laboratory tests were made. Modern hospital records provide for that. But was a thorough, painstaking investigation and analysis of his temperament of constitution made, including his mental or psychical characteristics and experiences, in order to discover the extent and degree to which his physical condition had been influenced by these important factors?.

There is no evidence that any such examination or analysis was made or even thought of. The tragical outcome proves it was not done; for it this had been done by men who were competent to make such examinations, and who realized what a powerful pathogenic influence they exert, no surgery would have been done at that time and Valentino would probably be alive today. Granting that he had appendicitis and gastric ulceration in active form : to reach that stage he must have passed through preceding stages of gradual development from were functional derangement onward to actual tissue changes and degeneration.

Gross, terminal pathology does not appear suddenly. Physical organic lesions are always preceded by mental and physical functional derangements, which manifest themselves in perceptible symptoms. During the entire period when such morbid changes are taking place there is progressive loss of vitality and resistance, so that when a neglected or medically untreated case reaches a critical stage a very serious problem is presented. It does not by any means follow that immediate operation is the best or only course to pursue. Such a patient may be and often is not in condition to safely bear an immediate or early operation.

It is not necessary in the majority of such cases to draw the line sharply between medical and surgical conditions in order to determine whether the welfare and safety of the patient will best be conserved by operation or by medical and hygienic treatment. Every such case has its medical and psychological aspects at all times-a fact far too often overlooked or denied by the surgically bent. The surgeon should always work in conjunction with the physician and psychoanalyst, and both or each should be governed by conservative principles, the right application of which involves far more careful consideration of all the factors, and especially the psychic factor, than is commonly given.

The disposition is to regard the case as wholly surgical and operation as the only proper course. From that point of view, because no other means of treatment are commonly known or employed, the tendency is to unduly hasten operation without giving time for proper rest, recuperation and preparation. Physicians having no knowledge of the law of cure, or of the marvellously soothing and healing power of potentiated, homoeopathic medicines in such cases and influenced by a false pathology, introduce another powerfully depressing and disorganizing element-namely, drugs. Pain and sleeplessness are treated by hypodermics of narcotics or anodynes.

The flagging heart action-perfectly natural under the circumstances-is stimulated by the deadly digitalis. Strychnin is administered to stimulate the spinal cord, the cardiac motor ganglia, the respiratory and vaso-motor-centers in the medulla, and to quicken the sensory nerves. Cathartics to whip up the tired, sluggish bowel and force it to act follow as a matter of routine, the while food-of course “light,” “liquid” or “predigested” – continues to be introduced at short intervals “to sustain the strength.” Thus every important clinical fact is misinterpreted, every law of vital economy violated and every dictate of common sense spurned.

It is silly, pathetic, ridiculous, exasperating or tragical, depending on the point of view and the mood of the independent observer. The plain demands and requirements of nature are entirely overlooked or misinterpreted in such treatment. A sick cat would know better. It would use teeth and claws to defend itself to the last of its nine lives from such physiological assaults, indignities and insults.

What such a s case needs above all else is rest-complete, natural, physical and physiological rest-not “stimulation”; rest for all the organs, but especially for the digestive organs. Every dose of crude drugs, every mouthful of food in such a condition is another nail in the coffin of the victim. The centers of vitality, the “wells of life,” are being poisoned. True rest is being made impossible, while life is ebbing hour by hour.

Put such a patient to bed in quiet, cheerful surroundings. Exclude noise and visitors. Stop the intake of all food. Give plenty of pure water, or diluted fruit juice, to drink and fresh air to breathe. Bathe gently. Apply heat or cold to the seat of pain whichever is most grateful or soothing to the patient. Encourage and reassure by simple explanations of the reasons for the procedures and friendly exhortations to patients, endurance and cooperation. Maintain and display quiet confidence. Prescribe and administer symptomatically-similar medicines in minimum doses according to the carefully noted indications. Avoid all drugs in “physiological doses” or for “physiological purposes.” Banish all “stimulation.” Promote normal rest and thus conserve the strength of every organ and tissue of the body.

Continue this course until nature responds and the patient is comfortable. It will not be necessary to wait long for results. Continue the fast until it is evident by the return of appetite and the natural desire for food that the digestive organs are rested and ready to resume work on a moderate scale.

A patient may remain thus resting without food under such conditions for many days and he be infinitely the better for it. The idea that food must be given to keep up the strength in such cases is false and delusive. Nature teaches this by abolishing the appetite and desire for food; by lessening the salivary, gastric, hepatic and intestinal secretions; by slowing down all the functions; and emphasizes it by the weakness, fever, pain and restlessness which ar all symptoms of toxemia. Nine-tenths of them have their origin in the gastro-intestinal tract, caused by the putrefaction of food it is incompetent to handle, and which should not have been taken. This interpretation is verified by the fact that improvement almost invariably begins as soon as the intake of food is stopped and nothing is allowed but water to quench thirst.

In thus presenting the case the fact has not been overlooked that there are cases of appendicitis in which immediate operation is imperative-cases of the “fulminating” type in which abscess, perforation or gangrene supervene suddenly or very rapidly. But even in these cases, which are comparatively rare, the suddenness is only seeming and the hygienic measures are not contraindicated. Every one of them has had premonitory symptoms, invasion, development, progress, perhaps obscure or unobserved, prior to the final explosion.

In these also, it is just as important to consider the psychic and morphological factors (and stop the intake of food) as in the other and more common type of cases; for, to some extent at least, the form and extent of the operative work and the post operative treatment may be modified to the great advantage of the patient by the knowledge thus gained. Reaction to anaesthetics, to the sick of operation and to after-treatment differs in accordance with individual difference of morphology-of constitution and temperament and mental characteristics. These differences should be sought for and made the subject of careful study in every case.

That the coarse-grained, heavily muscled, show-moving, dull- minded individual will react very differently, from the sensitive, high-strung, nervous, quick-moving, intellectual individual is probably known to every one. There are many intermediate types; but how often do even these most extreme differences enter into the diagnostic procedure and conclusions of the physician or surgeon when considering a case ?.

Do they commonly influence or modify treatment, medically or surgically? No so that it can be noticed, so far as the reports show.

Right here lies the explanation of a large percentage of medical and surgical failures, partial or complete.

There can be no doubt in the unprejudiced, thinking mind that the observance of the foregoing suggestions, in as very common class of medical and surgical cases, would prevent a large proportion of the catastrophes which all to frequently cut short precious lives and rend the hearts of sympathizing and solicitous communities. These two Satanic agencies, the use of poisonous drugs, masquerading under the name of “physiological medicine,” and unnecessary feeding to sustain the strength,” are responsible for untold suffering, disease and death. They are twin superstitions of ancient origin and tenacious hold. They should be abolished.

The restoration to honor and practice of that other ancient but honorable measure-the First-would go far toward solving many medical problems. If to the fast were added the equally ancient and honorable psychological recourse-Prayer and the Confession of Sins-many spiritual as well as physical problems would disappear.

“Prayer and fasting”-plus good homoeopathic prescribing (more honored in these days in the breach than in the observance) would certainly put a crimp in the unholy ambition of reckless physicians and surgeons and hasten the medical millennium.

Stuart Close
Stuart Close