Surely my act of kindness should not become an obligation for the future, nor should the fact that I conferred a benefit of my own free will constitute a reason that I should be ordered to do it against my will; neither should it become customary that once a "man has cured anybody, he must for ever treat all those whom his former patient wishes him to treat. Under those conditions we should have elected our patients to be our masters, paying them, too, by playing slave to them and executing all their orders. What could be more inequitable than this? Because I restored you to health in this way when you had fallen severely ill, do you think that you are therefore empowered to abuse my skill?

That is what I might have said if what he enjoined upon me were possible, and I were refusing to obey him in absolutely everything, and under compulsion. But as things are, consider now what his commands are like. “Since you have cured me,” says he, “from insanity, since my wife too is insane and has the same symptoms” (for so he thinks), “and has been given up by others in the same way, and since you can do everything, as you have shown, cure her too and free her forthwith from the disorder.”” That, to hear it so simply put, might seem very reasonable, particularly to a layman, inexperienced in matters of medicine. But if you will listen to my plea on behalf of my profession, you will discover that all things are not possible to us, that the natures of ailments are not alike, that the cure is not the same or the same medicines effective in all cases; and then it will be clear that there is a great difference between not wishing to do a thing and not being able. Suffer me to indulge in scientific discourse about these matters, and do not consider my discussion of them tactless, beside the point, or alien and unseasonable.

In the first place, the natures and temperaments of human bodies are not the same, although they are admittedly composed of the same elements, but some contain more, or perhaps less, of this, others of that. And I say further that even the bodies of males are not all equal or alike either in temperament or in constitution. So it is inevitable that the diseases which arise in them should be different both in intensity and in kind, and that some bodies should be easy to cure and amenable to treatment, while others are completely hopeless, being easily affected and quickly overcome. Therefore, to think that all fevers or consumptions or inflammations of the lungs or madnesses, if of one and the same kind, are alike in all bodies is not what one expects of sound-minded, sensible men who have investigated such matters. No, the same ailment is easy to cure in this person but not in that. Just so, I take it, with wheat; if you cast the same seed into different plots of ground, it will grow in one way in the ground that is level, deep-soiled, well watered, blessed with sunshine and breezes, and thoroughly tilled, yielding a full, rich, abundant harvest, no doubt, but otherwise in a stony farm on a mountain, or in ground with little sun, or in the foothills; to put it generally, in different ways according to the various soils. So too diseases become prolific and luxuriant or less so through the soils which receive them. Omitting this point and leaving it entirely uninvestigated, my father expects all attacks of insanity in all bodies to be alike and their treatment the same.

In addition to these important distinctions, it is easy to grasp the fact that the bodies of women differ very widely from those of men, both in respect to the dissimilarity of their diseases and in respect to one’s hopefulness or despair of a cure. For the bodies of men are well-knit and sinewy, since they have been trained by toils and exercises, and by an open-air life; but those of women are weak and soft from being reared indoors, and white for lack of blood, deficiency of heat, and an excessive supply of the moist humour. They are therefore more susceptible than those of men, prone to diseases, intolerant of medical treatment, and above all, more liable to attacks of insanity; for since women have much bad temper, frivolity, and instability, but little physical strength, they easily fall into this affection.

It is not right, then, to ask of the physicians the same treatment for both, when we know that there is a great gulf between them, dissociated as they have been from the very first in their entire mode of life, and in all their activities and all their pursuits. So when you say “It is a case of insanity,” add, “insanity in a woman,” and do not confuse all these variations by subsuming them under the title of insanity, which seems always one and the same thing, but distinguish them, as is right, in their nature and see what can be done in each case. That is what we do, for, as I remember telling you in the beginning of my speech, the first thing that we consider is the constitution and temperament of the patient’s body, what quality predominates in it, whether it is inclined to be hot or cold, whether it is vigorous or senile, tall or short, fat or lean, and everything of that sort. In short, if a man examines into these matters to begin with, he will be very trustworthy when he expresses any doubt or makes any promise.