The Disinherited (25-29)

My kindness of the past is not to be my duty of the future; a voluntary favour is not to be turned into an obligation to take unwelcome orders; the principle is not to be established that he who once cures a man is bound to cure any number of others at his bidding ever after. That would be to appoint the patients we cure our absolute masters; we should be paying them, and the fee would be slavish submission to their commands. Could anything be more absurd? Because you were ill, and I was at such pains to restore you, does that make you the owner of my art?

All this I could have said, if the tasks he imposed upon me had been within my powers, and I had declined to accept all of them, or, on compulsion, any of them. But I now wish you to look further into their nature. ‘You cured me of madness (says he); my wife is now mad and in the condition I was in (that of course is his idea); she has been given up as I was by the other doctors, but you have shown that nothing is too hard for you; very well, then, cure her too, and make an end of her illness.’ Now, put like that, it sounds very reasonable, especially in the ears of a layman innocent of medical knowledge. But

To begin with, human bodies differ in nature and temperament; compounded as they admittedly are of the same elements, they are yet compounded in different proportions. I am not referring at present to sexual differences; the male body is not the same or alike in different individuals; it differs in temperament and constitution; and from this it results that in different men diseases also differ both in character and in intensity; one man’s body has recuperative power and is susceptible to treatment; another’s is utterly crazy, open to every infection, and without vigour to resist disease. To suppose, then, that all fever, all consumption, lung-disease, or mania, being generically the same, will affect every subject in the same way, is what no sensible, thoughtful, or well-informed person would do; the same disease is easily curable in one man, and not in another. Why, sow the same wheat in various soils, and the results will vary. Let the soil be level, deep, well watered, well sunned, well aired, well ploughed, and the crop will be rich, fat, plentiful. Elevated stony ground will make a difference, no sun another difference, foothills another, and so on. Just so with disease; its soil makes it thrive and spread, or starves it. Now all this quite escapes my father; he makes no inquiries of this sort, but assumes that all mania in every body is the same, and to be treated accordingly.

Besides such differences between males, it is obvious that the female body differs widely from the male both in the diseases it is subject to and in its capacity or non-capacity of recovery.

It is quite unfair, then, to expect the physician to cure both sexes indifferently; we must recognize how far apart they are, their whole lives, pursuits, and habits, having been distinct from infancy. Do not talk of a mad person, then, but specify the sex; do not confound distinctions and force all cases under the supposed identical title of madness; keep separate what nature separates, and then examine the respective possibilities. I began this exposition with stating that the first thing we doctors look to is the nature and temperament of our patient’s body: which of the humours predominates in it; is it fullblooded or the reverse; at, or past, its prime; big or little; fat or lean? When a man has satisfied himself upon these and other such points, his opinion, favourable or adverse, upon the prospects of recovery may be implicitly relied upon.