THE MACHINERY OF THE BODY.
IT is lightly said that people who think much about their health generally lapse into hypochondria. It is arguable that the result of careful thought about the condition of one's body might very well he the converse ; and there is at least one group of people whose experience proves that argument to be true of themselves. Much depends on the intellectual approach to the question. The mental roads that lead in the one case to pride and confidence in what may be called the upkeep of the body, and in the other case to morbid misgiving, so that every chance pain and ailment appears as the symptom of a mortal illness, and every anxiety is aggravated by a passing acquaintance with the terms of medical science, are no doubt very difficult to define. For rational and well-
balanced persons an extensive knowledge of the human body must be an advantage. One may imagine them regarding the working of their bodies as a skilled mechanic watches the running of a motor. The mechanic forestalls the wants of the engine according to the stresses put upon it, and certainly the ideal mental attitude towards the human body is, while
never being afraid of it, to attend to it carefully as a com- plicated piece of machinery that needs continual watching and
overhauling. As the motor sends forth its unmistakable signs of labouring, so the human machinery gives its equivalent nervous signals of distress. The mechanic when he hears
strange sounds in his engine does not jump to the conclusion that all is up with it; and there is no more reason why a man should fall into the habit of supposing that his bodily machinery is past repair. But of course the competent mechanic, unlike the ordinary man in relation to his, body, is seldom taken unawares by puzzling but undeniable signs of something being wrong. He overhauls his engine regularly and prevents defects from developing.
Sir Horace Plunkett, who is famous for his faculty of translating principles into practice, deserves our consideration when he appeals for a more ordered fashion among educated people of attending to their bodily machinery and of conduct- ing their relations with the professors of medical science. In Some Tendencies of Modern Medicine (Dublin : Eason and Son. 6d.) he writes frankly as a layman who has read but one technical book on medicine in his life. The prejudice of the medical profession against lay dabblers is strong, but that prejudice cannot, or at least ought not to, touch an argument such as Sir Horace Plunkett offers. "How it strikes a layman" is always a valuable contribution to the true professional who may often need the intellectual assent of his thinking patients. The substance of Sir Horace Plunkett's pamphlet was delivered as a lecture in the theatre of the Royal Dublin Society last March. "The national health," he says in an introductory note, " demands above all things a, widely-spread knowledge of hygienic principles. If in the wealthier classes of society this knowledge is deficient no efforts to bring it home to the poorer classes of the population will avail ; for, absurd as it seems, fashion plays a part only second to science in medical practice." We think it was Sir T. S. Clouston who coined the good phrase a " health con- science " to describe the sense which people ought to cultivate of the national importance of hygiene. We fear that a good example in the elementary regimen of health will descend through the strata of society much more slowly than fashions in clothes. The figure of the mother at the inquest who says with pathetic pride when asked what her dead baby used to be fed on, "It always 'ad what we 'ad," or words to that effect, is unfortunately too familiar. Sir Horace Plunkett is always definite, and he proposes that a method, of which he had personal experience in the United States, of exceptionally careful and thorough examination of the human body before a treatment is suggested, or even before any treatment may be required, should be more readily available in the United Kingdom. He admits that all the methods of diagnosis with which he became acquainted in the United States are known and practised at home, but nowhere at home, he believes, are all the necessary equipments and specialists assembled in one institution. The human machinery, in other words, cannot get a perfectly skilled and complete overhaul except at the cost of visits to various specialists in. -various places.
But we must come without delay to the account of the experience in America which is the basis of Sir Horace Plunkett's thoughts. What we have said already has implied that what he wants to see established is a better co-operation between the patient and the doctor. He appeals for " a saner attitude on the part of the better-educated lay public towards the science of medicine " and for a " more educational" practice on the part of doctors. The patient is not to be discouraged from thinking about himself but to be taught to do so. Sir Horace Plunkett found the principles he has since learned to admire at work at the Battle Creek Sanitarium (as it is called), in Michigan. He had heard of this institution some time before, and of its connexion with a religious sect and its excessive vegetarianism, and be had been strongly prejudiced against it. He found, however, that the institution was genuinely philanthropic, and that the staff made sacrifice of worldly prosperity in a missionary spirit. But that is by the way. Of the methods of the institution Sir Horace Plunkett writes :-
" In the first days of the Sanitarium my apprehensions were intensified. My fellow guests—for they do not call themselves patients—seemed too fond of discussing their own and each other's symptoms, and were quite ready to take an interest in mine. I noticed, however, that they had far more medical knowledge than our doctors usually consider it prudent to impart. But I soon found that the doctors were thoroughly justified by this part, to my mind the most important part, of their procedure— the education of the patient, so as to secure his intelligent co-operation. Of this I shall speak presently, but I must say here that, so far from inducing morbid introspection and chronic hypo- chondriasis, the system seemed to be productive of a most salutary optimism. The moral atmosphere of the institution was wholly healthy, and calculated to engender a fine outlook to life. All the guests with whom I struck up an acquaintance exhibited the same attitude—a characteristically American attitude I may add —towards the treatment they were receiving. Among them were business men with large responsibilities, ministers of religion, University professors, judges, journalists, and others engaged in literary work, doctors, and professional men of various occupa- tions. Many of both sexes were engaged in social service. Every one of this miscellaneous company of health-seekers talked as if he had been given his first real chance to understand himself and to increase his efficiency. They were all convinced that they had entered upon a new epoch in their lives.
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To describe the diagnosis in detail is wholly unnecessary, but an indication of its thoroughness may be given. I was asked to tell everything I could remember about my family and personal history, my past ailments, treatments, and so forth. I was then examined externally from head to foot, note being taken of the reflex actions wh ich indicate nervous conditions. Everything capable of chemical or bacteriological analysis was analysed by the proper specialists in the several laboratories. My blood-pressure was taken. Innutrition being obvious, the test meal—a kind of forcible unfeeding—was resorted to. A skiagram of my stomach and the entire intestinal tract is serving anonymously for popular instruction—or perhaps as a warning—in the Sanitarium lecture lantern. A careful observation of the actual working of my internal economy at intervals during some forty-eight hours was also carried out in the X-ray department, which I am told by com- petent medical authority has earned a considerable reputation in European as well as American clinics. The strength of each principal muscle group in the body was recorded. In the pigeon- holes of the record office of the Sanitarium is filed away every material fact about my vile body, from such simple facts as my weight and strength, which I could find out myself, to my opsonic index and blood count, which only excite my curiosity. I got them to give me a copy of my complete diagnosis. I do not understand a tenth part of it—I suppose any doctor would under- stand it all—but what strikes me chiefly about it is that every determination of a condition or fact—and of these there are some hundreds—by the numerous specialists who are engaged in the several departments of the institution, is committed to writing, and capable of verification by any outside adviser I choose to consult. Such is my personal feeling about the Battle Creek procedure in arriving at an understanding of a case that if I were in need of medical advice, and out of reach of my own professional adviser, I would far rather consult a fresh physician by post, enclosing my Battle Creek documents, than present myself for diagnosis and treatment in the conventional way."
We need not go into the routine to which Sir Horace Plunkett submitted himself. Any man, woman, or child who lived by such regular rules as Sir Horace Plunkett accepted for the time being would be bound to profit by them, whether at Battle Creek or in his own home. Alas! most of us drink what we know is not very good for us because it is agreeable or because it is a key to companionship; we smoke for the same reasons; we eat dinner late in the evening because unless we could instantly reform the habits of society we should be cut off from society by refusing to fall in with its customs ; we decline to be vegetarians (even if we believe theoretically in vegetarianism, which personally we do not) because we enjoy dinner parties and fear to be an inconvenience to our hostess. Such are the reasons, trifling yet potent, that stand in the way of dietetic common sense. Sir Horace Plunkett himself was converted to a modified vegetarianism which admits eggs, milk, and milk products. But that is to us one of the least interesting of his conclusions. Nor are we impressed when Dr. Kellogg, the head of the Battle Creek Sanitarium, declares that for "tiger ferocity " (as, for instance, in the business of a prize-fighter, Sir Horace Plunkett having suggested that vegetarianism would be advanced if a vegetarian could knock out Jack Johnson) a carnivorous diet may be necessary. The logic seems almost too much like that of the African braves who eat lions' hearts to give them courage, or of the English bruisers who used to swallow gunpowder to give their blows an explosive force. We cannot agree, either, with Sir Horace Plunkett's assertion that medical science lags
behind the science of the age. The revolution of medical science by bacteriology during the past seventeen years or so is surely one of the most notable facts of our day. But we shall all approve the ideal of co-operation between doctor and patient, however difficult we may think it of attainment. The Insurance Act may only too easily work in the opposite direction. Mr. Sidney Webb has seen in the Act "an insidious and persistent tendency to a degradation of medical practice, ending, in the worst instances, in the lightning diagnosis ' and ' bottle of medicine' of the worst type of `sixpenny' charlatan—the strangulated hernia physicked as colic, and the cancer of the stomach as tea dyspepsia.' "
Sir Horace Plunkett—to summarize his argument—suggests the higher education of the patient, trusting to the patient's good sense to fortify him against morbidity ; the much wider recognition of the doctor's function as the preventer of break- downs in the machinery of the body by examining the machinery when no defects, or only doubtful defects, have as yet appeared ; and the possibility of regularly putting the results of an exhaustive examination of the body by an institution at the disposal of ordinary practitioners.
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