into the development of their cures by surgery because they have been looking at events so steadily from a materialistic standpoint; but I have become fully convinced that it does.

Surgeons are commonly rated according to the deftness and skill with which they execute their work. When we see a well-performed operation we are constrained to say that the operator is an excellent surgeon. And so he may be; but we should not forget that manipulative skill can be acquired by any one who possesses a good degree of mechanical ingenuity. I have seen carpenters capable of doing the finest cabinet work whose opinion on the construction of a building would be rated very low.

The true standing of a workman is determined by his character when placed beside those whose work has not only endured, but each part of which has borne a consistent relation to every other part. This means that we are to determine the value of work by the mental breadth of the doer and by the ultimate results of his doing.

Psychic Effect Determines Cure.

The foregoing has been said as introductory to the proposition that, even in surgery, the psychic effect determines very largely the result of treatment.

Effects are built upon the mental impressions received by the patient. Let one present himself to the surgeon for his opinion. The latter examines him with care and evinces much diagnostic skill. He looks seriously wise, and, after due thought, mildly advises an operation. He does not raise his patient's hope, nor does he, by

PSYCHIC EFFECT DETERMINES CURE.

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either word or demeanor, express much confidence in the results of the operation.

He operates.

The patient is returned to his bed and placed in the care of a nurse whose demeanor is not calculated to raise one's hopes. When the surgeon reappears he wears the same troubled look, and, in reply to interrogatories, still shows, beneath his platitudes and attitudes, a disheartening uncertainty.

Another patient presents himself to a surgeon of a widely different stamp. He may be neither as "scientific" nor as "experienced" as the other. The examination is not so exact, much being trusted to intuition; but the air with which the whole thing is done proves very taking to the patient. The operation is not coldly recommended, but is warmly insisted upon.

No time is to be lost in getting about it.

The patient goes to the table with an air of hopeful expectancy. He is not surprised to find himself still on earth when he wakes, and soon begins to talk of health and strength.

The

nurse is cheerful and reassuring, for the surgeon would tolerate no other. The surgeon is in and out with a smile and a word of pleasantry. There is sunshine in the air even though the shades be drawn.

Which of these patients, think you, is more likely to make a good recovery? I do not need to ask.

If we deem it wise to operate at all, it is wise to look for good results and lead the patient to expect the same, no matter how grave the procedure.

We are very apt to get what we cheerfully expect and to experience what we fear.

One is not long in surgery before learning that results are often out of proportion to the importance of the work done. What I mean is that the operation of powerful psychic forces soon becomes manifest. In one instance we see a patient, overburdened by life's cares and distresses and discouragements, submit willingly to an operation of only moderate severity. The ordinary effect of the operation is not of a depressing character, and yet, to our consternation, the patient fails to rally from his depression or hastens to a demise.

In another instance we find a patient in great distress of mind and body, presenting but few tangible symptoms and fewer still tissue changes. We do a minor operation, though there is little apparent demand for it. Mark the difference in results. The patient responds at once. feels relieved.

He

The fancied incubus has been removed and he becomes a well man.

Cause of Differing Results.

Now what is the meaning of all this? We say one has no constitution-no reserve force; while the other is full of the reactive power which is the rightful heritage of humanity. But what is constitution if not the result chiefly of habits of thought, going back, it may be, deeply into ancestry? What is physical resiliency if not the rebound which comes as the result of subconscious as well as conscious mental attitudes long maintained and energetically held. It is physical character resulting from a permanent effect produced on the subconscious activities.

But why should a simple and seemingly un

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necessary operation afford a patient so great relief? Because a patient recovers his normal feelings promptly after removal of a few papilla from the rectum is no positive evidence that those papilla were the cause of his troubles. We should not too hastily infer that removal of offending parts in any case is the sole, or even the most distinct, factor in the recovery that

ensues.

The point that I seek to make, and one which cannot be recognized too early in one's practice, is that psychic forces are at work; and that, if we avail ourselves of their aid, the results of treatment are likely to be satisfying.

Too Much Surgery.

But now I want to postulate that there is incontinent haste in the adoption of surgical measures. The pendulum has swung too far. It would not matter so much were not the consequences often disastrous to both health and life. But life is now jeoparded on the slightest pretext; and many lives are ruthlessly sacrificed to avarice and ambition.

Not long ago an eminent operator, in a paper presented to a State society,' recommended a certain procedure of a major character as a cure for ailments presenting typical surgical aspects, and alluded to it as "almost without danger.

In reply to a question concerning the mortality in his first hundred cases, which constituted the basis of his recommendations, he admitted a loss of six.

To be sure six per cent. does not seem like a heavy loss when we are operating for grave surgical conditions; but in this instance the ailments

were nearly all of a subjective type. If the mortality attending travel between New York and Chicago amounted to six in every hundred travel would certainly be interdicted by law, as it would be said to constitute wholesale butchery.

This same operator, in a quiet conversation after the meeting, said to me: "I don't suppose, Doctor Leavitt, that I value human life as highly as you do."

Too Little Discrimination.

The faults I have to find with modern surgery are (1) its prevalence and (2) its lack of sober discrimination between simple and grave procedures.

I insist that major surgery should be resorted to for only those ailments that assume grave characters and will not yield to milder measures. But the plea is that one might as well be dead as ill, and with this the surgeon justifies his assumption of the role of contingent executioner.

With the author, surgery is a chosen line of work, and he would love to do more of it, but he cannot accede to jeopardy of life on any but the best pretexts. I hope this will not be taken to represent a Pharisaical spirit. I only mean to say that it is not fair to the confiding patient to subject him to risk of life for the relief of troubles that may be cured in some other way.