our skill and
intelligence in combating the one and assisting the other.

Valuable and helpful as courage and confidence in the sick-room are,
they are but a broken reed which will pierce the hand of him who leans
upon it too heavily, be he patient or physician. We can all recall, as
among our saddest and most heart-breaking experiences, the cases of
fatal disease, which were well-nigh hopeless from the start, and yet in
which the sufferers expressed, and maintained to the last moments of
conscious speech, a bright and pathetically absolute confidence in our
powers of healing, based upon our success in some previous case, or upon
their own irrepressible hopefulness.

Even the deadliest and most serious of infectious diseases, consumption,
has--as is well known--as one of its prominent symptoms an irrepressible
hopefulness and confidence that they will get well, on the part of a
considerable percentage of its victims. This has even been formally
designated in the classical medical treatises as the "_Spes Phthisica_,"
or "Consumptive Hope." But these hopeful consumptives die just as surely
as the depressed ones; in fact, if anything, in a little larger
proportion. It well illustrates the other side of the shield of hope and
confidence, the danger of unwavering expectancy, in that it is chiefly
those who are early alarmed and turn vigorously to fight the disease
under intelligent medical direction, who make the recoveries. Too serene
a courage, too profound a confidence in occult forces, is only a form of
fatalism and a very dangerous one.

Broadly speaking, mental states in the sick-room are a pretty fair
index--I don't mind saying, product--of bodily states. Hopefulness and
confidence are usually favorable signs, for the reason that they are
most likely to be displayed by individuals who, although they may be
seriously ill, are of good physique, have high resisting power, and
will make a successful fight against the disease. So, roughly speaking,
courage and hopefulness are good omens, on purely physical grounds.

But these are only rough indications of probabilities, not reliable
signs; and as a rule we are but little affected by either the hopes or
the fears of our patients in making up our estimate of their chances.
The only mental symptom that weighs heavily with us is indifference.
This puts us on the lookout at once. So long as our patients have a
sufficiently vivid and lively fear of impending death, we feel p