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too well informed to do that."

  "No, I wasn't thinking of that sort of thing.  Every doctor

has references available and he can always come up with something which is at least officially recommended for the situation he is dealing with. No, I was thinking of the thousand trivial instances where a patient comes to an internist, not with a simple disturbance which calls for a simple and objective measure - those visits are really surprisingly rare. Usually the problem is oblique, to say the least; the symptom is more or less symbolic and the answer wanted is, therefore, mystic. Partly this arises because the patient is not willing to be factual, partly because he is activated by superstitions and does not recognize it because he feels that he is above "ignorant superstitions." With reference to the category of the symbolic symptoms I can remember one of the first patients I ever had, a woman who came in complaining of undue fatigue, I took a careful history, did a complete examination and received the blood counts and urine analysis, but found nothing to account for the complaints. "I didn't really come for all of this," she said. "I just wanted you to give me a tonic." This left me nonplussed and while she was dressing I slipped down the hall to [crossed out: another] older internist who was in the same office. "Fred," I said, "what in the world do you do if a patient comes in demanding a tonic? What do they mean?" "They mean they want their husbands to get a new washing machine or leave the car for them." "What in the world should I do about that?" "Give them what they ask for. Anything you want, just as it's dark and bitter and smells very bad. I'll write down some of them, if you like, just to get started with."

  I took the notations and went back to my patient.  As I

looked over my notes I had a quick vision of myself plodding home from my office every afternoon thinking of the placebos I had spent the afternoon prescribing, the substances being ever blacker and more malodorous and myself more compromised. So I explained to the stupefied Mrs. B that there was really no such thing as a tonic, that is, a medicine