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The propensity of certain neurotic characters for securing repeated surgical operations is a phenomenon even more familiar to the surgeons than to the psychoanalysts. When a patient submits to a surgical operation at least two persons are concerned—the patient and the surgeon. Naturally, unconscious motives determine the surgeon's behavior in operating no less than the patient's behavior in submitting to the operation. A consideration of the unconscious motives of surgeons in general would lead us too far astray, although in passing we may point out the obvious conclusion that surgery is a very immediate sublimation of sadistic impulses. It is true that psychoanalysis, teaching and the practice of medicine may also be sublimated sadism, but less immediate in form.
But if surgery is truly a sublimation and not merely a neurotic disguise, objective factors alone, i.e., the realities of infection, deformity, hæmorrhage, etc., will determine the decision to operate, so far as the surgeon is concerned. Unfortunately, even the most superficial inspection of surgical practice must dissuade us from this optimistic view. Leaving aside all secondary conscious motives for operating other than those provided by reality, we realize that much surgery betrays evidences of being undisguised sadism.
Certainly there is nothing in the practice of medicine so barbarous and so fraught with psychological danger as the prevalent custom of taking a child into a strange white room, surrounding him with white-garbed strangers, exhibiting queer paraphernalia and glittering knives and at the height of his consternation pressing an ether cone over his face and telling him to breathe deeply. The anxiety stimulated by such horrors is probably never surpassed in the child's subsequent life. Also the way in which surgery is proposed to