The century has witnessed a revolution in the treatment of disease,
and the growth of a new school of medicine. The old schools—regular
and homœopathic—put their trust in drugs, to give which was the
alpha and the omega of their practice. For every symptom there were
a score or more of medicines—vile, nauseous compounds in one case;
bland, harmless dilutions in the other. The new school has a firm faith
in a few good, well-tried drugs, little or none in the great mass of
medicines still in general use. Imperative drugging—the ordering
of medicine in any and every malady—is no longer regarded as the
chief function of the doctor. Naturally, when the entire conception
of the disease was changed, there came a corresponding change in our
therapeutics. In no respect is this more strikingly shown than in our
present treatment of fever—say, of the common typhoid fever. During
the first quarter of the century the patients were bled, blistered,
purged and vomited, and dosed with mercury, antimony, and other
compounds to meet special symptoms. During the second quarter, the
same, with variations in different countries. After 1850 bleeding
became less frequent, and the experiments of the Paris and Vienna
schools began to shake the belief in the control of fever by drugs.
During the last quarter sensible doctors have reached the conclusion
that typhoid fever is not a disease to be treated with medicines, but
that in a large proportion of all cases diet, nursing, and bathing
meet the indications. There is active, systematic, careful, watchful
treatment, but not with drugs. The public has not yet been fully
educated to this point, and medicines have sometimes to be ordered for
the sake of the friends, and it must be confessed that there are still
in the ranks _antiques_ who would insist on a dose of some kind every
few hours.
The battle against poly-pharmacy, or the use of a large number of drugs
(of the action of which we know little, yet we put them into bodies of
the action of which we know less), has not been fought to a finish.
There have been two contributing factors on the side of progress—the
remarkable growth of the skeptical spirit fostered by Paris, Vienna,
and Boston physicians, and, above all, the valuable lesson of
homœopathy, the infinitesimals of which certainly could not do harm, and
quite as certainly could not do good; yet nobody has ever claimed that
the mortality among homœopathic practitioners was greater than among
those of the regular school. A new school of practitioners has arisen
which cares nothing for homœopathy and less for so-called allopathy.
It seeks to study, rationally and scientifically, the action of drugs,
old and new. It is more concerned that a physician shall know how to
apply the few great medicines which all have to use, such as quinine,
iron, mercury, iodide of potassium, opium, and digitalis, rather than a
multiplicity of remedies the action of which is extremely doubtful.
The growth of scientific pharmacology, by which we now have many
active principles instead of crude drugs, and the discovery of the art
of making medicines palatable, have been of enormous aid in rational
practice. There is no limit to the possibility of help from the
scientific investigation of the properties and action of drugs. At any
day the new chemistry may give to us remedies of extraordinary potency
and of as much usefulness as cocaine. There is no reason why we should
not even in the vegetable world find for certain diseases specifics of
virtue fully equal to that of quinine in the malarial fevers.
One of the most striking characteristics of the modern treatment
of disease is the return to what used to be called the natural
methods—diet, exercise, bathing, and massage. There probably never
has been a period in the history of the profession when the value
of _diet_ in the prevention and the cure of disease was more fully
recognized. Dyspepsia, the besetting malady of this country, is largely
due to improper diet, imperfectly prepared and too hastily eaten. One
of the great lessons to be learned is that the preservation of health
depends in great part upon food well cooked and carefully eaten. A
common cause of ruined digestion, particularly in young girls, is the
eating of sweets between meals and the drinking of the abominations
dispensed in the chemists’ shops in the form of ice-cream sodas, etc.
Another frequent cause of ruined digestion in business men is the
hurried meal at the lunch-counter. And a third factor, most important
of all, illustrates the old maxim, that more people are killed by over
eating and drinking than by the sword. Sensible people have begun to
realize that alcoholic excesses lead inevitably to impaired health. A
man may take four or five drinks of whiskey a day, or even more, and
thinks perhaps that he transacts his business better with that amount
of stimulant; but it only too frequently happens that early in the
fifth decade, just as business or political success is assured, Bacchus
hands in heavy bills for payment, in the form of serious disease of the
arteries or of the liver, or there is a general breakdown. With the
introduction of light beer there has been not only less intemperance,
but a reduction in the number of the cases of organic disease of the
heart, liver, and stomach caused by alcohol. While temperance in
the matter of alcoholic drinks is becoming a characteristic feature
of Americans, intemperance in the quantity of food taken is almost
the rule. Adults eat far too much, and physicians are beginning to
recognize that the early degenerations, particularly of the arteries
and of the kidneys, leading to Bright’s disease, which were formerly
attributed to alcohol, are due in large part to too much food.
_Nursing._—Perhaps in no particular does nineteenth-century practice
differ from that of the preceding centuries more than in the greater
attention which is given to the personal comfort of the patient and to
all the accessories comprised in the art of nursing. The physician has
in the trained nurse an assistant who carries out his directions with a
watchful care, and who is on the lookout for danger-signals, and with
accurate notes enables him to estimate the progress of a critical case
from hour to hour. The intelligent, devoted women who have adopted the
profession of nursing, are not only in their ministrations a public
benefaction, but they have lightened the anxieties which form so large
a part of the load of the busy doctor.
_Massage and Hydrotherapy_ have taken their places as most important
measures of relief in many chronic conditions, and the latter has been
almost universally adopted as the only safe means of combating the high
temperatures of the acute fevers.
Within the past quarter of a century the value of _exercise_ in the
education of the young has become recognized. The increase in the means
of taking wholesome out-of-door exercise is remarkable, and should show
in a few years an influence in the reduction of the nervous troubles
in young persons. The prophylactic benefit of systematic exercise,
taken in moderation by persons of middle age, is very great. Golf and
the bicycle have in the past few years materially lowered the average
incomes of the doctors in this country as derived from persons under
forty. From the senile contingent—those above this age—the average
income has for a time been raised by these exercises, as a large
number of persons have been injured by taking up sports which may be
vigorously pursued with safety only by those with young arteries.
Of three departures in the art of healing, brief mention may be made.
The use of the extracts of certain organs (or of the organs themselves)
in disease is as old as the days of the Romans, but an extraordinary
impetus has been given to the subject by the discovery of the curative
powers of the extract of the thyroid gland in the diseases known
as cretinism and myxœdema. The brilliancy of the results in these
diseases has had no parallel in the history of modern medicine, but
it cannot be said that in the use of the extracts of other organs for
disease the results have fulfilled the sanguine expectations of many.
There was not, in the first place, the same physiological basis, and
practitioners have used these extracts too indiscriminately and without
sufficient knowledge of the subject.
Secondly, as I have already mentioned, we possess a sure and certain
hope that for many of the acute infections antitoxins will be found.
A third noteworthy feature in modern treatment has been a return to
psychical methods of cure, in which _faith in something is suggested_
to the patient. After all, faith is the great lever of life. Without
it, man can do nothing; with it, even with a fragment, as a grain of
mustard-seed, all things are possible to him. Faith in us, faith in
our drugs and methods, is the great stock in trade of the profession.
In one pan of the balance, put the pharmacopœias of the world, all
the editions from Dioscorides to the last issue of the United States
Dispensatory; heap them on the scales as did Euripides his books in
the celebrated contest in the “Frogs”; in the other put the simple
faith with which from the days of the Pharaohs until now the children
of men have swallowed the mixtures these works describe, and the bulky
tomes will kick the beam. It is the _aurum potabile_, the touchstone of
success in medicine. As Galen says, confidence and hope do more good
than physic—“he cures most in whom most are confident.” That strange
compound of charlatan and philosopher, Paracelsus, encouraged his
patients “to have a good faith, a strong imagination, and they shall
find the effects” (Burton). While we often overlook or are ignorant of
our own faith-cures, doctors are just a wee bit too sensitive about
those performed outside our ranks. They have never had, and cannot
expect to have, a monopoly in this panacea, which is open to all, free
as the sun, and which may make of every one in certain cases, as was
the Lacedemon of Homer’s day, “a good physician out of Nature’s grace.”
Faith in the gods or in the saints cures one, faith in little pills
another, hypnotic suggestion a third, faith in a plain, common doctor
a fourth. In all ages the prayer of faith has healed the sick, and
the mental attitude of the suppliant seems to be of more consequence
than the powers to which the prayer is addressed. The cures in the
temples of Æsculapius, the miracles of the saints, the remarkable
cures of those noble men, the Jesuit missionaries, in this country,
the modern miracles at Lourdes and at St. Anne de Beaupré in Quebec,
and the wonder-workings of the so-called Christian Scientists, are
often genuine, and must be considered in discussing the foundations of
therapeutics. We physicians use the same power every day. If a poor
lass, paralyzed, apparently, helpless, bed-ridden for years, comes to
me, having worn out in mind, body, and estate a devoted family; if she
in a few weeks or less by faith in me, and faith alone, takes up her
bed and walks, the saints of old could not have done more. St. Anne and
many others can scarcely to-day do less. We enjoy, I say, no monopoly
in the faith business. The faith with which we work, the faith, indeed,
which is available to-day in every-day life, has its limitations. It
will not raise the dead; it will not put in a new eye in place of a
bad one (as it did to an Iroquois Indian boy for one of the Jesuit
fathers), nor will it cure cancer or pneumonia, or knit a bone; but,
in spite of these nineteenth-century restrictions, such as we find it,
faith is a most precious commodity, without which we should be very
badly off.
_Hypnotism_, introduced by Mesmer in the eighteenth century, has
had several revivals as a method of treatment during the nineteenth
century. The first careful study of it was made by Braid, a Manchester
surgeon, who introduced the terms hypnotism, hypnotic, and nervous
sleep; but at this time no very great measure of success followed
its use in practice, except perhaps in the case of an Anglo-Indian
surgeon, James Esdaile, who, prior to the introduction of anæsthesia,
had performed two hundred and sixty-one surgical operations upon
patients in a state of hypnotic unconsciousness. About 1880 the French
physicians, particularly Charcot and Bernheim, took up the study,
and since that time hypnotism has been extensively practised. It may
be defined as a subjective psychical condition, what Braid called
nervous sleep, resembling somnambulism, in which, as Shakespeare says,
in the description of Lady Macbeth, the person receives at once the
benefit of sleep and does the effects or acts of watching or waking.
Therapeutically, the important fact is that the individual’s natural
susceptibility to suggestion is increased, and this may hold after the
condition of hypnosis has passed away. The condition of hypnosis is
usually itself induced by suggestion, requesting the subject to close
the eyes, to think of sleep, and the operator then repeats two or three
times sentences suggesting sleep, and suggesting that the limbs are
getting heavy and that he is feeling drowsy. During this state it has
been found that the subjects are very susceptible to suggestion. Too
much must not be expected of hypnotism, and the claims which have been
made for it have been too often grossly exaggerated. It seems, as it
has been recently well put, that hypnotism “at best permits of making
suggestions more effective for good or bad than can be done upon one
in his waking state.” It is found to be of very little use in organic
disease. It has been helpful in some cases of hysteria, in certain
functional spasmodic affections of the nervous system, in the vicious
habits of childhood, and in suggesting to the victims of alcohol and
drugs that they should get rid of their inordinate desires. It has
been used successfully in certain cases for the relief of labor pains,
and in surgical operations; but on the whole, while a valuable agent
in a few cases, it has scarcely fulfilled the expectations of its
advocates. It is a practice not without serious dangers, and should
never be performed except in the presence of a third person, and its
indiscriminate practice by ignorant persons should be prevented by law.
One mode of faith-healing in modern days, which passes under the
remarkable name of Christian Science, is probably nothing more than
mental suggestion under another name. “The patient is told to be calm,
and is assured that all will go well; that he must try to aid the
healer by believing that what is told him is true. The healer then,
quietly but firmly, asserts and reiterates that there is no pain, no
suffering, that it is disappearing, that relief will come, that the
patient is getting well.” This is precisely the method which Bernheim
used to use with such success in his hypnotic patients at Nancy,
iterating and reiterating, in a most wearisome way, that the disease
would disappear and the patient would feel better. As has been pointed
out by a recent writer (Dr. Harry Marshall), the chief basis for the
growth of Christian Science is that which underlies every popular
fallacy: “Oliver Wendell Holmes outlined very clearly the factors
concerned, showing (a) how easily abundant facts can be collected
to prove anything whatsoever; (b) how insufficient ‘exalted wisdom,
immaculate honesty, and vast general acquirements’ are to prevent an
individual from having the most primitive ideas upon subjects out
of his line of thought; and, finally, demonstrating ‘the boundless
credulity and excitability of mankind upon subjects connected with
medicine.’”