Medicine - The New School of Medicine
( Originally Published 1905 )
The nineteenth century has witnessed a revolution in the treatment of disease, and the growth of a new school of medicine. The old schools—regular and homoeopathic—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 characteristic of the New School is 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 some-times to be ordered for the sake of their 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 sceptical spirit fostered by Paris, Vienna and Boston physicians, and, above all, the valuable lesson of homoeopathy, 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 homoeopathic practitioners was greater than among those of the regular school. A new school of practitioners has arisen which cares nothing for homoeopathy 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, than that he should employ 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 think 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 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 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, 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 lighten 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 which doctors in this country derive from persons under forty. From the senile contingent—these 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 myxoedema. 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 anti-toxins 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 pharmacopoeias 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 doctors often overlook or are ignorant of our own faith-cures, we are just a wee bit too sensitive about those per-formed outside our ranks. We 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 Lacedemonian 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 Esculapius, 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 Beaupre 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 avail-able today in everyday 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 anaesthesia, 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, which 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 labour 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, while its indiscriminate employment 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 with 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 bound-less credulity and excitability of mankind upon subjects connected with medicine."