COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 23626 RC81 .B76 Man and his maladies RECAP 'MM tv.wX'/Mv/K 5v«v.'.v«vv/4'.'-'- L4 «V« 4 •<%«'• • • ■ ' KsvXv* I'- r«% 4% /< 4% • i • N>>vX'Xs« < 'i' ' » 4 4 4 4 «4 4 4 4 4 4 » 4 t ■ . KwKv.'Xn'X •/. ■ 4 4 4 4 4 4% 4 4 4 4 4\ . £4*4 4 4 4V'^4 4 <• «'»% . Jl 4 4 4 4 4 4 4 4 4 * 4 * *. » r« 4 4 4 4 4 4 4 4 i4 * 4 4 < . y.<.' X'.V W4V4\-.^4'.' J^^^v,^V4^« ^ss r4 4 4 4 4 4 % \ \ \ i 4 \ * (:4:«X4y4V4V4y4;. V i.4j« .<«:''• XC'M'X'''-'-*-*'*-'''-*-*'''''*'' ix<;<>,<>^<.o.< ^l.liS!' yA^y, t\ 4 4 4^ 40 t 4 * * 4 4-4'4 4 4"4 4 4 4 4 4 * 4 ;:.:.M.: *<'»*'V 1l<:^«rif^a/ destruction of the body will result. The excess force having thus expended itself, health returns, but a less secure health than before, a con- dition of body that, if life is to reach its natural term, must have adapted to it a special environment. This is organic or structural disease. Finally, from feebleness of the body, or from the pres- ence of a very unusual force in the environment, the com- plete and rapid overthrow of the body may ensue. This is mortal disease^ merely an advanced degree of organic disease. Now, if the above view of disordered action in the hu- man body be correct — and let the reader remember that the principle it embodies is one unchallenged in physics, and the application of it to living organisms is chargeable to no less a scientist than Mr. Herbert Spencer — it follows of necessity that the symptoms of disease are the efforts of the bodily forces to attain re-equilibration or health, and must in rational treatment rather be fostered than com- bated, the cause of their appearance — the unusual force — being the only evil to be removed. Again, most heretical of conclusions, it will also follow that symi)toms cannot lead to organic disease, to structural decay, as they are, by even leading medical men, every day asserted to do, for it can only be the persistence of the cause of these symp- toms, the persistence of an unbalanced force, that can con- vert functional into oriranic disease. THE CAUSES OP ILL-HEALTH. 41 Thus, to seek a practical example, it cannot be said that the symptom called diarrhoea can, if neglected, produce dysentery, but it is the persistence of the cause that pro- duced the diarrhoea, the impossibility of getting at it and removing it, which is the cause of the dysentery. As far as the mere symptom, diarrhoea, is concerned, its aim is purely beneficial. To this argument, which, if correct, would prove ortho- dox medicine — at the best so notoriously unsuccessful, when subjected to practical tests, as to raise serious ques- tion as to the morality of its use among the higher ranks of those who now profess it— to be founded upon gross physical error, upon a misinterpretation of natural phe- nomena, the only serious reply that can be made is as fol- lows : May we not, say the advocates of the orthodox system, support, by means of suitably adapted physic, the body locally or generally, and thus enable it to withstand the effect of these adverse forces which threaten its de- rangement or its overthrow; just as, in the case of the Kentish rock, w^e might arrest, by exerting pressure on the side opposite to that on which another one was press- ing, the swaying movements. Certainly, but conditions, all wanting, are necessary to give success where the human body is concerned. In the first place, you must possess, in medicines proper, agents equal to the task, you must be able to control and localize their action, and you must obviously apply your counter-force at the right moment, the very start. Moreover, you must be able to gauge ex- actly the adverse forces. Now, the only agents that can generate force in conjunction with the bodily cells are foods, and these must be given prior to the attack of dis- ease. No known drug — if we except such drugs, e.g., cod-liver oil, as are really foods — has any power to gener- ate in the body any force, though some, of which nature 42 THE PRINCIPLES OF ILL-HEALTH. are the stimulants and tonics, can liberate force already stored in the cells, leaving the latter afterwards weakened raid palsied. In great emergencies, extending only over a few hours, and as a mere jo/*" aller, such stimulating treatment may in rare instances be recommended. Even then it is fraught with subsequent danger, while to attempt to apply it generally in disease would indeed be a midsum- mer madness. Again, of no medicine can the effect be really localized or controlled. The medicine, w^hich you wish to do merely one or two things, persists, when it en- ters the body, in effecting a dozen other changes that you do not desire. Yet more, you know nothing of the kind and intensity of the forces you wish to counteract, and but little of the direction in which they act. Who, for ex- am^^le, can pretend to give a real sketch of the order and variety of phenomena to which a single fever germ gives rise ? As a matter of fact, however, orthodox medicine never recommends really the combating of a cause, the opposi- tion to it of an equal force, a principle that would be in- telligent, even though its carrying out were plainly impos- sible; a brief study of the standard works on therapeutics will show that it tries to effect something very different, something easier, something indisputably wrong. It seeks the arrest of sj^mptoms after they have arisen. It com- bats these while deluding itself into the belief that it is sapping their causation. Now just imagine, in the case of the pendulum, what risks would attend the sudden arrest of the exaggerated movements which ensue on a disturb- ance of its equilibrium; the extra force must either be quickly distributed over the body that shall arrest these, or the pendulum itself will run the greatest risk of frac- ture. But no drug can, fortunately, act as a buffer to the symptoms of disease. What drugs do, what the thera- THE CAUSES OF ILL-HEALTH. 43 peutist does, is to direct the symptoms, to prevent the effects of the mischief passing off most easily by the chan- nel of the least resistance, that selected of necessity by Nature, and foolishly to distribute it over a dozen other ones. A diarrhoeic symptom is arrested, but the skin, lungs, and kidneys pay a heavy price, unknown to the pa- tient, for the questionable service. They must pay it, if the law that energy is indestructible be not an erroneous one. It would not be difficult, though it would occupy too much space, to show that, as regards the race of man, dis- ease itself is a benefit, cutting off the weaklings, improv- ing and rendering more secure the lives of the stronger; Avhile as regards the individual man the symptoms of dis- ease are his real friends, the only bulwarks between him- self and worse evils. The words of Pope may not inaptly close, for the pres- ent, this subject: " All nature is but art, unknown to thee; All chance, direction, which thou canst not see; All discord harmony not understood ; All partial evil, universal good ; And spite of pride, in erring reason's spite. One truth is clear, whatever is, is right." Having dealt with the rationale of the symptoms and consequences of loss of equilibrinm, of ill-health, let me seek in each of its dej)artments, the functional and the or- ganic, a homely illustration of the principles involved. Functional Disorder. — D., who has of late been much depressed in health by overwork and worry, goes to a ball, feeling somewhat fagged, but otherwise fairly well. He experiences fatigue in the course of an hour or two, which is relieved for a time by a few glasses of wine. He goes home at an earlier hour than is usual, and, though the 44 THE PRINCIPLES OF ILL-HEALTH. night be fairly mild, experiences on his way very distinct sensations of cold. After retiring to rest he finds it diffi- cult to get warm, and wakes up next morning with the ordinary symptoms of catarrh in the head, which, in twen- ty-four hours, extend to his chest and are accompanied for some days by slight feverishness, lessening of the appetite and of the excretions, an increase of thirst, and, in short, all the ordinary signs of a cold. The interpretation of the sequence here is easy. The worry which preceded his going to the ball weakened the action of the nervous system, and lessened the resisting powers of the body, so that even moderate cold, following upon the heat of the ball-room, by acting upon him as a force which his body could not balance, sufficed to pro- duce the malady. On his way home the contraction of the blood-vessels in the skin, brought into contact with a colder atmosphere, was a benefit; had it not occurred he would have lost heat rapidly by radiation, and might thereby have run a grave risk of death.. The nerves of the body, how*ever, failed to perform their ordinary duty, to distribute the extra blood thrown suddenly upon the internal organs evenly among the latter, and as a result the superficial layers of tissue in the throat, nose, and bronchial tubes, probably because they were most exposed to the action of the cold, were the chief seats of the symp- toms, and became congested, receiving more than their normal supply of blood. No one will surely deny that, in such a state of matters, this congestion, this symptom of derangement, was beneficial. Had it not occurred, had the blood-vessels not been susceptible of this dilatation they would have given way, would have burst, or a congestion of some other part, but still a congestion, and for the same reason beneficent, would have occurred. The bronchial and nasal congestions are followed by a secondary symp- THE SYMPTOMS OF DISEASE BENEFICIAL. 45 torn, for from the dilated blood-vessels begins to ooze fluid, and the more this fluid escapes, and the more the p&tient gets rid of it by coughing and clearing his throat and nose, the easier he becomes. The rapidity of breath- ing, another symptom, was equally beneficial, for, the nor- mal aerating power of the lungs being crippled by this congestion, a greater number of respirations was requi- site to perform the necessary amount of work. The les- sened appetite was another good, for, in the state of f ever- ishness, consequent on the chill, but little assimilation by the cells was possible, and food taken in the ordinary amounts would have taxed severely and injuriously the already lessened power of the kidneys and skin. Thirst was a benefit as tending to promote assimilation, to thin the blood, and to restore the functions of the kidneys. Even the feverishness, the rise of temperature, had its good uses, for, by lessening the intake of much food and consequent increase of the already excessive blood pressure in the internal organs, it promoted a return to health. So that really all the phenomena witnessed had, as sole end, a return as speedily as possible of the body to a nor- mal state, a return which is complete in a few days if the sufferer merely keeps in an equable and mild atmosphere — i. e., if he keeps the cause of his derangement at bay. If any form of artificial treatment be attempted it should, in this case, surely take the form of an imitation and as- sistance of those efforts which Nature is herself so wisely making to insure a return of the bodily equilibrium. Even then it would probably do more harm than good, since such treatment would be in the nature of a local stimula- tion, and, as such, would be followed speedily by reaction, Avhich latter process might lead to further dangerous mis- chief. If people could only often \\:itness a comparison 46 THE PEINCIPLES OF ILL-HEALTH. between the rate and perfection of recovery in cases where the derangement is allowed to run its course, and those in which it is actively interfered with, they w^ould be disillu- sioned of their reliance on drugs. They do not know how often the complications arising in a complaint are accred- ited to the malady and the recovery to the drug, whereas the recovery is due to the natural course of the malady, and, in at least half the cases, the complications are due to the drugs. This may seem too sw^eeping a statement, and yet if people will but remember that the methods of treating similar derangements by different medical men are usually widely different, and that out of all the adopt- ed plans but one can really be correct, they must agree Avith me that the j^ractice of medicine, unless built on very sure ground, on facts that can be demonstrated to be truths — whole truths, not the half-truths of the ordinary therapeutist — and pursued wdth the utmost caution, may well deserve the censure which Shakespeare puts into the mouth of Timon: " Trust not to the ph3'sician; His antidotes are poison, and he slays More than you rob." If, instead of seeking an example of this variety of loss of balance, in the case of a man whose bodily power is be- low par, we had chosen to instance a man of normal vigor exposed to the action of some, to him, unusual force, such as excessive cold and damp, we should have witnessed the same result as that already described, and the phe- nomena observed would have admitted of the same inter- pretation. Organic Disease. — We now turn to a class of derange- ment which is of much greater importance, to that which results in destruction of some portion of the body, and which renders the subsequent course of life an exceeding- ORGANIC DISEASE. 47 ly uncertain one, and Avbicli, unless the invalid can protect himself by an artificial environment suited to his damaged structure, must result in curtailment of life, while it always exposes the patient to grave risk of death from what, in secure health, would be called trivial causes. The following will serve as an illustration of this vari- ety of disorder: E., a London business man of middle age, unused for years to great muscular exertions, in place of his usual Margate holiday trip, taken oi faniille, accompanies some young friends in a rowing excursion on the Thames. A few days of such exertion, combined with the exposure to damp at night in the camping-out, which is a part of the programme, suffices to bring upon him all the symptoms of rheumatic fever, and to confine him for three or four months to a warm bedroom. At the end of that time he feels himself again, though his doctor has warned him that a valve in his heart has become incompetent by conse- quence of the violence of the attack of illness through which he has just passed. His body is now in a state of insecure, of really imper- fect equilibrium, one that under the ordinary, the former, conditions of life must lead to premature death. How comes it, then, that the patient feels as w^ell as ever ? Every day the forces in the environment are outbalancing the sum of the forces in the body; but where are the per- turbations due to this ? In the heart itself, which, by un- dergoing organic change in the shape of thickening of that cavity which is closed by the defective valve, is still effecting a balance. But this process must come to an end before long, for this forced expenditure of the energy in the heart cells must, under any circumstances, lead to their premature exhaustion, and thus to an arrest of their multi- plication and of their functions. The day of failure then 48 THE PKIXCIPLES OF ILL-HEALTH. comes ; henceforward the heart falls out of line with the other bodily organs. Suppose the old course of life to be still pursued, the symptoms attendant on the discrepancy between the bodily force and the forces resident in the conditions of this man's life now begin to be developed in other organs; the breathing becomes short and so on; but even these symptoms have, in the bodily condition now under review, an aim conservative of life. Later on, yet another beneficent symptom, dropsy, supervenes. But for this exudation of fluid from the distended blood-vessels, these latter must give way, or the current within them must be arrested, either of which events would cause death. Finally, even the limits within which dropsy can save our embarrassed patient are reached, and death re- sults. Gloomy as is such a record, it must strike the reader forcibly that the exercise of a little common-sense on the part of the patient might have done much for him. Had he, in the earlier stages, only cut down his environment, his habits of life, to the impaired structure of his body — life by such a course might have been saved, and even when his breathing became impaired, wise economy in re- spect of the demands made on his bodily powers must have secured a longer lease of life. Finally, in organic disease, the proportion between the forces in a body and those in its environment may be so dissimilar that death of the whole body may quickly re- sult. Thus a human body immersed in water is brought suddenly into contact with conditions normal to a fish or even to the mammalian whale, but incompatible with hu- man life. Under organic disease must also be classed every inher- ited structural change in the man. A few words of ex- planation will make this clear. We have in congenital CONGENITAL BODILY DEFECTS. 49 diseases, such as scrofula, goQt, inlierited syphilis, inher- ited insanity, idiocy, etc., examples of a sufferer starting in life with a structural flaw — ^never, from the very first, can he equilibrate properly the environment of healthier beings born under the same climatic conditions. We have in these cases a faulty, an imperfect, equilibrium from conception, the body being comparable to a badly made watch, which can never be made to indicate, for more than a very short period, the right time. We all know that such unfortunate individuals can never be placed on a par with their healthier neighbors of a similar age. We may, by "tempering the wind to the shorn lamb " — in other words, by artificially suiting the environment to the special conditions present — keep down, or avert for a time, further structural mischief; but the risk of such mischief is, as every practical man knows, at all times very great. These weaklings are the children of elderly, degenerating parents, or of parents with some, possibly latent and unsuspected, structural weakness. They are commonly the offspring of marriages of consanguinity, the children possessing a double dose, one from each pa- rent, of any family failing, and therefore exhibiting very markedly some one defect. The so-called tumors, new growths, such as cancers, fibroids, etc., never spring from degenerated tissues, for the vitality of the cells of such are exhausted, but from tissue possessing some balance of vital energy, which bal- ance is exhausted, or largely so, in the growth ; it is prob- able that cancers spring from embryonic cells, from cells that have, from various reasons, lain dormant — slept, as did the hare in the fable — during the race of life, and which some irritation has suddenly aronsed to life and excessive growth. The cancers, and other so-called malignant tumors, are 3 60 THE PEINCIPLES OF ILL-HEALTH. dangerous mainly by reason of the special adaptability of their cells to travel by the blood and lymph channels, and then to set up similar growths in other and distant parts of the body. CHAPTER lY. THE PRINCIPLES OF SCIENTIFIC jMEDICINE. TREATMENT BY ORDrNAEY MEASURES. Resume of position. The ordinary measures of treatment, food, climate, and liabit. — I. Foods. Rules to guide us in their administration. These rules as modified by disease. Food accessories and artificial digestive agents. — II. Climate. The purity, temperature, and humidity of the air and the effects of these on health. — III. Habits and modes of life. Fallacies of hygienists. General rules. CHAPTER IV. THE PRINCIPLES OF SCIENTIFIC MEDICINE. TKEATMENT BY ORDLNARY MEASURES. " La nature est formatiice, couservatrice, et medicatrice. Voila le priii' cipe fondamental de la medecine. "II n'y a qu'une medecine, celle qui repose sur les lois de la nature. . . . Nous avons eu jusqu'ici assez de systemes pour savoir que la mede- cine ne reside point en eux." — Ed. Auber. " Peu de maladies guerissent dans les circonstances et les lieux ou elles naissent et qui les ont faites. Elles tiennent a certaines habitudes que ces lieux perpetuent et rendcnt invincibles. Nulle reforme pour qui reste dans son peche origiuel. ... " La terre est son medecin ; chaque climat est un remede. La mede- cine, de plus en plus, sera une emigration, une emigration prevoyante." — MiCHELET. Hitherto we have discussed, perforce with the utmost brevity, and only in general terms, the great foundations on which medicine, if it aspire to the rank of a science, must rest. So essential is it that these great underlying principles should be engraved on the mind of the physician — be he amateur or professional — that, at the risk of being, con- victed of tedium, I shall venture, ere an advance is sound- ed to the practical points of treatment, on a brief recapitu- lation of the present standpoint. I. Human life consists of two movements'. (a) Molecular Movement (i. e., chemical activity or chemical movement) occurring between each cell and its cell-food, albumen. The net results of this ceaseless proc- 54 THE PRINCIPLES OF SCIENTIFIC MEDICINE. ess are, as explained in our first chapter, multiplication of cells or growth, specialization of cells or development,* and the evolution of some few of the energies of life. The original, or germ, cell, the progenitor of all the body cells, is a somewhat intricate compound, consisting, nevertheless, of but six ordinary elements. Its latent or dormant power is due solely to its intricacy of structure, to the fact that it contains stored up w^ithin itself the energy expended by its parents in the j^roduction of its complex structure. This latent molecular, or chemical, energy exhausts itself gradually on the albumen with which it is brought into contact, and thus new com- pounds, new cells, at an ever gradually decreasing rate, are produced. Eventualh^ and as a natural consequence of the process just described, both intricacy of cell structure and emis- sion of energy become, the first so simplified, the second 80 minimized, that no further chemical interchange be- tween cell and albumen can occur; then ensues natural death. The germ-cell thus contains no special, no supernatural, energy; its action on albumen is closely similar to that of a coiled watch-sj^ring, or an elevated weight, on a clock mechanism. The price of each vital act in man, as of each revolution of the smallest wheel in the clockwork, is dissipation of a portion of that limited energy to which alone the movements of both man and clock are due. (b) Mechanical Motiement. — This variety of movement — not essentially different from the molecular, or chemi- cal, form, if chemistry be regarded as a branch of physics — is that which we witness when the whole body, or a distinct portion thereof, is set in motion by means of the * Food but partially specializes cell tissue ; other environing forces take a lar^c share therein. RESUME OF OUR CONCLUSIONS. 55 store of beat-energy produced by tbe combustion of fuel- food (fats and starches) within its tissues. The origin of this heat-energy and the method by which it produces motion are identical in man and in the ordinary steam locomotive, though in the human machine, by far the more perfect of the two, combustion is not only more complete, but the regulation and the steering of the ma- chinery are also provided for. The molecular movement therefore builds man and en- dows him with life in its most restricted sense; mechani- cal movement works the formed and complete machinery. The demand for albumen steadily decreases, ^er unit iveight of living bodily tissue, from conception to death; that for fuel-foods shows also, under conditions of perfect tranquillity, a similar decline — for the heat-storage power of cells decreases as they simplify — but this latter fall is masked by the fact that with all increase of work, up to a certain limit, a proportionate increase of fuel-food is, of necessity, demanded. II. We now view man as a single, complete being. As such he represents a comparatively small and fairly constant sum, or aggregate, of forces, brought ever into contact with the inexhaustible and varjdng forces (the aggregate of forces) in his environment. If man is to exist, his body must be able, without de- struction of any essential part, to effect a ready balance with these environing forces. Since, however, the sum of forces in both body and environment is ever changing, actual stable equilibrium is not attainable, but the body oscillates rhythmically, like a pendulum, about its centre of stable equilibrium. These rhythmical oscillations are represented by the reg- ular movements of health, breathing, heart-beating, etc. III. If this general moving condition of equilibrium be 66 THE PEINCIPLES OF SCIENTIFIC MEDICINE. disturbed, cither by some unusual deficiency in the body or excess of force in its environment, the effects ob- served will depend exactly upon the amount of force present in the environment in excess of that needed for the rhythmic health movements, and this excess force will, (a) if it be slight and its action but temporary, produce exaggerated oscillations (increase, or other derangement, of normal breathing, etc.) until, being balanced by the latter, the regular oscillations of health will return. This series of phenomena constitutes functional disorder, (b) But if severe and temporary, it will produce the same phenomena, plus destruction of tissue. This is known as organic or structured disease. If the part destroyed be not a vital one, a secondary and imperfect state of mov- ing equilibrium will, in the course of time, be established. If the excessive force be permanent, it will produce, in a, a chronic state of functional disorder, ending in pre- mature exhaustion of the mechanism (whether clock or body), and, in J, will tend to a still more rapidly fatal termination. Such, then, are our positions compressed into the small- est possible space. We have but two great classes of dis- ease to deal with: \\y!Q functional variety, with its accom- panying symptoms, all beneficial, because all tending to counterbalance that excess of force present which is be- yond the normal of health, and all ceasing when that force has been finally balanced. The body of man in such an emergency, like the sapling in a gale, bends before the storm to rise again erect and unhurt when the winds have fallen. In the second variety, the structural, the body of man again, in proportion to its youth and the elasticity of its frame, bends at first, but, when the utmost limit of elasticity in some parts has been reached, there will yet remain, pressing on those parts of his body, a force still KESUME OF OUR CONCLUSIONS. 57 unbalanced — then are such parts, which are those that are weakest and which offer most surface to the force of the storm, broken or blown aAvay, and when the gale has passed and the nninjured parts again erect themselves, the body shows its damage and bears lasting marks of the danger through which it has passed. Finally, parts of the structure essential to life may be destroyed, in which case no recuperation is possible. This corresponds to death. Structural disease is, as regards the individual, an evil,^ in so far as it entails destruction, to a greater or less extent, of his bodily mechanism; but as it affects mankind in general, it is a benefit, since by its aid the human fam- ily is gradually, and to its lasting good, purged of its weaker and less perfect members. There is perhaps yet one more point to which a few lines of explanation are due. What part, it may be asked, does the spirit of man — his soul — play in the processes of physical life ? Apparently none whatever. The body of man generates no energy, that which it emits is the exact equivalent of that which it acquires from its foods, and life is the result, not the cause, of energy. The spirit of man has no share in the working of his physical structure. It cannot, in fact, participate in a material process, unless our definition of it and our knowledge of matter and en- ergy be both at fault, for if the spirit be immaterial, it cannot contain that which alone can influence the body — energy — since energy can exist but in union with matter, in fact is probably identical with matter. Much mystifi- cation in the public mind has arisen from the vague and emotional tones in which some even good scientific men speak of the human germ-cell. They will ofttimes invest it, as does the love-sick swain his Dulcinea, with hypothet- ical charms and virtues, Does the germ-cell contain a diamond edition of man ? are the various portions of the 3'H 58 THE PRINCIPLES OF SCIENTIFIC MEDICINE. body already contained in it but invisible to us by reason of their minuteness? Does this cell contain a special, vital force ? What are these mysterious somethings, life and power of growth, which it possesses ? Such are a few of the fanciful problems with which these philosophers torture and perplex their own minds and those of their disciples. As logically might they ask if the water of a stream that kept in motion a paper manufactory, itself contained the paper, or if the coiled watch-spring or the elevated clock-weight contained the wheels and jjins, dial- plates and hands of the clock. The germ-cell corresponds to the falling water, containing like it a simple potential energy, the albumen (^. e., tissue-food) ever presented to it corresponds to the machinery of the mill and the raw fibre in its tanks. The result in the one case is a man, in the other paper. If the emotional scientist must give vent to his emotions over some material idol, let him then adore rather the albuminous food, by far a more important factor in the production of a human being than is the germ-cell.* And now to the question of treatment. As all disease may be conveniently divided into functional and organic, so, for the sake of clearness and convenience, may all measures for its relief be spoken of as ordinary or extraor- dinary. The classification is, I am well aware, bad and utterly unscientific, since derangement can be proj^erly met only by such agent or agents as exactly counterbal- ance the effects of the cause of such disorder, and as no disease is in a proper sense extraordinary, neither can * I do not of course deny the existence of a supernatural spirit in man, tbougli neither belief nor denial is here in question, but I pro- test most strongly against the assumption of an unknotrn agency in man and the subsequent adoption of such agency as a known and potent factor in physical phenomena. It is to sucli trickery only that I object. ORDINARY MEASURES OF TREATMENT. 59 there be a remedy to which such an expression can apply; yet so tangled is the maze of applied medicine as usually understood, so overgrown with the weeds of untenable theory and of incomplete experiment — the former, as we shall see, a form of fallacy known as the suggestio falsi, the latter of the nature of a siq'>2^ressio veri — that I have found it impossible to deal with the whole subject of treatment as one, and have been compelled to divide it into two categories, the former, the so-called ordinary measures, to comprise the well-known forces of Nature in their usual garb; the latter, the extraordinary, certain con- centrated and less known, or more complex, natural forces popularly recognized as drugs. Ordinary Pleasures of Treatmeyit. The ordinary means at the disposal of man for the main- tenance of his health, or for its restoration when lost, are capable of being grouped into the three headings of food, climate, and habit. They represent the three powers most ready to his hand, and to which he naturally first turns to effect the process of re-equilibration. Bearing in mind that we are concerned as yet only with the principles, the rationalia, of treatment, and that its practical details fall to be discussed in the second part of this book, I shall limit myself to the enunciation of gen- eral facts only. I. Food. The necessary aliment of man consists of four very dif- ferent varieties of substance. {a) Tissue-food, or albumen, derived from the once liv- ing and therefore most highly organized parts of plants and animals. The flesh of animals and the seeds of plants (storehouses of potential life) are representative structures, rich in this tissue-food. 60 THE PRINCIPLES OF SCIENTIFIC MEDICINE. The duty of tissue-food is — after it has undergone con- version from the colloid to the crystalloid state by means of digestion, has then entered the blood-stream and under- gone some combustion in the liver — to interact chemically with the living cells of man's body, and to thus produce the essential phenomena of continued life. Tissue-food, in short, in conjunction with living cells, causes the body to grow at first, and afterwards maintains, but with, of necessity, a gradually decreasing power as the cell energy becomes lowered, the living structure. (b) Fuel-food, represented by the fats, sugars, and starches, is — after its conversion by digestion from a col- loid to a crystalloid form — absorbed into the blood, and, by means of the oxygen contained in that fluid, burned (oxi- dized) so as to supply heat-energy, necessary for the bodily movements. It must be admitted that even albumen undergoes some combustion and therefore assists, though but to a trifling extent, in the development of the heat-energy. (c) Water. Necessary to dissolve the crystalloids and to keep them in solution in the blood. {d) Inorganic salts, of which common salt is the chief. These seem to assist the chemical actions without taking part in them. They have been compared, somewhat in- accurately, to the oil used to lubricate machinery. Now, let us see if we can arrive at anything like a use- ful general rule to guide us as to the necessary amount of each of these foods in a condition of health, for we must solve this question ere we can undertake to vary the amounts in cases of disorder. Normal Requisite of Tlssuefood. — In endeavoring to discover some rule for general guidance, it occurred to me that, if it be true that growth is due to the action of liv- ing cells on albumen, and if the individual cell-energy de- XOEMAL REQUISITE OF TISSUE-FOOD, 61 clines gradaaliy from conception to death, as it must do if it can only live by expenditm-e of its store, that, per unit of weight of living tissue, the demand for albumen must show a steady decline, quite irrespective of bodily work, during the whole period of life. Every diet-table, though such are founded only on a practical basis and are simply the result of experiment, I found to bear out the truth of this.* The mean of such tables gave the following result, reck- oning for peojole of ordinary fatness, for fat, not being a living tissue, but merely representing stored fuel, must, in cases of obesity, be allowed for in calculating bodily weight. Per pound weight, per diem, at birth the demand is about 30 grains, avoirdupois. As life advances this de- mand fails each year steadily at the rate of from -|- to J of a grain, till in extreme old age it has been reduced to 15 grains per pound weight, or but half of that at birth. Take a young baby, say of 18 lbs. weight, and, according to the above rule, it will need 540 grains of albumen per diem. Xow, each pint of cows' milk contains albumen, in the form of caseine, to the extent of about 360 grains, and therefore 1-| pint per diem will be the normal daily demand, and it is one which experience confirms as sufli- cient. Of mother's milk, which is poorer in caseine, more, about 2 pints, will be required. Let us now take the case of an old man of, say, the weight of 154 lbs. (11 stone). His demand per lb. weight, per diem, is 15 grains, and thus the total demand for his * The tables from which the above calculations have been made are those of Drs. Parkes, Davy, Playfair, De Chaumont, Von Yoit, and Von Pettenkofer. 62 THE PRIXCIPLES OF SCIENTIFIC MEDICINE. period of life will reach 2310 grains, or about 5 oz., of albuminous food. This represents the caseine of 6 pints of milk, and accords with the quite recent results of Dr. Germain See's investigations, for he reckons 3^ litres, almost exactly 6 pints, to be the normal daily require- ments of albumen in old age. It is quite possible that my calculations, being based on minimum necessary amounts, may fall a little below the physiological needs in some cases, but this does not affect the truth of this very useful underlying principle. The demand for albuminous food is not affected, of course, by any conditions of work, of climate, of race, of occupation, etc., all of which have a vast influence in mod- ifying the demands for fuel-foods and water. Now let us ask ourselves what are the results respect- ively of an excess or an undue lack of this necessary albu- minous material. An excess over and above the normal demands cannot increase growth or favor renovation of tissue, while a defi- ciency will hamper both of these processes. Excess of albuminous food, all of it that will pass the portals of digestion, will of course be burned, as all albu- minous food is burned in the liver; but if the excess be great or habitual, this oxidation process may be impaired, and gout or biliousness, as we shall see later on, will be the direct result of this overwork of the liver. But, sup- posing the liver equal to the excess, then, after combus- tion, the excess of albuminous food will be cast out of the body by the kidneys. An excess, thus, of albumen, while it assists somewhat in maintaining bodily heat and en- ergy, by virtue of the combustion process which it must undergo, taxes severely the stomach, intestines, liver, and kidneys. But the cells in the body of man must, if they are to ex- THE PLACE OF TISSUE-FOOD IX DISEASE. 63 liibit a regular series of phenomena as an outcome of their interaction with tissue-food, be supplied prett}^ equally at every part of the twenty-four hours with albumen. How is this equality of distribution to be maintained when food is taken but intermittently ? By a very simple process, analogous to that by which a city is kept, both in wet and dry seasons, supplied with water, by the intervention, be- tween the source of suj^ply and the consumers, of a reser- voir. The blood channels serve this end, and, as we shall see later on, the fluid portion of the blood is scarce any- thing more than a store of digested albumen, constantly supplying the cells with their necessary amounts, itself in- termittently fed by our daily meals; while we shall also find that the liver acts similarly as a storehouse for fuel- food of the starchy and saccharine order, placed between the supply and the demand; while the loose cellular tissue of the body plays the same role in reference to the fatty foods. Thus it comes about that, provided a man be sup- plied but with plenty of drinking-water (which always contains some of the necessary inorganic salts), he may, while deprived of every other form of food, not only live for many days, but live with a comparatively trifling loss of energy, especially if he be kept at rest and warm, for when at rest but little fuel-food is consumed, as the de- mand for heat-energy is small, while a warm atmosphere prevents any but the most trifling loss by radiation from the body to the surrounding air. But to return to our tissue-food. We have seen what the rule of the health supply is, let us discuss in what way this rule is modified by the presence of disease. T/ie Place of Tissue-food (Albumen) in Disease. — The human body being, as we saw in our first chapter, not a vast compound of beings, but a single individual, a unit, between each of which parts there is such close relation- 64 THE PKIXCIPLES OF SCIENTIFIC MEDICINE. ship that when one cell thereof is thrown off (in genera- tion), it bears in it the impress of the whole body down even to its minutiae, there cannot be, as in fact there is not, such a thing as local disease. The cells of one part may die or weaken before those of another, by reason of extra strain or of inherited debility, but to imagine that in a perfect mechanism like the body, all of whose parts arc interdependent, none of whose parts are de trop, one atom even can be lost without the whole body feeling and shar- ing in the loss, though our perceptions may not be fine enough to allow us to discern it, nor our microscopes potent enough to be able to measure it, is a physical absurdity to which no thouo:htful man will subscribe. All disease is therefore, perforce, general, though it is naturally the organs most allied in function or most ap- proximated in position to the seat of greatest disorder, to the so-called local malady, that share most in the mani- festations of derangement. All bodily disorders — some more, some less — interfere with the great function of nutrition, that one function which every organ of the whole body is built, directly or indirectly, but to subserve. Disease always hinders, when severe is said by competent authorities even to arrest, the action between living cells and their tissue-food, the cells in the cases of arrest seeming, by the imbibition of water and salts, themselves to nndergo a series of chemical changes which serve to maintain, but of course for a short time only, an imperfect life. Personally, I do not believe that actual arrest of the assimilation process by cells ever occurs, can ever occur, in a living body, but there can be no doubt but that in severe fevers the power of assimila- tion falls very low indeed. This impediment to assimila- tion of tissue-food in all disease is a cardinal fact to be re- membered, and the one on which the dietetic management THE PLACE OF TISSUE-FOOD IN DISEASE. 65 of all disorder is to be built. Concurrently with it, and proportionately to it, and also as a consequent of the bodily derangement, the digestive powers fail. In mild bodily disorders, and the best general guide we possess to the mildness of a disease, though it is but a rough one, is the clinical thermometer, we therefore di- minish the total quantity of tissue-food given, and we give it in the most simple form and with plenty of fluid. The simplicity of form serves two purposes : first of all it taxes less the muscular poicers of the digestive organs, a very important and essential part of the digestive process, and one, of course, also weakened in disease ; secondly, it en- ables any amount given in excess of the digestive capacity to pass off by the intestine in a shape likely to cause that structure least irritation, and also least likely to ferment and generate troublesome gases. For these reasons we administer in mild febrile disorders, those in which the temperature rises to 100° or 101° F., semi-solid albuminoids and semi-solid foods in general, soups — of which milk, cheese, meat, fish, or seeds, such as lentils or beans, form the main albuminoid basis — and milk puddings, the ingredients in which are slowly and thorough- ly cooked and not bound together by egg albumen. Then we often allow ripe fruits, especially such as are rich in grape-sugar, and also easy of digestion. We always give plenty of water. Finally, we possess various important, and indirectly highly useful, pseudo-foods, alcohol, gela- tine, tea, coffee, etc., which possess, according to eminent authorities, a certain poAver in arresting the denutrition of cells, and, while not actually foods, are, like the fire-bricks placed in some grates, economizers of fuel. In severe disease, when the temperature mounts, and in proportion as it mounts, to 104° F., or higher, we decrease the amount of albumen given as food, while we exercise 66 THE PRINCIPLES OF SCIENTIFIC MEDICINE. greater caution as to the form in which we give it, and we increase, on the whole, the amount of water and salts. We make our soups and meat essences thinner, we often have to do away even with the milk puddings as being too great a tax on the exceedingly restricted digestive powers, substituting, for the starch and sugar which they contain, fruit drinks or even grape-sugar dissolved in water. We take equal or even greater precautions as regards the fats, trusting to the cream in ordinary milk as the sole fat likely to pass the digestive processes. For above all we dread, by an injudicious administration of over-much food, to impair further the performance of the digestive acts. In the most severe of our cases, those in which we have reason to think that all, or nearly all, cell assimilation is at a standstill, our reliance falls on water, and the salts it contains, no mean food under the circumstances, for it can, by dissolving any remains of healthy albumen in the blood- stream, carry this on to the cells when all digestion is in abeyance. In this bad pass we may also turn hopefully to whey, and to infusions of tea and coffee, to gelatine, and above all to alcohol, which latter, in very tiny doses only (a teaspoonful of whiskey every hour is about the limit), but not in large ones, has apparently some power of arrest over the denutrition of the cells. The large doses, often administered, cannot do this ; they can only stimulate, rouse the cells to emit that little last residue of energy, on the economizing of which rest our last hopes of recovery. Normal JRequisite of Fuel-foods. — This may be briefly stated in the two following aphorisms : Per unit weight of living body tissue, there is a slight, but well-marked, decrease in the normal demand for fuel- food from birth to death. NORMAL REQUISITE OF FUEL-FOODS. 67 But this demand is affected (within the limits of the digestive capacities) by the amount of work performed — i. e., by the necessity for more heat-energy when much muscular work has to be done — and by the loss of heat by radiation from the body, the demand rising in cold weath- er, and when articles of attire that are good conductors of heat are worn. It is seen, therefore, that this second rule will not permit of our representing the demand for fuel-foods, as that for tissue-foods, as an even descent throughout life, for the downward grade is often temporarily interfered wdth by extra demands for heat-energy to perform extra w^ork, and by questions of air, temperature, and of clothing. Both of the above rules appeal at once to our reason, for, as regards the first, it is clear that as the cells of the body decline in vitality, so, in proportion to such decline, must be their limit of storing heat-energy ; while as re- gards the second, it is evident that if heat-energy be the body's great motor-power, the supply of fuel must rise with the work to be done, and with the greater losses by radiation from the body. The dangers attendant on an excess in the consumption and absorption of fuel-foods are those which follow on obesity, for such excess is deposited in the cellular tissues of the body as fat. When this deposit passes certain lim- its it affects by its weight and pressure the muscular tis- sues, rendering exertion difficult, and thus, unless some wise dietetic restrictions are taken, directly conduces to even greater deposits, until eventually the breathing pow- ers and the heart's action become seriously embarrassed. A deficiency in the necessary fuel-supply of the body causes loss of energy, and indeed one of the commonest troubles of advancing age, depression of spirits and in- ability for exertion, is often successfully combated by the 68 THE PKIXCIPLES OF SCIENTIFIC MEDICINE. administration of easily digested fats. In addition it leads, at all ages, but particularly in the young, and for special causes to be mentioned in the second part of this work, to risk of lung disease. The Place of Fuel-food in Disease. — Since fuel-food, by which we mean the starches and sugars (the carbo-hydrates) and the fats (the hydro-carbons), is, as compared with albu- men, of simple structure, and does not undergo, as does the latter, with the molecules of the body-cells any known chemical change, it would at first sight seem that in dis- ease we might, provided we did not exceed the digestive capacity, hope for very great help from a free administra- tion of it. To a great extent, however, the vitality of the cells determines the amount of possible combustion of these foods, for, while there is strong reason to think that the oxygen carried by the red- blood corpuscles and the fuel- foods meet, and by so doing evolve their heat-energy with- in the cell-substance, it is certain that the cells store the heat-energy, and that their storage power is decreased by all forms of derangement. For these reasons much the same rules, guarded by much the same precautions, must govern, in disease as in health, the administration of both tissue and fuel foods. But the fuel-foods are of two kinds, hydrates of carbon — i. e., the starches and sugars, from which relatively but little energy, and that from the oxidation of th^ carl)on only, can be drawn — and hydro-carbons — ^. 6., fats, sub- stances which yield for combustion not only carbon, but also a large quantity of hydrogen, an element from the combustion of which latter more heat can be evolved than from any other element. For these reasons the fats are, as fuels, worth nearly double their weight of starches or sugars, and there would seem a strong d jyriori reason for their employment in illness. Unfortunately, the teaching WATER AND SALT IN DISEASE. 69 of practical experience seems to indicate that the difficulty, even in health, of digesting fats is much greater than that of digesting hj^drates of carbon, and, as we shall see fur- ther on, the process of digestion in the two cases is also very different. Thus it happens that in states of disease we have to ex- ercise, in regard to the fuel-foods, much the same care as in the matter of the tissue-foods, selecting from them the substances most easy of digestion, and administering these in a simple and liquid form. Among the fats, cream and butter are the most palatable and easy of digestion, but their taste must often be disguised, and they must be ad- ministered only in free dilution. In the case of the starches and sugars, the former well cooked in the form of farina- ceous puddings with milk, but without eggs, are of great use in mild cases of illness, but they are very badly borne when the bodily temperature is high. Here, again, whey, by reason of its richness in sugar-of-milk, is often useful, or a malt extract, which may be generally reckoned on as being pure grape-sugar, may be given in barley or lemon water. Short detailed hints will be found in the Appen- dix, to which I must refer the reader for fuller informa- tion as to sick dietary. The Normal Requisite of Water and /Salts. — As to the necessary daily needs of the body in regard to water we have no rule, nothing much beyond our instinct, nearly always, by the way, a very efficient guide, to direct us. If the suppl}^ of this fluid fall below the necessary, the actiAnty of the cells and their heat-storage power will both suffer, for only when in solution with Avater can albumen and fuel-foods serve their ends in the body. A deficiency in water supply will tell also in another way, for the waste products that should pass out by the kidneys having also to be kept in a dissolved state, it follows that elimination 10 THE PRINCIPLES OF SCIENTIFIC MEDICINE. by these channels will be interfered with, and certain dis- eases, especially gout and rheumatism, will then menace the body. The various necessary salts of the body, of which com- mon salt is the chief, are but seldom consumed in excess, and then they appear often to produce skin affections. Any deficiency in the supply of them is attended by much more grave mischief, by a general interference with the assimilation of food and by local changes in the kidneys,, skin, and bones. 27ie Place of Water and Salts in Disease is an impor- tant one. We have seen that by the free administration of water alone, life may be prolonged for many days, and when we consider that starvation is, in nearly all disease, the final cause of death, we shall not be likely to under- value it as a potent aid in the combat with grave dis- ease. Food Accessories. — Tea, coffee, coca, and cocoa each contain within them a substance which apparently has the effect of lessening cell waste. Used with discretion they are therefore, especially in disease, valuable dietetic aids. Alcohol, in very small quantities, is also serviceable in a similar way. Condiments, such as mustard, pepper, etc., are, in civilized races, useful, and, by reason of habit, often necessary adjuncts to food. They are not, as ignorantly asserted by certain hygienists, stimulants, but have be- come of the nature of the ordinary forces in the environ- ment of civilized man, though in the lower animals they act as local stimulants simply because these latter are not of a race habituated as yet to their use. Artificial Digesting Agents. — In what I hold to have been a singularly unlucky day for posterity, Dr. Eberle, rather more than half a century ago, first separated froiu the stomach of the pig its special digestive ferment, pep- ARTIFICIAL DIGESTING AGENTS. Vl sin. Here was, in truth, a crutch for the crippled stomach of the dyspeptic; in this substance surely lay the hope of bringing food to the starving cells of the fever-smitten ! So thought the public, and those of the medical world whose enthusiasm outran their knowledge of physiology. The debilitated stomach got weaker, more hopelessly un- equal to work, by leaning on the support of pepsin, while the deranged stomach of the fever-smitten, taken at a dis- advantage, let slip sometimes through its coats the arti- ficially digested food, and hampered with it the body-cells — starving not for want of food, but because they could not eat — and often blocked the struggling kidneys, end- ing the life of the patient by the vast increase of nitroge- nous waste thus intruded on the blood-stream. Since its discovery pepsin has had a host of colleagues and rivals : trypsin, pancreatin, diastase, etc., all ready to the hand of him who thinks that the aim of medicine is to thwart and circumvent the operations of Nature, because such operations, in the case of disease, are sometimes un- intelligible to him. Long since the great chemist, Liebig, gave birth to a vast truth when he said that " Nature re- fused to be made the handmaid of chemistry." There are, however, rarely occurring emergencies, as we shall see, Avhen artificial digesters afford us a temporary aid, but this accommodation has even then to be subsequently and dear- ly paid for. Any necessary special modifications of food in disorders such as gout, dyspepsia, etc., will be dealt with when the treatment of those disorders comes in question. Brief as has then been our survey of the foods, it has suflSced to raise in our minds a strong susj^icion that many disorders of man may be due to a deficiency or an excess in this, the greatest factor in what we call the environ- ment of man. Let us now, under the heading of climate, - 72 THE PRINCIPLES OF SCIENTIFIC MEDICINE, view the part that may be played by atmospheric air in the maintenance or the restoration of health. II. Climate. The question of climate resolves itself mainly into an examination of the air, and of the effects which the differ- ent airs exert on the body of man. Parity, temperature, moisture, force, and direction are the qualities of air. {a) The Purity of Air. — The average air may be said to consist of an admixture of \ oxygen gas and of nearly ^ nitrogen gas, the small balance being made up of wa- ter, vapor, carbonic acid, and various other solid and gas- eous ingredients. The oxygen may exist either in the form of the ordinary gas (Og), or in the condensed and unstable form of ozone (O3), which latter parts readily, when in contact with anything oxidizable, with the third atom of its molecule, and thus like oxygen, but to a yet greater extent, assists decay oci the conversion of the or- ganic to the inorganic, while in living beings that inhale it in small quantities, it assists the combustion of their fuel foods, acting thus as a mild stimulus in the produc- tion of energy. . Nitrogen gas in the air plays, as far as its discoverable influence on the body of man is concerned, the part of a diluent to the oxygen. The relative amount in air of car- bonic-acid gas, the amount of which varies from 3 to 6 parts in 10,000 parts of air, is apparently only of impor- tance to man inasmuch as with its proportionate rise is there remarked a change, a development, in certain very interesting inhabitants of all air, the bacteria. The bacteria— in which term I include the globular mi- crococci, the long bacilli, the short bacteria?, and the spiral spirilla} — are the natural inhabitants of the air, and are THE TEMPEEATUKE OF THE AIR. 73 probably of a vegetable nature. Their one function is to cause fermentation in dead or enfeebled organic matter — in other words, they are the agents of decom2)osition. Like everything else that has life, the bacteria may be al- tered in structure, and consequently in power and func- tion, by their environment. It is on them that the differ- ence in the composition of the air in various places tells, and through changes thus produced in them, that man is, in a secondary and indirect manner, affected by what is termed impurities of the air. The ordinary bacteria, the inhabitants of the air of open spaces, have no power to hurt the bodies of living animals; not that the bacteria are providentially designed not to affect these, but because the ordinary bacteria, like the other ingredients of ordi- nary air, are one of the usual forces in an animal environ- ment, a force probably not only innocuous but beneficial. But new and strange conditions — as those which result from overcrowding — produce novel changes in the air, and novel varieties of bacteria, and these novel varieties rep- resent a novel force — one unbalanceable by men and ani- mals unaccustomed to them — which does not, of course, spare living tissue, but sets up, even within it, a fermen- tation which is called fever. Once formed, these novel bacteria, provided their surroundings be favorable, live and 23ropagate themselves. Incredible as may seem to the lay reader the above statements, they are nearly all de- monstrable by actual experiment. {h) The Temperatureofthe Air, — Almost the sole source of atmospheric heat is the sun. Dry air, however, is so diathermic — ^. e., allows radiant heat to pass so readily through it — that it is only in proportion to the water- vapor present that air can be much affected by direct solar rays; in point of fact, the main source of the tem- perature of the air is quite indirect, and due to heat im- 4 74 THE PRINCIPLES OF SCIENTIFIC MEDICINE. parted to it by the solid and liquid substances of which the upper earth crust consists, and Avhich have first ab- sorbed, and then imparted to the air, the heat of the direct solar rays. But the reflected sun-rays from light soils, from sheets of water, and even from snow-fields, are also sources of atmospheric heat. To the reflection from the neighboring snow-fields, Davos and Saint Moritz owe largely their high winter temperature; and to that from the sea, the winter health-resorts on the south of the Isle of Wight are main- ly indebted for a like result. But water plays, in the distribution of heat, other very important roles. Water absorbs heat more than does land, and by reason of this and of the rising of the low- er, warmer strata, when its surface cools, it has a more permanently warming effect on the superjacent air than land. Moreover, water is fluid, and, as a result of the ine- quality of sun-heat in the different portions of the earth, is kept constantly in motion. Thus the two great ocean cur- rents, that of warm surface water from the equator to the poles, and that of deeper cold water from the poles to the equator, are formed. The first of these exerts a great in- fluence in raising the mean winter temperature of certain portions of land exposed to its full influence to a point which their latitude alone would by no means entitle them to. Then, again, the winds that come to us in winter from over extensive tracts of sea, like our w^est and southwest winds, though moist, are warm, while the east and north- east winds at that time of year are cold, travelling as they do, before they reach us, over extensive tracts of land that have long since lost all the heat derived from their sum- mer sun. The relative position of mountain-chains and the pro- tection thev afford against cold winter winds, again affects HUMIDITY OF THE AIR. 75 very considerably the mean winter temperature, while ele- vation above sea-level, and many other minor conditions, further influence it. The effects of even hot direct solar rays, if the air be dry, are not much to be feared, and are rarely productive of sunstroke. If, however, much moisture be present, the risks from the latter disorder are very great if much exer- tion be undertaken, and this not only when the individual is exposed to the direct rays of the sun, but even while he remains in shade. (c) Humidity of the Air. — The habitual presence of an excess of water- vapor in the air is traceable as a rule to one of two conditions — the neighborhood of large masses of water, especially of fresh water, and the nature of the soil. Although the former of these might seem to have by far the more important effect on the air and on the human beings that breathe it, the opposite is actually the case, for, providing the air currents are not cut off by the shelter of surrounding hills, and the houses be raised well above the highest flood mark, the residents, even those much influ- enced by the presence of an excess of watery vapor in the air, are not very specially subject to the ailments which are apt, in people of certain constitution, to follow ex- posure to damp. A damp and ever-perspiring soil is, however, a potent factor in bringing out rheumatism, gout, bronchitis, phthi- sis, catarrhs, and in actually developing more dreaded dis- orders, such as English cholera, ague, dysentery, crou}". and diphtheria. By a damp soil is understood one which is more or less impermeable to water. Clay is one great example of such. Not that the clay stands out conspicuous to the eye, ex- cept, perhaps, in patches here and there; it is covered usu- 76 THE PRINCIPLES OF SCIENTIFIC MEDICINE. ally by a few inches or feet of alluvial soil, which rests upon what is called a bed, a subsoil, of clay. Sometimes a stratum of sand or gravel, several feet in thickness, may be interposed between the two above-mentioned layers, masking to the eyes of superficial observers the real char- acter of the ground. Whatever the nature of the upper- most layer or layers, provided there be a subsoil of clay thick and tenacious enough to prevent the passage through it of water, and the level position of the clay-bed be such that the water cannot run off, the soil will be a damp and also a cold one. We can readily understand that such a soil, always moist, always perspiring under the influence of solar heat, must keep the superjacent air ever full of moisture, and must predispose to such disorders as rheumatism, gout, etc.; but the method in which it can actually breed cer- tain germ diseases, such as dij^htheria, demands some fur- ther explanation. The upper layers of all land contain vegetable or animal organic matter in a state of decomposition — i. e., loaded with bacteria more or less developed, according to the pabulum on which they feed, the amount of air or moist- ure in the soil, etc. Now, in a dry soil the rain-water passes through this layer, carrying downioards all such animal life. In a damp soil the moisture from the upper sodden layers has to reappear shortly in the form of per- spiration from the ground, and such perspiration brings up with it many of these bacteria. Much will depend upon the atmospheric conditions whether these bacteria develop further, or remain as they are, or die. During summer heats they apparently undergo changes which con- vert them to the germs of English cholera and of dysen- tery; in damp, cold, stagnant atmospheric states into the germs of diphtheria, croup, pneumonia, etc. We all know HUMIDITY OF THE AIR. 11 liow certain places are insalubrious at certain times of the year. But a clay subsoil need not always be equally a damp one. If the drainage be deep and good, or if the clay bed slope, much of the surface water will be carried off, and the soil will be drier. Some clays are, again, more imper- meable than others — that which underlies a large portion of London is less tenacious in composition than that found so extensively in the eastern counties. We have seen that either gravel or sand may overlie a bed of clay; but, independently of this state of matters, a low-lying gravel soil near a large river is to be always strongly suspected, for such is often sodden with water and far damper and more dangerous than the worst clay soil. Speaking generally, a chalk subsoil is the best and driest, next in order coming gravel and sand, and then a sloping, well-drained clay bed. We must content ourselves with this very brief survey of a large subject, and pass on at once to inquire what are the effects on man of much moisture in the air. Dry air is a bad conductor of heat, moist air a good one ; a dry, cold air has therefore far less effect on the body, and is much more easily borne by it, than a moist one of equal temperature. A warm, dry air favors perspi- ration, and induces a high state of assimilative activity in the body. A warm, moist air checks tissue change, and thus, other conditions being equal, tends to produce both lethargy and to favor increase in weight. Thus, formerly, warm, moist airs were in repute for all wasting diseases, such as consumption, but at the present day less warm, but drier, airs are recommended, and are found indirectly, by increasing the vigor of the bodily functions, to conduce in such diseases to an increase in bodily weight, as well as to bodily vigor. 78 THE PRINCIPLES OF SCIENTIFIC MEDICINE. Sir James Clark deliberately says : " Of all the physical qualities of air, humidity is the most injurious to human life." Prostration of strength, depression of spirits, a wearying heaviness, deficient appetite, and disinclination to bodily and mental vigor, are the symptoms which are complained of by those who, unsuited to such air, are compelled by force of circumstances to reside in a humid atmosphere. Those of the nervous and sanguine temper- ament are, however, often fairly well in damp, relaxing airs ; the gouty, the rheumatic, the bilious, the lymphatic of temperament, are generally the worst sufferers. Innu- merable diseases have been ascribed to a moist air; some are actually generated in the damp soil; some are merely'- favored by the presence of much atmospheric moisture. Rheumatism, gout, heart disease, bronchitis, pneumonia, pleurisy, hypochondriasis, dysentery, diphtheria, typhoid fever, puerperal fever, and even cancer, have, each and all, by eminent medical authorities, been traced to the influ- ence of damp. Such sweeping assertions must, however, be received with caution, for it is only on those whose cor- poreal conditions demand a dry air that damp can tell ad- versely, and, as a matter of fact, large and healthy popula- tions cover some of the dampest soils in England. Finally, it is well to note that much will depend upon the construction of his house as to whether the resident on a clay soil will become painfully aware of the moist- ure that it holds. The well-built portions of the west of London that rest on clay are, if relaxing, still whole- some, while the extensive areas in the same district, cov- ered by the works of the jerry-builder, are infested with, among other complaints, diphtheria in cold weather and English cholera in hot weather, firmly established as epi- demic disorders. Force and Direction of the Air Currents. — As most of HABITS AND MODES OF LIFE. 79 my readers already know, winds are produced by the un- equal heating of the air in different parts of the earth, and are, in fact, magnified draughts. Passing over the foreign windy celebrities, such as the Fohn of Switzerland, the Khamsin of Egypt, the Sirocco of IS'orth Africa and Southern Europe, the Bora of the Adriatic, and the Mistral of the South French coast, we have but space to say, in reference to the winds that visit Great Britain, that the north wind is moderately dry, and for obvious reasons nearly always cold; the east and north- east winds are cold and dry in the winter, hot and dry in the summer; the south wind is moderately warm and usu- ally dry, while the west and southwest winds, coming over wide ocean tracts, are warm and moist, especially in winter, and as the air of the land is cooler, large part of their moisture is condensed into clouds and rain, much latent heat being liberated in the process. To this influ- ence is traceable the warm wet winters of Ireland and of the western shores of England and Scotland. III. Habits and Jlodes of Life. That these have an important bearing on individual health, and therefore furnish the physician, when wisely and cautiously used, as levers in re-equilibration — i. e., in the restoration of health — no one can doubt. Spite of such authorities as Drs. B. W. Richardson, Partes, De Chaumont, Wilson, and Farr, whose names are familiar to all who dip into the subject of general sanita- tion, there are very few unhealthy trades and occupations. These authorities often fall into the fallacy of dealing with the average man, the standard man, and their re- searches have therefore usually no practical bearing on individual health, and are worse than useless for the pur- poses of the general physician. It is of the nature of a 80 THE PRINCIPLES OP SCIENTIFIC MEDICINE. truism to say that no two men are alike, and to surmount this always exceedingly great obstruction to the laying down of rules for health guidance, and to give to what should be, what can be, but general directions, the weight of dogmas, the civil hygienist (and the therapeutist) rig up the average man, a subjective homo, who, inasmuch as he has no existence, demands no treatment. On the other hand, the military medical hygienist views all men as sol- diers; the efficient soldier is the standard by which he would measure all his fellow-creatures. The penitentiary doctor takes capacity for oakum-picking and for tread- mill exercise as his standard, a point of view that is un- impeachable as long as convicts are in question, but which can form the basis of no guide to the general health of mankind, to whom, however, he can rarely resist the temptation of applying it. The statistician tries to deduce a moral, on insufficient premises, as to the danger attend- ant on many trades, but practically he knows little if any- thing of the main factors that go to elevate the rate of mortality in them. It is much more often the low rates of pay, the temptations to drink, and the drafting into oc- cupations of men who have lived under totally different conditions, that tell on the death-rate, and which are prac- tically all unpreventable, rather than some casual and pre- ventable risk of lead, or other metallic, poison. The sole condition of health is, as Darwin long since, but in another connection, expressed it, " correspondence with the envi- ronment," in other words, a power of acclimatization, of bodily adaptation, to the special surroundings of every-day life ; and for this condition to be secured there must exist, as I have in an earlier chapter stated, three necessary con- ditions : a body sufficiently'- ductile, sufficiently pla^ic to take, without destruction of any vital part, the impressions of the new mould in which it is to be cast, or by which it UNHEALTHY OCCUPATIONS. 81 is already surrounded, and as a rule in youth only is this plasticity very great; secondly, the moulding process must — if the new mould be very different from that in which the man is already cast — be always slow, and the less plas- tic the body the slower must be the operation; thirdly, the limits in the process beyond which no bodily structure can go, at least in the span of an ordinary lifetime, must be remembered. If, for example, you take a middle-aged farmer, and place him in a bookbinder's shop in central London, he will begin to suffer at once from ill-health, and he will probably continue so to suffer for years ; his body is, as I explained when speaking of functional de- rangement, constantly influenced by unusual forces in his surroundings, constantly oscillating beyond the regular limits of health, seeking ever to balance its new conditions and never succeeding. " Ah !" the hygienist will say, " you have placed him in an imhealthy employment, vide Dr. Farr's tables." But what about his fellow- workers, born cockneys? They are thoroughly well. Spite of their white faces and thin hair, their expectation of life is quite up to Dr. Farr's standard. Let us take one of these latter, a bookbinder of many years' standing, put him in the farmer's old country residence, set him to the work of farming, and visit him a week or two afterwards ; what shall we find ? — that he is brimming over with thankful- ness for an increase of health, of spirits, and of bucolic virtue ? Not at all; he will tell us that he is not nearly so well. The dullness and lack of companionship are, so he will tell us, killing him, and the exposure is already crippling him with rheumatism; in fact, the bookbinder's body is experiencing all the throes which accompany an atterappt at equilibration with altered surroundings, and these may last for years or even never cease, everything, as with the transposenj farmer, depending upon the adapt- 4* 82 THE PRINCIPLES OF SCIENTIFIC MEDICINE. ability of the body and the exact nature of the environ- ment. When we approach the third condition to a successful acclimatization — namely, attention to the limits within which alone the body of man is plastic, we first see our way clearly to speak within very narrov^ limits dogmatically of a few trades and occupations as essentially unhealthy. We know of no process of moulding, however slow, which can accustom the body of man to the absorption of much lead, mercury, antimony, or zinc, nor of any that can make the fumes of sulphurous acid or of nitric acid, or an air laden with coal-dust, or with fine particles of hair, feathers, etc., factors of health. Yet even in the- trades where workmen are exposed to such influences, the exer- cise of care can minimize the danger, and a large amount of tolerance of these conditions is established in the bodies of those long exposed to their influences. And what we have said of occupations applies even to habits. There are, spite of the alarmists, few essen- tially bad habits. If we take such a habit as smoking into just consideration, we find ourselves unable to pro- nounce a general anathema against it. The anti-tobacco- nist will, indeed, seek to dismiss the subject with what, to his mind, will seem a valid and conclusive reason against the practice. " Smoking is clearly unnatural," he will tell us, " and therefore ought to be discouraged." But when we ask him to define what he understands by unnatural, we detect the flaw in his argument. The fact of the mat- ter is, that the word natural has, except in wide limits, no fixed and constant value whatever as applied to man ; that only can be condemned as universally unnatural which, as far as human experience goes, Nature will toler- ate in no individual, that which is inconsistent, in every known instance, with health. We know that an habitual BAD HABITS, THEIR INFLUENCE ON MAN. 83 consiim2)tion of mercury, of lead, of copper, of iron, and of many other substances, renders, as far as human expe- rience teaches, the maintenance of the steady balance of health impossible, but this cannot, by an impartial judge, be affirmed of the systematic iise of tobacco. That many persist in the habit of smoking, notwithstanding the evi- dent fact that it is injurious to them, no one can doubt; but this may be said equally of all habits, even of the simplest and of those most generally commended. And what is true of smoking applies equally to the habit of taking alcohol. It is only when a certain limit — varying in each individual — is exceeded, that the practice becomes injurious and will deserve our condemnation, while, up to that point, tobacco or alcohol may become, may be, an actual factor in the maintenance of health, a factor which, if the body be aged or deranged, and therefore slow at equilibration, cannot be suddenly dismissed, under the penalty of more or less severe derangement of health. I may even proceed still further and state that which will be borne out by all medical men of experience in the line, that loss of general health, evidenced by digestive failure, derangement of the heart's action, muscular weakness, and, above all, by prostration of the nervous system, is the consequence of the sudden discontinuance of habits and modes of life which are distinctly contra honos mores, and, for the latter reason, and that only, intolerable, and to be discontinued even were life itself to be the sacrifice. The question of clothing, w^hich belongs to the dej^art- ment of habits and mode of life, I shall deal with, practi- cally, in the second part of this book. A few words b}'' way of conclusion. Our first duty in undertaking any treatment is to comprehend the signifi- cance of the phenomena of disorder, and then to study the environment — to be found in the conditions of life — 84 THE PRINCIPLES OP SCIENTIFIC MEDICINE. of the sufferer, for this environment is the mould in which the man is cast, and which lends itself readily to such alterations as may be required for the good of the invalid. The process is simple, but requires some thought, some judgment, often some strategy and skill. In the first place, the past physical history, family and personal, has to be learned. This supplies us with data for the estimation of the original form of the mould from which the individual has issued, that in which he was well, and to a return to which it will, in most cases, be comparatively easy, and nearly always beneficial, as nearly as possible to revert. Inquiries into the medical history also bring out the exist- ence of certain constitutional taints — gout, insanity, etc. — of which otherwise we should possibly have remained com- pletely ignorant, and which, in a latent state, may be at the bottom of much mischief. Then the plasticity of the body of the patient has to be gauged. This will depend on his age, on the presence of structural disease, on the rate at which he has been spending life, for there is sound philosophy in the French adage, "L'homme a toujours I'age de son cceur," which teaches us that a man may be gray at heart when few summers have passed over his head, or, conversely, be old in years and young in strength and vital energy. Having thus arrived at as correct an estimate as is pos- sible, in the circumstances of any given case, of the sum and the distribution of the forces of the invalid's body, and having considered the various agencies which have brought about the present physical derangement and the part played by each one of them in the process, we turn to the three great measures which I have discussed for means of relief. All of them will often require to be pressed into our service. This caution is necessary, for even the fair and open field of hygiene, that in which it might have been FALLACIOUS VIEWS OF DISEASE. 85 imagined no guide but common-sense would have been tol- erated, is infested with those pseudo-pilots of medicine — the one-idea men. These "worshippers of detached ideas," as Professor Bonamy Price would have called them, stum- bling against a fragment of truth, would have us to cling to it alone for physical salvation, to the ignoring of all else. Such are the men who are going to regenerate hu- manity by means of diet only, or of climate, or of elec- tricity, or of massage, or of faith in hysterical religion. They are conscious that there is truth in their means of cure, but they fail to see its limit. They are ignorant of, or they shut their eyes to, the one great physical truth, that the body of man is the equation of all his surround- ings. Not on one power alone in these surroundings, to the exclusion of all others, can reliance alone be placed, but on a wise and skilful combination of all of them. Again, the various theorists of this order are not even agreed among themselves as to the ideal man ; the one recognizing great capacity for mental work as the stand- ard of perfection, another the virtues which go to form the athlete, another those which mark the moral and relig- ious man. I have now completed my very short sketch of the three great every-day moulders of mankind — diet, climate, and habit. It is evident, provided the exact nature and the extent of any malady be determined, and the body of the invalid be not already partially destroyed by structural disease, that these great agents, wisely moderated to suit the exigencies of each case, will be equal to its relief and cure. In the darkest ages of superstition this fact has always been recognized by a chosen few, and at the pres- ent day, though rarely acted up to, is never seriously con- tested. Why, then, is recourse had so often to the extraor- dinary measures, drug action, powerful and unnatural 86 THE PRINCIPLES OF SCIENTIFIC MEDICINE. mental influences, etc. ? Mainly for two reasons : the first being that the means of cure by ordinary measures are often out of reach of the sick man or not according to his inclination ; and the second, that there is even now a considerable hesitation, even in high scientific quarters, in throwing over the old belief in the supernatural causation of disease, and a belief in this is inconsistent with an hon- est reliance on the every-day, common-sense methods of cure. Certainly nine tenths of the sick people one is called on to treat think they discern in their disease the hand of the Almighty scourging them for some moral defect, and not, as it should be, and is, his hand leading them, by the operation of natural laws, back from physical transgres- sions and their certain consequences, to the enjoyment of health. Only when it has come to be recognized, and the main object of this book is to teach it, that the latter is the real solution of the problem of disease, will natural remedies receive their full share of popular reliance ; and even then extraordinary measures, such as drugs, though occupying a subordinate position, will not be completely discarded, for they, as I shall attempt to show in the next chapter, find a place, by no means unimportant, in a sclieme of scientific and rational medicine. CHAPTER V. THE PRINCIPLES OF SCIENTIFIC MEDICINE {continued). TREATMENT BY EXTEAORDESrARY MEASURES. Extraordinary measures are called for in treatment, because extraor- dinary combinations of forces are relied on in health by civ- ilized man. Medicines may act in any one of the following ways : {a) as foods ; {U) as elements of disturbance, of which nature are stimulants, tonics, and alteratives ; (c) as mechanical scavengers ; or {d) as antidotes. An instance of the treatment in a case of gout. The fallacies of the orthodox drug system : («) its assumption of the possibility of local disease ; {b) its pre- tence to possess drugs that act only locally ; (c) its wrong in- ductions ; {d) its misinterpretation of the phenomena of disease, and consequent misapplication of remedies. The only rational lines of treatment. Physico-mental agents. Structure of the nervous system and method in which it, and, through it, the whole body, is affected by these agents. CHAPTER Y. THE PRINCIPLES OF SCIENTIFIC MEDICINE {continued). TREATMENT BY EXTRAORDINARY MEASURES. "The day of orthodoxies is over; the day of real science is only just dawning. Enormous evils have accrued to humanity and to tlie medical art from a blind reliance upon the traditions of the ag-es, and often upon traditions wrongly interpreted. . . . The physician of the future will do well if he remembers always the pernicious despotism which has been ex- ercised over his own art by the fetters of these dead orthodoxies, and will therefore be very slow to acknowledge their claim upon him to any more than an historical regard." — Professor Gairdner {Presidential Address on Medicine at the British Medical Association's Annual Meeting in August^ 1888). " La mddecine aurait done besoin d'etre soumise a une critique analogue a celle que Kant a fait subir a la philosophic. Par cette operation cruelle sans doute, mais en definitive salutaire, elleperdrait beaucoup de ses pre- tensions ambitieuses et de ses droits usur^Des, mais elle verrait clair dans ses affaires et pourrait vivre avec securite et honneur." — Louis Peisse. " True science is perennial ; systems of science are perishable. Science belongs to mankind ; a system only to the time and circumstances which have begotten it." — Hufeland. TowAKDS the conclusion of the last chapter I hinted that in the actual conditions of every-day civilized life, circumstances may and do constantly arise which warrant a recourse to various forces of Nature, differing often so far both in intensity and in character from those to whose influence mankind is commonly subject, as to deserve the title, when applied to man in his physical distresses, of ex- traordinary measures of treatment. But why should man, born of, and ever environed by, 90 THE PRINCIPLES OP SCIENTIFIC MEDICINE. tlie ordinary forces of Nature, seek aid from combinations of force apparently foreign to his economy ? Such, in con- densed form is the plausible argument of a school ycleped hygienic, that professes to worship Nature without ap- parently having any adequate comprehension of her ways. Man is not a constant quantity — and this truism cannot be too often reiterated — but each individual of the race, while preserving a general common likeness to all its other members, is compounded of forces infinitely diverse both in arrangement and in relative amount. We allow our- selves to be deceived by a23pearances, and because the North American Indian and the Englishman agree in their number of limbs, in their mode of progression, and in the possession of certain special senses, we call each a man, and then unconsciously assume them to be practically in all respects equal in their physical attributes. It is only when we surround the noble savage with what, to us, are the great blessings of civilization, because they have become a necessary part in our environment, and remark how the darker race pines and dies, that we begin to comprehend that these men, so similar to us in the contour of their bodily structure, demand, for continued health and vigor, surroundings in life widely different from our own. The savage, accustomed to face and to battle with untamed Nat- ure, languishes in civilization just as do flowers and shrubs rudely translated to new soils and fresh climates. Physi- ology knows no rigid ideal ; that only is best for the health of the individual which his body is best fitted to balance ; each body has been produced, and is maintained in health, by a separate mould, and the shape of that mould cannot in any direction be suddenly altered without throwing the whole contents, temporarily or permanently, out of bal- ance. Health, then, is an equilibrium with special sur- roundings, varying in the case of every man, not, as the METHODS TX WHICH MEDICINES ACT. 91 liygienist would liave us believe, conformity with some ideal environment. The European of the nineteenth cen- tury has long since ceased to be a child of Nature ; for the maintenance of health he demands what, from the point of view of the savage, are extraordinary conditions, and for the relief of physical suffering he may, therefore, for very sound reasons, look also for extraordinary rem- edies. That the latter have become discredited is due only to their misapplication, and to a misinterpretation of the phenomena of Xature as observed in disease. All extraordinary measures of treatment may, for the sake of convenience, be divided into medicinal and phy- sico-mental. This division is purely an artificial one, for the only essential difference between the two varieties lies in the channels through which they act on the body, the medicinal selecting generally the blood system, the phy- sico-mental the nervous system exclusively. The methods in which medicines act may thus be sum- marized : The human body consists, as we know, of cells which receive and store the energies derived from food, which food, in the form of blood, is ever circulating in our tis- sues. The cells of the separate organs, moulded variously by the conditions which surrounded their growth, differ, for reasons already fully explained in our first chapter, not only in external outline, but, by virtue of that colloid- al character which permits of their interior being per- meated and "moulded by crystalloid material in solution, also in actual chemical composition, and being thus en- dowed with different chemical afiinities, they abstract from the blood-current different materials and hence perform different functions. If, therefore, you introduce into the blood-current soluble crystalloids, such as are the vast ma- jority of our drugs, it is clear that not only ^^'ill they act 92 THE PRINCIPLES OF SCIENTIFIC MEDICINE. upon each and every cell, but that they will act in a very unequal manner on the various groups of cells, the so- called organs. We will now briefly discuss the drug system, and seek from the tangled mass of medical creeds to arrive at some- thing like a correct conclusion as to the limits within which the employment of medicinal agents is commendable. Medicines. Medicines, when taken internally, act, then, in almost every case by way of the blood-channels, and, mixing with the blood-stream, are conveyed with the food to every por- tion of the body. Kow we know that the cells of the different organs of the body differ in chemical composition (^. e., in the ar- rangement of their constituent molecules), and, according to the chemical afiinities existing between them and the foods presented to them, so do they act more or less accord- ing to chemical laws on that food. Precisely the same occurs in the case of medicines. By the light of these simple facts let us see in bow many ways medicines can act on the cells. 1. As Foods. — We possess no known medicinal com- pound which can merit the name of a real tissue-food or in any way replace albumen. It is true that, in caffeine and guaranine, we have com- plex nitrogenous bodies which exert a marked influence on the body, and that phosphorus — an element having in its chemical attributes some relationship to nitrogen — has been vaunted as a nerve-food, but these drugs, and others of the same class, cannot be administered, for any extended period, without producing obvious mischief, and therefore cannot actually be classed as substitutes for, or even as real adjuncts to, our natural tissue-food, albumen. FOOD-MEDICLNES. 93 Popularly classed as medicines we possess, however, some very useful fuel-foods. Cod-liver oil and the vari- ous fatty emulsions are of this nature, to which also be- long the so-called malt extracts. Many of the lighter wines and the malt liquors may also find a place under this heading, though their action on the body is, unlike that of the pseudo-drugs just named, not purely nutritive. Necessary salts that have been omitted from every-day food are sometimes administered as drugs and spoken of as substances alien to the body, though they cannot really be viewed in that light. Thus many salts of sodium, potassium, ammonium, mag- nesium, lime, and iron are natural constituents of the hu- man frame, and the necessary amount of each is repre- sented, though we may be unconscious of the fact, in our common articles of diet. Sometimes, however, especially among the rich, who prefer the finer varieties of meal, which contain too small a percentage of these salts, it be- comes very necessary to order by themselves, and in the form of medicine, these preparations. Great good may thus be effected, but the dose of the salt must never be too large in amount, and it must be administered in a great deal of water. This is the secret of the great suc- cess in gouty states of such very weak mineral waters as those of Contrexeville and Kronenquelle, and of many others, and of the evil wrought by large, concentrated amounts of the same salts when obtained by prescription. Under this heading of foods, we may also rank certain artificial digesters of food, of which pepsin, trypsin, pan- creatin, and malt are familiar examples. Their field of utility is very restricted. When of the best manufacture, and administered with correct knowledg^e of the condi- tions under which alone it is possible for them to act in a desirable way, they digest artificially certain foods, but this 94 THE PEINCIPLES OF SCIENTIFIC MEDICINE. only franks these foods through the wall of the stomach or intestme ; it can do no more, and, as physiology tells us, this is but a fraction of complete digestion. It is, more- over, demonstrable that they can only do this when the general bodily health is fairly good, a state of matters in which they can rarely be required. In the presence of any marked gastric or intestinal derangement, such as is present in febrile states, they are ofttimes administered by the ignorant with a view to circumvent the beneficial blockade w^hich Nature has established at those many mouths of supply of the circulation situate in the stomach and bowel, but, fortunately for the patient, such attempts usually fail. II. As Elements of Disturbance, in respect to the ordi- nary cell functions. Most of this class act as stimulants, their eifect being more marked on some tissues than on others. Alcohol, chloroform, ether, opium, Indian hemp, etc., are examples of such acting in various ways, but always mainly as stimulants, on the nervous tissue, their stimulating action on the cells being, more or less, speedily followed in every case by a species of arrest of function. We do not wonder at this result when we remember that a stimulant does not, cannot, generate energy, but can only liberate that already stored in the cells. It can, therefore, only leave behind a state of cell exhaustion. Each of the above stimulants selects by preference — really by chemical affinity — a certain portion of the nervous system, but they do not, as w^e know, leave the other portions of this sys- tem or of the general body unaffected, though these col- lateral effects are often masked by the more striking ner- vous ones. Then we have the large group of so-called alteratives, under which heading the orthodox therajieu- tist ranks any drug that will disturb the economy, and recommends it to be administered in obscure diseases on THE SO-CALLED ALTERATIVE AND TONIC DRUGS. 95 the off-chance that a better condition of health may, after a general concussion, make its a23pearance. Then comes a large grouj) of slow stimulants, which, according as they act most conspicuously on any one part of the body, are said to tone that part, and are called tonics. There is absolutely no place in the economy of man's body for a drug, unless it be a food that acts as a permanent restorer of health and tone, for practically that is what the therapeutist wishes to be understood by the word tonic. Iron is either a food or a poison according as it is administered, quinine is probably a food,* while many wines and malted liquors, phosphorus, caffeine, etc., are, in varying proportions, foods as well as stimulants. Digitalis, strophanthus, nux vomica, strych- nia, and vegetable bitters are, in their ordinary dosage, examples of slow stimulants, and their use is attended by that fatal but inevitable drawback attendant on such stimulation — viz., subsequent exhaustion, which manifests itself most, but 7iot solely, in the organ, the cells of which have shown the greatest affinity for the drug. It is true that the unfortunate patient will but rarely attribute his eventual breakdown to the drug-stimulant upon which he has been relying for help, for he is quite ignorant of what the course of his malady would otherwise have been, and he is, therefore, not in a position to trace cause and effect; but any skilled physiologist will assure him, with me, that a tonic is a mere therapeutist's day-dream, a scientific ab- surdity, and any intelligent man who has had experience of both the orthodox and the expectant systems of treat- ment can also assure him that recovery without the use of * An alkaloid resembling, if not identical with, quinine, exists, according to Drs. Dupre and Bence-Jones, normally in the liver and other animal organs, and, according to Dr. Lauder Brunton, near allies of it are found, in considerable quantity, in the human intestine. 96 THE PEINCIPLES OF SCIENTIFIC MEDICINE. tonics is more prompt, and, above all, more lasting, than that apparently favored by the use of these agents. I have said that there are some members of this group which, from their extensive range and their rapidity of action, may be called general stimulants, while there are others which show a preference, a chemical affinity, for some one or more organs only, and act much more slowly. There exists yet a third variety, whose action is such that one of the several functions of the cells in an organ only is stimulated, while the others are more or less unaltered. Take an example. The liver cells have each three or four important and very different duties to perform, yet we possess drugs that can increase temporarily their power of bile-making, while leaving their other functions in statu quo. The members of this last subdivision of stimulants are numerous and important, but are perhaps greater dis- turbers of the general economy than any others, and re- quire to be therefore used with the greatest wisdom and discretion. III. The third Group., ichlch act as 3Iechanical Scaven- gerSy is a small one, and it must be confessed that nearly all its members belong more or less to the class just named, that of local stimulants. Castor oil is the best example of a drug whose action is almost purely that of an evacuant acting on the intestine, and water consumed in such large quantities as to merit the name of an extraordinary remedy, perhaps our only example of one that acts on the urinary and cutaneous system in a like simple manner. IV. The fourth Group coiisists of certain Antidotes to Poiso7is. — But what is a poison ? It is that quantity of anything, be it popularly viewed as food or drug, which will act deletcriously on the human body. Thus common salt and the most prized of our fruits may, when consumed in excess of our needs, act as violent, or even as fatal, poi- A SPECIMEN OF EATIONAL TEEATMEXT. 97 sons. Under the beading of antidotes to poison may also be classed all drugs which destroy parasites, as also all chemical compounds which directly neutralize the effects of such dangerous compounds as arsenious acid, strong alkalies, acids, etc. It is much to be regretted that we possess not one single drug that has the power, without killing the patient, of destroying the fever ferment which has entered the blood-stream. Perhaps this is not to be wondered at, since we are not as yet quite certain as to the identity of the special poison in each case. Quinine was long thought to be such an antidote, but its title to such a claim is, for reasons already given, open to serious doubt. Such beino; the divisions within which all medicines that can produce any effect whatever on the body of man are susceptible of being ranged, I will now very briefly sketch the plan upon which they should be administered, and will then show to what depths of absurdity partial ex- periments, a blind reliance on tradition, prejudice, and in- famous logic have sunk the orthodox therapeutist lights of the present day. Let us hark back for a moment and ima2:ine ourselves in the presence of an invalid suffering from a mild attack of gout. AYe will also, for the sake of simplicity, suppose that all the organs of his body are, for his time of life, structurally perfect. ^ In gout we have in the first place, as prime cause, a liver that, as the result of overwork, of congenital weak- ness, of debility in its nerve supply, or most often of all of such causes combined, has broken down in one of its main functions, the making of urea. As a direct result of this breakdown, uric acid, a less oxidized substance than urea, a kind of half -formed urea, appears in large quantities in the blood. Like the urea which it in part rejilaces, uric acid must 5 98 THE PRINCIPLES OF SCIENTIFIC MEDICINE. pass out of the body by the kidneys. If these organs are in good condition, they strain it off rapidly, and if present in large quantities, it will appear in the urine as sand or gravel. If the patient continues his usual course of life, and the kidneys remain functionally active, this sand will, at short intervals, for a long period of years, make its ap- pearance, though there is ever present the grave risk that some of it may be retained in the kidney or bladder and form the nucleus of a hard stone. In the vast majority of cases, however, the excretion of uric acid does not keep pace with its production, and as a result the uric acid accumulates in the blood. Now com- mences to be manifested a host of symptoms — all of them endeavors by the body to cast out the offender — two or three of the commonest of which we will refer to. The surface of the stomach inflames, in other w^ords, gastric catarrh sets in ; the patient's appetite, and indeed his pow- er of retaining food, are both arrested, the supplies of nitrogenous food, from which uric acid is formed, are cut off, and the kidneys are thus afforded time to deal with the poison whose production has hitherto exceeded their powers of elimination. More than this, however, occurs: the heat of the inflammatory action going on in the stom- ach wall helps to convert the uric acid in the blood to urea, and this process is further favored by the oxygen in the l)lood, which, finding an insufliiciency of fuel-food, readily assists in the oxidation of the uric acid, wiiich, oxidized, becomes urea. As there is no difficulty in the excretion even of large quantities of urea by the kidneys, it thus happens that in two or three days the excess of uric acid which has set up the symptoms will be expelled the blood-current, and health will return. Instead of the stomach one or more joints may become A SPECIMEN OF RATIONAL TREATMENT. 99 inflamed. The sequence of matters is, however, still the same, the loss of appetite and the inflammation leading di- rectly to a cure. In other cases, in place of either the stomach or a joint, the external skin will take on the in- flammatory action, and patches, more or less extensive, of acute eczema will be seen. The chain gives way at its weakest link, and the least healthy, or most overworked and exhausted, organ of the body will be the first to hang out the signal of distress ; but the process of cure thereby induced is in all cases the same. It is scarcely necessary to indicate the lines of treat- ment, so obvious must they be. {a) We cut down at once the supply of albumen, the nitrogenous food from which comes uric acid, to the least possible dimensions, and we further advise the patient to be always in the future exceedingly cautious not to con- sume, in any but the least quantities compatible with health, this form of food, and we do wisely to add the caution that all combinations of food which usually cause distress to a weak stomach will deleteriously tell on the gout. We furthermore give a smart purge to stop at once the further passage of supplies of albumen to the liver by emptying the stomach and bowels. Lastly, we order an alkaline salt, as uric acid robs the blood of alka- lies by forming compounds with them. (b) We try to wash out the surplus uric acid by giving large draughts of water, and we may administer some drug that excites the kidney, already excited by the pres- ence of the excess of uric acid, to further action. (c) We enjoin rest to the inflamed organs, and we in- crease the amount of heat already present in them by the application of poultices, or we prevent the radiation of heat from them by means of cotton-wool or flannel. (d) Sometimes, so acute is the pain, we are forced to 100 THE PKINCIPLES OF SCIENTIFIC MEDICINE. cut short the attack by a few doses of a potent and special liver stimulant, colchicum. This practice is, however, as all gouty men know, not a commendable one, for the pres- ent benefit is purchased at the certainty of a return of the attack more speedily than would otherwise have been the case. Such, with a few general hints as to the avoidance of worry, and a possible change of climate, together with a short inquiry into the patient's habits and mode of life to ascertain if in them is to be found any cause directly pro- vocative of gout, complete our indications. We have thus in the one complaint presented to our view the great truths that underlie the scientific and rational use of drugs. We administer a needed food, an alkaline salt, while we suppress the further supply of unnecessary ones. We use, in the form of a purgative and of water, useful scav- engers. We favor the symptoms of disease, as far as is 2)0ssible,hj means of drugs. We do not try an antidote, because we do not possess one, and if, in a weak moment, w^e have recourse to a stimulant (colchicum), we regard it, with wisdom, as only a doubtful friend. From this example we learn that people who live under the extraordinary conditions of civilization, in an environ- ment which is not that of man in a state of nature, are justified by their own reason in having recourse to certain extraordinary agents in their search for the means of re- covery, more especially if they have first made a satis- factory trial of ordinary means and have found these lat- ter unequal to the occasion. Do I then consider that the British Pharmacopoeia and the various standard commentaries thereon are safe guides, and that, when the Darwin of tlie future shall have regen- erated medicine, these books will still occupy an honored THERAPEUTIC FALLACIES. 101 place ? Not for one moment. There is not one of them that is not a mine of fallacious reasoning, while in the one or two that, discarding a mere dependence on written and oral tradition, attempt to support their drug system by an appeal to experiment, the proof in every single case com- pletely fails because of the striking incompleteness of the experiment. I will briefly indicate one or two of the flaws patent to even the least learned of the readers, and which vitiate the conclusions arrived at. First of all, and on every page of such works, the exist- ence of purely local disease is assumed. Now, it is scarce- ly necessary to inform the reader that if there is one fact in physiology which is established beyond all doubt, and the truth of which is universally accepted, it is that all the parts of the body are absolutely and perfectly interde- pendent. They are not, of course, all of equal importance to the economy, but not one derangement, however insig- nificant, is conceivable which does not react on the whole economy, or which is not, as is more frequently the case, an expression of a general disorder of the body. It is true that the existing general derangement cannot always be submitted to ocular demonstration. Medical men often have presented to them skin affections of very limited area. When the patient is questioned as to his general health, he replies that he is exceptionally sound and well. No physical examination may be able to shake this asser- tion; the microscope may fail to show in the blood the very faintest sign of disorder, and yet the skin disease will often tell, more plainly than could words, of a consti- tution rotted to its last fibre by scrofula, syphilis, or other constitutional taint. Having assumed the existence of strictly localized dis- ease, the therapeutist almost naturally passes on to another assumption, equally at variance with all scientific research, 102 THE PRINCIPLES OP SCIENTIFIC MEDICINE. of the existence of drugs whose action is also purely local. I have said that drugs, like foods, have onore affinity for one organ than for another, but even if it were possible that any medicine, after in some way modifying the con- stitution, and, then of necessity, the function of one organ, could then pass straight out of the body without produc- ing the least action in its transit on any other tissue, even in such a practically impossible case, the changes set up in the aifected organ would react on the whole body. In all fairness it must be admitted that the therapeutist will state — as far as medical knowledge goes in this mat- ter, which in the case of no single drug is very far — the collateral effects of the administration of a given drug, but even then he proceeds usually to recommend the use of the drug for the relief of 07ie of the indications only. Let me take as example a familiar drug, tobacco, and, opening the last edition of perhaps the best-ordered thera- peutic guide-book of the day, we will see what the author has to say about its action and uses. Tobacco is stated to act a little (in what way is not mentioned) on the brain; to excite the spine; to lower the functional activities of the motor nerves; to contract the pupils of the eyes; to be injurious to vision; to lower the temperature; to pro- duce cardiac irritability; frequently to cause dyspepsia, and to possess a slightly purgative action. Then follows, side by side with the last remark, this extraordinary sen- tence: "Moderate smoking as a rule aids digestion by acting as an aperient." Great heavens ! an aperient ac- tion aid digestion ! Digestion a purely local business ! Why, if there be one process of the body, in the comple- tion of w^hich every organ is concerned, and the nervous system most of all, it is digestion. That a drug which runs amuck in the ways described among the bodily or- gans should work anything but disaster in the digestive THERAPEUTIC FALLACIES. 103 function is inconceivable and ridiculous on the very face of it. But apart even from this fatal flaw, another and a deeper error traverses the whole article on tobacco, one to which I have more than once referred as the fallacy of the assumed ideal standard. The writer of the article has had before his mind's eye an ideal man with ideal organs and with ideal surroundings, and his whole book, as indeed all modern works on therapeutics with which I am acquaint- ed, is written for, and true only in tbe case of, such a purely imaginary being. The real facts, as regards to- bacco, are that there exist many men for whom tobacco is one of the ordinary every-day forces in their environ- ment, one which their bodies have become accustomed to balance, and one which has therefore become an ele- ment in their actual maintenance of health under the conditions in which they live. If they discontinue its use their bodies actually become a little deranged for a short time, and until accustomed to the want of it, because one power, though a small one, in their health-producing sur- roundings is lacking, just as people unaccustomed to the effects of tobacco experience discomfort on commencing its use, because a new power is added to the accustomed sum of forces in their life. Such are a few of the out- rages on the human reason, a dozen samples of which may often be found on a single page of a modern treatise on Materia Medica. I have said that experiment is often pressed into the service of the therapeutist, but two grave errors invalidate the results which one might have looked for from a prom- ising method of investigation. Firstly, the experiments are made nearly always on the lower animals, and, second- ly, they are too partial to warrant the conclusions drawn. As to the first of these objections I have not much to say, nor do I view it as a disturbing factor of sufficient weight 104 THE TRINCIPLES OF SCIENTIFIC MEDICINE. often to invalidate the results, inasmuch as there is oft- times ample evidence of a close similarity of action be- tween certain of the tissues in man and in the lower ani- mals, though the habits and customs of men and animals- it must be remembered, are widely different, and to rea- son of the effects of meat or tobacco on meat-eating, smoking man from observations confined to the vegeta- rian, anti-narcotic monkey is scarcely a proceeding likely to advance science. But the partiality of the experiments, at least when viewed w^th their appended conclusions, is a much graver error, and robs them absolutely of all real value. Let us take the largest book of the day on Pharma- cology — and I omit purposely all names, as I am attacking an evil principle and not an individual — and in every one of the very numerous experiments recorded therein, one organ or one group or set of organs, or even a mere fraction of an organ, is singled out as the subject of a drug test, and from the results observed is drawn a conclusion as to the value of the given medicine in a disease affecting the icJiole body ! But man is not a nerve, a gland, a heart, a pair of lungs, or a muscle, but a complete mechanism, each j^art of which lives and performs a certain function, which has no real existence and no useful purpose when viewed alone, but only when regarded as an essential factor in the mainte- nance of a certain general balance. Moreover, it is not ex- plained — for the explanation, if full, would in the majority of the cases show a balance of utility against the drug, even in the special organ whose benefactor it is supposed to be — what are the collateral, and above all the second- ary, the after-effects of each drug. Sometimes, indeed, another method of research, quite of equal value with the last, is adopted. A selected drug is administered to perhaps a dozen individuals with some FALLACIES OF THE ORTHODOX DRUG SYSTEM. 105 one symptom. If this symptom improve in all, or in the great majority, of such cases, the drug is forthwith given out, iirhi et orbi, as a cure for such. To take an example. Three or four years ago, with a great heralding of trump- ets, it was stated that, in suppression of certain periodic female discharges, permanganate of potassium (the salt from which Condy's fluid is prepared) was eminently suc- cessful as a means of relief. But of the cases quoted it was soon evident that, in some, the suppression was phys- iological, and that, therefore, no attempt to interfere with it was justifiable; and apart from this error, which is such a common one in therapeutics that I shall presently have to refer to it expressly, on extended research, and after some millions of women had been dosed with this by no means harmless salt, it became clear that the zeal of the discoverers had carried them away, and that the drug w^as practically inert in the cases for which they had recom- mended it. But even if the fatal objections to its credit which I have urged against the modern, orthodox, therapeutic creed could be explained away, yet a heavier charge would remain. Modern philosojDhy has demonstrated the relationship between man and his environment, and has shown disease to be a salutary process ; all symptoms and all groups of symptoms, and therefore all functional dis- ease, to be of direct benefit in the restoration to health of the individual ; organic, degenerative disease being, as far as its lesion is concerned, a benefit to the race of man, which it purges of its least fit members, Avhjle its symp- toms retard the fatal issue, making death more gradual and more easy to the sufferer. To this view many leaders in medicine have long since subscribed ; not so the ther- apeutist. To him a symptom acts as does the red rag on a bull ; down goes his head, and away, at all costs, must the 106 THE PRINCIPLES OF SCIENTIFIC MEDICINE. objectionable color. To him a constipation, a diarrhoea, a skin eruption, a heart that does not beat the regulation stroke, or that does not convey the regulation impression to the listening ear, a liver or a stomach that does not secrete up to a certain amount, are ever and always legiti- mate game. They must conform to an ideal standard, if twenty other organs fall, as a result, out of the equi- librium, and a drug stimulant suited to that end is select- ed ; whereas the real treatment, if treatment be needed at all, should consist in an effort to increase simultaneously the power of all the organs, to elevate the general equili- brium, and this can be effected only by foods, by changes of climate, by exercise, and similar means. Such are a few of the more striking fallacies of the or- thodox drug system ; nor is it difficult, by the light that their exposure sheds, to understand why this system of physic has become utterly discredited, and why educated men so often prefer to trust their lives in illness to irreg- ular practitioners of doubtful honesty than to the ortho- dox physician. Long ago Adam Smith said that to the quackery of the orthodox faculty were due, in England, all other forms of quackery. As a matter of fact, any system of medicinal treatment, or none at all, succeeds better than the orthodox one. The people at large are unaware of the fact that curable disease cures itself, and, moreover, takes the readiest and best methods to attain that end. Ignorant intermeddling on the part of the sufferer with the process is the danger most to be feared; the impostor has, therefore, but to place the patient in surroundings favorable to his recovery, and these in most cases common- sense suggests, to occupy his time, and save him from the risks attendant on meddling with Nature, by giving him some pleasant and inert compound, and, hey presto ! health returns, and the empiric reaps both reward and honor. RULES FOR ADMINISTRATION OF DRUGS. . 107 In vain does orthodox medicine protest ; her undoubted honesty does not save him from the humiliating failure that awaits all those who work on wrong principles. It needs only that some one of our rising medical scien- tists should have the courage of his convictions, and should subject to clear and pitiless scrutiny the fallacies on which the present drug structure is built, and then, in the words of Peisse, quoted at the commencement of this chajDter, "medicine, while losing many of her ambitious pretensions and of her usurped rights, would," in return, " see her way clear in her own domain, and could live with security and honor." But it is time for us to consider, since common-sense authorizes an occasional recourse to drugs, on Avhat lines and within what limits we should employ them. I can attempt only a very brief sketch. In the first place, the cause of disease, which is an un- doubted evil, should be sought for and removed. Some drugs of the antidotal class can meet, in many cases, this indication. In the second place, whether the cause be persistent and irremovable, or has already been found and placed out of action, the symptoms of disease, being in their very essence of a beneficial nature, should be favored. This line of treatment imitates Nature, and expedites the end she has in view, the cure. In the third place, while still imitating natural methods, it may in rare cases be permissible to open fresh channels of relief for her by raising artificial symptoms, similar in nature and kind to those already in existence, but in a part of the body where the mischief of ultimate destruc- tion of tissue will be smaller than in the structure affected. A plaster or a stimulating liniment may thus often bene- ficially be used to congest or inflame the skin, and com- 108 THE PRINCIPLES OF SCIENTIFIC MEDICINE. pel it to share in the strain thrown on more deeply seated organs. In the fourth place, stimulating drugs should be used with caution, and with due regard to the troublesome and often serious reaction which is attendant on their employ- ment. Evacuants, such as castor oil, should be had re- course to also occasionally, but only in emergencies. Their action always partakes somewhat of that of stimulation, and their secondary effects therefore nullify often the primary and desirable purgative ones. In the fifth place, the food-adjuncts, such as pepsin, and the drugs that partake of the nature of condensed foods, should be administered with due regard to the needs of the body, and not on the idle preconception that because natural appetite is lacking it is advisable to force it. There is no hard-and-fast line between foods ineptly given and agents popularly recognized as poisons. Lastly, drugs should be had recourse to only when sim- pler means have failed, for the knowledge we possess of the complete action of drugs is too restricted to justify us in seeking of them what is, at best, but a questionable ser- vice. All potent drugs should be banished from the do- mestic medicine-chest. The best test we possess, though it is by no means an infallible one, of the action of a drug is its behavior in a number of healthy individual men. This method of re- search was that largely relied on by the late Sir Robert Christison and many other eminent therapeutic authori- ties. All states of real health are closely alike, are all simply conditions of equilibrium, and the invariable effects of a given drug in health, when the experimentation is extensive, leads to some definite knowledge of its action, and furnishes at least some useful data for its exhibition in disease; whereas no tw^o states of ill-health can be even PIIYSICO-MENTAL AGENTS. 109 approximately identical, for loss of equilibrium is neces- sarily of all shades and degrees. Thus the latter method, the more specious and the more fashionable, is actually the less reliable of the two. Tlie PJiysico-mental Af/e/its emjyloyed in the Treatment of Disease. Before we advance, it will be advisable to sum up our posi- tion. The body of man can be influenced either in health or in disease, thouo-h the latter onlv of these states now concerns us, through the medium of two channels, the blood and the nervous system. For the sake of convenience, we have divided our agents into ordinary and extraordinary. When a patient pre- sents himself for treatment we generally turn first of all to the ordinary methods of relief, and if we consider it best to effect a change in his bodily state by acting on his blood system, we make what we consider the alterations necessary to that end in his daily food.* In many cases, especially those of chronic but slight illness, such a change, if wisely and judiciously carried out, meets all the indica- tions for treatment, and health promptly returns, but in some cases, from various causes, it may partially or com- pletely fail. The body, for example, may have been fight- ing hard for years against antagonistic forces, its gallant stand unappreciated by its owner, till at last, with its army of cells decimated, and the survivors exhausted or demoralized, it is forced to beat a hasty retreat, which may threaten soon to end in final and complete discomfit- ure. Such is the actual state of matters in manj^ acute diseases that the physician is called on to deal with. There is absolutely no time to obtain aid from a mere * It must l3e remembered that the blood is merely food Iq its final state of preparation. 110 THE PRIXCIPLES OF SCIENTIFIC MEDICINE. change of diet, and a raj^id alteration of environment is rendered by the patient's state impossible. Something must be done, and done quickly, to prevent death. The feeble cells are roused to renewed vigor by stimulating drugs, while unnecessary burdens are removed by pur- gative ones. Time is thus gained, and this is employed in endeavoring to relieve the pressure of the antagonistic forces, and, if this can be effected, the body may be able yet to hold out against dissolution, though figuratively at its last ditch, for many years. But we may have presented for our consideration and advice an invalid whose dietary is perfection, and whose blood is, to all intents and purposes, pure. His may, moreover, be a case in which recourse to drugs is unadvis- able, and, be it remembered, the sick man has, in any case, to pay very dearly in the end for the temporary accommo- dation derived from that source. In such an emergency we shall do well to turn our attention to his nervous sys- tem and investigate the daily impressions made on this. These latter are often inadequate to his bodily require- ments, and we therefore advise that a new and stronger daily stimulus be applied, to -which end we recommend a greater variety of scene, the company of cheerful friends, an occasional visit to places of amusement, and, possibly, change from monotonous, dreary, routine work to employ- ment that calls for varied mental exercise, and that holds before the eyes of the worker some ambition, a something worthy to work for and to win. How many apparently utterly hopeless cases of chronic dyspepsia, or of long- standing and seemingly incurable mental depression, are set right by these means ; how vast and interesting, but too often neglected, this department of rational treatment, and how great and lasting its successes compared with those of the therapeutist ! Under the heading of the or- PLAN OF THE XERVOUS SYSTEM. Ill dinary measures of treatment I have already spoken, in climate and habit of life, of some of those nervine remedies, those of the ordinary variety. Let lis now ask ourselves if we do not possess also ex- traordinary means of rapidly and suddenly acting on the nervous mechanism of man — in other Avords, if we cannot find agents whose action on this system is analogous to that of druses on the blood-svstem. We shall see that we not only possess them, but that they are in frequent em- ployment, though the simple methods by which they act are generally misunderstood. In order to render their action intelligible to the general reader, I must precede the enumeration of such extraordinary nervine remedies by a very brief sketch of the plan of the healthy nervous system. The nervous system consists mainly of bundles of nerve cells, the so-called nerve centres, and of two sets of nerves, the one carrying impressions, sensations, to the centres, and hence called sensory or afferent {ad, to, and/e?*o, I carry) nerves, the other carrying motor influence/rom the centres to the muscles and to the blood-vessels, and these latter are appropriately styled motor, or efferent (e, from, and/ero, I carry) ones. The impression made on the end of the sensory nerve travels to its centre, sets up certain changes in the cells there, and, as a result, causes an emission of motor energy* down the motor nerve, which either contracts the cells of a muscle and thus causes a limb to move, or alters the size, the state of contraction, in the cells of a blood-vessel, and thus leads to an increase or decrease in the supply of blood to a part, and, since the blood is the cell food, the material by union with which it performs its work in life, * Each nerve cell is a storehouse of energy, which, like the heat- energy of the muscle cells, is derived solely from food. 112 THE PRINCIPLES OF SCIENTIFIC MEDICINE. consequently to an increase or a decrease in the functions of the part. The number of such nerve centres is very large. There are hundreds scattered through the body whose function is nothing more than what I have sketched. Each one with its afferent and efferent nerves is as purely an auto- maton as one of the machines for supplying matches and sweetmeats to be seen at the railway stations. They are aptly called reflex centres, inasmuch as their sole function in health is to reflect impressions, and in response to a stimulation, a call, from any portion of the body, to send down by the motor nerve an amount of energy equal to such stimulation, which expends itself in dilating the local blood-vessels and thus temporarily increasing the local power of doing w^ork. This, in brief, is the nervous mech- anism by virtue of which all of our internal organs per- form, without the direct interference, or, in health, without even the knowledge, of the brain, those manifold func- tions — breathing, digesting, heart-movement, etc.— which are necessary to life. It must, however, be added that each one of the many reflex centres in the body is connected also, indirectly, with the brain, which thus becomes conscious of a sensa- tion — pleasurable or painful — when the stimulating mes- sage travelling from any organ to its reflex centre is in. ex- cess of the ordinary. Thus, for example, though we are, in the ordinary wa}^, absolutely unconscious of the inces- sant movements in the coils of the intestine, any indigest- ible article of diet will speedily afford to us a painful proof of their reality ; and, moreover, this sensation, going to the brain, will be reproduced, as are all such impres- sions, in the form of motion, and thus new groups of mus- cles, in this case those of the abdominal wall, are set in movement and aid in the expulsion of the undesirable guest. THE BRAIN AND ITS NERVE CENTRES. 113 Let US now turn to that most important and complex nerve centre, the brain, for on a conception of its mode of working will depend our comprehension of the manner in which external impressions of various kinds may be util- ized as remedial agents of a highly important character. In ground-plan the human brain may be said to be an aggregation of reflex centres, each receiving a specii^lized impression, each emitting ordinary motor force as a con- sequence thereof. Thus we have the centres for sight, for hearing, for smelling, for tasting, and for feeling, together with many others, mention of which, for the sake of sim- plicity, we must here omit. Now, it is perfectly certain that the impressions which are represented in the human brain by vision, by sounds, by odors, by sapid substances, and by contact with the skin, are, each and al), the result of the impact on certain parts of the body of matter in some one of its well-known forms, and that the flnal and wide difference in the impressions conveyed to the brain are due merely to differences in the forms and the move- ments of such matter, and, most of all, to the special ap- paratus, situated at the termination of each sense-nerve and on which the impression first falls. In short, there can be no doubt as to the absolute materiality of the im- pressions, of the existence of special apparatus for receiv- ing and specializing them, and of their final exit from the brain as motor force capable of setting any part of the body in action. Each nerve centre in the brain, though occupying a dis- tinct area and being to a large extent a separate entity, has nevertheless important relations with all the others, for the impressions (called, in the brain, the sensations) it receives, ere their final exit as motion, blend with those from other centres, and thus produce w^hat we know as an " association of ideas," and from this compounding of sen- 114 THE PRINCIPLES OF SCIENTIFIC MEDICINE. sations naturally arises an equivalent blending in the re- sulting motor currents, and hence such really comj^lex raovements as those of speech, music -playing, dancing, etc. The above slight sketch will suffice to outline the way in which external and purely material impressions, acting on the impressionable sense organs, influence, and, indeed, command the brain, which, in its turn, holding in its hands the reins of the whole body, may in response set muscles or limbs in motion, or contract blood-vessels and decrease their local functional activity, or may employ one motor energy to counterbalance some other motor energy, and thus dilate blood-vessels and increase muscular functions, or check — in physiological language, "inhibit" — some movement that would otherwise have taken place. Such then are some of the ordinary powers of the brain, whose existence is placed by innumerable direct experi- ments beyond the pale of doubt, and which are common alike to man and to the higher animals. Thus we see that, in addition to the food channels, the arteries, we possess in the nerves of the special senses five great channels, by acting upon which we may influence at will each and every part of the bodily mechanism, pro- vided only that the cells of the brain, and of the rest of the body, be fairly supplied with their proper store of en- ergy by the food system, which is after all the first and most essential of all the systems, and literally and truly the source of life. The reader will now, w^ithout difiiculty, be able to un- derstand how very easily, since the movements, the func- tions, and the very life of each and every organ, and portion of an organ, are under the direct control of that great nervous mechanism, tlie brain, we may, by applying suitable stimuli to the sense organs, increase, decrease, or THE BRAIN AND ITS NERVE CENTRES. 115 regulate the activity of any part of the body, and how sim- ply it happens that the stern voice and the fixed glances of the mesmerist can throw into a cataleptic state the limbs of the patient, or hold the brain functions of the latter temporarily in his power. Given an impressionable set of nerve organs and a definite number and variety of impressions acting upon them, and the result is certain. The operator does not control the patient by his will, as for the greater mystification of the people he would fain have them believe, but by the purely material agency of words and glances ;* for were the phenomena witnessed due to any psychic, any spiritual, agency, it is quite clear that the operator could dispense with all words of com- mand and glances. Certain localities are also capable of a powerful influence over the bodies of some individuals, and the connection between cause and effect is precisely the same as in the case of mesmerist and subject. The solemn surroundings of such places are, to the eyes of the pilgrims, what were the glances of the mesmerist, and the wonderful stories of the benefits received are the exact analogues of his words of command, the direction thus given to the nerve currents resulting in the one case in rigidity of limbs, or the performance of comical actions, in the other in the return of power to weakened organs or in the healing of obstinate ulcerations. The thoughtless public do not know that it is simply and solely owing to the limited powers of the human eye that the real cause of the wonders observed, the impact of material impres- sions on the sense organs, and thence on the brain cells of the affected, is not actually visible, though its existence is * Faith iu the operator is usually considered, and is, indeed, a powerful aid towards success. It would seem to consist in a condi- tion of the brain in which the inhibitory mechanism already referred to is in a state of quiescence. 116 THE PRINCIPLES OF SCIEXTIFIC MEDICIXE. as demonstrable and as tangible as is that of the vapor of absolute alcohol, of chloroform, or of ether, which, though invisible, can, at the will of the administrator, convert a quiet and harmless individual into a dangerous madman, or place speech and moveinent beyond the control of the subject. It is then, I consider, clearly the duty of medicine to rescue from the hands of impostors these very powerful means of affecting for good or for ill — for they are equal- ly potent for both — the body of man, and to formulate the nature and scope of their employment. In such a treatise as this I can do little more than mention a few of the methods in common use to restore health through the nervous mechanism. Of these, electricity is the first in importance. Very rarely indeed is this potent agent applied to the nerves of vision, hearing, smell, or taste, or to the brain tissue it- self ; its use is restricted almost purely to the restoration of lost or defective motor and sensory nerve currents. Of the four forms in which it is employed, that known as static electricity, or Franklinism, is the most generally use- ful, the most easily applied, the safest, and the least known to the public. The electric force is, for this purpose, gen- erated by friction, the Toepler-Holtz apparatus, with its large circular glass plates, which forms so prominent a feature in physical laboratories, being the instrument gen- erally used in its production. It may be applied to the whole body, when it may be said to cause a general exal- tation of functions, or mild stimulation, of use, backed up by surer means, in the treatment of hysteria, hystero-epi- lepsy, nervous exhaustion, and even in some varieties of real epilepsy; or its application may be localized, and its stimulating properties centred on one or more groups of muscles or other organs. In this way wry-neck, contract- ELECTRICITY AS A NERVINE STIMULANT. 117 ures of limbs, spastic rigidity, and some forms of paraly- sis and of St. Vitus's dance, may be relieved or even per- manently cured. Next in utility as a means of treatment, comes the dy- namic form of electricity. This is usually generated by the conversion of chemical energy, as the static variety is by that of friction energy, to electric energy. Dynamic electricity supplies us with the means of burning tissue (electro -cautery), or of more slowly disintegrating it (electrolysis), and is the usual agent employed in those portable baftteries that produce the familiar " shocks," though sometimes the electric force is, in these cases, de- rived from a magnet, the name of electro-'inagnetism being then given to the results of this combination. In the second part of this work, which will deal with the Art of Healing, I shall, where necessary, enter into detail as to the means of applying electric force in disease. In this place I will ask the reader to observe that, in elec- tricity, we possess an agent which is capable, among other uses, of being employed to rouse any part of the nervous system, excepting the special nerves of vision, of hearing, of taste, and of smell. When it is desirable to act on these, other, and what are generally regarded as more mysterious, agents have to be found.* In 7nesmerism^ as I have already explained, we possess a potent method of influencing the whole body by acting directly on the brain. ITypnotism, so much in vogue as a therapeutic agent in Paris at the present day, is but mes- merism. It cannot be denied that, extraordinary as are * While -writing this my eyes fell on the following paragraph- lieading in the Lancet of July 28, 1888, "Recovery of Vision by Lightning;" under which is given an account of the restoration of sight by the sudden stimulation of the retina of the eye by an elec- tric flash, a most instructive and suggestive lesson. 118 THE PRINCIPLES OF SCIENTIFIC MEDICINE. often the benefits derived from the use of this agent, there exist great drawbacks to its frequent employment, for, while it has recalled many a sufferer from chronic nerve debility to health, it has also sent a large number across the border ipto the realms of insanity. There can be no doubt that extended study will enable us to better regu- late the strength of impression, and that science may even provide us with a mechanical mesmerist; and an instru- ment producing the necessary kind and variety of impres- sion on the sense organs is well within the limits of me- chanical skill; but in the meantime this agent is liable to great misuse, all the more as it is in the power of every one readily to become more or less of a successful opera- tor with it; and for this reason it should seldom, and only with certain safeguards, be had recourse to. Faith-healing is an agent closely allied in its rationale with mesmerism. The glances of the mesmerist are re- placed by the equally potent agents of impressive sur- roundings, the stacks of crutches, etc., to the influence of which the optic apparatus of the invalid is exposed, and the words of command by the narratives of those who have witnessed or themselves experienced the eflicacy of the cure. As in the mesmeric performance, so in the proc- esses of faith-healing, belief is insisted on as a sine qua non. Faith in God, which implies faith in the operator, or the locality, which are to be viewed as tools in his hand, is the first essential. I have had the advantage of meeting and conversing with many who have profited by faith-healing, and I have also read more than one well- authenticated work on the subject, and, while I am con- vinced of the truth of the results, which are usually, how- ever, somewhat exaggerated, I have never seen any reason whatever for regarding them as divine or miraculous. In fact, the best and most }>ermanent case I have ever wit- CURES "by impressions." 119 nessed of a cure by impressions was that of a bedridden woman* who was restored suddenly and com[)letely to healthy vigor by the intelligence that her husband had been arrested and imprisoned for stealing. It is most instructive in this connection to note how well the ancients understood the power of sudden impressions made on the nervous system. Look at their methods of curing insanity. The unlucky patient was well beaten, or was hung head downward, or was nearly drowned, but, unless we are prepared to say that there was an organized conspiracy to lie, the desired result was often attained. Indeed, the ancients were closer observers of cause and effect than we are, and it is simply incredible that such cruelty would have received, as it did, official sanction unless there existed some really substantial evidence in its favor. About eight years ago there was reported by the medical officer of a northern asylum, in either the Lancet or the British Medical Journal, the case of a woman un- der his charge, who, after having for years suffered from insanity of an inveterate and apparently incurable type, had completely recovered her reason after being resusci- tated from apparent death due to a most determined effort to strangle herself. Of course, such methods of cure are not commendable, nor indeed are they probably as successful as the more modern and humane ones, but the study of them teaches us the useful lesson that a stimulation of the nervous sys- tem, even if painful, may be, and often is, beneficial in diseases that no drug can touch, and that no ordinary means can hope to effect. Faith-healing then, like kindred agencies, may now and * She had been six years in bed with functional paralysis, and her case had been regarded as hopeless by many doctors who bad at- tended her. 120 THE PRINCIPLES OF SCIENTIFIC MEDICINE. again, in well-selected cases, be pressed into the service of the physician. We now turn to almost the only means of the class we are considering of which modern medicine will take offi- cial cognizance — namely, 3Iassage. Massage differs from both mesmerism and faith-healing, inasmuch as it not only provides the patient with healthy mental and physical pabulum, but also aids recovery by removing deleterious influences.* The state of matters, in the case of invalids for whom massage is advisable, is often much as follows: The pa- tient, usually an impressionable female, is surrounded by a sympathizing crowd of friends and attendants, almost the sole subject of conversation being the state of the real — more often supposed — disease under which the suf- ferer labors. From these, and often from the doctors, come many unwise questions, such as — Have you no pain here, no tenderness there ? These questions in the debili- tated mind of the patient take the form of suggestions, and new crops of symptoms are the result, and a complete physical and mental demoralization ensues. In these cases, massage acts like a charm. The patient is isolated, the flow of baneful sympathy is arrested and replaced by the firm words of direction and of hope of the professional rubber. Recovery, as a subject of con- versation, replaces valetudinarianism. In addition, the body is kneaded in all directions, and the accumulations of waste in the unused muscles and the current of blood in the capillaries are hurried forward, the kidneys excrete more freely, and appetite returns naturally. Nourishment is, after the first day or two, freely supplied, and in the course of a few weeks both the blood and the nervous * I refer here to "general massage" — i. e., massage of the wbolr body. THE USE AND ABUSE OF MASSAGE. 121 system have recovered their normal state, and the cure is complete. Sometimes the patient is one of those despondent, intro- spective, hypochondriacal males, nearly always the subject of chronic neurotic dyspepsia. In massage we then possess a rational and most excellent means to bring what we have called an extraordinary in- fluence, or combination of influences, to bear beneficially on an advanced derangement of the nervous system ; un- fortunately, the system has been, and is, discredited by the unscrupulous use that is frequently made of it to unjusti- fiably deplete the pockets of the rich, the extraordinary nature of the remedy being used as a lever. It can be carried out thoroughly, at really very little expense, by any conscientious nurse to whom a few lessons in manipu- lation, and on the rationale of the process, have been given. And now the first half of our allotted task — that which deals with the great underlying principles on which the existence of man rests — approaches completion. Let us once dispassionately view the human being as he really is, a bodily substance intricate and complex indeed in the ar- rangement of its several parts, but none the less purely physical in both structure and function, and keep ever steadily before our eyes the relationship which must exist between it and every other embodiment of force in its vi- cinity, and we shall discern clearly what health is, and on what its maintenance must depend — an equilibrium be- tween the sum of the bodily and of the surrounding forces. Secure on this firm principle, it will be easy to trace the source of nearly every derangement, and, comprehending thus the real causation of bodily disorder, and possessing the key to the right interpretation of the phenomena, the symptoms manifested in the course of it, the sure road 6 122 TUE PRINCIPLES OF SCIENTIFIC MEDICINE. to a simple and scientific method of treatment will be- come plain and easy. Such is my idea of a rational system of medicine ; too conscious in its own strength to feel the pangs of jealousy or to dread the advent of rivalry ; too anxious for its own perfection to discountenance truth from any quarter ; too wholesome to breed quackery; too secure in its hold on the human reason and too single-minded in its aims to doubt its own honor or its hold on the gratitude and affection of the human race. Such, when the time comes, will be the gospel of medicine, and, if I interpret aright the prevailing spirit of dissatisfaction regarding the present medical creeds, as well in the circles of the educated and thought- ful public as in those of the medical world, its advent can- not long be delayed. My attempt is, compared with such an effort, quite unambitious, more to write down in the spare moments of the day a sketch of what rational medi- cine should be, and thus possibly to act as the not alto- gether unworthy forerunner of a greater man. PART II. TRE ART OF HEALING, mXEODUCTIOR We now approach the practical application to the phys- ical derangements of humanity of the principles of our science of medicine. The human body is, as we have seen, not a mere aggre- gation of independent or semi-dependent organs, each pur- suing selfishly its own course, but a perfect mechanism of nicely adjusted and interdependent portions, producing a real concert of functions emitting in health but one har- monious tune. If, then, for purposes of study, a grouping of such organs becomes necessary, it will be advisable to make our definition of each group as wide and inclusive as possible, and to base it on the sure ground of physiological knowledge. What, we ask, does the body of man ? First- ly, it lives and moves, by virtue of the supply to its cells of material with which those cells can so act as to pro- duce those phenomena ; let then our first division com- prise all the organs concerned in the food system. Sec- ondly, it regulates its internal economy and its relations ^ith the external world; let then our second group include the organs concerned in bodily government under the term nervous system. Thirdly, it possesses a system of fulcra and levers, the bones and muscles, which constitutes its inotor system. This we must next study. Fourthly, and lastly, it reproduces itself, and therefore we shall have to say a few words on the reproductwe system. 126 INTRODUCTION. Grouping thus the bodily organs in the only rational manner in which any grouping of the parts of a perfect mechanism is permissible, according to their duties, and not in the ordinary method, geographically, according to the regions of the body which they chance to occupy, or, still more absurdly, according to the alphabetical order of the initial letters of their names, we shall be able to trace, without I hope anj^ very great difficulty, many apparently disconnected phenomena of ill-health, having but the one origin, and requiring therefore but the one line of treat- ment. Ko. i.—Ubc foo^ system* CHAPTER YI. SOURCES AND DESTINY OF HUMAN FOODS. 1. The Foods of Man, Iheir Origin, their Digestion, and their Uses. 2. The Processes of Digestion. 3. The Organs of the Food System. Ube foot) System. CHAPTER YL SOURCES AND DESTINY OF HUMAN FOODS. Ix our first chapter we saw that the body of man, or, more correctly, the living cells of his body, requires two varieties of food, tissue-food, represented by albumen, by chemical union with which these cells live and multiply ; and fuel-food, represented mainly by the fats, starches, and sugars, from the combustion of which, by the oxygen in the blood, the cells derive heat-energy to enable them to perform their various duties in life. Inorganic salts also are required to assist the above chemical processes, and water to hold the food in solution. All the above-named substances must be presented to the cells as crystalloids; the salts and the water are already of this nature, but the albumens and the fuel-foods are colloids, and therefore, ere they can be utilized as cell- foods, must be converted to crystalloids — must, in other words, undergo a process called digestion. Let us now consider, in a little more general detail, the foods, the digestive process, and the parts assigned to the different organs of the food system in the body. 6* 130 SOURCES AND DESTINY OF HUMAN FOODS. 1. The Foods. (1) The albumens^ or tissue-foods, the material whose chemical union with the cells is the actual physical cause of the phenomena known collectively as growth and main- tenance, must approach* in complexity of structure and in composition to the cells themselves, and a substance fulfilling such conditions can, as we might expect, only be found in organisms that have themselves lived. Now in the scale of life the animals come far before the plants, for every part of their structure, except the fat deposit, may be said to enjoy a share of life; in every part of them therefore, with the exception named, do we find the albu- minous substance called protoplasm, fitted to act as a tissue- food. In the vegetable kingdom this is, however, not the case, the seeds only possessing a large share of that life essence, albumen, while the rest of the structure contains it but in small proportion. The bodies of animals and the seeds of plants are thus our main sources of albumen or tissue-food. (2) The fuel-foods, represented by the fats, starches, and sugars, whose destiny in man's body it is simply to under- go combustion, and thus to supply it with that motor power which, like a steam-engine, it derives from heat-energy, * The energy of a living cell is dependent on complexity of struct- " Motor system. Reproductive system. •^ i ■•^ I ^ 3 <» \^ s I i Vi