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Remedies Plus Suggestion

Prof. Richet, the head of the department of physiology, University of
Paris, quotes the expression of a French critic of medicine: "Hurry up
and take the new remedy while it still cures. After a time it will
lose its power." The power that is lost as remedies grow familiar is
the suggestive element that accompanied them at the beginning. They
were announced with a flourish of trumpets as a discovery in
therapeutics, a number of cases treated with them were much
benefited (because of the feeling that they must do good), and it was
only after a great many cases had been treated, many of them under
circumstances where patients knew nothing of the claims made for the
remedies, and where physicians had little or no previous confidence in
them, that their true place in therapeutics was revealed. Every
physician of experience has seen the popularity of remedies wax and
wane as a consequence of the attention called to them. We have new
therapeutic discoveries every week. Enthusiastic articles are written
about them, many of them in perfect good faith, and then after a time
no more is heard of them, or they sink back into the long list of
dubious remedies that may be tried when others have failed, but have
no special claim upon us, in spite of the fact that some physicians
continue to think them wonder-working.

"Time is short and art is long, the occasion is fleeting, experience
fallacious and judgment difficult," as Hippocrates bemoaned 2400 years
ago, and conditions in medicine continue the same. With suggestions
and coincidence ever at work, it is still practically impossible to
determine the intrinsic value of any remedy until after a prolonged
trial. In the olden time it was still more difficult because there had
been no such accumulation of experience as we have to guide us, and so
it is not surprising to find striking examples of even great
physicians recommending remedies whose main therapeutic influence must
have been the element of suggestion.

Galen's Theriac.--Perhaps the most striking instance of suggestive
therapeutics is Galen's famous theriac, various prescriptions for
which have come down to us, some of them much more complex than
others, so Galen is probably not responsible for all its absurdities.
This remedy contained a host of ingredients, some of which neutralized
others, and all of which taken together could have had but little
effect save by a strong suggestion to the patient that as he was
taking so many drugs he surely must be benefited.

Bernard's Theriac.--Almost in our own time another theriac came
prominently before the public. In his younger years Claude Bernard,
the French physiologist, worked in a little drug store in a country
place not far from the farm on which he was born. There he found that
the most called for remedy was a theriac. It was good for most of
the ills that flesh is heir to and was bought in quantities by the old
women of the neighborhood, who administered it on every occasion. The
remedy was made in large quantities, but the secret of its composition
in this particular pharmacy was what interested Bernard. Whenever any
compound was for any reason spoiled in the drug store, the rule was,
"Put that aside for the theriac." This much sold remedy then
consisted of the most heterogeneous drugs. It was so diluted that it
could do no harm, though it had quite sufficient taste and odor to
make every one who took it realize that without doubt they were taking
a strong medicine.

The effect of the knowledge of the composition of this wonderful
remedy on Claude Bernard was the best that could have been
anticipated. He resolved to study the physiological effects of drugs
so that they could be given scientifically, and not in the hit or miss
fashion that made possible the success of the theriac.

The custom of Bernard's country drug store, however, was not different
from that of most country drug stores of the time. Unconscious
psychotherapeutics we may well call it, because the main therapeutic
factor was suggestion, renewed as often as the mixture was taken,
that the patient ought to feel better, until finally whatever symptoms
were due to over-attention and to concentration of mind on feelings of
discomfort were diverted. Just as soon as the inhibition exercised by
this over-attention ceased its hampering effect nature completed the

Suggestion in Colds.--Many remedies acquired a reputation for breaking
up coughs and colds. It is, however, extremely doubtful whether any
one has ever aborted a cold, or any other infection, that had gained a
hold on the patient. We now know that this common affliction is not
due to cold but to absorption of infectious material. Nansen spent two
winters near the North Pole without catching any cold, and his men
were as healthy as himself. He had been back in civilization scarcely
a week before he and his men were confined to bed with a grippy cold.
In the far north, and high on mountains where the temperature is low,
colds are not as common as they are in crowded cities and especially
among those who are much in crowds. Cold weather only predisposes to
the infection, and after it has occurred it is sure to run its course.
That course may be longer or shorter. The cold is usually preceded by
chilly feelings. Every one knows it is possible to have chilly
feelings that seem to portend a cold, yet be well the next day. If in
the meantime any remedy is taken, credit will be given to the remedy.
When a cold was supposed to be merely a disturbance of circulation or
a congestion, one might expect to break it up. Now that we know that
it is a microbic infection, and know further that microbic diseases
are usually cured by a definite reaction on the part of the body, we
are not so likely to think of breaking them up. There are still
physicians who think they can abort a threatened pneumonia or
abbreviate typhoid fever, but they are not those who know most about
the science of medicine.

We have the story, then, of a series of remedies used with great
confidence in coughs and colds, some of them physically beneficial,
many of them, especially those containing opium, often physically
harmful, yet taken with such confidence that undoubtedly the patient
was helped through his mind if not otherwise. What is thus true for
this class of diseases can also be said of other minor affections.
Many internal remedies have been used for boils and styes and other
external infections and have often had wide vogue. The reason for
their acceptance as remedies has been that the giving of anything
produces a more hopeful attitude in the mind of the patient and this,
by bettering the general health, sometimes overcomes the tendency that
may exist to a repetition of such infectious processes.

Erysipelas.--The medical history of erysipelas is just a succession of
remedies recommended, each claimed to be almost infallible, yet
abandoned after a time for another for which like exaggerated claims
were made. The doctrine of signatures played a large role in the
treatment of erysipelas, and, strange as it may seem, still survives.
According to the doctrine of signatures, erysipelas, being a disease
involving intense redness of the skin, red things in nature would be
likely to do it good. Red pepper, for instance, was suggested for it
over and over again, both internally and externally. Various red
remedies have been favorites at different times in history. At
present, in many country places, a poultice made of cranberries is
supposed to be most efficacious. For many years I lived in a small
town where one of the grocers put in a large stock of cranberries
each fall, though the people of the neighborhood used them but little
on the table, because during the winter there were many calls for them
for the making of poultices for erysipelas. People who have had
erysipelas, especially if it has occurred on unexposed portions of the
body, are supposed to be protected against its recurrence--for there
is a distinct liability to its recurrence--by the wearing of red

There is scarcely any drug that has not at some time been recommended
as almost a specific for erysipelas. Anything that was given on the
third or fourth day, and it was only at this time as a rule that
patients came to physicians to be treated, seemed to bring about the
alleviation of symptoms that occurred on the fifth or sixth day.

Erysipelas, because of the sudden irruption of fever which accompanies
it, the intense redness which characterizes it, and the discomfort
which is often present, is an affection that disturbs patients very
much. For them, then, the presence of the physician and his assurance
that their affection is not likely to be severe, and his prompt relief
of certain conditions, all act by suggestion on the patient's mind and
strengthen the natural curative reaction.

In country places where physicians were not near, erysipelas was one
of the affections that continued almost down to our own day to be
treated by incantations. I have known in a little American country
town of a woman making a "charm," as it was called, for erysipelas.

Pneumonia.--Pneumonia is another of these sharply self-limited
diseases that give opportunity to many remedies for the acquisition of
a reputation as cures. Croupous pneumonia is so disturbing in its
onset, so rapid in its progress, yet so strictly self-limited in the
previously strong and healthy, that in the old days there were many
remedies that were supposed to bring about the crisis. The old
text-books contain so many cures that it is surprising pneumonia
should have continued to be the fatal disease it has been at all
times. Almost any remedy that is used for three or four days in
pneumonia will be followed by the crisis with, in most cases, a
favorable termination. The crisis takes place some time from the
seventh to the tenth or eleventh day, and often we do not see a
pneumonia patient until the second or third day of the disease. Just
before the crisis the patient runs into a series of acute and more or
less alarming symptoms. Often there is much restlessness, difficulty
of breathing with complaint of heaviness, and perhaps prostration. The
pulse and temperature are high, the skin hot and dry. Then in the
midst of this the patient sleeps, there is a critical sweat, the
temperature drops, the patient wakes up feeling quite well, there is
little difficulty in breathing, and he feels that recovery is sure to
come. The change is so great that it is natural that it should have
been attributed to all sorts of remedies which had been used
immediately preceding the crisis.

I once heard an old physician declare at a meeting of a large and
important medical society that calomel in divided doses was
practically a specific for pneumonia. He said he waited forty-eight
hours to be sure that the affection was pneumonia, and also that it
had reached that diffusion in the lungs beyond which it was not likely
to go, then he gave the calomel. He said that, almost as a rule,
during the next forty-eight hours the crisis came--and he attributed
it to the calomel. We have had other remedies just as curious as this
recommended and taken quite seriously. Some years ago a Russian
physician, who had been treating soldiers in the Russian army for the
pneumonia which occurs so commonly after exposure on the Steppes,
announced that he had found in digitalis almost a specific. He pushed
the tincture up to twenty drops three times a day, beginning it just
as soon as the pneumonia was detected, and the rate of mortality among
his patients was about one per cent. According to his theory, it was
the failure of the heart in pneumonia that made the disease fatal.

Apparently the character of the patients in whom his pneumonias
occurred was forgotten. They were absolutely the most favorable cases
that could be selected. Most of them were young men between twenty and
twenty-five. At this age no one who is given a reasonable amount of
fresh air should die of pneumonia. If the patient had a serious heart
lesion, or a crippled kidney from nephritis after scarlet fever, or
crippled lungs because of a previous attack of tuberculosis, then the
pneumonia might be fatal--indeed, almost inevitably would be, or, in
the last-mentioned case, would end by lysis and not crisis. It really
matters little what remedy is given to young, otherwise healthy,
adults; they will get better, barring serious complications. The use
of digitalis lessened the chances of recovery by stimulating too early
in the case the heart that later had to bear one of the most serious
strains that the organ can stand. But doubtless this harm was more
than overcome by the patient's knowledge that he was taking a new and
powerful remedy, supposed to be particularly calculated to cure him.

Moreover, the special interest of the physician in these cases, and
his administration of a remedy with confidence which inspired the
patient, undoubtedly did much good. Pneumonia is one of those diseases
in which the patient is likely to be greatly depressed unless he is
surrounded by favorable mental influences, and is encouraged to
believe that he is going to get well. Every physician has probably had
cases in which patients died, not because of the severity of the
disease, but because they gave up the struggle in fright. If several
of a man's friends have died of pneumonia during the year or two
before he gets it, he is likely to conclude, especially if he is of
the worrying kind, that his doom is sealed as soon as the diagnosis of
pneumonia is made. If this thought persists hardly anything will save
him. He must be assured that pneumonia is not necessarily serious,
that there are remedies that influence it, and that his own case is
particularly likely to respond favorably to them.

We now realize that nursing is the most important element in the
treatment of pneumonia. Such attention to the patient as will treat
symptoms so as to prevent them from disturbing him, will secure him
against discouragement, will arouse his resistive vitality by assuring
him of a favorable termination. This will above all prevent the
patient from feeling that he is attacked by a fatal disease. The
presence of the doctor and his general directions make the patient
realize how thoroughly the course of the disease is understood and
therefore how likely it is that a favorable termination will be
brought about. We know how much the mind may interfere with the
breathing if allowed to dwell on it, and therefore if the patient
becomes over-solicitous about the condition of his lungs he seriously
hampers his recovery. In pneumonia the physician has always brought
relief, and he has usually attributed his success to his drugs, though
he has felt, too, that the confidence inspired by him meant much
for his patient. It would have been better had he exaggerated the
mental influence rather than the drug power.

Typhoid Fever.--Typhoid fever is another affection for which we have
many therapeutic suggestions, with wide vogue, that are nevertheless
almost directly opposed to what we know about the pathology and
etiology of the disease. Typhoid fever runs its course in from between
twenty to thirty days. The majority of people who take the affection
and who give in to it early enough, so as not to wear themselves out,
come through successfully. Complications may carry them off, but we
expect uncomplicated cases to recover. The longer course of typhoid
has made the action of drugs appear less striking than in pneumonia
and erysipelas, but a number of remedies have been proclaimed to
shorten its course, to make it less dangerous, to cure, and sometimes
actually to abort it. So often have these come and gone that the
physician who knows the history of therapeutics is likely to be
suspicious of them. Even at present there are certain remedies
supposed to have this effect, but one does not find them used in
hospitals where large numbers of cases are seen and where there are
opportunities for comparative observation. They are used only by
physicians who see a few cases every year, and to whom coincidences
may mean much more than they are likely to when extensive statistics
of the disease are made.

As a rule, these remedies are founded on some real or supposed
scientific principle. The antiseptic treatment of typhoid, for
instance, was based on the supposition that if one can kill the
microbes in the intestine the disease will run a shorter course. The
principle apparently fails to note that any remedy likely to kill
microbes is still more likely to kill cells of other kinds, and above
all human cells lessened in their resistive vitality by disease. The
advocates of this remedy also forget that typhoid is now recognized as
a general disease with only a local manifestation in the intestines,
and that the treatment of this local manifestation is no more likely
to affect the course of the disease than the treatment of the symptoms
of typhoid would be likely to do. But the giving of remedies with the
thoroughgoing confidence that awakens trust is in itself an excellent
therapeutic agent, and patients thus treated are sure to be benefited
in so far as they share the physician's confidence. Just the same
effect, however, can be produced by careful nursing and by making the
patient realize that even though typhoid fever runs a definite course,
which we cannot abbreviate nor probably influence, we can by nursing
so prevent complications as to make a fatal termination almost

Whooping Cough.--Perhaps none of the common affections illustrate the
influence of psychotherapy better than it is exemplified in the
history of the therapeutics of whooping cough. We have had all sorts
of remedies suggested for it, and most of them have been introduced by
those who had found them of great service in shortening the course of
the disease, and in making the "whoop" disappear much sooner than
would otherwise be the case. There have been internal and external
remedies, inhalations and inunctions, as well as many less likely
methods of treatment. Practically none has maintained itself. Whooping
cough is likely to run a rather long course. We know now that as a
consequence of the strain upon the lungs tuberculosis not infrequently
develops. Whenever this is true the tendency to cough is likely to be
prolonged far beyond the natural period, and from habit ingrained
upon the nervous system the "whoop" is likely to continue, though
there is no necessity for it. It is this secondary period of the
affection that the remedies have succeeded in shortening either
apparently or in fact.

Practically anything that is done for children is likely to instil the
persuasion that the "whoop" should disappear. Anything impressive will
arouse this favorable attitude of mind toward the affection, and hence
the remedies have obtained a reputation. In the interior of many
countries draughts of sea water are a popular remedy for whooping
cough. Sea water, it is said, loses its efficacy if carried long
distances from the shore, so the children must be brought to the
seaside. In mining regions children are taken down into the mines. The
experience is enough of itself, especially when talked over a good
deal in the family, and when the occasion is often the first outing
that the child has had for months, to bring with it such improvement
in health as will enable it to suppress the whoop. If the exposure to
the mine air does not bring improvement, it is said to be either
because the child was not taken deep enough, or because there was no
gas in the air, or the wrong sort of mine was chosen, or some other
plausible excuse is advanced.

The development of scientific medicine, or at least what we are
pleased to think of as more scientific therapeutics than they had in
the past, has not kept us from having many and varied remedies for
whooping cough, which, after being introduced on apparently good
authority and apparently accomplishing many good results, have
eventually been allowed to drop into innocuous desuetude. Whenever the
administration of any such remedy was accompanied by strong
suggestion--when the internal remedies were particularly distasteful,
or the inhalations rather trying or at least sure to attract the
attention of the sufferers--then good results followed. But the cures
were due to the mental influences at work. In recent years various
serums, including diphtheria serum, have been tried with reported good
results. The giving of the injection is one of those little operations
that is likely to impress itself forcibly upon the child's mind, and
when given in connection with the promise, implied or explicit, of
improvement it is easy to understand that there will be a tendency to
lessening the frequency of the whoop, at least during the secondary
periods of the disease.

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