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 umber 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

cure.





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

flannels!



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

impossible.





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.