Popular Science Monthly/Volume 19/October 1881/Physical Education X
By FELIX L. OSWALD, M. D.
REMEDIAL EDUCATION (continued).
THE vicissitudes necessarily incident to an out-door and primitive mode of life are never the first causes of any disease, though they may sometimes betray its presence. Bronchitis, nowadays perhaps the most frequent of all infantile diseases, makes no exception to this rule; a draught of cold air may reveal the latent progress of the disorder, but its cause is long confinement in a vitiated and overheated atmosphere, and its proper remedy ventilation and a mild, phlegm-loosening (saccharine) diet, warm sweet milk, sweet oatmeal-porridge, or honey-water. Select an airy bedroom and do not be afraid to open the windows; among the children of the Indian tribes who brave in open tents the terrible winters of the Hudson Bay territory, bronchitis, croup, and diphtheria are wholly unknown; and what we call "taking cold" might often be more correctly described as taking hot; glowing stoves, and even open fires, in a night-nursery, greatly aggravate the pernicious effects of an impure atmosphere. The first paroxysm of croup can be promptly relieved by very simple remedies: fresh air and a rapid forward-and-backward movement of the arms, combined in urgent cases with the application of a flesh-brush (or piece of flannel) to the neck and the upper part of the chest. Paregoric and poppy-sirup stop the cough by lethargizing the irritability and thus preventing the discharge of the phlegm till its accumulation produces a second and far more dangerous paroxysm. These second attacks of croup (after the administration of palliatives) are generally the fatal ones. When the child is convalescing, let him beware of stimulating food and overheated rooms. Do not give aperient medicines; costiveness, as an after-effect of pleuritic affections, will soon yield to fresh air and a vegetable diet.
Worms.—Intestinal parasites are symptoms rather than a cause of defective digestion, and drastic medicines (calomel, Glauber's-salt, etc.) are merely palliatives; even a change of diet may fail to afford permanent relief if the general mode of life favors a costive condition of the bowels. Like maggots, maw-worms seem to thrive only on putrescent substances, on accumulated ingesta in a state of self-decomposition, and disappear as soon as exercise, cold fresh air, and a frugal diet have reestablished the functional vigor of the digestive organs.
Diarrhœa.—An abnormal looseness of the bowels is an effort of Nature to rid the stomach of some irritating substance, and suggests the agency of a dietetic abuse, either in quantity or in quality. An excessive quantum even of the healthiest food will purge the bowels like a drastic poison, unless the alimentary wants—and consequently the assimilative abilities of the system—have been increased by active exercise. On the hunting-grounds of the upper Alps, an Austrian sportsman can assimilate a quantity of meat which the kitchen artists of the best Vienna restaurant could not have foisted upon the stomach of an indolent burgher. Dysentery medicines can be entirely dispensed with if one can get the patient to try the effect of Nature's two specifics—fasting and pedestrian exercise. Combined they will only fail when opiates have produced an inflammatory condition of the bowels, in which case a grape-or water-cure must precede the more radical remedies. The languor of dysentery is always combined with a fretful restlessness, and should not be mistaken for the exhaustion that calls for repose and food: the patient is safe if we can fatigue him into actual sleepiness, or anything like a genuine appetite; when the digestive organs announce the need of nourishment, they can be relied upon to find ways and means to retain it.
Constipation.—A slight stringency of the bowels should never be interfered with; in summer-time close stools are consistent with a good appetite and general bodily vigor. Aperient medicines provoke a morbid activity of the bowels, followed by a costiveness that differs from a summer constipation as insomnia differs from a transient sleeplessness. In England and the United States the use of laxative drugs has repeatedly become epidemic and in its consequences a true national misfortune; and a sad majority of otherwise intelligent parents are still afflicted with the idea that children have to "take something"—in other words, that their bowels have to be convulsed with poisons, for every trifling complaint. Constipation is often simply a transient lassitude of the system, a functional tardiness caused by fatigue and perspiration, and very apt to cure itself in the course of two or three days, especially at a change from a higher to a lower temperature. After the third day the disorder demands a change of regimen: cold ablutions, lighter bedclothes, in summer-time removal of the bed to the coolest and airiest available locality, and liberal rations of the most digestible food—bran-bread, sweet cold milk, stewed prunes, and fresh fruit in any desired quantity; faute de mieux, cold water and sugar, oatmeal-gruel, and diluted molasses. The legumina, in all their combinations, are likewise very efficient bowel regulators, and common pea-soup is a remedial equivalent of Du Barry's expensive "revalenta Arabica" (lentil-powder). For real dyspepsia (rarely a chronic disease of youngsters in their teens), there is hardly any help but rough out-door exercise, daily pedestrian exercise or out-door labor, continued for hours in all kinds of weather. The Graham starvation cure might bring relief in the course of time, but for one person with passive heroism enough to resist the continual cravings of an abnormal appetite, hundreds can muster the requisite resolution for an occasional active effort, which will gradually but perceptibly restore the vigor of the system. Drugs only change the form of the disease by turning a confirmed surfeit-habit into a still more obstinate and less commutable alcohol-habit; the vile mixtures sold under the name of "tonic" bitters have never benefited anybody but their proprietors and the rum-sellers, to whose army of victims the patent-medicine dispensaries serve as so many recruiting-offices.
Active exercise is also the only remedy for those secret vices whose causes are as often misunderstood as their consequences. The pathologists who ascribe precocious prurience to the effects of a stimulating diet seem to overlook the fact that the most continent nations of antiquity, the Scythians and ancient Germans, were as nearly exclusively carnivorous as our Indian hunting-tribes, the apathy of whose sexual instincts has been alleged in explanation of their gradual extinction. For the same reason the gauchos of the tropical pampas are an unprolific race, while the Russian mujiks and the sluggish boyars of the Danubian principalities are as salacious as the inert (though frugivorous) natives of southern Italy. Independent of climate and diet, the continence or incontinence of the different nations, or different classes of any nation, bears an unmistakable proportion to the degree of their indolence. Lazy cities and small, thickly populated islands (Lesbos, Paphos, Cythera, Otaheite) have been most conspicuous for the absence of those virtues which the Grecian allegory ascribed to the goddess of the chase. The menu prescribed by the founders of the monastic orders was rather ultra-Grahamite in quality and quantity, yet neither barley-bread nor the frequent fasts to aid the minutio monachi could counteract the effects of deficient exercise; if we can believe the publicists of the Reformation, the chronique scandaleuse of Lesbos and Capri was far surpassed in the record of some mediæval convents—and not in the flagrant latitude of Italy alone (Robert Burton's "Anatomy of Melancholy," volume of miscellanies, pp. 449-451, quotations, etc.). Nor can we mistake the significance of the circumstance that sexual aberrations in the years of immaturity are almost exclusively the vice of male children, whose potential energies, with the same diet and the same general mode of life, find no adequate vent in an amount of active exercise nearly sufficient for the constitutional wants of the other sex. Moral lectures are sadly ineffectual in such cases, because, as Gotthold Lessing remarks, vicious passions pervert the constitution of the mind as effectually as they subvert that of the body—"the evil powers blindfold the victims of their altars." A frugal diet may subserve the work of reform, but the great specific is competitive gymnastics, the society and example of merry, manly, and adventurous companions. Crank-work gymnastics won't do; enlist the pride of the young Trimalchion, watch him at play, find out his special forte, no matter what—running, jumping, or throwing stones—and organize a sodality for the cultivation of that particular accomplishment. Beguile him into heroic efforts, offer prizes and champion badges: as soon as manful exercises become a pleasure, unmanning indulgences will lose their attractions. The depressing after-effect of sensual excesses, the dreary reaction, is a chief incentive to the repetition of the vicious act, and the success of all reformatory measures depends at first upon the possibility of relieving this depression by healthful diversion, till, in the course of time, regained mental and bodily vigor will help the remedial tendency of Nature to neutralize the morbid inclination.
"Rickets" is a sign of general debility, owing to mal-nutrition during the years of rapid growth. The best physic for a rickety child is milk, bran-bread, and fruit; the best physician, the drill-master of the turner-hall. Rickety children are apt to be precocious, and till their backs are straightened up their books ought to be thrown aside. Knock-knees, bow-legs, "chicken-breasts," and round shoulders are all amenable to treatment, if the cure be begun in time—during the first three years of the teens, of all ages at once the most plastic and the most retentive of deep impressions.
For the cure of young topers, smokers, and gluttons I am persuaded that punishments are only of temporary avail, and homilies of no use whatever. The most glowing eloquence palls before the suasion of a vicious penchant. Here, too, the chances of saving the tempted depend upon the possibility of silencing the tempter—by outbidding his offer. Provide healthful diversions; the victims of the poison habit yield to temptation when the reaction (following upon every morbid excitement) becomes intolerable. Relieve the strain of that reaction by diverting sports; improvise hunting expeditions and mountain-excursions, or Olympic games; between exciting diversions and sound sleep the toper will forget his tipple, and every day thus gained will lessen the danger of a relapse.
It can not be denied that poison-habits (the opium-habit as well as "alcoholism") are to some degree hereditary. The children of confirmed inebriates should be carefully guarded, not only against objective temptations, but against the promptings of a peculiar disposition which I have found to be a (periodical) characteristic of their mental constitution. They lack that spontaneous gayety which constitutes the almost misfortune-proof happiness of normal children, and, without being positively peevish or melancholy, their spirits seem to be clouded by an apathy which yields only to strong external excitants. But healthful amusements and healthy food rarely fail to restore the tone of the mind, and, even before the age of puberty, the manifestations of a more buoyant temper will prove that the patient has outgrown the hereditary hebetude, and with it the need of artificial stimulation.
Chlorosis, or green-sickness, is a malignant form of that dyspeptic pallor and languor which one half of our city girls owe to their sedentary occupations in ill-ventilated rooms. The complaint is almost unknown in rural districts, and the best cure is a mountain-excursion, afoot or on horseback; the next best a course of "calisthenics," a plentiful and varying vegetable diet, fun, frequent baths, and plenty of sleep. "Tonic" drugs are sure to aggravate the evil. It is only too well known that a fit of nervous depression can be momentarily relieved by a cup of strong green tea. The stimulus goads the weary system into a spasm of morbid activity: the vital strength, sorely needed for a reconstructive process (one of whose phases was the nervous depression), has now to be used to repel a pernicious intruder; and this convulsion of the organism, in its effort to rid itself of the narcotic poison, is mistaken for a sign of returning vigor—the patient "feels so much better." But, as soon as the irritant has been eliminated, the vital energy—diminished now by the expulsive effort—has to resume the work of reconstruction under less favorable circumstances; the patient now "feels so much worse"—by just as much as the reaction following upon the morbid excitement has since increased the nervous depression. In the same way precisely a "tonic" medicine operates upon the exhausted organism, and in the same way its effect—a morbid and transient stimulation—is mistaken for a permanent invigoration.
Pulmonary consumption, in its early stages, is perhaps the most curable of all chronic diseases. The records of the dissecting-room prove that in numerous cases lungs, wasted to one half of their normal size, have been healed, and, after a perfect cicatrization of the tuberculous ulcers, have for years performed all the essential functions of the sound organ. Still, the actual waste of tissue is never perfectly repaired, and fragmentary lungs, supplying the undiminished wants of the whole organism, must necessarily do double work, and will be less able to respond to the demands of an abnormal exigency. But the lungs of a young child of consumptive parents are sound, though very sensitive, and, if the climacteric of the first teens has been passed in safety, or without too serious damage, the problem becomes reduced to the work of preservation and invigoration: the all but intact lungs of the healthy child can be more perfectly redeemed than the rudimentary organs of the far-gone consumptive; the phthisical taint can be more entirely eliminated and the respiratory apparatus strengthened to the degree of becoming the most vigorous part of the organism. The poet Goethe, afflicted in his childhood with spitting of blood and other hectic symptoms, thus completely redeemed himself by a judicious system of self-culture. Chateaubriand, a child of consumptive parents, steeled his constitution by traveling and fasting, and reached his eightieth year. By a relapse into imprudent habits, the latent spark, which under such circumstances seems to defy the eliminative efforts of half a century, may at any time be fanned into life-consuming flames, but in ninety-nine out of a hundred cases it will be found that the first improvement followed upon a change from a sedentary to an out-door and active mode of life. Impure air is the original cause of pulmonary consumption ("pulmonary scrofula," as Dr. Haller used to call it), and out-door life the only radical cure. The first symptoms of consumption are not easy to distinguish from those transient affections of the upper air-passages which are undoubtedly due to long confinement in a vitiated atmosphere: hoarseness, and a dry, rasping cough, rapid pulse, and general lassitude. Spitting of blood and pains in the chest are more characteristic symptoms, but the crucial test is the degree in which the respiratory functions are accelerated by any unusual effort. A common catarrh will not prevent a man from running up-stairs or walking up-hill for minutes together, without anything like visible distress; subjected to the same test, a person whose lungs are studded with tubercles will pant like a swimmer after a long dive, and his pulse will rise from an average of 65 to 110 and even 140 beats per minute. Combined with a hectic flush of the face, night sweats, or general emaciation, shortness of breath leaves no doubt that the person thus affected is in the first stage of pulmonary consumption. If the patient were my son, I should remove the windows of his bedroom, and make him pass his days in the open air—as a cow-boy or berry-gatherer, if he could do no better. In case the disease had reached its deliquium period, the stage of violent bowel-complaints, dropsical swellings, and utter prostration, it would be better to let the sufferer die in peace, but, as long as he were able to digest a frugal meal and walk two miles on level ground, I should begin the out-door cure at any time of the year, and stake my own life on the result. I should provide him with clothing enough to defy the vicissitudes of the seasons, and keep him out-doors in all kinds of weather—walking, riding, or sitting; he would be safe: the fresh air would prevent the progress of the disease. But improve he could not without exercise. Increased exercise is the price of increased vigor. Running and walking steel the leg-sinews. In order to strengthen his wrist-joints a man must handle heavy weights. Almost any bodily exercise—but especially swinging, wood-chopping, carrying weights, and walking uphill—increases the action of the lungs, and thus gradually their functional vigor. Gymnastics that expand the chest facilitate the action of the respiratory organs, and have the collateral advantage of strengthening the sinews, and invigorating the system in general, by accelerating every function of the vital process. The exponents of the movement-cure give a long list of athletic evolutions, warranted to widen out the chest as infallibly as French-horn practice expands the cheeks. But the trouble with such machine-exercises is that they are almost sure to be discontinued as soon as they have relieved a momentary distress, and, as Dr. Pitcher remarks in his "Memoirs of the Osage Indians," the symptoms of consumption (caused by smoking and confinement in winter quarters) disappear during their annual buffalo hunt, but reappear upon their return to the indolent life of the wigwam. The problem is to make out-door exercise pleasant enough to be permanently preferable to the far niente whose sweets seem especially tempting to consumptives. This purpose accomplished, the steady progress of convalescence is generally insured, for the differences of climate, latitude, and altitude, of age and previous habits, almost disappear before the advantages of an habitual out-door life over the healthiest in-door occupations.
A tubercular diathesis inherited from both parents need not be considered an insuperable obstacle to a successful issue of the cure. The family of my old colleague, Dr. G——, of Namur, adopted a young relative who had lost his parents and his only brother by febrile consumption, and was supposed to be in an advanced stage of the same disease. The Antwerp doctors had given him up, his complaint having reached the stage of night-sweats and hectic chills, and, though by no means resigned to the verdict of the medical tribunal, he had an unfortunate aversion to anything like rough physical exercise. But his uncle, having from personal experience a supreme faith in the efficacy of the open-air cure, set about to study the character of the youngster, and finally hit upon a plan which resulted in the proudest triumph of his professional career. Pierre was neither a sportsman nor much of an amateur naturalist, but he had a fair share of what our phrenologists call "constructiveness"—could whittle out ingenious toys and make useful garden-chairs from cudgels and scraps of old iron. That proved a sufficient base of operations. The doctor had no farm of his own, and the only real estate in the market was a lot of poor old pastures on a sparsely wooded slope of the Ardennes. Of this pasture-land he bought some ten or twelve acres, including a hilltop with a few shade-trees and a fine view toward the valley of the Sarabre. At the first opportunity one of Pierre's garden-chairs was sent up to the lookout point, but rain and rough usage soon reduced it to its component elements—scrap-iron and loose cudgels. Pierre volunteered to repair it, and was supplied with such a variety of material and tools that he made two more chairs, and while he was about it also a rustic round-table with a center-hole, corresponding to the diameter of one of the shade-trees. The hill was only two miles from town, and soon became a favorite evening resort of the G—— family; but the road was rather steep, and Mrs. G—— appealed to the ingenuity of her constructive nephew: could he not try and make a winding trail by knocking some of the rocks and bushes out of the way? Pierre tried, and his success, the uncle declared, proved him and intuitive engineer, the peer of Haussmann and Brunei. That new road had so increased the value of the old pasture that it would be worth while to put up a pavilion and make it a regular hill-top resort. The only drawback upon the advantage of its situation was the want of good drinking-water; but there was a sort of a spring in an adjoining pasture on the opposite slope of the ridge: would Pierre make an estimate of the number of bricks requisite to wall it up and keep the cattle from muddling it? The requisition proved an under-estimate, but Pierre made up the deficiency by collecting a lot of passably square stones. The water now became drinkable, and somehow the rumor got abroad that Pierre had discovered the spring, whereupon his uncle's neighbor urged him to exercise his talent for the benefit of his valley-meadow, in all but the want of water the best pasture in the parish. Pierre selected a spot where a lot of day-laborers were set to work and actually struck water by digging deep enough. The gratitude of the farmer was almost too demonstrative for the modest lad, who, however, agreed with his uncle that a talent of that sort might make its possessor a public benefactor, and ought to be cultivated. Would Pierre undertake to locate a well on his uncle's hill-pasture, a little nearer to the lookout point? The brick-spring was too far down, and it would be so convenient to have water on one's own premises! Judging from analogies, the young hydrologist fixed upon a spot at the junction of two ravines, but too near the upper boundary of arboreal vegetation, and after digging down to a stratum of dry sandstone detritus, the workmen gave up the job in disgust. But Pierre himself would not yield his point, and offered to dig the well alone if they would give him time, and a boy to turn the windlass of the sand bucket. His wish was granted, and before he had been a week at work, his asthma had left him, his digestion improved, and his appetite became ravenous. The well-project had finally to be relinquished, but his uncle consoled him by purchasing the adjoining lot and letting him make a winding road from the brick-spring to the hill-top. The road was built, but Pierre indorsed the opinion of a professional engineer that the well-hole, too, would be full of water if the woods of the upper ridge had not been so ruthlessly destroyed and that the replanting of forest-trees along the line of the subterranean water-courses would not only replenish the springs but redeem the arid pastures of the foot-hills. The doctor controverted that point, but—just for the sake of experiment—procured a hundred beech-tree saplings, which Pierre planted and watered with untiring assiduity. Some sixty per cent, of the trees took root, to the unending astonishment of the uncle, who now declared that his confidence in the fertility of the ridge-land had increased to a degree which encouraged him to try his luck with orchard-trees. They procured a lot of young apple, almond, and apricot trees, about two hundred of each, and planted them along the line of the suppositive water-courses. Pierre superintended the work, and was kept so busy for the next eighteen months that he had no time to be sick for a single day. The boy that was given up by the Antwerp doctors is now a well-to-do horticulturist, able to climb without a stop the steepest ridge in the Ardennes and to fell a forty-years oak-tree in twenty minutes!
In the beginning of this chapter I have mentioned two forms of disease which, thus far, have not proved amenable to the hygienic (non-medicinal) mode of treatment, though it has already been ascertained that a mild vegetable demulcent—sarsaparilla, for instance—is as efficacious in those cases as the virulent mercurials of the old school. Antidotes and certain anodynes will, perhaps, also hold their own till we find a way of producing their effects by mechanical means. But, with these few exceptions, I will venture the prediction that, before the middle of the twentieth century, the internal use of drugs will be discarded by all intelligent physicians.
"If we reflect upon the obstinate health of animals and savages," says Dr. Schrodt, "upon the rapidity of their recovery from injuries that defy all the mixtures of materia medica; also upon the fact that the homœopathists cure their patients with milk-sugar and mummery, the prayer-Christians with mummery without milk-sugar, and my followers with a milk-diet without sugar or mummery—the conclusion forces itself upon us that the entire system of therapeutics is founded upon an erroneous view of disease."
And, moreover, I believe that the chief error can be accounted for: it is founded upon our erroneous view of the cause and cure of evil in general. Translated into plain speech, the foundation-principle of our system of ethics is this: that all natural things, especially our natural instincts, are essentially evil, and that salvation depends upon mysterious, anti-natural, and even supernatural remedies. This bottom error has long biased all our physical and metaphysical theories. The use of our reasoning powers is naturally as agreeable as the exercise of any other normal function: the anti-naturalists declared war against free inquiry, assured us that the study of logic and natural science is highly dangerous, and that the seeker after truth must content himself with the light of ghostly revelations. We have since ascertained that the ghosts are grossly ignorant of all terrestrial concernments, and that their reports on the supramundane state of affairs are, to say the least, suspiciously conflicting.
In all but the vilest creatures the love of freedom is as powerful as the instinct of self-preservation: the anti-naturalists inculcated the dogma of implicit submission to secular and spiritual authorities. The experiment was tried on the grandest scale, and the result has demonstrated that blind faith leads to idiocy, and that absolute monarchs must be absolutely abolished.
The testimony of our noses justifies the opinion that fresh air is preferable to prison-smells; the anti-naturalists informed us that at various seasons of the year, and every night, the out-door atmosphere becomes mortiferous, and that sleepers and invalids ought to be confined in air-tight apartments. We believed, till we found that the most implicit believers got rotten with scrofula.
Animals seem to live and thrive on the principle that palatable food recommends itself to the stomach, and that repulsive things ought to be avoided. The anti-naturalists reversed the maxim, and assured us that sweetmeats, uncooked vegetables, cold water, drunk when it tastes best—i. e., on a warm day—raw fruit, etc., are the causes of countless diseases, and that the execrable taste of a drug is not the least argument against its salubriousness. During the middle ages parents used to dose their children with brimstone and calomel, "to purify their blood," and, for the same purpose, the most nauseous mineral springs of every country are still pumped and bottled for the benefit of invalids. There is not a poison known to chemistry or botany but has been, and is still, daily prescribed as a health-giving substance, and, in the form of pills, drops, or powders, foisted upon a host of help-seeking invalids. But, since the revival of free inquiry, we have compared the statements of ancient historians and modern travelers, and it appears that the healthiest nations on earth have preserved their health on the principle that guides our dumb fellow-creatures, and would guide our children if they were permitted to follow their inclinations. An overwhelming testimony of facts has proved that the diseases of the human race can be cured easier without poison-drugs—easier in the very degree that would suggest the suspicion that every ounce of poison ever swallowed for remedial purposes has increased the weight of human misery. And that same suspicion is forced upon us by very cogent a priori reasons. If the testimony of our senses helps us to select our proper food, and warns us against injurious substances, have we any reason to suppose that such salutary intuitions forsake us at the time of the greatest need—in the hour of our struggle with a life-endangering disease? Shall we believe that at such times our sense of taste warns us against salubrious substances? And does it not urgently warn us against ninety-nine out of a hundred "medicines"? Shall the sick believe that an all-wise Creator has staked the chances of their recovery upon the accident of their acquaintance with Dr. Quack's Quinine Bitters or Puff & Co.'s Purgative Pills? Yet, is it possible to mistake the analogy between the remedial theories of our nostrum-mongers and the alleged moral "plan of salvation"? Is not the key-note of the Semitic dogma mistrust of our natural instincts and reliance upon abnormal remedies—mummeries, mysteries, and miracles?
Poison-mongers, physical or spiritual, will cease to be in request whenever their customers begin to suspect that this world of ours is governed by laws, and not by special acts of intervention; that sickness can be cured only by conformity to those laws, and not by drugs and prayers—i. e., anti natural and supernatural remedies. To the children of Nature all good things are attractive, all evil repulsive: the laws of God proclaim and avenge themselves; the Author of this logically-ordered universe can never have intended that our salvation should depend upon the accident of our acquaintance with the dogmas of an isolated act of revelation; and, as surely as the germ of the hidden seed-corn finds its way through night to light, the unaided instincts of the lowliest islander would guide him safely on the path of moral and physical welfare.
These words would be truisms if Truth had not been a contraband for the last eighteen hundred years: To nine tenths of our Christian contemporaries God's most authentic revelation is still a sealed book; and, before any reformer can hope to turn this chaos of vice, superstition, and quackery, into anything like a cosmos, he must convince his fellow-men that the study of Nature has to supersede the worship of miracles, even though that conviction should imply that the fundamental dogmas of our priest-religion are perniciously false.