Popular Science Monthly/Volume 19/September 1881/Physical Education IX
By FELIX L. OSWALD, M. D.
I. REMEDIAL EDUCATION.
"We can not buy health; we must deserve it."—Francis Bichat.
"PREVENTION is better than cure and far cheaper," said John Locke, two hundred years ago; and the history of medical science has since made it more and more probable that, in a stricter sense of the word, prevention is the only possible cure. By observing the health laws of Nature, a sound constitution can be very easily preserved, but, if a violation of those laws has brought on a disease, all we can do by way of "curing" that disease is to remove the cause; in other words, to prevent it the continued operation of the predisposing circumstances.
Suppressing the symptoms in any other way means only to change the form of the disease, or to postpone its crisis. Thus, mercurial salves will cleanse the skin by driving the ulcers from the surface to the interior of the body; opiates stop a flux only by paralyzing the bowels i. e., turning their morbid activity into a morbid inactivity; the symptoms of pneumonia can be suppressed by bleeding the patient till the exhausted system has to postpone the crisis of the disease. This process, the "breaking up of a sickness," in the language of the old-school allopathists, is therefore in reality only an interrupting of it, a temporary interruption of the symptoms. We might as well try to cure the sleepiness of a weary child by pinching its eyelids, or the hunger of a whining dog by compressing his throat.
Drugs are not wholly useless. If my life depended upon a job of work that had to be finished before morning, and the inclination to fall asleep was getting irresistible, I should not hesitate to defy Nature, and keep myself awake with cup after cupful of strong black coffee. If I were afflicted with a sore, spreading rapidly from my temple toward my nose, I should suppress it by the shortest process, even by deliberately producing a larger sore elsewhere, rather than let the smaller one destroy my eyesight. There are also two or three forms of disease which have (thus far) resisted all unmedicinal cures, and can hardly be trusted to the healing powers of Nature—the lues venerea, scabies, and prurigo—because, as Claude Bernard suggests, their symptoms are probably due to the agency of microscopic parasites, which oppose to the action of the vital forces a life-energy of their own, or, as Dr. Jennings puts it, "because art has here to interfere—not for the purpose of breaking up diseased action, but for the removal of the cause of that action, the destruction of an active virus that possesses the power of self-perpetuation beyond the dislodging ability of Nature."
But with those rare exceptions it is better to direct our efforts against the cause rather than the symptoms—i. e., in about ninety-nine cases out of a hundred it is not only the safer but also the shorter way to avoid drugs, reform our habits, and, for the rest, let Nature have her course; for, properly speaking, disease itself is a reconstructive process, an expulsive effort, whose interruption compels Nature to do double work; to resume her operations against the ailment after expelling a worse enemy—the drug. If a drugged patient recovers, the true explanation is that his constitution was strong enough to overcome both the disease and the druggist.
Dr. Isaac Jennings, the greatest pathologist (or, at least, patho-gnomist) of our century, was sadly misunderstood, chiefly, I believe, because he called his method the "Let-alone Plan." Prevention Plan, or Unmedicinal Cure, would have been a better word. Diseases do not want to be let alone; they call loudly for relief—not, though, from their own symptoms, which, in fact, are so many alarm-signals, but from the obstacle which has forced the vital process to deviate from its normal course. Pain, in all its forms, is an appeal for help, and the urgency of the appeal corresponds to the degree of the distress; probably, also, to the possibility of relieving that distress. A deadly blow stuns the vital forces yield without a struggle. The last stage of pulmonary consumption is a comparatively painless deliquium when a conflagration grows uncontrollable, the alarm-bells cease to ring. Yellow-fever doctors give up their patients for lost when the burning headache changes into a lethargic stupor. The last sensations of drowning, strangled, and freezing persons are said to be rather pleasurable than otherwise. In certain cases the appeal for help continues into an apparently hopeless stage of the disease. Apparently, I say: Nature is too practical to waste her efforts on a forlorn hope; her resistance yields to necessity; and, when the art of healing shall devote itself to the exegesis of disease rather than to the exorcism of its symptoms, that rule will probably be found to apply to pathology as well as to chemistry and ethics.
All bodily ailments are more or less urgent appeals for help; nor can we doubt in what that help should consist. The more fully we understand the nature of any disease, the more clearly we see that the discovery of the cause means the discovery of the cure. Many sicknesses are caused by poisons, foisted upon the system under the name of tonic beverages or remedial drugs; the only cure is to eschew the poison. Others, by habits more or less at variance with the health laws of Nature; to cure such we have to reform our habits. There is nothing accidental, and rarely anything inevitable, about a disease; we can safely assume that nine out of ten complaints have been caused and can be cured by the sufferers (or their nurses) themselves. "God made man upright"; every prostrating malady is a deviation from the state of Nature. The infant, "mewling and puking in its nurse's arms," is an abnormal phenomenon. Infancy should be a period of exceptional health; the young of other creatures are healthier, as well as prettier, purer, and merrier, than the adults, yet the childhood years of the human animal are the years of sorest sickliness; statistics show that among the Caucasian races men of thirty have more hope to reach a good old age than a new-born child has to reach the end of its second year. The reason is this: the health theories of the average Christian man and woman are so egregiously wrong, that only the opposition of their better instincts helps them against their conscience, as it were to maintain the struggle for a tolerable existence with anything like success, while the helpless infant has to conform to those theories with the above results.
"I have long ceased to doubt," says Dr. Schrodt, "that, apart from the effects of wounds, the chances of health or disease are in our own hands; and, if people knew only half the facts pointing that way, they would feel ashamed to be sick, or to have sick children."
A vestige of the hygienic insight which in savages appears to be a gift of Nature, would, indeed, almost obviate the necessity of a treatise on the diseases of infancy; nay, wherever people have got rid of four or live of the grossest physiological prejudices, the art of preserving the health of a healthy-born child is even now a sort of intuition with every true mother; but nurses, physicians, and foster-parents, are often called upon to mend the mistakes of their predecessors, and to undertake a task whose less intuitive duties may be facilitated by some of the following hints on remedial education:
Shakespeare's "mewling and puking" representative of babyhood was probably overfed. The representative nurse believes in cramming; babies, like prize-pigs, are most admired when they are ready to die with fatty degeneration. The child is coaxed to suckle almost every half-hour, day after day, till habit begets a morbid appetite, analogous to the dyspeptic's stomach distress which no food can relieve till over-repletion brings on a sort of gastric lethargy.
"Many hand-fed infants, weighing about ten pounds, will swallow one and a half quart of cow's milk in one day," says Dr. Page; "now, considering the needs of a moderately working man to be equal in proportion to size, a man weighing one hundred and fifty pounds should take 'fifteen times the quantity swallowed by the infant, or twenty-two and a half quarts—a quart for nearly every hour of the day and night!"
Vomiting, restlessness, and gross fatness, are some of the symptoms of the surfeit-disease, and its proper cure is—not soothing-sirups, but—fasting. Four nursings a day are enough, five more than enough, and the ejection of milk after suckling is a sure sign that the quantity given at each meal should be diminished. A pint of milk a day is about as much as a dyspeptic infant can really digest, and to cram it merely in order to stop its crying is quite mistaking the cause of its restlessness; a half-starved child will not cry, because the languor of insufficient nutrition is a pleasure compared with the gastric torments of the surfeit-disease. Children actually perishing with hunger will utter from time to time a peculiar sharp cry, almost like the call of a hungry nest-bird, but the first mouthful of food makes them relapse into a sort of dreamy silence.
There are nurslings who get at least four times more milk and pap than they can possibly assimilate, and whose digestive organs have to reject the surplus in a way that would make life intolerable to an adult, though most nurses seem to consider retching and "dripping" as a normal phase of infant life.
Drugs only complicate the disorder: many children whose constitution would have resisted the cramming process succumb to opiates, "surfeit-water" and ipecacuanha; but, unless foul dormitories still further aggravate the evil, each night generally undoes the mischief of the day; the child becomes plethoric with fat; Nature has shifted the burden from the vital organs to the tegumental tissues, and in hopes of final relief manages to hold the fort of life against daily and complicated attacks. Relief comes at last when the nursling is weaned and reduced from ten or twelve to three meals a day. The aftereffects of medication may retard recovery for a while, but, the main cause being removed, the morbid symptoms disappear in the course of four or five months.
A less frequent but (through gross maltreatment) often more dangerous disease is scrofula, the cachectic degeneration of the humors resulting from the combined influence of unwholesome food and foul air. In the rural districts of our milk and corn-bread States scrofulous children are as rare as white wolves in the tropics; in Northern Europe the disease is now far less prevalent than formerly; and the operatives of our large cities, in spite of their wretched habitations, might avoid it altogether, or at least obviate its more serious consequences, but for the fatuous quackery which so often turns a transient skin-disease into a chronic lung-complaint. In the middle ages, when science was at its lowest ebb and supernaturalism in full tide, the "king's-evil" was considered an almost unavoidable disease, resisting all common remedies and yielding only to the mandate of royalty—the touch of a legitimate king, supplemented by the mandamus of a clerical exorcist. In the fifteenth century from eight to twelve thousand families per year performed long journeys to the English capital; Charles II, in the course of his reign, touched near a hundred thousand persons. The days on which the miracle was to be wrought were solemnly notified by the clergy of all parish churches (Macaulay's "History of England," Chapter XIY). Traveling was expensive in those days, and, scrofula being distinctively a disease of the poor, nine out of ten patients of the royal doctor had probably come "afoot, and often from distances which suggest the explanation of the marvelous cures: the pilgrims left the pest-air of their hovels behind, and Nature availed herself of the respite, as she improves a temporary change from city fumes to the woodland air of some rural retreat whose salubriousness is ascribed to the accidental presence of a nauseous sulphur-spring—the one abnormal thing about the place. The king's-evil patients, as well as the exorcists, ascribed the cure to what Dr. Joel Brown called the charisma basilicon—the healing touch of the Lord's anointed—in other words, they believed that the cure of a Yorkshire man's disease depended upon the chance of the Yorkshire man's coming in contact with a Londoner who, perhaps ten or twenty years ago, had undergone the rites of a certain ceremony. Imagination probably helped a little, for after the spread of skepticism "perfect cures became much less frequent," as Dr. Brown naïvely remarks. The charisma basilicon has now fallen into utter discredit, but our present method is so little of an improvement that the patients of a future century would probably prefer to resume the Whitehall pilgrimages. Instead of ventilating our houses and abolishing our sauerkraut (the long-notorious cachexia of the ill-housed and ill-fed classes having sufficiently indicated the cause of the malady), we suppress the morbid symptoms by sarsaparilla, iodide of potassium, or patent "medicines": only reliable liver-pills and infallible blood-purifiers—in other words, we believe that the cure of a common disease depends upon the accidental or providentially ordained discovery of some mysterious compound. The bottom error is the same as in the king's-evil delusion, and can be easily traced to the radical fallacy of our speculative dogmas; we still regard sin and disease as something normal, aboriginal, and unavoidable, and expect salvation from mysterious, extra-natural remedies, while the truth of the very contrary is becoming more and more evident, namely, that all evil, including moral and physical unsoundness, is due, and generally traceable, to wholly abnormal causes, and (those causes being removed) recovery the effect of the self-acting and self-regulating laws of Nature. The removal of the cause is a remedy which the sufferers from almost any disease might prescribe for themselves, and here especially: fresh air and abstinence from indigestible food, particularly pickles and fat meat. Pork is not the only unwholesome kind of animal food, for Jews are not exempt from scrofula, and were formerly subject to a still worse skin-disease; and, if we had not forgotten the art of interpreting the language of our instincts, we would not overlook the significancy of the circumstance that ninety-nine per cent, of all young children detest every kind of fat meat except in the form of taste-deceiving ragouts. Farmer-boys, who have to share the out-door labors of their parents, can eat with comparative impunity many things which only the hardiest of their city comrades can digest: pork, greasy and pickled cabbages, fritters, and salt beef. Even young Hottentots could not eat such stuff without being sooner or later the worse for it, whenever the counteracting hardships of a savage life alternate with a period of physical inactivity. But children afflicted with cachectic symptoms should at once be restricted to a wholly vegetable and non-stimulating diet—farinaceous preparations, boiled legumina, and, if possible, ripe, sweet fruit.
The summer diet of a scrofulous child can not be too frugal, in the ancient sense of the word, and, where a supply of ripe tree-fruits can be easily obtained, I should think it the best plan to dispense altogether with made dishes—for a while, even with farinaceous dishes. Parents who have no hesitation in cramming their children with salt pork, beer, and sauerkraut, would shudder at the idea of feeding them on fruit alone, yet the happiest of all visitors to the southern Rhineland are probably the patients of a Swabian Trauben-Kur, where dyspeptics, etc., are fed almost exclusively—often for days together quite exclusively—on ripe, sweet grapes. Combined with plenty of exercise in the bracing air of a highland region, the efficacy of the grape-cure surpasses all the miracles of the king's touch. It will cure children, "too scrofulous to look out of their eyes," cheaper and quicker than any nostrums, and has the still greater advantage of eliminating instead of suppressing the virus.
Those who deny the pharmaceutic efficacy of the homœopathic sugar-pellets can not deny that, in this case, homœopathy has proved the possibility of curing diseases without any drugs at all—merely by a change of diet and regimen. Frugality, abstinence, bathing, ventilation, cold water, and exercise in the open air, have already superseded half the materia of the old medical dogmatists, and personal experience has convinced me that the following diseases of children are amenable to a strictly hygienic treatment.