Hence they dreamed of effecting causal cures by endeavoring to remove these imaginary and presumed material causes of the disease. Hence their assiduous evacuation of the bile by vomiting in bilious fevers; their emetics in cases of so-called stomach derangenments;* their diligent purging away of the mucus, the lumbrici and the ascarides in children who are pale-faced and who suffer from ravenous appetite, bellyache, and enlarged abdomen**; their venesections in cases of haemorrhage;*** and more especially all their varieties of blood-lettings,**** their main remedy in inflammations, which they now, following the example of a well-known bloodthirsty Parisian physician (as a flock of sheep follow the bellwether even into the butcher's slaughter-house), imagine to encounter in almost every morbidly affected part of the body, and feel themselves, bound to remove by the application of often a fatal number of leeches. They believe that by so doing they obey the true casual indications, and treat disease in a rational manner. The adherents of the old school, moreover, believe that by putting a ligature on polypi, by cutting out, or artificially exciting suppuration by means of local irritants in indolent glandular swellings, by enucleating encysted tumors (steatoma and meliceria) by their operations for aneurysm and lacrymal and anal fistula, by removing with the knife scirrhous tumors of the breast, by amputating a limb affected with necrosis, etc., they cure the patient radically, and that their treatment is directed against the cause of the disease; and they also think, when they employ their repellent remedies, dry up old running ulcers in the legs with astringent applications of oxide of lead copper or zinc (aided always by the simultaneous administration of purgatives, which merely debilitate, but have no effect on the fundamental dyscrasia), cauterize chancres, destroy condylomata locally, drive off itch from the skin with ointments of sulphur, oxide of lead, mercury or zinc, suppress ophthalmiae with solutions of lead or zinc, and drive away tearing pains from the limbs by means of opodeldoc, hartshorn liniment or fumigations with cinnabar or amber; in every case they think they have removed the affection, conquered the disease, and pursued a rational treatment directed towards the cause. But what is the result! The metastatic affections that sooner or later, but inevitably appear, caused by this mode of treatment (but which they pretend are entirely new diseases), which are always worse than the original malady, sufficiently prove their error, and might and should open their eyes to the deeper-seated, immaterial nature of the disease, and its dynamic (spirit-like) origin, which can only be removed by dynamic means.
* In a case of sudden derangement of the stomach, with constant disgusting eructations with the taste of the vitiated food, generally accompanied by depression of spirits, cold hands and feet, etc., the ordinary physician has hitherto been in the habit of attacking only the degenerated contents of the stomach; a powerful emetic should clean it out completely. This object was generally attained by tartar emetic, with or without ipecacuanha. Does the patient, however, immediately after this become well, brisk and cheerful? Oh, no! Such a derangement of the stomach is usually of dynamic origin, caused by mental disturbance (grief, fright, vexation), a chill, over-exertion of the mund or body immediately after eating, often after even a moderate meal. Those two remedies are not suitable for removing this dynamic derangement, and just as little is the revolutionary vomiting they produce. Moreover, tartar emetic and ipecacuanha, from their other peculiar pathogenetic powers, prove of further injury to the patientŐs health, and derange the biliary secretion; so that if the patient be not very robust, he must feel ill for several days from the effects of this pretended causal treatment, notwithstanding all this violent expulsion of the whole contents of the stomach. If the patient, however, in place of taking such violent and always (a) hurtful evacuant drugs, smell only a single time at a globule the size of a mustard seed, moistened with highly diluted pulsatilla juice, whereby the derangement of his health in general and of his stomach in particular will certainly be removed, in two hours he is quite well; and if the eructation recur once more, it consists of tasteless and inodorous air; the contents of the stomach cease to be vitiated, and at the next meal he has regained his full usual appetite; he is quite well and lively. This is true causal medication; the former is only an imaginary one and has an injurious efect on the patient.
Even a stomach overloaded with indigestible food never requires a medicinal emetic. In such a case nature is competent to rid herself of the excess in the best way through the oesophagus, by means of nausea, sickness and spontaneous vomiting, assisted, it may be, by mechanical irritation of the palate and fauces, and by this means the accessory medicinal effects of the emetic drugs are avoided; a small quantity of coffee expedites the passage downwards of what remains in the stomach.
But if, after excessive overloading of the stomach, the irritability of the stomach is not sufficient to promote spontaneous vomiting, or is lost altogether, so that the tendency thereto is extinguished, while there are at the same time great pains in the epigastrium, in such a paralyzed state of the stomach, an emetic medicine would only have the effect of producing a dangerous or fatal inflammation of the intestines; where a small quantity of strong infusion of coffee, frequently administered, would dynamically exalt the sunken irritability of the stomach, and put it in a condition to expel its contents, be they ever so great, either upwards or downwards. So here also the pretended causal treatment is out of place.
Even the acrid gastric acid, to eructations of which patients with chronic diseases are not infrequently subject, may be today violently evacuated by means of an emetic, with great suffering, and yet all in vain, for tomorrow or some days later it is replaced by similar acrid gastric acid, and then usually in larger quantities; whereas it goes away by itself when its dynamic cause is removed by a very small dose of a high dilution of sulphuric acid, or still better, if it is of frequent recurrence, by the employment of minutest doses of antipsoric remedies corresponding in similarity to the rest of the symptoms also. And of a similar character are many of the pretended causal cures of the old-school physicians, whose main effort it is, by means of tedious operations, troublesome to themselves and injurious to their patients, to clear away the material product of the dynamic derangement; whereas if they perceived the dynamic source of the affection, and annihilated it and its products homopathically, they would thereby effect a rational cure.
** Conditions dependent solely on a psoric taint, and easily curable by mild (dynamic) antipsoric remedies without emetics or purgatives.
*** Notwithstanding that almost all morbid haemorrhages depend on a dynamic derangement of the vital force (state of health), yet the old-school physicians consider their cause to be excess of blood, and cannot refrain from bleeding in order to draw off the supposed superabundance of this vital fluid; the palpable evil consequences of which procedure, however, such as prostration of the strength, and the tendeny or actual transition, to the typhoid state they ascribe to the malignancy of the disease, which they are then often unable to overcome - in fine, they imagine, even when the patient does not recover, that their treatment has been in conformity with their axiom, causam tolle, and that, according to their mode of speaking, they have done everything in their power for the patient, let the result be what it may.
**** Although there probably never was a drop of blood too much in the living human body, yet the old-school practitioners consider an imaginary excess of blood as the main material cause of all haemorrhages and inflammations, which they must remove and drain off by venesections, cupping and leeches. This they hold to be a rational mode of treatment, causal medication. In general inflammatory fevers, in acute pleurisy, they even regard the coagulable lymph in the blood - the buffy coat, as it is termed - as the materia peccans, which they endeavor to get rid of, if possible, by repeated venesections, notwithstanding that this coat often becomes more consistent and thicker at every repetition of the bloodletting. They thus often bleed the patient nearly to death, when the inflammatory fever will not subside, in order to remove this buffy coat or the imaginary plethora, without suspecting tbat the inflammatory blood is only the product of the acute fever, of the morbid, immaterial (dynamic) inflammatory irritation, and that the latter is the sole cause of the great disturbance in the vascular systan, and may be removed by the smallest dose of a homogeneous (homopathic) medicine, as, for instance, by a small globule of the decillion-fold dilution of aconite juice, with abstinence from vegetable acids, so that the most violent pleuritic fever, with all its alarming concomitants, is changed into health and cured, without the least abstraction of blood and without any antiphlogistic remedy, in a few - at the most in twenty-four - hours (a small quantity of blood drawn from a vein by the way of experiment then shows no traces of buffy coat); whereas another patient similarly affected, and treated on the rational principles of the old school, if, after repeated bleedings, with great difficulty and unspeakable sufferings he escape for the nonce with life, he often has still many months to drag through before he can support his emaciated body on his legs, if in the mean time (as often happens from such maltreatment) he be not carried off by typhoid fever, leucophlegmasia or pulmonary phthisis.
Anyone who has felt the tranquil pulse of a man an hour before the occurrence of the rigor that always precedes an attack of acute pleurisy, will not be able to restrain his amazement if told two hours later, after the hot stage has commenced, that the enormous plethora present urgently requires repeated venesections, and will naturally inquire by what magic power could the pounds of blood that must now be drawn off have been conjured into the blood-vessels of this man within these two hours, which but two hours previously he had felt beating in such a tranquil manner. Not a single drachm more of blood can now be circulating in those vessels than existed when he was in good health, not yet two hours ago!
Accordingly the allopathic physician with his venesections draws from the patient laboring under acute fever no oppressive superabundance of blood, as that cannot possibly be present; he only robs him of what is indispensable to life and recovery, the normal quantity of blood and consequently of strength - a great loss which no physician's power can replacel - and yet he vainly imagines that he has conducted the treatment in conformity to his (misunderstood) axiom, causam tolle; whereas it is impossible that the causa morbi in this case can be an excess of blood, which is not present; but the sole true causa morbi was a morbid, dynamical, inflammatory irritation of the circulatory system, as is proved by the rapid and permanent cure of this and every similar case of general inflammatory fever by one or two inconceivably minute doses of aconite juice, which removes such an irritation homopathically.
The old school errs equally in the treatment of local inflammations with its topical bloodlettings, more especially with the quantities of leeches which are now applied according to the maniacal principles of Broussais. The palliative amelioration that at first ensues from the treatment is far from being crowned by a rapid and perfect cure; on the contrary, the weak and ailing state of the parts thus treated (frequently also of the whole body), which always remains, sufficiently shows the error that is committed in attributing the local inflammation to a local plethora, and how sad are the consequences of such abstractions of blood; whereas this purely dynamic, apparently local, inflammatory irritation, can be rapidly and permanently removed by an equally small dose of aconite, or, according to circumstances, of belladonna, and the whole disease annihilated and cured, without such unjustifiable shedding of blood.
A favorite idea of the ordinary school of medicine, until recent (would that I could not say the most recent) times, was that of morbific matters (and acridities) in diseases, excessively subtile though they might be thought to be, which must be expelled from the blood-vessels and lymphathics, through the exhalents, skin, urinary apparatus or salivary glands, through the tracheal and bronchial glands in the form of expectoration, from the stomach and bowels by vomiting and purging, in order that the body might be freed from the material cause that produced the disease, and a radical causal treatment be thus carried out.
By cutting holes in the diseased body, which were converted into chronic ulcers kept up for years by the introduction of foreign substances (issues, setons), they sought to draw off the materia peccans from the (always only dynamically) diseased body, just as one lets a dirty fluid run out of a barrel through the tap-hole. By means also of perpetual fly-blisters and the application of mezereum, they thought to draw away the bad humors and to cleanse the diseased body from all morbific matters - but they only weakened it, so as generally to render it incurable, by all these senseless unnatural processes.
I admit that it was more convenient for the weakness of humanity to assume that, in the diseases they were called on to cure, there existed some morbific material of which the mind might form a conception (more particularly as the patients readily lent themselves to such a notion), because in that case the practitioner had nothing further to care about than to procure a good supply of remedies for purifying the blood and humors, exciting diuresis and diaphoresis, promoting expectoration, and scouring out the stomach and bowels. Hence, in all the works on Materia Medica, from Dioscorides down to the latest books on this subject, there is almost nothing said about the special peculiar action of individual medicines; but, besides on account of their supposed utility in various nosological names of diseases, it is merely stated whether they are diuretic, diaphoretic, expectorant or emmenagogue, and more particularly whether they produce evacuation of the stomach and bowels upwards or downwards; because all the aspirations and efforts of the practitioner have ever been chiefly directed to cause the expulsion of a material morbific matter, and of sundry (fictitious) acridities, which it was imagined were the cause of diseases.
These were, however, all idle dreams, unfounded assumptions and hypotheses, cunningly devised for the convenience of therapeutics, as it was expected the easiest way of performing a cure would be to remove the material morbific matters (si modo essent!).
But the essential nature of diseases and their cure will not adapt themselves to such fantasies, nor to the convenience of medical men; to humor such stupid baseless hypotheses diseases will not cease to be (spiritual) dynamic derangements of our spirit-like vital principle in sensations and functions, that is to say, immaterial derangements of our state of health.
The causes of our maladies cannot be material, since the least foreign material substance,* however mild it may appear to us, if introduced into our blood-vessels, is promptly ejected by the vital force, as though it were a poison; or when this does not happen, death ensues. If even the minutes splinter penetrates a sensitive part of our organism, the vital principle everywhere present in our body never rests until it is removed by pain, fever, suppuration or gangrene. And can it be supposed that in a case of cutaneous disease of twenty yearsŐ standing, for instance, this indefatigably active vital principle will quietly endure the presence of such an injurious foreign, material exanthematous substance, such as a herpetic, a scrofulous, a gouty acridity, etc., in the fluids of the body? Did any nosologist ever see with corporeal eyes such a morbific matter, to warrant him in speaking so confidently about it, and in founding a system of medical treatment upon it? Has any one ever succeeded in displaying to view the matter of gout or the poison of scrofula ?
* Life was endangered by injecting a little pure water into a vein. (Vide Mullen, quoted by Birch in the History of the Royal Society.)
Atmospheric air injected into the blood-vessels caused death. (Vide J. M. Voigt, Magazin fur den neuesten Zustand der Naturkunde, i, iii, p. 25.)
Even the mildest fluids introduced into the veins endangered life. (Vide Autenreith, Physiologie, ii, ¤ 784.)
Even when the application of a material substance to the skin, or to a wound, has propagated diseases by infection, who can prove (what is so often maintained in works on pathology) that some material portion of this substance has penetrated into our fluids or been absorbed?* The most careful and prompt washing of the genitals does not protect the system from infection with the venereal chancrous disease. The slightest breath of air emanating from the body of a person affected with smallpox will suffice to produce this horrible disease in a healthy child.
* A girl in Glasgow, eight years of age, having been
bit by a mad dog, the surgeon immediately cut the piece clean out, and yet
thirty-six days afterwards she was seized with hydrophobia, which killed her in two days.
(Med. Comment. of Edinb., Dec. 2, vol. ii, 1793.)