Psychotherapy Part 4

St. John Long's Liniment.--An interesting exemplification of the power of mystery in adding to the curative value of a commonplace remedy is found in the story of the famous St. John Long liniment. St. John Long was a well-known quack in London in the early part of the nineteenth century. Like all quacks at all times, his specialty was chronic diseases. He claimed to be able by means of external applications to cure the pains and aches to which the old are so likely to be subject.

St. John soon acquired an immense reputation. He gave a liniment with a secret formula that was literally a miracle worker. People who used it found after a few times that they were free from, or at least greatly relieved of, aches that had bothered them for years. It was good for sprains and for internal pains of all kinds, as well as for the so-called chronic rheumatisms, which have as their princ.i.p.al symptom pains and aches around joints. So great a reputation, indeed, was acquired by the remedy that an agitation was begun to have Parliament buy the secret from its inventor in order to present it to the British nation. The proposition was actually carried through the legislative chambers and a considerable amount of money, still larger in those days because of the comparatively greater value of money, was voted to St. John Long.

His liniment had a place in the British Pharmacopeia under his name for many years afterwards. It proved to be only a simple old-fas.h.i.+oned remedy, the basis of which was turpentine, and one of the princ.i.p.al ingredients was the white of egg. Just as soon as the secret was known the power of the remedy began to decline. So long as it remained mysterious and unknown, discovered by a man who supposedly had made a special study for many years of these conditions, and had finally worked out the external applications necessary for them, it accomplished wonders. Just as soon as it was known to be a combination of familiar turpentine and egg it lost its power. The remedy is, of course, an excellent counter-irritant, and the gentle rubbing undoubtedly did much good. The most important element, however, was the mental influence, the feeling that now things must be better, which thought distracted attention from the aches and pains and caused the unfavorable influence of over-concentration of mind on the part to cease, for the vaso-motor system is particularly under mental influence. Every now and then since that time some {30} liniment or oil containing nearly the same ingredients as that of St. John Long's acquires a reputation as a consequence of a campaign of advertising.

It is the printers ink that counts, however, and just as soon as the advertising ceases to attract attention the remedy fails in efficiency.

Alcohol Plus Suggestion.--Alcohol has been employed in medicine with the persuasion that it is a remedy for many states of exhaustion, though we have gradually gotten away from its use to a great extent, because we realize that subsequent physical ill consequences outweigh, in most cases, the physical good it may do. Its use was undoubtedly due to the confidence of physicians communicated to patients, and the sense of good feeling which it gives and which proves a further strong suggestion to the patient. This sense of well-being is illusory, for it is sure to be followed by a longer period of dejection, which more than counteracts it unless the dose of alcohol can be maintained for some time.

A generation ago few physicians would have cared to treat exhausting diseases, the continued fevers for instance, without liberal doses of alcohol. Practically the only treatment for pyemia and septicemia on which any stress was laid, and in which there was any general confidence, was the administration of alcohol in large quant.i.ties. In the septicemia consequent upon puerperal infection it was the common teaching to give alcohol by the tablespoonful or more every hour, or oftener, until its effects began to be noticed, and ordinarily large quant.i.ties were required, so that sometimes nearly a quart was taken in the twenty-four hours. Undoubtedly these septic conditions were accompanied by great mental prostration, and this was emphasized by the knowledge that they are often fatal. So patients were usually depressed into a state of mind in which their resistive vitality was much lowered. Alcohol, then, by producing a sense of well-being as well as by stimulating hope in other ways and suggesting possibilities of recovery, undoubtedly exerted a powerful and favorable influence on the mind. Its use in these cases nearly always did good, in spite of its inevitable depressive reaction, for the course of these infections was rapid and the dosage of alcohol could be maintained until there was a change for the better or the fatal termination was in sight.

Alcohol was frequently used in many other conditions of a similar nature, and above all in the septic conditions so common in hospitals before the days of antisepsis and asepsis. When it is recalled that amputations yielded a mortality from sepsis of at least one in four, the extensive use of alcohol in hospital practice two generations ago will be readily understood. We have changed that, however, and Sir Frederick Treves, at a meeting of the British Medical a.s.sociation at Toronto, five years ago, called particular attention to the statistics of the use of alcohol in British hospitals. During the last forty years milk and alcohol have exactly changed places in the London hospitals. Between 1860 and 1870 about four times as much was spent for alcohol as for milk in these hospitals; during the last decade about four times as much was spent for milk as for alcohol.

A corresponding change has taken place in many other phases of treatment in which alcohol was commonly used. The physician of fifty years ago would have thought that one of his most efficient remedies had been taken from him if he could not use alcohol freely in tuberculosis. There are practically no well-known specialists in tuberculosis now who recommend the use {31} of alcohol. On the contrary, most of them point out the dangers from its use and consider that the depression which follows even a moderate dose is likely to do much more harm than the temporary and fleeting stimulation which it gives can do good. In the treatment of phthisis in recent years milk has done much more than take the place of alcohol: it has displaced it entirely. The medical profession realizes now that what the consumptive needs is not more stimulation--for more of that than is good for him is forced upon him by the toxins of the disease--but more nutrition to enable him to resist the progress of the disease and raise his resistive vitality against its toxemia. The one stimulant that is of service in the affection is oxygen, and even that should be given in nature's dosage rather than by artificial means.

_Alcohol in Pneumonia_.--A corresponding change has taken place in the professional att.i.tude towards the use of alcohol in pneumonia. There was a time not so very long ago when alcohol was considered the sheet anchor of our therapeutics for pneumonic conditions, especially those in which from the beginning a fatal termination seemed inevitable, because of the age of the patient or some complication. There were physicians who said that if they had to choose between all the drugs of the pharmacopeia on the one hand without whiskey and whiskey without all drugs whatsoever, for the treatment of pneumonia, they would make the latter choice. We are not as yet entirely away from the point of view that attributes a certain value to alcohol in pneumonia, though even those who still employ alcohol are less emphatic in their advocacy of it. Any one who has seen the result of the fresh air for pneumonia patients will think less and less of alcohol. One well-known clinical authority declares that the very best place to treat pneumonia in our cities would be beneath the trees in the parks. Our patients are being treated at the ends of wards with the windows up, on the balconies, and on the roofs, and the death rate is much reduced and the necessity for any other than oxygen stimulation seems much less.

_Alcohol in Vague Affections_.--The suggestive influence of the effect of alcohol is unconsciously obtained in a number of vague and rather chronic affections. Among these the most noteworthy are women's diseases. Various alcoholic home remedies, gin and whiskey, usually disguised by some bitter, used to be popular. But the known presence of alcohol in these discredited them. Then the nostrum vendors proceeded to supply something just as good. They were, in fact, the same things under another name. Many of the much-advertised remedies that are supposed to cure the ills the weaker s.e.x is liable to, have been found to be little more than dilute whiskey, for in alcoholic strength they were about equal to whiskey diluted once with water, and the other substances were added only to disguise the taste and the odor of this princ.i.p.al ingredient. Many of these remedies have elicited innumerable flattering testimonials and not all of these were fraudulent or obtained by questionable means, but many of them were given because of results secured through the remedies. The alcohol gave the well-known sense of well-being, and the suggestive influence of this increased the appet.i.te, tempted the patient to move around more, and to get more into the air than before, and the consequence was an improvement in the general health, in the midst of which many symptoms that seemed to the excited imaginations of run-down individuals to be serious were relieved. In a great many cases, however, the result was the {32} formation of a whiskey habit; hence the crusade which has discredited these remedies.

Other patent medicines, and, indeed, some of the proprietary preparations, commonly recommended as nutrients and the like, and supposed to be ethical, are found to owe whatever efficiency they have to their alcoholic content. Here once more the suggestive elements were the more important, and enabled substances of little physical efficiency to produce effects that seemed to indicate the presence of powerful energizing materials.

_Whiskey in Snake-Bites_.--A typical example of a remedy which owes its efficacy to mental influence over the patient is the use of whiskey for snake-bites. It is generally recognized that whiskey is not only of no special beneficial effect for snake-bite, but that when taken in the large quant.i.ties usual in such cases it probably produces an ill effect by disturbing the patient's general condition and lowering his resistive vitality. I have no doubt, however, that its use in considerable quant.i.ties has in these cases proved of value because of the mental effect upon the patient. Ordinarily a snake-bite is followed by a sense of extreme terror and prostration that lowers the resistive vitality. This is overcome by the temporary stimulation of the alcohol. The generally accepted idea that whiskey is almost a specific remedy for snake-bite takes away from most people this dread and consequent depression, and does this especially at a time when the acuter symptoms of the venom are making themselves felt. Only about one in six even of those bitten by large rattlesnakes are likely to die. Many circ.u.mstances are in their favor. The bite is not likely to be fatal unless the full contents of the poison sac is injected--which will not be done if the sac has been emptied in the preceding twenty-four hours--and if there are any obstacles, such as clothing or even hair, on the part struck by the snake. Most people, however, would almost die from fright, and such a thing is quite possible, if they thought there was no remedy. The fact that they understand that alcohol is an almost infallible remedy gives them courage, and as soon as they receive some whiskey and it begins to take effect this intense depression is relieved.

It would be better if the knowledge we now have as to snake-bites were more generally used, and if people understood that only rarely is such an accident fatal. In this way there would be no necessity for an appeal to mental influence through whiskey. It is probable, however, that alcohol will still be used for many years, at least in the country districts, because the supposed knowledge is too widely diffused for a correction to come soon, and then other modes of treatment have not that persuasive mental influence which whiskey has as the result of the long tradition. There are many other popular remedies for snake-bite not quite so inefficient as whiskey, but that will continue to enjoy a reputation and really have a certain efficacious result as a consequence of the expectant att.i.tude evoked by the fact that for as long as the patient has heard anything about these things this particular remedy has been mentioned always as the one thing sure to do good.

Other Cures.--Fontana, toward the end of the eighteenth century, was sure that he had discovered in caustic potash an absolute specific for snake poisoning. He had had a series of cases, and felt that he had actually observed this substance following the snake poison into the system and neutralizing it. Its active effect on the external tissues proved eminently suggestive for {33} the patient and good results followed. We have had many specifics since, and yet we are not quite sure how much any of them avail unless recent biological remedies prove lasting in their effects and are really of therapeutic efficiency.

Antidotes and Suggestion.--For many other poisons beside snake venom there have been announced supposed antidotes of all kinds. The literature of the antidotes used for opium is extremely interesting and even in recent times contains many disillusions. Twenty years ago our medical journals contained any number of cases in which a solution of pota.s.sium permanganate seemed to have proved effective in neutralizing not only opium itself but its alkaloids and derivatives.

Not only was it efficacious, then, if taken while the opium was still in the stomach but, just as with Fontana's caustic potash and the snake venom, it followed the opium into the tissues and at least blunted its action. Numbers of cases were reported in which pota.s.sium permanganate was supposed to have had this desirable effect. The effect of alcohol in neutralizing carbolic acid attracted as much attention as did pota.s.sium permanganate for opium. Here there was no doubt that alcohol immediately after the external application of carbolic acid did prevent its corrosive action. It was supposed to do the same thing in the stomach and even, as some enthusiastic observers thought, followed the carbolic acid into the tissues. Here once more the claim is not proven and it is evident that the influence on patients' minds when small doses of carbolic acid were taken, was the real therapeutic factor at work.

Poultices in Suggestive Therapeutics.--Poultices represent another phase of the value of suggestion in medicine and surgery, though for many centuries those who used them were sure that the reasons for their employment were entirely physical and not psychic. All sorts of poultices have been used and each was supposed to do specific curative work. New forms of poultice material have been introduced, and physicians and patients have been certain that each worked wonders of its own. The drawing power of the poultice was extolled until patients dwelt on the idea that this external application was literally engaged in extracting from them, even from distant portions of their anatomy, virulent material that would do harm if allowed to remain in them.

Poultices in suitable cases, because they represent moist heat, do good by counter irritation, by bringing about the expulsion of gas, by diverting internal hyperemia to external tissues, but most of their supposed efficacy has been really due to the bother required to prepare and apply them, the discomfort of having them on, and the feeling that now something had been done and the aches and pains must get better. They are still used, but to a much less degree than before. Now the ordinary teaching is that a hot water bag wrapped in dry flannel, if dry heat is the agent desired, and in moist flannel, if moist heat is the desideratum, is much more efficient. It takes but a few minutes for a poultice, no matter how hot when applied--and occasionally in the olden time they were applied so warm as to burn or scald--to decrease in temperature to that of the body. After that they represent only a moist compress.

It is easy to understand that the suggestive influence of poultices might serve for an age that knew less about the realities of the efficacy of external applications than ours. As a matter of fact, we have, nevertheless, shown ourselves to be quite as credulous and ready to receive a.n.a.logous remedies as the past generation. With the waning of the popularity of the poultice, not {34} only among the profession, but also among the people generally, there came into use various plasters which were supposed to have even more wonderful efficacy than the poultice of the olden time. These required a good deal of trouble to apply and once applied remained on for hours, and so continued to produce a definite curative effect on patients' minds. When first introduced, exaggerated claims were made for their therapeutic value and a regular crusade to diffuse correct information regarding them had to be made, in order to set them in their proper place as mere wet compresses, without any therapeutic efficiency beyond that of cloths wrung out in water and kept in touch with the skin.

_Poultices and the Doctrine of Signatures_.--There was a general impression in the past that the indication of the ailment for which substances are medically useful has been set on them by nature, either through the color, or the form of the plant, or other qualities. In general, the law of similars is supposed to hold in the doctrine of signatures--like cures like. Hence the cornmeal poultice for light jaundice, the flax-seed meal poultice for darker jaundiced conditions and for tendencies to gangrene. The charcoal poultice was employed for this same purpose with no better reason, though some of its efficacy may have been due to oxygen present in the pores of the charcoal. I have already spoken of the appeal to the patient's mind in the use of the cranberry for erysipelas, and various other berries were used in like manner on the doctrine of signatures.

_Deterrent Materials and Suggestion_.--Another basic principle in the making of poultices was the use of deterrent, repulsive materials, because these were more effective on the patient's mind. All the ordures were so employed. Goose and chicken excrement was supposed to be particularly efficacious for many of the purposes for which we now use iodine. It was applied over sprains and bruises on the unbroken skin. Cow-dung was employed as a poultice for sprains of the larger joints, especially on the feet and legs, but to be efficacious it had to be applied fresh. I have known, within twenty years, of physicians in two so supposedly cultured parts of the country as Pennsylvania and Maryland, to employ such ordure poultices for the cure of sprains and dislocations, and these physicians had a great reputation among the people of their countryside. They were known especially as good bone doctors, and their use of such deterrent materials instead of decreasing their practices rather added to them.

Ointments.--In the Middle Ages ointments made of the most far-fetched materials were employed even by distinguished surgeons. That, indeed, is the one serious flaw in the surgery of the thirteenth and fourteenth centuries, when they did everything else so well. These ointments contained all manner of materials that were likely to impress patients and make them feel that something wonderful was being done for them. Crushed insects of all kinds were employed for external lesions. Here the doctrine of similars seems once more to have been in play. Insects gave creepy feelings, and whenever such feelings, or the paresthesiae generally, were complained of, a poultice or ointment made of insects seemed to be the natural remedy. The more repellent the materials, the more efficient they were likely to be. Many of the paresthesiae are due to neurotic conditions and it is not surprising that when an ointment of crushed lice--these insects being collected from barnyard {35} fowls or from hogs--was used, the suggestive influence was strong. Another important ingredient in ointments were portions of dead bodies. A bit of a mummy from the East was supposed to be particularly efficacious. Portions of the bodies of men who had been hanged, or of the moss that grew on the skulls of malefactors whose bodies had been long exposed in chains to the air, were also favorite ingredients. Plants and shrubs gathered in graveyards, especially in the dark of the moon, because on account of the terror of the place they were then harder to get, also had a great reputation.

CHAPTER IV

SIGNATURES AND PSYCHOTHERAPY

_Similia similibus curantur_, like is cured by like, is a very old idea. According to the doctrine of signatures nature had put an external natural marking or a symbolical appearance or characteristic upon a plant, mineral or other object, to indicate its special usefulness for the treatment of certain diseases or for affections of certain organs. Sir Robert Boyle, sometimes spoken of as the father of chemistry, said, "Chymists observe in the book of nature that those simples that wear the figure or resemblance, by them termed signature, of a distempered part, are medicinal for that part or that infirmity whose signature they bear." On this principle yellow flowered plants were good for jaundice, because they resembled it in color. The blood stone was good for hemorrhage, and plants of certain forms were good for the organs or parts of man which they resembled. Certain plants were named with this idea. Kidneywort, liverwort, are typical examples. Scorpion gra.s.s, our familiar forget-me-not of the _genus myosotis_, was so-called because its spike resembled a scorpion's tail and was, therefore, good against the scorpion's sting, or against pains similar to that produced by such a sting. Some of the resemblances were extremely far-fetched, but in spite of the defect of nature's signature on them, they seem to have been effective in therapeutics. The plant, sometimes called Jew's ear, which can by an effort of the imagination be made to bear resemblance to the human ear, was, for instance, supposed to be a successful cure for diseases of that organ.

We know now that there is no significance in this doctrine of signatures. It represented one phase of pseudo-science. But the idea of itself was enough to help people to throw off many symptoms, to relieve discouragement, to encourage them with the thought that they ought to get better; accordingly they took new heart, ate better, went out more, and as a result naturally slept better, and then nature did the rest. Signatures are an exquisite example of pure psychotherapy, as the initial agent and natural curative methods accomplis.h.i.+ng the cure.

Signature Details.--Some of the details of the doctrine of signatures are amusing. For a considerable period nuts were supposed to be a good brain food, and some traces of this idea are still extant, although there does not seem to be any better reason for it than the fact that many nuts have an arrangement of their lobes which resembles the conformation of the brain. On the same principle the Chinese use ginseng-root as a general tonic. The extract is not {36} of any special significance in medicine, though it has come to be much advertised in recent years, and the Chinese continue to pay high prices for it. The reason is that the root of the ginseng plant often resembles the human body. The more nearly this resemblance can be traced, the more virtue there is for the Chinese in the particular specimen of ginseng. The signature is on the roots. It is good for man because it looks like man, just as the nuts are good for the brain because they look like the brain. In modern times we are likely to think that we are far away from any such self-deception. But our deceptions have a more appealing pseudo scientific element in them.

Fish was for some time considered a good brain food because fish has phosphorus in it and so has the brain. The two reasons have as much connection as that between nuts and the brain; or ginseng and man.

Astrological ideas came in to help out ignorance and foster supposed knowledge. The sun and the stars were favorable planets and the moon unfavorable. If anything about a plant reminded the gatherer of the sun or the stars, then that plant was sure to be beneficial, especially in chronic diseases. If anything reminded him of the moon, however, then it could be expected to be maleficent in influence.

Though childish, this had yet its power to help.

The use of nitrate of silver, which in the old days was called lunar caustic, because it had, in a fresh state, a silvery, moon-like sheen, was largely a matter of signatures. The signature went both by similitude and by contrary. Since the lunar caustic supposedly had a moon quant.i.ty, therefore it would be good for moon-struck people--the lunatics of the old time and of our own time. As a consequence nitrate of silver was used in many obscure nervous and mental diseases. In epilepsy it was commonly employed. Even in our own times, entirely on empiric grounds, it was used for such severe organic nervous diseases as locomotor ataxia and sometimes to such an extent as to produce argyria. Undoubtedly, its use, with confidence on the part of the physician and suggestion and persuasion on the part of the patient, did much to relieve sufferers from discouragement and from such psychic disturbance of their general health as would have made their condition seem worse.

Wines as Remedies.--How much suggestibility means in the choice of remedies that of themselves are more or less indifferent, may be well judged from the recommendations with regard to various wines that have been made by physicians. At one time and place it is red wine, at another it is white wine that is particularly effective. For certain nations the stronger wines, as Port or some of the Hungarian wines, have appeared to exercise specific effects. Except for the tastiness of these various brands or for other trivial accessories, it is probable that the therapeutic efficacy of the wine depends entirely on the alcohol and the effect of this upon the patient. In his "Memories of My Life," Francis Galton relates that Robert Frere, one of his fellow pupils with Prof. Partridge, who became through marriage in later years a managing partner in a very old and eminent firm of wine merchants, told him that the books of the firm for one hundred and fifty years showed that every cla.s.s of wine had in its turn been favored by the doctors.

In prescribing wine the doctrine of signatures probably had more to do with the special choice than anything else. Red wines were recommended for anemic people, because somehow the coloring was supposed to affect the {37} patient in such a way as to make up for the lack of coloring in the blood. On the other hand, the light, and especially the straw-colored wines, were recommended for liver troubles, because of their relation in color to the yellow of bile. Light wines were best for people who had more color than normal. Some wines are much stronger than others, and the alcohol, as in so many of our patent medicines, had a stimulating tonic effect, but in olden times this was supposed to const.i.tute only the smallest portion of the efficiency of the wine, while the ingredients that made its color and taste were extremely important. The taking of red wine by anemic patients often proved suggestively valuable, and the alcoholic stimulation led them to eat more freely and look at things more hopefully and, consequently, to improve in health more rapidly than would have been the case had they not had the feeling that somehow they were actually consuming elements that would make their blood red.

Precious Stones.--The doctrine of signatures applied particularly to precious stones, and many of the popular medical superst.i.tions with regard to precious stones were founded on it. The blood stone was said to be efficient as a tonic: it stimulated people: it made the anemic stronger and ruddier if it were worn on the fingers. The torquise turned pale when its owner was in poor health. It was the stone that was an index of what has been called "the blues" or what one modern writer has dignified by the t.i.tle "splanchnic neurasthenia." Dr. Donne wrote of:

A compa.s.sionate turquoise that doth tell By looking pale, the owner is not well.

It is probable that the pallor of the patient's hands as the background to the stone made the difference in its appearance thus noted. It became deeper in hue, as it were, when people were in ruddy health. The suggestive influence of such beliefs is easy to understand. It is even possible that the wearing of an amethyst did help to keep people from indulging in liquor to excess, for that is the traditional effect of the wearing of this stone, though its virtue seems to be founded on nothing better than the supposed derivation of the name from the Greek _a_ privative and _methuo_, "I get drunk,"

suggesting strongly to the wearer that he should not get drunk.

The jacinth superinduced sleep and doubtless the strong suggestion of this supposed influence helped many sufferers from so-called insomnia to get sleep. The single fixed idea that now they must get to sleep would greatly help them. Pillows in the olden time were occasionally set with bits of jacinth, and there is even the record of bed-linen embroidered with it. This would probably be quite as effective as are hop-pillows in the modern time, for their main influence, as is also true of pine pillows, seems to be through suggestion. Some other traditions with regard to precious stones are harder to understand, yet may be explained. The owner of a diamond was supposed to be invincible. Diamonds represented money and money meant power. It is harder to explain the tradition that the possession of an agate made a man able and eloquent.

The wide acceptance of the doctrine of signatures, and of allied ideas, as to the effect of precious stones and metal and jewelry upon disease, makes {38} it clear that the acceptance of a mental persuasion with the changes in habits that follow, may serve as the basis of a successful system of therapeutics. The materials a.s.sociated with the idea had absolutely no more physical influence than does the carrying of a horse chestnut or a potato in the pocket serve to keep off rheumatism.

CHAPTER V

PSEUDO-SCIENCE AND MENTAL HEALING

An interesting phase of psychotherapy is found in the history of the applications of new scientific discoveries to medicine. The development of every physical science has been followed by an attempt to apply its new principles and discoveries to the treatment of disease. Such applications have nearly always been followed by excellent results at the beginning. But almost without exception, the medical significance of these discoveries has, after a time, been found to be _nil_. When these discoveries were made they became the center of public attention. The announcement of their application to medicine then seemed natural and produced a feeling that another great therapeutic principle had been discovered. Sometimes wonderful therapeutic effects were noted. The chronic diseases particularly were helped for some time, at least, and practically all the affections that have mainly subjective symptoms were greatly relieved, or actually cured. After a time, however, when the novelty of the discovery wore off, its suggestive power was lessened and then the remedy lost its therapeutic power.

ASTROLOGY

Astrology is the typical example of pseudo-science in medicine. The stars, and particularly the planets and the moon, were supposed to have great influence on human destiny, human health, and human const.i.tutions. Astrology was an organized body of knowledge over 3,000 years ago. Mr. Campbell Thompson has recently translated a series of 300 inscriptions from the cuneiform tablets in the British Museum, and Professor Sudhoff of Leipzig has compiled all the references to medicine in these. The latter's studies show the extent which star influence was supposed to have over human health. A halo round the moon, an obscuration of the constellation of Cancer, the pallor of a planet in opposition to the moon, the conjunction of Mars and Jupiter, and other movements and phenomena of heavenly bodies were supposed to foretell the approach of disease for man and beast.