The Evolution of Modern 
Therapy. 
AN ADDRESS READ BEFORE THE SOCIETY OF THE ALUMNI OF 
THE MEDICAL COLLEGE OF VIRGINIA. 
BY 
SIMON BARUCH, M.D., New York, 
Physician to Hood Wright Memorial (formerly Manhattan General) Hos 
pital, and Consulting Physician to the Mpntefiore 
Home for Chronic Invalids. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, JUNE 15 AND 
JULY 15, iSgg. 
WILLIAM M. WARREN, PUBLISHER. 
1899. 
DETROIT, MICH. BY THE SAME AUTHOR. 
1864. 
56. 
Bayonet Wounds. (Fifteen Cases.) 
Hypodermic Medication. 
>7- 
Subinvolution of the Uterus. 
168. 
Decolorization of Tr. lodine by the Sulphites. 
Ligature of the Common Carotid for Traumatic Aneurism of the 
Occipital. (A Successful Case.) 
iyo. 
Two Successful Cases of Tetanus. 
>74- 
A New Point in the Medico-legal Aspect of Strychnine Poisoning. 
The Progress of Medicine. 
Presidential Address on Methods of Fostering the Interests of Medi- 
cal Science. 
1880. 
1883. 
Vaccination. 
Diagnosis of Malarial Fevers. 
Malaria as an Etiological Factor in New York City. 
1884. 
Practical Hints on the Treatment of Catarrh. 
The Prevention of Puerperal Infection. 
Management of the Third Stage of Labor. ’ a' 
1885. 
1888. 
1889. 
Therapeutic Significance of the Cervical Follicles. 
Therapeutic Memoranda on Diphtheria. 
The Treatment of Typhoid Fever. 
Antiseptic and Aseptic Midwifery. 
1890. 
Relation of Peripheral Irritation to Disease. 
The Status of Water in Modern Medicine. 
Causes and Treatment of the Summer Diarrhoea of Infants. 
1891. 
Utilization of Hydrotherapy. 
A Plea for Public Baths. 
Hydrotherapy and Mineral Springs. (Hare’s American System of 
Therapeutics.) 
1892. 
A Plea for the More Methodical Management of Chronic Diseases. 
The Pathognomonic Signs of Perforating Appendicitis. 
Conditions Indicating Change of Air and Baths in the Summer 
Diarrhoea of Infants, 
The Uses of Water in Modern Medicine, (Translated and published 
in Leipzig by Dr. Grosse, 1894.) 
im- 
practical Data on the Application of Water in Some Intractable 
Diseases. 
A Plea for Physiological Remedies, 
Non-medicinal Remedies in Anaemia. 
i 894- 
Therapeutic Reflections. 
The Rationale of Hydrotherapy. 
1895. 
The Clinical Aspect of Dyspepsia. 
1896. 
Kneipp’s Water Cure in the Light of Medical Science. 
Practical Data on Some European Health Resorts. 
The Management of Pneumonia Patients. 
1897- 
iBgB. 
Some Desperate Cases of Typhoid Fever Treated with and without 
Cold Baths. 
The Principles and Practice of Hydrotherapy. THE E VOL UTION OF MODERN THERA P V* 
Physician to Hood Wright Memorial (formerly Manhattan 
General) Hospital, and Consulting Physician to the 
Montefiore Home for Chronic Invalids. 
By Simon Baruch, M.D., New York, 
What is the status of therapeutics to-day ? 
How does it compare with that of the past? 
What lessons may we gather from the con- 
templation of its history; what deductions for 
our individual and collective betterment, from 
a retrospective analysis of the therapeutic 
aims of our predecessors? 
As brothers let us consider this vital sub- 
ject in our family circle. I propose to offer 
you a brief outline of the therapy of the past 
in order to show that despite the emancipa- 
tion of medical men from the iron rule of 
leaders of schools and systems, we are still 
far from the golden truth in therapeutics. 
How may a better therapy be evolved ? 
In the days of Hippocrates, Galen, and their 
successors, these great leaders attempted to 
guide the physician through the mazes of 
doubt and mysticism, their own intellects 
darkened by ignorance of anatomy and 
physiology the blind indeed leading the 
blind! Is it surprising that they groped 
amid the problems of life, disease, and death 
without reaching their solution, when we, 
whose paths are illumined by the brilliant 
discoveries of a Harvey, a Claude Bernard, a 
Bichat, a Darwin, a Huxley, a Virchow, a 
*Address before the Society of the Alumni of the 
Medical College of Virginia. 2 
Pasteur, and their followers and colaborers, 
are still so far from the key to the cure of 
disease ? 
“Life is short, art is long, opportunity 
fleeting, experiment dangerous, judgment 
difficult,” has been well said by that grand- 
est of medical intellects, the father of medi- 
cine. Read his works to-day and you will 
find that despite the dense pall of ignorance 
which oppressed and often misguided him, 
he divined the true aim of therapeutics. I 
propose to show you that modern therapeu- 
tics only attains perfection when it approaches 
most nearly to the teachings of Hippocrates. 
True, the golden grain of rationalism was 
buried deep amid the fallacies and traditions 
of his day, and obscured by crude concep- 
tions of the structure and functions of the 
human organism. But if he had done noth- 
ing more than discover that pithily expressed 
attribute of the diseased human organism, 
“vis medicatrix natures” his name would de- 
serve to be immortalized, for these three 
words are the still small voice which has 
brought his empiricism- and ignorance-sod- 
den followers, in all epochs of medical history 
down to the present time, back to the true 
aim of healing. Although he regarded vene- 
section as necessary, Hippocrates warned 
against excesses, because he deemed it a 
highly debilitating measure to be applied 
with the greatest caution, and one which 
should be almost forbidden in weak per- 
sons, children, old people, and pregnant 
women. With therapeutic intuition he re- 
garded inflammation and fever as manifes- 
tations of the conservative tendencies of the 3 
organism against which so heroic a measure 
was likely to react unfavorably. Although 
he bled freely in inflammatory conditions, he 
constantly cautioned the wisest care and 
attention to the condition of the patient’s 
strength and vitality, his aim being “to re- 
lieve pain, moderate perturbed febrile move- 
ment, and promote crisis.” For this reason 
he preferred local bloodletting. His plan of 
treating disease was cautiously watchful of 
the indications of nature [cpvoiff), by which 
he meant the organism. In his work on epi- 
demics he writes; “We must do nothing fool- 
ishly bold, but be quiet and wait; if one does 
not help the sick, one at least does them no 
harm.” In fevers he advised an abstemious 
diet, barley water, as a drink water and 
honey. Of medicines he used emetics, laxa- 
tives, and revulsives; radix hellebori, asses’ 
milk, and juice of euphorbium. All his writ- 
ings display an acuteness of perception which 
makes his observations valuable. The noble 
spirit which he sought to inculcate is evi- 
denced by the Hippocratic oath, which com- 
mands the physician to live virtuously and 
piously and to preserve his art. 
The enormous proportions which blood- 
letting assumed among many succeeding 
generations of physicians testify not only to 
the dominance of this remedial agent, but its 
rise and fall illustrate the varying concep- 
tions of the aim of therapeutics which held 
sway at various times. I can therefore offer 
you no more striking illustration of these 
therapeutic conceptions than by briefly tra- 
cing the fate of this chiefest of so-called 
curative agents throughout medical history. 4 
The death of Hippocrates (366 years b. c.) 
resulted in more or less desuetude of his 
philosophical and rational teachings. Pro- 
fessing adherence to and extolling the latter, 
his scholars and their followers gradually 
swerved from the lines of strict bedside ob- 
servation and deduction, which he had incul- 
cated as the first duty of the physician. They 
attempted to construct systems of medicine 
by substituting their own speculations for the 
more simple methods of the Nestor, and thus 
they fell into false practices. There were a 
few exceptions among these impracticable 
men, who urged bloodletting and purgation 
in all diseases. Chrisippus and his pupil 
Erisistratus held boldly to the master’s 
teachings and insisted that spoliative meth- 
ods were contrary to nature. Indeed, few 
physicians at the present day excel Erisistra- 
tus in the wise ordering of abstention, baths, 
enemata, and other harmless therapeutic 
measures. Phillipus of Cos and Serapion 
(260 b.c.) formed the empirical school, based 
upon the pure Hippocratic doctrines. They 
cast aside all dogma and hypothesis, and 
depended solely upon bedside observation. 
They were extremely cautious with venesec- 
tion, and regarded plethora and retained ex- 
cretions as the principal etiological factors. 
They depended chiefly upon enemata and 
laxatives, and resorted to bleeding only when 
these failed, avoiding it always in chronic 
cases. 
When the exponents of this sensible prac- 
tice passed away, their pretended followers 
deviated from their teachings and lapsed into 
the most crude empiricism. Medicine was 5 
rescued from the latter by Asclepiades,* who 
adopted as a motto of treatment tuto cito et 
jucunde, depending chiefly on diet, rubbing, 
exercise, rest, and bathing. By reason of his 
great popularity in Rome his propaganda for 
bathing in health and disease obtained enor- 
mous success. 
Galen is a familiar name. Being a man of 
culture and possessing great oratorical pow- 
ers, he so skilfully constructed a system of 
medicine by a conglomeration of all former 
doctrines and practices that it endured for 
thirteen centuries. His fantastic ideas of the 
residence of the cardinal powers of life in the 
heart, the brain, and liver, and his doctrine 
of the four temperaments based upon the 
predominance of mucus, blood, yellow and 
black bile, stamp him as an idealist. Still 
he insisted upon the Hippocratic doctrines, 
and by his remarkable cures he acquired 
enormous repute, which is evidenced by his 
becoming physician to the Emperor Marcus 
Aurelius. He advised bloodletting as the 
surest remedy in plethora, in chronic ailments 
due to suppressed hemorrhages, and as a 
prophylactic, but he warned against bleeding 
to syncope. Although he was an active 
bleeder, he cautioned against excessive de- 
pletion, urging that “loss of blood may be- 
* This truly great physician and philosopher was the 
bosom friend of Cicero and a pupil of Democritus, who 
really foreshadowed the “cellular theory” by teaching 
contrary to the prevalent humoral theory, that “ not the 
juices of the body but its elements and atoms are active 
in promoting health, and that their disturbance consti- 
tuted disease.” The intellectual preeminence of Asciepi- 
ades is attested by Pliny. 6 
come harmful, because the vital spirit flows 
away with it and large losses must impair all 
the natural processes.” 
The first centuries of the Christian era, 
when science and art lay prostrate, constitute 
the darkest period of the history of medicine. 
Amid the darkness, and the excesses com- 
mitted by the monks and others who arrogated 
to themselves the title physician, a few true 
medical spirits shone like gleams of promise. 
Alexander of Tralles, living in the sixth 
century, though a follower of Galen, was 
courageous enough to oppose him by insist- 
ing that the physician should not follow any 
system of treatment, but that he should be 
guided in each case by the age, constitution, 
natural powers, and mode of life of the 
patient. Despite these sound views, bleed- 
ing was his chief remedy, though he 'cau- 
tioned against the excesses which he daily 
witnessed among the motley practitioners of 
his day. 
The fifteenth century produced that er- 
ratic but clever reformer, Paracelsus, of 
whom the historian Ranke has said: “In 
him lived a spirit ingenious, profound, and 
endowed with rare knowledge.” Although his 
vanity and bad habits made many enemies, 
and his alchemistic doctrines betray the spirit 
of ignorance which was the prevailing char- 
acteristic of his time, he displays true med- 
ical intuition in the earnestness with which 
he inveighed against Galen’s doctrines and 
spoliative practices, and in his recognition of 
the authority of Hippocrates. He wrote: 
“When disease attacks the body, all the 
healthy organs must combat it, for disease 7 
tends to kill them all. Nature recognizes this 
fact, and therefore she attacks it with all her 
might.” What Hippocrates called 11 vis medi- 
catrix natures” Paracelsus termed “the inner 
alchemist.” He proclaimed boldly: “Nature 
is the physician, not you! Since I saw that 
the doctrines of the ancients have accomp- 
lished nothing but the making of corpses, 
death, deformity, and decay, I was compelled 
to pursue the truth by another way.” What- 
ever the failings of this man, be he charlatan 
or wiseacre, these ideas betray a realization 
of the aims of the true physician as we re- 
gard them to-day. 
The same century produced Brissot, who 
with great learning and logical acumen in- 
culcated that inflammation does not always 
demand venesection, because “ the powers of 
nature, which always aid the diseased organ- 
ism, may produce salutary congestion.” He 
opposed general bleeding and preferred, like 
Hippocrates, local depletion. It is a sad 
commentary on the spirit of the 'medical 
profession of that day, and exemplifies the 
enormous prejudice in favor of bleeding, to 
record the fact that poor Brissot was not 
long permitted to sing the praises of “ vis 
medicatrix." He was driven from Paris to 
Portugal, where he died a martyr to his 
excellent doctrines, amid the curses and mal- 
edictions of his confreres. 
In every country bleeding, purging, and 
other spoliation continued the weapons with 
which disease was attacked. 
A reformer appeared in the seventeenth 
century. Van Helmont sought to end the 
sad reign of spoliative therapy which had 8 
resulted from the perversion of the doctrines 
of Hippocrates during the dark ages. De- 
spite his fantastic and mystical tendencies and 
practices, he was a brilliant physician, which 
is evidenced by the fact that even in that 
early time he laid special stress upon the 
fallacy of treating symptoms. “ Diseases 
have no roots,” he wrote; “their termination 
is based upon the removal of their causes; 
the aim of treatment should not be the cool- 
ing of temperature and removing the chang- 
able symptoms; the physician who directs 
his chief attention to these things and not to 
the removal of the cause, loses time, labor, 
and opportunity.” He prescribed opium as 
a stimulant, and mercury, antimony, and wine 
in fevers. Against depletion he strove with 
might and main: “I estimate that indication 
most highly which is based upon the main- 
tenance of the strength; venesection is di- 
rectly opposed to the latter; the entire 
treatment should be for the maintenance of 
these powers. In fevers the indication for 
bleeding is absent. It is forbidden that he 
injure Nature, who should hasten to her aid 
when she tries to help herself. She can do this 
more perfectly the more vigorous she is. The 
physician should certainly know that without 
his interference the patient is debilitated 
enough by the disease, the loss of appetite, 
restlessness, pain, fear, wakefulness, and per- 
spiration. By the rapid withdrawal of blood 
Nature is hindered in the destruction of her 
enemy. It is an insane practice to draw 
blood so frequently and at the same time 
offer the patient-nourishment, regardless of 
the complete abeyance of his digestive pow- 
ers.” To us of this enlightened era these views 
have the true ring; how singularly perverse 
was the medical mind in refusing to accept 
these salutary lessons! How steeped the 
medical profession was in its errors, and how 
authority ridden, is sadly evident from the 
fact that Harvey, the discoverer of the circu- 
lation of the blood, was so persecuted by 
reason of his teachings that he lost his large 
practice in London, and his work, being re- 
fused censorship in England, was printed in 
Frankfort several years later (1628). In 
Paris his book was also prohibited. 
9 
It required a bold spirit indeed to antag- 
onize the prevailing doctrines and the hap- 
less therapy based upon them. 
Now appeared upon the scene the famous 
Sylvius (1660), who taught Van Helmont’s 
method in the University of Leyden. He 
added certain chemical doctrines which seem 
extremely absurd at the present time. He 
spared the patient’s vitality by refraining 
from depletion, his chief remedies being 
simple diluents. His influence was good, but 
it did not seriously check the bloodthirsty 
doctrines. The discovery of the circulation 
of the blood even did not bring order out of 
the then prevailing therapeutic chaos. The 
circulation was regarded as a hydraulic proc- 
ess, and diseases were thought to be due to 
a despoiling of the blood, which could be 
remedied by bleeding and even by injecting 
medicinal agents or animal blood. The holo- 
caust to venesection continued to accumulate, 
and the voices of the few great reformers 
were silenced amid the detractions of a mul- 
titude of despoilers. 10 
In the latter part of the seventeenth cen- 
tury a brilliant star arose in the medical 
firmament. Thomas Sydenham strove to re- 
instate the lost doctrines of Hippocrates and 
relegate Nature to her merited position as a 
healer. A rational empiricism, a treatment 
free from speculation and based entirely upon 
observed facts, was his aim. Sydenham de- 
fined disease as “an effort of Nature to pre- 
serve the patient; this effort is manifested 
either by a purifying fever, the symptoms of 
which are the signs of Nature’s battle, or by 
intestinal evacuation, sweating, or cutaneous 
eruptions. If Nature conquers the disease 
becomes acute; if not it becomes chronic.” 
Although Sydenham, like Hippocrates, be- 
lieved that it is the physician’s duty to watch 
closely the processes of Nature in the further- 
ance of cure, he erred, like the great Nestor, 
in regarding high fever as an abnormal action, 
which must be modified by antiphlogistics, 
bleeding, purges, watery diet, and cool sur- 
roundings. He was a determined yet wary 
bleeder, always cautioning against excesses 
and deploring the therapeutic barrenness 
which forced him to resort to venesection, a 
remedy which he regarded as debilitating and 
destructive to the whole body. He said that 
“a regular system of management frequently 
cures many diseases better than the powder 
of the apothecary.” He valued cinchona and 
opium highly. As a pupil of Locke and a 
student of the Montpelier school, which had 
served to maintain the rationalism of Hippo- 
crates amid the chaotic confusion into which 
it had degenerated, he was a strict observer 
and insisted upon definite indications for all 
treatment. 11 
Another evidence of returning good thera- 
peutic sense is furnished by the life and teach- 
ings of one Gideon Harvey, a contemporary of 
Sydenham, who was physician to King Charles 
11. and William 111., and city physician of Lon- 
don. He wrote a book in 1689 on “The Art 
of Curing Disease by Expectation,” in which 
he violently assailed the prevailing spoliative 
methods. He may be regarded as the father 
of the expectant treatment, which came into 
vogue in the latter half of this century. 
The enlargement of knowledge resulting 
from Harvey’s great discovery and Syden- 
ham’s philosophic and yet practical teachings 
appear to have influenced therapeutics very 
little. We find in the writings of Pechlin 
(1700), who was a very conservative practi- 
tioner, the statement that spoliative methods 
continued in vogue in Europe and that espe- 
cially in France bloodletting became a verita- 
ble fashion, against which the scathing satire 
of Moliere was as impotent as the eloquent 
warnings of the few rational physicians. 
Even Boerhaave, who was justly regarded 
as the most celebrated physician in Europe, 
labored under the terrific error of spoliative 
therapy. Despite the fact that he recognized 
and warned against the devitalizing effect of 
depletion, he not only bled in most diseases, 
but recommended venesection to facilitate 
the absorption of medicines. He had a large 
following in all parts of the world. He wrote: 
“If we compare the good which half a dozen 
sons of Hisculapius have accomplished since 
the origin of the medical art upon the earth, 
with the evil which the immense mass of 
doctors have done among the human race, 12 
there can be no doubt that it would have 
been far better if there had never been a 
physician in the world.” This sentiment, 
which was afterward wittily reiterated by our 
own Oliver Wendell Holmes, certainly reflects 
much truth, so far as internal medicine is 
concerned. The forlorn plight of therapeu- 
tics, its sad consequences for suffering hu- 
manity, cannot be depicted more eloquently 
than by this statement of the foremost physi- 
cian of Europe, who was himself so enamored 
of the spoliative practice which he condemns 
that he was utterly unconscious of his own 
participation in it. 
After figuratively wading through tales 
of blood - spilling, the diligent student of 
medical history is refreshed by the clear and 
rational teachings of Friedrich Hoffman, in 
“De natures et artis efficacia in medendo.” 
Inveighing against the habit of being bled, 
because “in the blood is contained the entire 
stock of vitality,” he recommends a simple 
therapy, consisting of bland diet, cool drinks, 
and baths, mineral waters, milk, wine, lead, 
camphor, iron; and opposes the use of opium 
and other poisons. 
A staunch defender of Nature among the 
multitude of bleeders was Gaub, professor at 
Heidelberg, who wrote the first book on 
pathology. He regarded Nature amply 
competent to remove disease, which he con- 
sidered quite as natural as life or death. 
Stahl is another great man who left a 
favorable impress upon therapy. He wrote: 
“Nature, the physician of diseases, offers a 
better prospect of curing them than the most 
perfect apparatus of our art,” He warned 13 
against too active medication and depletion, 
“ which suppress the completely misunder- 
stood efforts of Nature.” 
In France an outspoken opponent to de- 
pletion was Borden, who dubbed the Charite 
“the leech bureau.” He lived in the latter 
half of the eighteenth century in Paris, when 
venesection was running riot. He disregarded 
plethora and valiantly defended Nature. Al- 
though he used the lancet, he warned against 
it in fever because “bleeding shatters the 
constitution and disturbs the function at 
a time when the organism requires all its 
vitality for the purpose of removing the 
disease.” “Many a broken-down constitu- 
tion,” he writes, “is dragging itself around 
burthened with chronic disease as a result 
of disturbance and hindrance of Nature’s 
work by bloodletting in acute diseases. In 
rheumatic and catarrhal diseases especially 
Nature is the sole curative factor.” 
While a reaction against depleting methods 
was brought about in France by the teach- 
ings of Borden, Castellot, and others, and by 
the conservative doctrines emanating from the 
great Montpelier school, the teachings and 
practice of Sydenham continued to be per- 
verted by English physicians. Unfortunately 
many of them disregarded his warnings and 
blindly bled for all diseases. 
The philosophic Cullen was an active 
bleeder, although, like Hippocrates, he 
warned against excesses; he laid down indi- 
cations for drawing blood and prescribed 
tonics, stimulants, cinchona, wine, and opium. 
Depletion still continued to sway the med- 
ical mind, however, until De Haen appeared 14 
in the latter part of the eighteenth century. 
A true exemplar of rational medicine, he 
taught that “ Nature must not be disturbed by 
powerful medicines.” He prescribed chiefly 
absolute diet, cooling drinks, and mild ca- 
thartics. De Haen is the founder of the 
Vienna school of medicine, which was des- 
tined with interruptions to endure to the 
present day. His beneficent teachings struck 
the first decided and lasting blow to spolia- 
tive methods, and gave birth to greater trust 
in the vital restorative powers than had ever 
before been embraced by medical men. Some 
of his immediate successors, like Stoll and 
Peter Frank, neglected his teaching, while 
his later offspring, Skoda, exaggerated it into 
a therapeutic nihilism. Gottlieb Vogel and 
Peter Frank, men of great renown, bled with- 
out stint, but warned the students against 
syncope, and taught that the organism should 
be allowed to retain sufficient vitality, so 
that “we may not murder with the cupping- 
glass those whom the disease had spared.” 
As an evidence that Vienna was still the 
center of spoliative therapeutics in the latter 
part of the seventeenth century, let me cite 
Wollstein, formerly a most zealous bleeder, 
who seeing the error of his ways, became a 
violent propogandist against venesection. He 
candidly admitted having nearly killed him- 
self with it and having since his youth spilled 
thousands of pounds of blood. He writes: 
“I now look back with horror upon the 
twenty years of my bloody activity, by which 
health, animal nature, vitality, and its best 
weapon against disease fever were de- 
stroyed, a practice into which I had been decoyed by teachers and books 
I know from my own experience no case in 
which bleeding deserves the name of a cura- 
tive agent. Even in these troubles it helps 
only man; cattle and horses suffering in the 
same manner are not relieved by it. We 
should, we must, tremble in the application 
of an agent which makes weaklings of strong 
men and animals,” Wollstein pointed out as 
no one before him, and until recently few 
succeeding him, have done, that the physician 
should not be deceived by occasional brief 
improvement of symptoms after venesection; 
he pleads for due regard of its evil after- 
effects. “If the patient survives it, destruc- 
tion of body and mind are the sad conse- 
quences which the doctor will observe after 
a cure by the cupping-glass.” The courage 
of his convictions aroused this simple doctor 
to a valiant battle with prejudices and prac- 
tices which were universal. His voice, how- 
ever, was too feeble to stem the tide of blood 
surging around him. Antagonists arose on 
every side and counteracted his warning. 
15 
In the last years of the eighteenth century 
the medical philosopher Gall exercised a 
favorable influence upon his contemporaries. 
Recognizing the natural conservative activity 
of the organism, he endeavored to restore 
that simplicity in therapeutics which had been 
so long lost in practice, and to show the 
fallacy of the view that because Nature some- 
times attempted to relieve by spontaneous 
bleeding from the nose, hemorrhoids, etc., 
diseases may be prevented or cured by re- 
moving a great deal of blood. Like Hippo- 
crates, Gall regarded bloodletting as a de- vitalizing agent, which never weakened the 
disease, and only acted as a palliative by 
freeing the natural powers when plethora ex- 
isted. He inveighed against these one-sided 
methods in acute diseases, which “by rough 
and forcible interference lowered the system,” 
and warned earnestly against “ those extrava- 
gant losses of blood which produce relapses 
and enfeeblement if they do not destroy life.” 
That the medical profession remained cal- 
lous to the admonitions of these wise phy- 
sicians is a deplorable fact, evident from the 
writings of that day.* 
The close of the eighteenth century wit- 
nessed little abatement of spoliative thera- 
peutics. With regard to medicinal agents it 
may be of interest to recall the fact that 
while in its earlier years many absurd reme- 
dies, like mummy, wood lice, dung, were re- 
garded as efficacious, many medicinal agents 
were added which are of great value. Cin- 
*A graphic picture of the practice at that time is fur- 
nished by Metzler, who “ as the son of a country surgeon 
often saw in one day several hundred persons assemble 
for bloodletting, during the Easter holidays. Without 
any idea of medicine I was astounded by the indifference 
with which entirely healthy people, as well as those weak- 
ened by age or disease, allowed one or two pounds of 
blood to be taken, how one after the other dragged him- 
self away faint and trying to refresh themselves by cold 
sprinkling of their faces, how they often made sport of 
persons lying in deathlike faints, and then seated them- 
selves and allowed their blood to flow until they too 
grew weak and pale, often vomiting and sinking down 
exhausted. This silly action of the country folk aston- 
ished me, and this fearful effect of bleeding made a deep 
impression on my youthful mind. The correct ideas 
which I formed by reflection upon them were dissipated 
by the teachings of my professors at the medical schools. 
Fortunately I soon became convinced of the narrowness 
of the latter, how little I learned from them, and how chona and opium were firmly established, 
despite violent opposition. Dover’s powder 
was introduced; conium, stramonium, hyos- 
cyamus, colchicum, were investigated by 
Stoerck, digitalis by Withering and Darwin, 
potassic solutions of arsenic by Fowler, ace- 
tate of lead by Goulard, corrosive sublimate 
by Van Swieten; oxygen was introduced for 
inhalation and mineral springs were studied; 
the external and internal use of water 
was introduced by Floyer in England, and 
by Friedrich Hoffman in Germany. The 
latter recommended cold baths “to restore 
elasticity to the solid parts.” Hahn in Ger- 
many and Currie in England introduced the 
modern bath treatment of fever. Electricity 
was also introduced as a remedial agent. 
The therapeutic attitude of the better class 
of medical men at the dawn of the nineteenth 
century is evident from the writings of 
Reil, who had distinguished himself by ad- 
much I still lacked in medical knowledge. I therefore 
studied the ancients, threw aside the laboriously learned 
school knowledge, and endeavored to gather all the 
Hippocratic teachings as my guide. Thus I became a 
physician; thus I obtained my conceptions of blood- 
letting and found myself more content at the bedside.” 
He relates how his practice diminished because he 
refused to bleed pregnant women, drunken priests, and 
hypochondriacal politicians. He was dismissed from 
the practice of one convent because he advised exercise, 
abstinence from priestly labors and gormandizing in- 
stead of bleeding. “ I only bled when it was in accord 
with ray principles, and I have never had cause to regret 
this practice. I have published my views from time to 
time; they have been read from Slavonia to Paris. I 
have written of the beneficence of fever and against the 
thoughtless use of bleeding, and all those remedies which 
practitioners so constantly ply like a trade for the calm- 
ing and suppression of febrile movements, which are so 
often useful.” vocating the abolition of the medieval mal- 
treatment of the insane: “Bloodletting is a 
very effective remedy, which alone is capable 
of saving life in some fevers and of paving 
the way in others. The untimely use of ven- 
esection is injurious; simple benign fevers 
do not require it, only the severe grades. 
Nature, not bleeding, removes fever. In 
inflammatory pneumonia a single bleeding 
restores expectoration, while excessive bleed- 
ing reduces the tone so that expectoration is 
absent and we are compelled to resort to 
senega, sulphur, etc. A bottle of porter 
often saves a patient who would have been 
killed by bleeding. Excessive and untimely 
bloodletting disturbs resolution, retards the 
crisis, slows convalescence, and sometimes 
produces effusions of lymph into the chest, 
with dropsy, suffocation, and apoplexy.” 
Readers of medical history are familiar 
with the Bruonian System, promulgated by 
the brilliant Thomas Brown. His stimulating 
practice is said to have “slaughtered more 
human beings than the French Revolution 
and the wars of Napoleon.” This extrava- 
gant charge is probably the anathema of his 
depleting contemporaries, proclaimed upon 
his revolutionary doctrines,* 
. In America the depleting practice was ad- 
vocated by the well known Benjamin Rush. 
He recognized but two types of remedies, 
*lt is stated by Haeser that Marcus, a follower of 
Brown, “consumed in his hospital at Bamberg in one 
year, I drachm of opium, 195 grains of camphor, 529 
grains cinchona, besides other medicines, for each of 367 
patients.” How well endowed this hospital must have 
been ! stimulants and depressants. He called calo- 
mel the Samson of the materia medica; his 
opponents contended that he was right, since 
it had undoubtedly slain its thousands (Ros- 
well Park). In his treatise (“Upon the Ad- 
vantages which Bloodletting Offers in Many 
Important Diseases ”) Rush proves himself 
a valiant and ardent defender of venesec- 
tion, recommending it even in infants six 
weeks old and in the aged. The teachings 
of Rush dominated American medicine for 
many years, practically without opposition. 
Throughout the entire world the battle 
between the depleting and conservative prac- 
tice went on, the former always represented 
by the great mass of physicians, the latter 
espoused by a few isolated spirits who dis- 
played laudable courage in thus opposing 
the popular destructive treatment of disease. 
Among the latter was at this time Ernst 
Horn, who wrote (1803) that “the waste of 
blood should be punished just like every 
poisoning; indeed, physicians who permit 
themselves to be deceived into bleeding by 
real or imaginary fulness of the pulse by 
increase of heat, stupor, delirium, etc., should 
be deprived of practice,” 
How the same fallacious theory may form 
the basis of opposite modes of practice is 
illustrated by that interesting but fatal 
method of treatment of the Italian teacher, 
Rasori, who had become a warm advocate 
of the Bruonian stimulant and contrastimu- 
lant theory. He differed from Brown mate- 
rially in that he regarded the latter as far 
more frequently indicated than the former. 
In an epidemic of typhus at Genoa Brown's 20 
stimulating treatment was so destructive that 
Rasori afterward resorted to depleting meas- 
ures in most cases. He not only used vene- 
section freely in so-called sthenic cases, but 
he also applied it as a diagnostic feeler to 
ascertain whether to stimulate or depress. 
As if the hapless victims of this celebrated 
doctor were not yet miserable enough, he 
plied them with enormous doses of tartar 
emetic in pneumonia, which at that time 
prevailed extensively in Europe. A case of 
anasarca reported from the Genoa clinic re- 
ceived within fifteen days six venesections, of 
eighteen to twenty ounces, and forty - six 
ounces of saltpeter; a patient with pneu- 
monia lost in eight days fifteen pounds of 
blood and received 220 grains of digitalis, 
after which he promptly died. Another case 
of elephantiasis received besides abundant 
venesection twenty-eight drachms of extract 
of aconite in gradually increasing doses. 
It is a sad commentary upon the status of 
medicine in the early years of the present 
century to know that this destructive prac- 
tice found a large following among European 
physicians, who modified it more or less. 
Disease continued to be attacked as an 
enemy hidden within the human body; the 
battle went on regardless of the injuries in- 
flicted by the attacking forces. 
Unhappily a brilliant clinician appeared at 
this juncture, whose contempt for the doc- 
trine of Hippocrates acted as a blight upon 
rational therapy. Broussais, rhetorician, 
writer, theorist, sought to establish the so- 
called physiological school of medicine, a 
term as inappropriate as was his practice. 21 
He claimed that numerous post-mortem ex- 
aminations showed that most diseases are 
due to local inflammation, chiefly of the gas- 
trointestinal tract. In the effort to meet 
these, leeches were applied to a ludicrous 
extent. It has been stated that 400 leeches 
were used daily in each ward of the Hotel 
Dieu, and that the Parisian hospitals con- 
sumed six million leeches annually. 
You are doubtless familiar with the history 
of this remarkable practice, which must have 
cost many lives, because the influence of 
Broussais and his brilliant pupil Bouilland 
among the Latins was far-reaching. 
Again a courageous dissenter appeared in 
the person of Andin-Riviere, who was pro- 
fessor of hygiene in the Lycee de Paris in 
1827. A true follower of Hippocrates, he 
scourged with the lash of brilliant rhetoric, 
sustained by statistics and clear bedside ob- 
servations, the outrageous practice of Brous- 
sais. He refers to a mild epidemic of 
smallpox in 1824, in which 1136 persons 
died, nine-tenths of whom were subjected to 
repeated bleedings. Dr. Frappart ordered 
for one patient 1800 leeches, under which 
the latter promptly died. These statements 
brought Riviere before the courts, which 
mulcted him in the sum of 500 francs dam- 
ages and prohibited his book! During the 
reign of the bloodthirsty Moloch few dared 
to rebel against the scientific ministers of 
this healer (?). Riviere suffered for his te- 
merity. 
So great continued the influence of spoli- 
ative medicine that the renowned Laennec 
actually prescribed moderate venesection and 22 
large doses of tartar emetic in pneumonia, 
which proves that Laennec’s therapeutic in- 
sight was not as deep as was his diagnostic 
skill. The latter is also evident from the fact 
that he attempted to create artificial sea air in 
the badly ventilated wards of his hospital, by 
scattering fresh seaweeds under the beds 
of his phthisical patients ! 
The time was now ripe for a reform! The 
great French school founded by Bichat gave 
birth to such men as Louis, Andral, and Ma- 
gendie. These laid the foundation for ex- 
posing the fatal errors of Broussais and of 
his predecessors. Andral and Gavarret, 
whose blood studies were the pride of 
physiological text-books in my student days, 
opposed the spilling of blood and resorted to 
cathartics and emetics. Magendie, the father 
of modern physiology, exercised an enormous 
influence in favor of rational therapeutics. 
‘‘Medicine,” he wrote, “is nothing more than 
the physiology of the sick man. It is really 
depressing to examine the different remedies 
used in each disease. Let us examine how 
things are going in our Parisian clinics. Take 
a case of typhus. One practitioner treats it 
with purgatives, another with bleeding, a 
third with so-called tonics. Others, to which 
category I belong, allow the disease to go 
undisturbed through its various stages.” 
Nevertheless Magendie was not a thera- 
peutic nihilist; for he investigated, with that 
acumen which has immortalized him, the 
various medicinal alkaloids, in order to ob- 
tain from animal experimentation positive 
results not to be obtained from crude drugs, 
thus conferring a lasting benefit, which we of 23 
the present day still enjoy. He assisted most 
efficiently in overthrowing the fatal doctrine 
of local phlogosis urged so brilliantly by 
Broussais, and he insisted that “the entire 
organism must be regarded in our treatment 
of disease. It must not be forgotten,” said 
he, “that a pneumonia patient suffers from 
something else besides a diseased lung.” 
Louis, who sought to establish the numer- 
ical method for proving the value of reme- 
dies, published a work on pneumonia to 
prove the inutility of venesection, whether 
it was copious or moderate. “The result 
of my investigations,” he writes, “upon vene- 
section agrees so little with the universal 
opinion that I hesitate to publish it.” 
In England many eminent physicians grad- 
ually abandoned extreme spoliative methods 
in acute disease and adopted an entirely op- 
posite treatment in chronic diseases, which 
they regarded as due to debility Iron, cin- 
chona, and other tonics were judiciously ap- 
plied in connection with hygienic and dietetic 
measures. To the credit of English medi- 
cine be it said that the first work upon the 
hygienic treatment of chronic diseases was 
written by Sir James Clark (“ On the Sana- 
tive Influence of Climate”). Thus the seed 
for more rational therapeutics was sown 
among the leading medical minds of Eng- 
land, while the ordinary practitioners still 
continued to bleed and purge and vomit 
their long-suffering patients. 
While rational methods of treatment, based 
upon professedly exact pathological and 
chemical data, were promulgated by the 
greatest physicians of France and England, 24 
there appeared a reform movement in Ger- 
many— a new system, which was distinctly 
outspoken in its theory and diametrically 
opposite in practice to all former ones. I 
refer to homeopathy. 
Hitherto the fanciful structures of the sys- 
tem builders were sufficiently strong to resist 
the incubus of venesection and depleting 
measures, which like a great ogre sat upon 
and overshadowed them all. 
The voices which now and then were raised 
against these spoliative methods, though 
earnest and soul-stirring, proved too feeble 
amid the general acclaim for depletion. We 
are too familiar with the eccentricities of Hah- 
nemann, which have been long inveighed 
against by many earnest physicians (called 
by his followers allopaths). And yet when 
we compare the crudities of Hahnemann 
with the fatal doctrines which have weighed 
like a nightmare upon the practices of our 
own predecessors, we may discern very little 
if any cause for the diatribes that have 
been launched against homeopathy. I am 
free to confess that medicine really is in- 
debted to Hahnemann for having dared to 
set his face against the universal and fatal 
spoliative practice which dominated the en- 
tire medical world and oppressed even the 
most judicial minds. As you know, he de- 
pended entirely upon infinitesimal doses, 
whose inertness the following example shows. 
He writes: “When lycopodium is treated in 
the manner homeopathic art develops crude 
drugs, and one grain is brought by means of 
triple trituration of one hour, each time with 
100 grains of milk-sugar, to the millionth 25 
dilution and potency, a remedy of such won- 
derful activity is produced that one grain of 
it dissolved in 100 drops of dilute alcohol 
and twice shaken in the hands, results in a 
fluid which in the smallest possible dose is 
still too active in the disease for which it is 
appropriate. Not until the potentized sex- 
tillionth dilution is produced does the drug 
begin to be useful.” 
Such positively inert medication, to which 
he wisely added good dietetic and hygienic 
management, surely left the vis medicatrix 
full sway, and right royally did Dame Nature 
assert herself. Hahnemann thus became un- 
wittingly the creator of an epoch in medicine, 
to which may be traced the reinstatement of 
the doctrines of Hippocrates and Erisistratus, 
untrammeled by the anatomical and physio- 
logical obscurity of their day. 
THE RISE OF MODERN THERAPY. 
Being for the first time in the history of 
medicine clearly defined, the issue between 
the spoliative and constructive management 
of disease was now approaching decision. 
Many of us have witnessed this contest. Let 
me rapidly trace its fortunes and draw from 
it some deductions for our mutual benefit. 
Foremost among the modern reformers in 
medicine stands Hufeland, who wrote a severe 
arraignment of the absurdities of homeopathy, 
in which he exhibits the most judicial fair- 
ness. He wrote: “Medicine is a science of 
experience; practice or continuous experi- 
ment on human beings, and the experiment 
is not yet concluded. If we have allowed 
the Bruonians, and if we still allow the con- trastimulants, to apply opium and other 
heroic agents in large doses, why should not 
the homeopaths have permission to use them 
in infinitesimally small doses ? It is Nature 
which cures disease; art only bears its share 
in that it understands how to guide and aid 
it. It is infinitely better not to disturb this 
work than to confuse it by irrational and 
forcible measures, mislead its movements.” 
26 
Krukenberg, of Halle, approached the 
true therapeutic ideal and served almost 
more than any one else in his day to advance 
rational treatment. He insisted that the 
physician should be filled with a pious regard 
for Nature. The organism must be taken as 
a whole. “Our art is undoubtedly capable 
of decisive action, but let it not mistake the 
fact that in many cases its activity is quite 
superfluous, in others quite void or inade- 
quate, in many injurious. Indeed, what vir- 
tues are not assigned to one and the same 
remedy! When we read such commenda- 
tions we seem to be actually standing in the 
presence of the mountebank’s booth.” These 
are words freighted with the spirit of truth, 
which should be taken to heart by all enthu- 
siasts in medication ! 
Schoenlein, who taught in the Berlin Uni- 
versity, was also a cautious exponent of this 
doctrine. Being intent upon curing rather 
than philosophizing, he used drugs without 
professing absolute faith in them, and when 
necessary he did not hesitate to bleed and 
use milder antiphlogistics. 
Although the masses were still bleeding 
and blistering and purging, earnest protests 
against these spoliative practices became more frequent and more authoritative. The 
new Vienna school was destined to play a 
leading rdle in this propaganda, Skoda’s 
therapeutics were pithily stated by him as 
follows: “Air, water, cleanliness, and tem- 
perance are the best pills. And the drug 
store? Well, perhaps there is some good 
in that, too.” 
27 
Dietl wrote (1845): “Of what use is it to 
ascertain valvular disease of the heart with 
the stethoscope, the formation of tubercles 
by the scalpel, the diminution of blood cells 
by the microscope, the increase of albumin 
in typhoid by the test-tube ? We cannot cure 
these diseases, and typhoid is cured more 
surely if we leave it to the mild care of 
Nature. Nature alone can heal; this is the 
highest fundamental law of practical medi- 
cine, to which we will be forced to adhere 
even when a curative principle which is sub- 
ordinate to it will be discovered. This chief- 
est fundamental law has been misunderstood 
in all times. The educated physician rarely 
has the courage to confess it to his patient. 
While the physician should not promise more 
than he can really fulfil, he should be active 
at the bedside, always ready to help. A 
rational treatment is therefore the highest 
aim of the physician, and the greatest benefit 
which suffering humanity expects of medi- 
cine. The principal thing is not to damage 
the patient—Nature produces and maintains; 
therefore it may also cure. Among all cura- 
tive powers, the curative power of Nature 
must be acknowledged as the highest. What 
she cannot do we must endeavor to do; what 
she is capable of doing we need not do. An- 28 
other able exponent of this school appeared 
in Wunderlich. He opposed therapeutic 
nihilism as hopeless, and justly taught that 
although in almost all forms of disease a 
number of cases recover without the physi- 
cian and many other cases are lost in spite of 
all medical effort, there yet remains a con- 
siderable number of cases in which an intel- 
ligent intercession on the part of the physi- 
cian is of most positive consequence. It 
is a very, narrow conception of professional 
activity to suppose that its sole object is 
to restore health to the sick. Shortening of 
suffering, removal and mitigation of discom- 
fort, protection against threatening dangers, 
are quite as serious duties.” 
The teachings of the Vienna and French 
schools exercised a favorable influence upon 
the leading physicians in England and 
America. In England we find them repre- 
sented by the great Edinburgh clinician, 
Hughes Bennet, who wrote:* “Most diseases 
in vigorous constitutions, so far from having 
a tendency to destroy, have a marked tend- 
ency to get well of themselves, whilst instead 
of loss of blood, weakness, and prostration 
being remedies, they are sources of danger 
and the chief cause of a fatal result. I re- 
member accompanying M. Louis many years 
ago in his visit to the Hotel Dieu. Asking 
him what treatment he gave the numerous 
cases of severe erysipelas I saw there, he re- 
plied none at all, because they all get rapidly 
well of themselves in healthy constitutions. 
And I found it to be so. In the many cases 
* Practice of Medicine, p. 295. 29 
of erysipelas in the Royal Infirmary I have 
never given the tincture of iron or anything 
else but good diet, with lotions of acetate of 
lead, flour or oil locally to alleviate irritation, 
and I have not had a fatal case. It is the 
book of Nature, which is open to all, that we 
ought to peruse and study; and why should 
we read it through the eyes of past ages, 
when the light of science was comparatively 
feeble and imperfect, instead of bringing all 
the advanced knowledge of the present time 
to elucidate her meaning.” 
In a most philosophical and logical man- 
ner Bennet attacks the prevalent practice of 
bleeding and mercurializing, insisting that 
“the real tests of successful practice are not 
to be sought in the alleviation of symptoms, 
but in the removal of disease, and that treat- 
ment is the best which, cceteris paribus, causes 
the fewest deaths and brings recovery in the 
shortest time. He states that a vigorous 
antiphlogistic treatment of pneumonia was 
followed by a mortality of one in three cases; 
the treatment by large doses of tartar emetic, 
according to Rasori, by one in five cases; 
moderate bleeding, according to Grisolle, re-, 
suited in a mortality of one in cases; the 
dietetic treatment combined with occasional 
small bleedings and emetics in severe cases 
(Skoda) gave one death in seven cases; and 
the purely dietetic treatment of Dietl one in 
thirteen cases—all being reports from large 
hospitals. The result of treatment directed 
to further the natural progress of the disease 
in the wards of the Royal Infirmary of Edin- 
burgh under Bennet’s care was one death in 
forty cases; there being no mortality in un- 
complicated cases. Bennet taught also that “the confident 
belief in mercury causing absorption of 
lymph is not only opposed to sound theory, 
but like the effect of bloodletting, it is not 
supported by experience. I cannot,” says 
he, “resist the conclusion that the principles 
which led to an antiphlogistic practice in 
acute inflammations were erroneous, and are 
no longer in harmony with the existing state 
of pathology. Read the accounts of distin- 
guished teachers and hospital practitioners 
as to the effects of bloodletting and compare 
them with what you have seen here with your 
own eyes of the successful treatment of in- 
flammation. So powerful and so persistent 
have been the doctrines of the past that not- 
withstanding the facts which I made public 
in 1857 as to my results in treating pneu- 
monia, and notwithstanding the fact that 
an antiphlogistic practice in this country is 
almost universally abandoned, every system- 
atic work up to this date (1864) still recom- 
mends for that disease bloodletting, anti- 
mony, and calomel.” 
Here we have a true picture of the status 
of therapeutics in England in 1864. 
These rational views percolated very slowly 
through the mass of the profession in America. 
Notwithstanding that Oliver Wendell Holmes 
had sent the shafts of irony into the ranks of 
the polypharmacists, and Bigelow had (1835) 
written his “Self-limitation of Diseases” and 
“ Nature in Disease,” antiphlogistic treatment 
continued in vogue until Austin Flint and his 
successor called a halt. How difficult this 
reformation was is evident from the severe 
criticisms made by the American editor of Reynolds’ System of Medicine in 1879 upon 
the advanced therapeusis of the English 
author, which conclude as follows; “The in- 
tention of these remarks is not to antagonize 
but to qualify the summary conclusion which 
the language of Dr. Reynolds appears to 
convey, that venesection and kindred meas- 
ures may with advantage be dismissed as 
obsolete. Of names not yet antiquated in 
favor of the occasional and moderate use of 
the lancet in the early stages of acute inflam- 
matory disorders it may suffice to mention 
Aitken and B. W. Richardson of England, 
Niemeyer and Wunderlich in Germany, Jac- 
coud, Herard, and Count in France, S. D. 
Gross and Fordyce Barker in America.” 
31 
The influence of the modern Viennese 
school upon therapeutics had now become 
quite pronounced, at least among the lead- 
ing physicians of the world. Especially in 
acute diseases was its trust in Nature effect- 
ively applied. When, however, Virchow pro- 
claimed in 1854 {Spec. Path, and Therapy 
vol. i) a deviation of temperature as the 
pathognomonic sign of fever, and showed 
that it was due to increased tissue change 
which in its turn is traceable to an inhibition 
of the heat-regulating centers by the fever- 
producing element, and this was supported 
by exact thermometric measurements, the 
leading clinicians of Germany sought in the 
reduction of this pathognomonic sign the all- 
important therapeutic indication. Bartels, 
Juergensen, Liebermeister, and others en- 
deavored to prove that an abnormally high 
temperature was really the chief lethal factor 
in the infectious fevers, and as a logical corollary reduction of temperature was the 
chief aim in their treatment.* Digitalis, qui- 
nine, veratrin, cold baths, and later antipyrin 
and other coal-tar products were plied with 
might and main. At last scientific precision 
was in view; the thermometer demonstrated 
exactly the needs of the suffering system and 
its remedy. This doctrine spread rapidly, 
owing to speedy modes of communication, 
over the entire world, A new era seemed 
to dawn; antipyresis became the watchword, 
which has misled the medical profession as 
sadly as antiphlogosis had done in former 
years! 
32 
When our own Welch and others showed 
the untenability of the excessively lethal in- 
fluence of high temperature, and when the 
uncertain quinine and salicylic acid as anti- 
thermics were replaced by the positive anti- 
pyrin, the eyes of calm bedside observers 
were opened to the fallacious theory and 
practice. They reasoned that if high tem- 
perature was really the lethal factor, the key 
to the solution of the treatment of acute dis- 
eases must be found in antipyrin ! But, alas, 
though this agent reduced high temperature 
with positive certainty, its influence on the 
mortality statistics was either negative or 
actually unfavorable; the only advantage at- 
tained seemed to be that antipyrin permitted 
the patient to die with a lower temperature. 
* Wunderlich, a leader of nihilistic therapeutics, even 
abandoned it when the thermometric observations for 
which he is noted, in typhoid fever, established the dan- 
ger of high temperature, and sought in infusion digitalis 
a panacea for this disease. Its reputation lasted three 
years, when one of his own pupils, Thomas, overthrew 
its dominion. This is the first instance in the history of 
medicine where a medicinal agent pointed 
the way to more rational treatment of dis- 
ease, and was afterwards abandoned. One 
who has passed through the various thera- 
peutic phases of the latter third of this cen- 
tury in the treatment of fevers, and who, like 
myself, was taught cupping, blisters, mercu- 
rialization, nauseants (nitrous powders), ver- 
atrum, and passed on to aconite, digitalis, 
salicylic acid, alcohol, quinine, antipyrin, cold 
sponging, and baths, can realize the enor- 
mous change produced by the discovery of 
the coal-tar antipyretics, the avidity with 
with which they were taken up as a magnum 
donum dei, and the sad awakening when their 
vaunted curative action was disproved. Had 
this great discovery been made many centu- 
ries ago, when means of communication were 
meager, and methods of observation and in- 
vestigation were imperfect, it would have 
required several centuries to demonstrate to 
physicians that they were pursuing an ignis 
fatuus when they sought in reduction of 
temperature the patient’s salvation. Happily 
we live in a more favored time. Not alone 
have the damaging effects of medicinal anti- 
pyretics upon the excretion been clearly de- 
monstrated, but the investigation upon the 
subject extended to clinical studies on the 
comparative effect of these antipyretics and 
the cold bath treatment. These were made 
chiefly by Ernst Brand and his follower, A. 
Yogi, who thus discovered that the beneficial 
effect of the cold bath was not due to re- 
duction of temperature, inasmuch as its anti- 
thermic power was ludicrously inferior to 
33 antipyrin. They correctly concluded, too, 
that the beneficent results from cold bathing 
in typhoid fever were really due to a re- 
freshing stimulating effect upon a depreciated 
nervous system. This view had long been 
taught by Winternitz and other hydrothera- 
peutists, but had not been heeded until recent 
years. Thus the failure of the much lauded 
coal - tar antipyretics had led to the en- 
lightened and correct treatment of fever, 
chiefly by cold hydriatic procedures. 
34 
THE LESSON OF HISTORY. 
Fellow alumni, I have sketched for you 
the lights and shadows of therapeutics from 
the pages of history. The colors are drawn 
from life, for I have permitted each exponent 
to speak in his own words. How does this 
rapidly drawn sketch strike the unbiased 
seeker after therapeutic truths ? What lessons 
does it inculcate ? How may a more useful 
therapy be evolved ? 
We are saddened by the fact that the 
history of our profession is darkened by 
somber shadows cast by each epoch. When 
we reflect that medicine began its career 
under the glorious aegis of a Hippocrates, 
whose insight into the true aims and pos- 
sibilities of therapy has been demonstrated 
to have been almost inspired and pro- 
phetic, so that we must recognize the fact 
that even to-day our therapeutics approach 
perfection only in so far as they approach 
the ideals of our great Nestor, our hearts 
must be bowed with sorrow over the painful 
revelation that twenty centuries have passed 
away in argument and disputation over the 35 
treatment of disease, while suffering humanity 
lay prostrate, helpless victims of their errors 
—errors due to the neglect of the teachings 
of Hippocrates and to indifference to the 
warnings of a few brave and wise men who 
cried aloud in the anguish of sorrow and 
despair, urging a halt in the spoliation of 
human blood. If you accept without fear 
and without favor the testimony I have just 
cited before you, you cannot avoid this sad 
conclusion. Hippocrates himself with char- 
acteristic prevision foresaw it all, for he 
warned us that “ disputes among doctors en- 
gender disrespect of the whole art among 
the people, so that they begin to doubt the 
existence of medical art. For in the treat- 
ment of acute diseases practitioners seem to 
disagree so much that what one declares as 
the best is by another thrown aside as the 
worst.” 
Viewing the medical profession in the 
light of its own history, we can hardly be 
surprised that it has been the butt of satire 
from the time when Plato said that no gentle- 
man should devote himself to medicine as a 
calling, to Moliere and to the present day, 
when, as in a recent newspaper discussion on 
Kipling’s recovery from pneumonia, a writer 
was applauded who regarded pneumonia as 
less dangerous than the doctors who treat it. 
While in the sanctity of our alma mater’s 
home I unburthen the sad thoughts which 
the contemplation of the history of thera- 
peutics inspires, I am not oblivious to the 
fact that other professions are not exempt 
from error. Let us not therefore condemn 
our predecessors, who often accomplished 36 
wonders under the most inauspicious condi- 
tions, and who were misguided by false 
lights, their pathway not blazoned by knowl- 
edge which has since their day and genera- 
tion dawned upon us. Let us rather endeavor 
to draw from their deeds and writings lessons 
that may inure to the advantage of suffering 
humanity, which entrusts its best interests 
into our frail hands. 
This is the burthen of my words to you to- 
day ! 
What are the chief errors which the history 
of therapeutics emphasizes? 
i. The persistent effort to attack disease 
as an entity—an enemy which has invaded 
the human body and which must be driven 
from its stronghold. With few exceptions 
this idea, as I have shown, pervaded the 
theory and practice of all physicians so com- 
pletely that even many enlightened practi- 
tioners of the present stagger under it. The 
disease is treated; it is attacked by the doc- 
tor with might and main. In acute cases 
phlogosis among the ancients, inflammation 
among the moderns, demanded venesection, 
purgatives, emetics, and revulsives. With 
few exceptions the ruling idea was to weaken 
the enemy, to destroy him. The result was 
disastrous. The doctor and the disease 
fought the valiant fight to a finish—but too 
often the patient also was finished ! Being 
the battle-ground between the contending 
forces, he suffered from both. If he suc- 
cumbed, the disease was charged with the 
victory; if he survived, the remedies of the 
doctor received the credit. How fallacious 
this idea is is clearly shown by history. 37 
Bacteriology has discovered certain micro- 
organisms, which appear to be present in 
certain diseases, and great industry is dis- 
played in searching for remedies that may 
be antagonistic to these under the false idea 
that they constitute the disease. Let the 
search for specifics continue, but let us not 
permit ourselves to be misguided by the 
noble ambition and continue to fight disease 
with antiseptics and antimycotics which can- 
not reach the microorganisms that have en- 
tered every recess of the suffering body, and 
which would damage the latter, if they were 
capable of destroying the former. 
Until other specifics are positively found, 
I would urge upon you not to treat the disease, 
but the patient. 
2. Another error pointed out by medical 
history is the neglect of the Hippocratic teachings 
regarding the vis medicatrix natures. The sad 
consequences of this neglect run like a dark- 
ening shadow throughout the entire history 
of therapeutics. Now and then men like. 
Erisistratus among the ancients and Hufe- 
land and Audin-Riviere among the moderns 
attempted, as we have seen, to recall their 
colleagues from their false practices. The 
regulative capacity of the human organism, 
which had been observed by them, had em- 
bedded itself in their minds, and they sought 
with all the earnestness of their natures to 
convey its salutary tendencies to ears which, 
alas, proved deaf to the most eloquent ap- 
peals. Not until the letter half of the pres- 
ent century do we find their warning lessons 
heeded. The Vienna school, led by Skoda 
and confirmed by the success of medicinally inert homeopathy, inaugurated a nihilistic 
practice, founded upon what they regarded 
as a scientific basis. The physician, it is 
true, now occupied a more dignified posi- 
tion; he no longer attacked disease. But 
he erred in the opposite, though not -so 
destructive, direction of trusting too much 
to Nature. The therapeutic nihilist failed to 
realize that even in health he does not trust 
to Nature alone, but aids her by proper care 
in habits, removal of irritating elements, etc., 
and that in disease there is often even greater 
demand for aiding Nature in the execution of 
her beneficent designs. Moreover the pa- 
tient, distressed by illness, was not content 
with the improved exactness of diagnosis nor 
with the more scientific attitude of his doc- 
tor. Such is suffering human nature. The 
sick man clamors to be cured; he not only 
wants to know the nature of his ailment and 
its probable outcome, but he demands to be 
placed in the best possible position to attain 
a pleasant and rapid recovery. The doctor 
cannot stand an idle spectator of Nature’s 
process of cure; he feels himself impelled to 
act, to act promptly and wisely. This brings 
me to another error in the therapy of the past 
and of the present time. 
38 
3. The treatment of symptoms. The nihilistic 
treatment of disease introduced by Skoda 
and practiced by his followers did not satisfy 
the people, who demanded active treatment 
when sick. To meet this serious issue, the 
expectant method was evolved, which claimed 
for its object the treatment of disagreeable, 
painful, or threatening symptoms, the fore- 
stalling of dangerous enfeeblement, by timely 39 
and abundant nutrition and stimulation. Be- 
ing a vast improvement upon spoliative meth- 
ods, more satisfying, and really more effective 
than the nihilistic method, it rapidly obtained 
a large following in all parts of the World. 
It is to - day the accepted treatment of all 
acute and many chronic diseases. In the 
eagerness to satisfy the urgent demands of 
the patient or of the disease, the physician 
errs in the opposite direction when he at- 
tempts to meet every symptom. Hippocrates 
regarded bleeding as a valuable remedy be- 
cause it relieved pain in the side, and many 
modern remedies have attained reputations 
because they relieved symptoms. Yeratrum 
viride reduces the pulse to normal, digitalis 
increases its tension; antipyrin reduces tem- 
perature to normal; chloral and sulfonal pro- 
duce sleep; morphine relieves pain. Besides 
these positive remedial agents there is a host 
of others, which have obtained more or less 
repute, through commercial propaganda or 
medical self-deception. Thus the materia 
medica has grown enormously, until to-day 
scarce a day passes without your receiving a 
circular or an agent vaunting this and that 
remedy for this and that symptom, and sus- 
taining its claims by scientific and pseudo- 
scientific statements. The physician has 
learned sadly by experience the utter fallacy 
of these claims. He realizes that while the 
reduction of pulse and temperature by medi- 
cines may give temporary comfort, they are 
toxic agents which depreciate the vital 
strength. Yeratrum produces collapse, mor- 
phine checks secretion, chloral enfeebles the 
heart, and the coal - tar antipyretics have been proven to interfere with excretion of 
urea. Nevertheless we need not hesitate 
to use the latter moderately in diseases of 
brief duration—to relieve muscular pains, to 
reduce high temperature, to produce diapho- 
resis. They are valuable remedies for the 
production of comfort in the diseases in 
which there is no toxemia, and even in the 
infectious fevers an occasional dose is com- 
forting without being harmful. 
40 
Cold ablutions and baths have been ascer- 
tained to be less actively antithermic, but 
their effect being refreshing and antifebrile, 
they have become the favorite modern treat- 
ment for fevers. 
Bloodletting was used by Hippocrates for 
subduing pains in the side in pneumonia and 
allied affections. His practice was followed 
for 1800 years ere its harmfulness was real- 
ized. Morphine has proven equally efficacious 
and less harmful; hot poultices and later cold 
compresses soothe the pain in most cases. A 
milder and less damaging treatment of this 
symptom has thus been evolved, and yet the 
patient’s comfort is not neglected. The 
routine treatment of symptoms must, how- 
ever, be constantly striven against; the 
patient’s demand for relief must be met, but 
not when more harm may result from follow- 
ing our sympathy than good from our judg- 
ment, This is the lesson of history. 
4, The attempt to elevate medicine to the 
rank of a science is another error emphasized 
by history, which clearly demonstrates that 
the accumulation of data and the speculation 
upon theories do not make a science. Medi- 
cine cannot reach beyond the limit flatter- ingly assigned to it by Bacon, who called it “a 
conjectural branch of the natural sciences.” 
Despite the enormous mass of positive 
data accumulated during the latter half of 
the present century—i. e., during the most 
brilliant period of medicine—the latter still 
occupies the position of which Virchow wrote 
in his salutatory editorial of the Archiv fuer 
Anatomic und Physiologic: “Therapeutics 
must rise from its empirical standpoint; cul- 
tivated by practical physicians and clinicians 
and combined with pathological physiology, 
it must be elevated into a science, which up to 
this time it is not." This was written fifty 
years ago, and it is true to-day! The reason 
is evident. Therapeutic problems involve so 
many uncertain and indefinite premises that 
deductions from them must be equally inex- 
act and therefore unscientific. Nevertheless 
the search after positive data must continue, 
in order that a medical art may be con- 
structed upon a scientific basis. Such a 
therapy is now in process of evolution in 
the modern development of the hygienic, 
dietetic, climatic, and hydriatic management 
of patients, as illustrated by typhoid fever 
among the acute and phthisis among the 
chronic maladies. 
Having pointed out the therapeutic errors 
of the past and present, let me state as briefly 
as possible what I humbly conceive as the 
remedy. Therapeutics will not be perfected 
until we return to the simple teachings of 
Hippocrates, which have governed some of 
the best minds of our profession, even when 
their judgment was obscured by darkest 
ignorance of the processes of health and dis- 
ease, which misled their striving after truth. Standing in the brilliant light of latter-day 
physiology and pathology, aided by epoch- 
making discoveries in bacteriology and chem- 
istry, and provided with instruments of pre- 
cision, we are in a position to avoid the 
errors of the great Nestor, while striving to 
attain that deep insight into the processes of 
Nature which he taught to be the surest 
guide to the true art of healing. 
42 
A normal relation between the income and 
output of the human organism, an exact per- 
formance of work by each organ for the 
production of heat and labor in the main- 
tenance of life—these represent a condition 
of health. They are governed by laws as 
inexorable as any law of Nature. The en- 
trance of an etiological factor which disturbs 
these normal conditions does not suspend 
these laws, but directs their operation to the 
effort of readjusting the disturbed relations, 
by diminishing the work of one or more 
organs and increasing that of others—all 
with the single purpose of protecting the suf- 
fering organism against damage and death. 
Ripened experience leads me to reiterate 
to-day what I said over a quarter of a century 
ago.* “As the healthy organism stands under 
the maternal protection of the laws of Nature, 
so does the disease. How else can we ex- 
plain those remarkable processes, whereby 
health results from the chaotic and turbu- 
lent forces that violently assail the human 
economy ? 
“To these laws do we trace that vis medi- 
catrix whose guidance we should ever seek, 
* Presidential address before the South Carolina Med- 
ical Association, 1873. 43 
which arouses the whole organism to rebellion, 
when it is invaded by noxious agencies that 
endanger its integrity. Disease is not the 
negative of health, for the same forces which 
are silently evolved in the normal and peaceful 
action of life are aroused from their quietude 
by unfriendly influences. Order and law reign 
even where the human eye discerns only 
labyrinthine confusion and disorderly tur- 
moil.” Having held this view for the greater 
period of my professional career, I have de- 
rived more satisfaction and consolation from 
it than from all the books in my library. 
When difficulties assailed me and doubts 
threatened to obscure my judgment, I para- 
phrased Cromwell’s warning, “Trust to God 
and keep your powder dry,” into “Trust to 
Nature and be prepared to act.” 
The turbulent manifestations of disease 
are often but evidences of the antagonism 
between the action of the etiological factor 
and the activity of the curative factors in the 
organism. If the former prevail the patient 
succumbs or the disease becomes chronic; if 
the latter predominate the patient succumbs. 
Rest, exercise, heat, cold, food, drink, light, 
air, baths, avoidance of unfavorable condi- 
tions— these are the means which uncon- 
sciously and automatically operate for the 
maintenance of healthy conditions. Their 
adaptation and utilization by the physician 
may restore the disturbed equilibrium in dis- 
ease. Their regulation requires more judg- 
ment and skill than the prescription of 
medicines, because they are more flexible, 
less easily applied, and less rapid in effect. 
They are unfortunately not so well taught and understood as is the materia medica. 
Do not understand me as despising the lat- 
ter, Among the vast array of useless articles 
it contains some remedies—alas, but too few 
—that may be of great value, if judiciously 
applied, and without which I should feel my- 
self shorn of considerable influence. It should 
be the chief aim, then, of the modern physi- 
cian to treat the patient and not the disease, 
by girding the former with strength to with- 
stand the latter, whether it be by physiological 
agents, as baths, by bacteriological products, 
as antitoxin, or medicinal articles, as quinine, 
always with an eye single to the safety of 
the patient. 
44 
The multiplication of remedies for each 
disease has done much to retard the advance 
of therapeutics. Simplicity is the first pre- 
requisite to precision and success. 
Let me cite briefly a practical illustration 
•of the beneficent evolution of modern ther- 
apy, which I have drawn from that familiar 
disease, enterocolitis, the so-called summer 
diarrhea of infants. Time was when this 
very common disease was treated as an 
inflammation of the bowels, with leeches, 
poultices, mercurials, and other antiphlogistic 
and spoliative measures. Later a more con- 
servative course was adopted laxatives, 
chalk mixture, opiates, and astringents being 
the chief remedies. 
Fellow alumni, you have doubtless, like 
myself, experienced much anxiety and sor- 
row in these cases, and you have, as I often 
have, dreaded to encounter them. How help- 
less were we to save these little sufferers— 
how impotent even to prolong their lives! 45 
They died from marasmus or from so-called 
spurious hydrocephalus. I say candidly there 
is no disease in which I felt the inadequacy 
of my art so keenly as in these trying cases, 
until Soxhlet, Escherich, and others demon- 
strated them to be chiefly traceable to the 
ingestion and multiplication of microorgan- 
isms present in the food, which produced 
pathological changes analogous to those re- 
sulting from septic microorganisms. Like 
the latter they produce heat, redness, and 
swelling, with all their concomitants and 
sequelae, only modified by the location and 
functions of the parts involved. This clearly 
ascertained,pathological fact has led not only 
to the prevention of the disease by proper 
sterilization of the food of infants, but it also 
afforded a key to its management. Thorough 
cleansing of the affected tract, best accom- 
plished by lavage and enteroclysis, and in 
cases accompanied by much fever cool ablu- 
tions and baths to refresh the depreciated 
nervous system, have revolutionized the re- 
sults in these cases. Whoever has, like my- 
self, witnessed how these withered little crea- 
tures, with their stony gaze, parched lips, 
wizened faces, and panting chests, gradually 
sank into coma and death, while their vitality 
was being sapped by choleraic stools which 
neither astringent nor opiate could safely 
control, and who now sees these same sad 
cases quickly bloom into health and joyous 
child life under the modern management, 
must feel as grateful for living in this 
happy era as is the surgeon who has passed 
from the septic into the aseptic era of his 
calling. 46 
A successful therapy has been evolved 
from scientific basic data. The dawn of a 
happier therapeutic era is upon us. Under 
earnest investigation of the laws of organic 
life, under incessant search for and recog- 
nition of errors, the evolution of therapy will 
go on to the end of time. FEBRUARY 15, 1898; 
WROLE SERIES, VOL. XXIT. No. 2. THIRD SERIES, VOL. XIV, 
Therapeutic Gazette 
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