Compliments of the Author 
Therapeutic Reflections 
A PLEA FOR 
Physiological Remedies 
BY 
SIMON BARUCH,1 M.D. 
Attending Physician to the Manhattan General Hospital and New York Juvenile Asylum 
READ AT STATED MEETING OF THE NEWYORK ACADEMY OF 
MEDICINE, OCTOBER 15th, 1893 
Reprinted from The Journal of Balneology, December, 1893 
New York 
Press of STETTINER, LAMBERT & CO. 
22, 24 &26 Reade Street 
1893 THERAPEUTIC REFLECTIONS 
A PLEA FOR PHYSIOLOGICAL REMEDIES 
Dr, Simon Baruch read a paper 
entitled 
period that they seemed impregnable 
against all attacks. I need but call 
from the shadows of the past the 
spectre of venesection. Though 
hoary with age, and lauded by men 
whose works are to-day revered, this 
therapeutic flower withered under 
the light of modern physiology and 
pathology. 
He said; The prudent merchant 
resorts from time to time to an in- 
ventory of his obligations and assets, 
in order that he may diminish the 
former and increase or enhance the 
value of the latter. It would surely 
inure to the satisfaction of the physi- 
cian and to the advantage of his suf- 
fering clients if he would follow this 
example. This I propose to do, ask- 
ing your indulgence if I bring before 
you trite observations and experi- 
ences which are not novel to you. 
Indeed, if my remarks call forth a 
responsive echo in your minds, this 
will demonstrate that I have truly 
given voice, as is my intent, to actual 
observations at the bedside. From 
such I propose to draw lessons and 
to elicit discussion, which may en- 
able some of us to leave this hall 
better armed for the battle with dis- 
ease and death which we are daily 
waging. 
THERAPEUTIC REFLECTIONS. 
Another remedy, once the sheet- 
anchor in many serious diseases, has 
been dethroned and has taken fhe 
subordinate though most useful posi- 
tion of a simple anodyne. 
Time was when in certain forms 
of peritonitis opium was the chief 
remedy, because it “ acted as a splint 
to the inflamed surfaces ” ; to-day 
Lawson Tait’s teaching, that it is 
dangerous and that the opposite 
treatment by saline purgatives is 
more useful, is more successfully fol- 
lowed. Let him who grows fulsome 
in his laudations of a remedy bear 
in mind how these mighty giants 
have fallen, and endeavor to rescue 
the remedy he espouses from a simi- 
lar fate by judicious tests and un- 
prejudiced comparisons. What is the 
status of therapeutics to-day ? What 
are the assets with which the phy- 
sician may meet his daily obligations 
to cure the sick ? 
ENTHUSIASM IN THERAPEUTICS 
is indeed unwarranted, for the his- 
tory of medicine abounds in the rise 
and fall of the most brilliant struc- 
tures, in the explosion of the most 
plausible theories, and, what is more 
painful than all else, the overthrow 
of remedies which have seemed to be 
so firmly entrenched in the minds of 
the foremost physicians for so long a 
UNRELIABILITY OF MOST MEDICINAL 
AGENTS. 
Let us confess that the materia 
medica consists chiefly of medicinal 
agents whose action on the human 2 
body, with the exception of very few, 
is uncertain, and whose effect upon 
disease is either neutral or unreliable. 
How often can we conscientiously 
say that we have accomplished, by 
means of any medicinal agent or 
combination of such agents, the cure 
or removal of any disease ? With the 
exception of quinine, and perhaps of 
mercury and the iodides, there is not 
a single medicinal agent which may 
be regarded as actually curative. 
tions whose effect, like that of salol, 
as an intestinal antiseptic, has never 
been definitely proven. The vast 
majority of remedies in our Pharma- 
copoeia have no better foundation 
than salol, and yet they are constant- 
ly used upon the strength of so-called 
clinical observation. 
SYMPTOMATIC TREATMENT. 
The rock upon which therapeutics 
has always split, and which continues 
to menace us because we seem not to 
profit by the teachings of history, is 
the treatment of symptoms. In my 
student days, when venesection was 
in its last gasp, veratrum viride had 
in the South gained many adherents. 
A rapid pulse was the chief manifes- 
tation of all fevers ; here was a rem- 
edy which in small doses perfectly 
controlled the pulse. A reduction to 
one-half of its rate could readily be 
produced. I shall never forget one 
of the first cases of pneumonia which 
I treated as house physician of a 
hospital. Veratrum was given until 
the pulse was reduced from 140 to 80, 
and yet the consolidation continued 
to the bitter end, and the patient suc- 
cumbed with a normal pulse. 
NEGLECT OF HYGIENIC REMEDIES, 
And yet we constantly meet intelli- 
gent physicians who insist upon the 
contrary, and in so doing neglect 
remedies that are more valuable be- 
cause their action is clearly explicable 
upon rational principles. Faith in 
drugs is almost as frequent among 
physicians as faith in being drugged 
among patients. As an illustration I 
would refer to a case of acute entero- 
colitis in a child which I saw recently 
in consultation with a gentleman who 
is justly esteemed by colleagues and 
patients. The usual symptoms, fever, 
a large number of evacuations, loss 
of sleep and appetite, etc., were pre- 
sent. Upon the antiseptic theory 
salol had been frequently adminis- 
tered ; to meet other symptoms, bis- 
muth, Dover’s powders, and other 
remedies. The simple substitution 
of intestinal irrigation for the sa- 
lol, together with abolition of milk 
diet, produced a complete change in 
this case. It may be held that the 
latter course is that recognized as 
proper at the present time. But I 
cite this case to show that it is not so 
universally recognized as it should 
be, and to illustrate the difference be- 
tween medicinal and non-medicinal 
remedies for the purpose of empha- 
sizing the chief point of this paper— 
viz., the too frequent neglect of those 
non-medicinal agents whose action 
in disease is so simple, rational, and 
clinically effective, and the unhappy 
reliance on pharmaceutical prepara- 
History repeats itself in the appli- 
cation of the coal-tar antipyretics re- 
cently so much in vogue. The tem- 
perature may be readily reduced 
from 105° to ioo°, and, as in the case 
of veratrum, we may even have the 
questionable satisfaction of seeing 
the patient die with a normal tem- 
perature. This striving after symp- 
tomatic remedies is the unhappy 
legacy which our forefathers have 
bequeathed to us. It is an echo of 
the mysticism which veiled their idea 
of disease, and which led them to re- 
gard the latter as an essence rather 
than as a manifestion of certain dis- 
turbances in the economy which ren- 
dered the latter incapable of regulat- 
ing its functions. Therapeutics would 
be a simple art in this day of pdtent 
medicinal agents, could its aims be 3 
merely filled by meeting certain 
symptoms or certain definite altera- 
tions in the functions of the body. 
experience can gainsay this proposi- 
tion. It must be patent to the most 
enthusiastic polypharmacist that he 
accomplishes only an amelioration or 
removal of certain manifestations of 
disease—a result which may and 
probably does facilitate a restoration 
to health, but is rarely if ever the 
direct means of such restoration. 
EARLY DIAGNOSIS IMPORTANT. 
As pathologists it is our function 
to discover changes in the organs ; 
but as physicians who stand at the 
bedside of those who implore us to 
heal them, we can accomplish but 
little if we are called to act after 
these changes in the tissues have 
taken place. As has been well said 
by another, the physician who is 
called to combat a case of well-estab- 
lished organic disease with remedies 
may be likened to the sanitarian who 
is called upon to prevent an infectious 
disease by disinfecting the emana- 
tions of the patient. The physician 
who would cure, must assume the 
task early ; in the beginning of that 
anomalous relation between capacity 
of the system for work and the de- 
mand upon it for work which is really 
the inception of all tissue changes 
and which may be prevented by lim- 
iting the labor imposed upon the 
organs. To discover this anomalous 
relation in its incipiency, and to 
guard against its development into 
organic disease, is the function of the 
true physician. The latter must soon 
discover that in this contest medici- 
nal agents play an unimportant role 
when compared with those methods 
which we learn by observation of 
Nature’s course in health. As an 
illustration may be mentioned dila- 
tation of the stomach, an organic 
alteration which is most commonly 
the result of long-continued insuffi- 
ciency of its functions. The early 
recognition of the causes, the adapta- 
tion of diet, mode of life, manner of 
eating, gastric lavage, etc., to each 
individual case, will conduce far 
more to the prevention and cure of 
the organic disturbance than all the 
medicinal agents, from ancient gen- 
tian to modern strychnine, from mu- 
riatic acid to pepsin. No physician of 
MASKING THE DISEASE. 
In the large preponderance of acute 
diseases, among which may be num- 
bered all infectious diseases, the 
administration of these medicinal 
agents is not only entirely sympto- 
matic, but in many instances abso- 
lutely harmful. Take as an example 
a case of appendicitis. The tendency 
to treat such a case as localized peri- 
tonitis, and to meet the symptoms, 
tempts the average practitioner to 
prescribe morphia to subdue pain, 
ice or poultices to the right iliac re- 
gion, food to satisfy the bugaboo of 
coming failure of the vital powers, 
and an antipyretic to reduce the tem- 
perature. This is not a fancy picture, 
but a chapter from personal experi- 
ence. Coming into contact with such 
a case as a consultant, how can the 
latter take his bearings ? Like a 
mariner in a fog, he is handicapped, 
pain is absent, temperature perhaps 
normal, all is serene, except the anx- 
ious countenance, perhaps vomiting, 
and the attendant’s fear that some- 
thing may be brewing. 
Here the remedies employed have 
hidden the enemy’s movements ; the 
physician has become the ally of the 
disease ; diagnosis and prognosis be- 
come difficult, and valuable time may 
be lost. lam sure many of my hear- 
ers have passed through this experi- 
ence. 
NIL NOCERE. 
Am I presuming too much then if 
I counsel that in the early stages of 
disease the warning of Italy’s la- 
mented clinician, Cantani, be con- 4 
stantly before our eyes, “Nilnocere”? 
To make a clear diagnosis is import- 
ant for a favorable issue. It is better 
for the patient to suffer some discom- 
fort than to have his life jeopardized 
by remedies which obscure the real 
issues of the case. Later in the case, 
too, it should be our constant en- 
deavor to avoid damaging the system 
which is staggering under disease 
and cries out for every possible aid 
on the part of the physician. In this 
day of powerful symptomatic reme- 
dies, veratrum for the pulse, antipy- 
retics for the temperature, pilocarpin 
for the secretions, morphia for the 
pain, chloral for sleeplessness, all 
agents which strike mighty blows at 
the manifestations of disease often 
lead to disaster by lulling the physi- 
cian into a false sense of security. 
And yet how eagerly they are re- 
sorted to, daily observation teaches 
but too sadly. It may be urged in 
defence of such a course that the pa- 
tient and his friends are importunate 
to have the pain, the fever, etc., com- 
bated. Medicine is a business, said 
a gentleman in a recent discussion on 
antipyretics, and we must yield to 
the demands of our patient to be re- 
lieved of his fever. It has doubtless 
been your experience, as it has been 
mine, that much can be accomplished 
by placebos, by mild remedies, by 
gentle reassurance, and by taking the 
friends into our confidence. 
Ten years ago the belief had be- 
come all but unanimous that the 
only direction in which therapeutic 
effort was most conducive to the pa- 
tient’s benefit, lay in following the 
tendency of Nature in each disease. 
Vis niedicatrix natures is an old rally- 
ing cry of the profession, but one 
which did not gather many steadfast 
defenders. At one time a complete 
therapeutic nihilism, emanating from 
the Vienna school, threatened to be- 
come its expression. But when the 
chemist evolved those potent thera- 
peutic sledge-hammers which could 
beat down symptoms, the gentle 
handmaiden Nature was thrust aside, 
and the patient was beaten down 
with the symptoms. To-day a reac- 
tion is happily setting in. . Once 
more are heard warning voices that 
bid us follow Nature’s prompting. 
To join these and to re-echo them in 
these halls, is the purport of my 
paper to-night. 
VIS MEDICATRIX. 
REST A PHYSIOLOGICAL REMEDY. 
For instance, rest is the first 
prompting of Nature in diseased con- 
ditions. What can be more simple 
and obvious than rest in inflamma- 
tory conditions ? The surgeon puts 
an inflamed joint into a splint and 
trusts to Nature—i.e., the restorative 
powers of the system—to heal the 
disease. May not an acutely in- 
flamed kidney be treated in a similar 
way ? Its functions must go on. In 
this respect it differs from the in- 
flamed joint. But the intelligent 
physician, knowing that the chief 
function of the kidney is to eliminate 
urea, so arranges the patient’s diet 
that this work is reduced to a mini- 
mum ; knowing that other functions 
of the kidney may be vicariously 
taken up by the skin and bowels, he 
endeavors to utilize these vicarious 
eliminants for the purpose of reliev- 
ing the inflamed organ from labor. 
And yet we find the contrary so often 
When there is severe pain, as in 
some cases of appendicitis, I prefer 
to keep the patient gently under the 
influence of chloroform until a deci- 
sion for or against operative measures 
can be reached. In a case of perforat- 
ing appendicitis at Long Branch, two 
years ago, morphia administered by 
an able colleague was discontinued, 
chloroform substituted for twelve 
hours with intervals, until Dr. Wyeth 
arrived. The patient was not aware 
of his arrival, nor of the laparotomy 
performed on her, until an hour after- 
ward. She made a good recovery. 5 
that I may be pardoned for empha- 
sizing here the necessity, nay, the 
duty, of doing in internal diseases 
what is so obvious and so successfully 
done in external diseases. Only re- 
cently I saw a case of acute nephritis 
with a well-informed physician of 
ten years’ graduation from a most 
exacting school, a hospital physician 
too, who treated the case with digi- 
talis and acetate of potassium as 
diuretics, because the secretion was 
reduced to nineteen and a half 
ounces, paying no attention to the 
physiological aids which Nature 
points out. 
acid in acute articular rheumatism 
would seem supererogation in this 
assemblage. But bear with me if I 
apply it as an illustration of my 
views on positive medication, for 
which I plead. I have seen capable 
men in hospitals and private prac- 
tice order five grains of salicylate of 
soda every two hours in rheumatism. 
Is it surprising that these gentlemen, 
are unwilling to testify to the value 
of this remedy ? Twenty grains 
every two hours of pure salicylic 
acid, until tinnitus aurium is pro- 
duced and affords evidence of its 
having been absorbed, is the method 
I adopt. I can therefore not be 
charged with antagonism to reliable 
medicinal agents. I would only in- 
veigh against the thousand and one 
impotent drugs with which the 
sick are deluged ; drugs without as- 
certainable effects upon the economy, 
though many frogs and dogs may 
have died and lived under their ex- 
perimental use, have no charms for 
me. 
In acute conditions rest must be 
provided ; in chronic conditions rest, 
judiciously alternated with gentle 
exercise of the functions of the dis- 
eased organs, is indicated, and will 
prove far more useful than medica- 
tion. Let me not be understood, 
however, as despising the latter. 
There are few to whom I should be 
willing to yield in dependence upon 
our well-tried medicinal agents. But 
I spurn them if their action is based 
on empirical observation alone, the 
ipse dixit of one or more men. 
SUPERIORITY OF PHYSIOLOGICAL 
REMEDIES. 
If careful observation among vari- 
ous classes of patients in country and 
city, private and hospital practice, in 
peace and war, may crystallize one’s 
experience into some definite shape, 
permit me to say here to-night that 
far more actual curative results may 
be obtained from watching and cau- 
tiously following the tendencies of a 
disease and applying those agents 
which are potent in maintaining the 
system in health—viz., rest, exercise, 
diet, baths, change of environment— 
than from the most intelligent appli- 
cation of medicinal agents, highly 
though I esteem some of these. To 
demonstrate this proposition in a 
representative acute disease, let us 
choose 
Those medicines alone which 
evince their presence in the system 
by certain definite signs have my 
confidence. When quinine is admin- 
istered in sufficient doses to cinchon- 
ize the patient, I know, without fear 
of contradiction, that whatsoever 
effect is produced on the paroxysm 
may be attributed to it; when it is 
used in small doses three times a 
day, for so-called malaria, I spurn 
the remedy as Ido the disease. True 
malaria will as surely yield to cin- 
chonization before the paroxysm as 
spurious malaria (the so-called civic 
or international malaria) will fail to 
yield to it. This much I may say 
positively, from a long experience on 
the banks of Southern rivers. 
MEDICATION MUST BE POSITIVE. 
TYPHOID FEVER. 
Here we have a malady which runs 
a more or less definite course, whose 
To refer to the value of salicylic 6 
etiological factors are beyond our 
control. We are called upon here to 
contend against a foe of great power. 
The system is overwhelmed by the 
toxines due to the biochemic activity 
resulting from the life and death of 
the micro-organisms to which the 
disease is traceable. Be that as it 
may, we do know clinically that we 
stand in the presence of an intense 
toxasmia which exercises a depress- 
ing, a devitalizing influence upon 
the nervous system. Every function 
which draws its force from the latter 
suffers visibly. The brain itself is 
more or less overwhelmed. The 
patient lies in a semi-stupor, his face 
is expressionless, the eyes dull and 
glassy, lids are closed (typhoid coun- 
tenance). His perceptions are blunt- 
ed, he mutters incoherently, he has 
no control over his sphincters. In 
brief, there exists great cerebral de- 
pression. The pulse is rapid, feeble, 
dicrotic—all manifestations of cardiac 
enfeeblement. The blood is dete- 
riorated, its leucocytes decreased. 
The respiration is shallow and inef- 
fective ; hypostatic conditions, bron- 
chial congestions, and pneumonia 
result. The temperature is elevated, 
either because of the loss of regula- 
tory influence of the heat centres, or 
by diminution of heat radiation from 
the skin, or both. The secretions are 
impaired ; the urine, for example, is 
concentrated, highly acid, and loaded 
with products of active tissue change. 
These, together with the shallow res- 
piration, are evidences of the crip- 
pled condition of the emunctories, 
whose integrity is vitally important 
for the maintenance of health. In 
brief, the patient’s vitality is sapped 
because the organs upon which it de- 
pends receive imperfect sustenance 
from the nervous system. Modern 
physicians are agreed that every ef- 
fort should be made to maintain the 
patient’s vitality, to counteract the 
palpable toxaemia, be it due to micro- 
organisms or not; in short, to sustain 
life until tlie disease has run its course. 
The expectant treatment, so-called, 
was the outcome of the fatality 
of the former spoliative treatment. 
Liebermeister’s great success in the 
Basle Hospital made high tempera- 
ture the chief point of attack. So 
long as we had no real medicinal 
antipyretic it was not clear whether 
to the (medicinal) quinine or to the 
(physiological) baths administered 
by him were due the superior results 
which he attained. The high-tem- 
perature idea was plausible, and 
gained many adherents rapidly, until 
the discovery of the coal-tar series 
brought to the physician the first 
real antithermic remedies. A few 
years’ use of these positive remedies 
has awakened the profession to the 
fallacy of regarding high tempera- 
ture as the chief lethal agent. To- 
day a reaction is impending. While 
in the medical centres the coal-tar 
antipyretics are being reluctantly 
abandoned, it will be long ere the 
less enlightened rural practitioner 
will let this comforting drug slip 
from his fond grasp. The same fate 
has befallen other medicinal agents, 
which, however, were not so readily 
abandoned, because their specific 
effects are not so patent ; for exam- 
ple, veratrum, to which reference 
has been already made. 
INTERNAL ANTISEPSIS. 
To-day internal antisepsis has be- 
come a fad. Though claiming to be 
based upon the attractive germ 
theory, which threatens to upset all 
past pathology, the advocates of this 
method have thus far failed to de- 
monstrate its tenability by actual 
experiment. Until such demonstra- 
tion shall be made, it is difficult to 
accept the idea that the mild anti- 
septics (naphthalin, naphthol, sulpho- 
carbolate of zinc, etc.), which are 
applied in typhoid fever, are capable 
of disinfecting a long intestinal ca- 
nal containing more or less fluid 7 
which dilutes or otherwise neutral- 
observers. The physician, therefore,. 
izesthem. Moreover, long before the 
disease has been diagnosed, during 
its incubation, these pathogenic 
germs have been circulating in the 
blood. Having already passed into 
the lymphatic glands and spleen, it 
borders on the absurd to assume 
that these antiseptics are capable of 
searching out and destroying them. 
When the patient comes under ob- 
servation he is really suffering more 
(if deductions from recent investiga- 
tions may be accepted) from the tox- 
ines generated by these pathogenic 
bacilli than from the presence of the 
latter. Disinfecting the intestinal 
canal may prevent some auto-intox- 
ication, but it surely cannot reach 
the pathogenic germ nor its toxines. 
That there are fewer bacteria in 
the faeces after some of these anti- 
septics are administered, even if it 
had ever been positively demonstrat- 
ed, does not by any means justify the 
deduction that the intestinal mucous 
membrane has been rendered aseptic, 
much less that pathogenic germs 
have been destroyed. The surgeon 
would not be content with such a 
demonstration. Why should the phy- 
sician be ? Hence this pseudo-scienti- 
fic claimant to our faith in numerous 
drugs is feeble indeed, and must go 
the way of its predecessors. 
is forced to acknowledge his entire 
dependence on the vis medicatrix,. 
which he attempts to aid by with- 
holding all injurious elements and 
utilizing physiological remedies. 
Rest, seclusion, proper adaptation of 
food and drink, and cleanliness are the 
chief agents in the so-called expect- 
ant plan of treatment, whose supe- 
riority over the former spoliative and 
the present antipyretic treatment 
clinical observation has demonstrat- 
ed. 
HYDROTHERAPY MUST BE JUDICIOUS. 
There is, however, one physiologi- 
cal remedy which, judiciously adapt- 
ed to the case as are diet, rest, etc.,, 
has produced a vast improvement in 
the condition of the patient and in 
the final issue of the case. The bath 
treatment of typhoid fever no longer 
requires defence before an enlight- 
ened medical audience. It has de- 
monstrated its value in so many clin- 
ical tests on large numbers that I need 
refer here only to its salient advan- 
tages. Being a physiological agent— 
i.e., an agent which, if used in health, 
promotes the latter—its judicious ap- 
plication is as potent as that of air, 
food, and rest. Its injudicious appli- 
cation is as injurious as that of the 
latter agents. For example, the wrap- 
ping of a typhoid patient in a cold 
wet sheet, and sprinkling it with ice 
water until the temperature is re- 
duced—a method actually used by 
eminent practitioners—is as injurious 
to the patient as the exposure to 
draughts of cold air or the adminis- 
tration of a mixed diet would be. 
In the one case it would still be bath- 
ing, in the other it would still be 
ventilating and feeding. In all it 
would be an injudicious, senseless 
application of useful remedial agents. 
MEDICATION SUPPRESSES SYMPTOMS. 
It follows, from these brief consid- 
erations, into which the lack of time 
does not permit me to enter more 
fully, that the only active medicinal 
agents, those agents whose effect has 
been positively demonstrated, have 
simply afforded the physician means 
for suppressing certain pronounced 
symptoms. Pulse and temperature 
are still important indices to the con- 
dition of the patient. Nevertheless, 
despite the fact that we have positive 
medicinal agents to bring them to 
an almost normal standard, they are 
proven absolutely harmful by good 
HYDROTHERAPY NOT APPRECIATED. 
The judicious application of venti- 
lation and diet are pretty well under- 8 
stood by the profession ; the judicious 
application of water is unfortunately 
still a terra incognita to the large 
majority. It is true, nearly all util- 
ize water in some form. Cold spong- 
ing is quite commonly adopted in 
fever, and yet the feeble refreshment 
obtained from it may be compared 
to the ventilation obtained by the 
opening of a window one inch ! In- 
judicious application may assume 
both extremes of directions, doing 
too much or too little. 
that it appeals to our best judgment 
at once. We have an overwhelming 
of the nerve centres by the products 
of infection. The shock and subse- 
quent stimulus to the cutaneous sur- 
faces are conveyed to the nerve 
centres, and thence reflected to the 
heart, lungs, and other organs. Ob- 
servation at the bedside at once ren- 
ders these effects patent. The first 
effect is a refreshment, an enliven- 
ment of the cerebrum. The eyes are 
opened ; the face loses its apathetic 
stare; consciousness returns after 
one or more baths ; the inspiration is 
deepened ; expectoration is facilitat- 
ed ; the widening of the peripheral 
vessels and the stimulation of their 
coats relieve the heart; blood pres- 
sure is increased ; and the laboring 
organ becomes as quiet as does a sea- 
tossed ship in the hands of a skilled 
mariner. The secreting glands are 
aroused to activity. Moreover, the 
temperature is reduced, not so vio- 
lently as by medicinal agents, but 
more definitely, more in accord with 
normal tendencies. In brief, all the 
manifestations of the disease are fa- 
vorably influenced because the nor- 
mal standard is slowly but steadily 
and lastingly approximated under 
the influence of repeated judicious 
bathing. Even the exacting de- 
mands of the most recent ideas are 
met by this treatment. Metchni- 
koff has shown, by his interesting 
studies, that inflammation is the pha- 
gocytic reaction of the organism to 
an irritant. Cells are phagocytes, 
hungry to devour any toxine or mi- 
crobe that may find entrance into 
the blood. We may successfully aid 
the system in this “reaction against 
toxines ” by endowing its main vital- 
izing agent, the nerve centres, with 
vigor, by furthering elimination from 
the skin and kidneys, by removing 
hypersemia of the organs, and facili- 
tating the passage of phagocytes into 
the tissues ; but more especially by 
rendering the blood more alkaline. 
The Brand bath has proved the 
most successful method of treating 
typhoid fever, The more nearly we 
approximate it the more surely may 
we depend upon obtaining its grand 
therapeutic results. This has been 
acknowledged by Jlirgensen and oth- 
ers, and it is the personal experience 
of many, myself included. 
BRAND BATH NOT APPRECIATED. 
In a letter received a few days ago 
from the venerable author of the 
Brand method, he writes: “ Who 
reads what we write ? Who acts upon 
it ? No one. My typhoid treatment 
has proved this sufficiently; now, after 
thirty years’ labor, debate, discus- 
sion, and polemics, only a few know, 
the multitude knows not, what the 
aim of the Brand method is; they 
still confound it with the symptoma- 
tic method.” These words from the 
man who has revolutionized typhoid 
treatment are indeed a sad commen- 
tary. They truthfully depict the 
present state of knowledge of this 
subject. In this city there are only 
three hospitals in which the Brand 
method is correctly applied ; in oth- 
ers it is modified to suit personal 
predilections, irrespective of the fact 
that its results cannot be any more 
fairly judged by such modification 
than the rules of antisepsis in sur- 
gery can be judged if some essential 
of cleanliness be omitted. 
RATIONALE OF BRAND BATH. 
The rationale of the bath is so simple 9 
and thus more favorable to the pha- 
great Neapolitan clinician, Semmola, 
gocytes. 
All these are accomplished, accord- 
ing to well-established experiments, 
by the cold-bath treatment. It has 
been recently shown by Thayer, in 
the Johns Hopkins laboratory, that 
the leucocytes are more than doubled 
after a Brand bath. On the other 
hand, the destructive effect of medi- 
cinal antipyretics on the leucocytes, 
their inhibition of excretion of pro- 
ducts of tissue change, and their ef- 
fect on the heart have been again 
and again demonstrated. 
who says : “ The methodical internal 
and external application of water, 
modified in temperature as required, 
together with climate, an appropriate 
diet, muscular exercise, etc., are aids 
by which hydrotherapy excites cuta- 
neous activity and, with it, all func- 
tions of tissue changes and organic 
purification, so that by these means 
often real marvels of restoration in 
severe and desperate cases may be 
accomplished.” The reports of the 
Montefiore Home for Incurables, and 
my papers read before the State and 
County Medical Societies, contain clin- 
ical proofs of the correctness of this 
apparently enthusiastic view. Cases 
of intractable ansemia, dyspepsia, 
angina pectoris, Bright’s disease, dia- 
betes, phthisis, and epilepsy are re- 
corded, which have been under ob- 
servation by Drs. T. Gaillard Thomas, 
Janeway, A. H. Smith, Jacobi, and 
others, the results of which justify 
Prof. Semmola’s claim. 
A COMPARISON. 
Here we have an obvious illustra- 
tion of the action of medicinal reme- 
dies and physiological remedies in 
a very common acute disease. The 
same observation may be made in all 
acute diseases. While in those of 
short duration and characterized by 
absence of serious depreciating ten- 
dencies medicinal agents are more 
useful, chiefly because more agree- 
able and practicable than baths, the 
latter are far superior in all those 
acute maladies which endanger life. 
Baths, though unpleasant to the pa- 
tient and friends, absolutely give sus- 
tenance to the crippled organs which 
are struggling to maintain life, while 
medicinal agents, though agreeable 
to patient and friends, serve only to 
enfeeble the heart, cripple the kid- 
neys, and thus aid the disease rather 
than the patient. 
It is not my purpose, however, so 
much to dwell upon these results as 
to afford illustration of the superior- 
ity of these hygienic or physiological 
measures over the medicinal agents. 
Let us take as an example, for this 
purpose, chlorosis. I have chosen 
this chronic affection because it is as 
well, or perhaps as poorly, understood 
as any other, but more especially 
because in its treatment one medici- 
nal agent, iron, has long been regard- 
ed as almost a specific. Chronic dis- 
eases do not, like the acute forms, 
tend to spontaneous recovery ; chiefly 
because patients affected by them 
are not, as they are in acute diseases, 
forced to be removed from their 
etiological agencies, and they are 
not, as in acute disease, usually sub- 
jected to physiological remedies. A 
patient suffering from typhoid fever 
or scarlatina is withdrawn from the 
source of his infection ; he is placed 
at rest and secluded ; good air, proper 
diet, etc., are usually afforded him as 
CHRONIC DISEASES. 
In chronic diseases the difference 
in effect of medicinal and physiologi- 
cal remedies is no less striking. If 
such diseases are attacked ere serious 
organic degeneration has ensued, the 
most threatening and subsequently 
incurable diseases become amenable 
to treatment. Even when these are 
advanced, good results may be ex- 
pected. I can affirm, from personal 
observation, the statement of the a matter of course. A young woman 
suffering from anaemia usually re- 
mains within the sphere of the etiolo- 
gical factors of her disease, while the 
doctor attempts, by iron, food, etc., 
to reconstruct the blood, which is 
unhappily regarded as the chief point 
of attack. 
furnish. How much more rational 
is the removal of the patient into 
pure air, where the hunger of the 
oxygen-carrying haemoglobin may 
be appeased ! How much more ra- 
tional than iron administration is the 
placing of an anaemic seamstress 
into a well-aired hospital ward, 
where good food, rest for her treadle- 
wearied limbs, baths, etc., could be 
methodically applied ! 
There can be no doubt in the mind 
of any practical observer that the 
same care that is given (perforce) in 
typhoid fever to the removal of the 
patient from his unfavorable environ- 
ment would, if afforded the .chlorotic 
girl, conduce far more to her recov- 
ery than the faithful dosing with 
iron in any of its more or less vaunt- 
ed forms. Who has not seen a pallid 
school-girl, who had been for months 
dosed in vain with Blaud pills, regain 
her ruddy color, spirits, and appetite 
so soon as she was removed to the 
country, where she had access to 
unpolluted air, water, and food; 
where she was allowed untrammelled 
movement of muscle and lung and 
heart ? Hygienic remedies are as 
potent for good here as they are in 
typhoid fever. Many of the latter 
recover under the expectant or me- 
dicinal treatment, more recover 
under a rational application of phy- 
siological remedies ; many cases of 
chlorosis recover at home, even 
under unfavorable conditions and 
unphysiological treatment, more re- 
cover under the judicious use of exer- 
cise (rest, which is just as important), 
proper (not necessarily so-called 
strengthening) food, etc. Despite 
these patent facts, physicians con- 
tinue to ply these unhappy patients 
with drugs whose reputation rests 
upon a purely empirical basis. The 
abuse of iron in an£emia is a crying 
shame, when it is considered that the 
quantity in the entire human body 
amounts to about fifteen to forty-five 
grains, and that the greatest loss 
ever found in an anaemic patient was 
three to four grains, which one quar- 
ter pound of good beef would readily 
PRECISION NEEDED 
Allow me to urge a more meth- 
odical application of non-medicinal 
remedies. If there is any point upon 
which we are derelict as a class, it is 
the lack of precision in our prescrip- 
tion of remedial measures, especially 
those valuable non-medicinal agen- 
cies which, as Nothnagel and more 
recently Osier have shown, are com- 
ing to the front as chief remedies. 
While there is no lack of insistence 
upon the systematic administration 
of medicines, while the regulation 
teaspoonful doses three times daily, 
or powder every three hours, are 
swallowed with the utmost punctu- 
ality, the patient suffering from a 
chronic malady is allowed to drift 
along as best he may, taking his ex- 
ercise, his diet, his rest, his bath as 
pleases his sweet will or suits his 
personal convenience. 
In this connection I cannot refrain 
from again referring to the neglect of 
the chief hygienic remedy in chronic 
disease—water. Its value in acute 
diseases is so well recognized by 
some of the best teachers in this city 
and country that I may well leave its 
fate to the good seed annually sown 
by these earnest men. In chronic 
diseases, however, which are the 
bane of our lives and the opprobria 
of medicine, much missionary work 
is required to arouse a just apprecia- 
tion of the great value of water as 
an auxiliary to other physiological 
remedies. Abroad this is no longer 
the case. The most prominent teachers and consultants constantly 
dwell upon and prescribe it. In this 
country a few men like Draper and 
Peterson have written upon it. The 
clinical results obtained by it abroad 
and at home surely entitle it to a 
more careful investigation. While 
electricity, whose clinical results are 
far inferior, is taught in our schools, 
there is not a single chair from which 
the principles of hydrotherapy are 
explained or its technique demon- 
strated, If one tithe of the interest 
manifested in new drugs, which in 
most instances benefit only the man- 
ufacturer and leave physician and 
patient deluded and disappointed, 
were devoted to the study and prac- 
tice of hydrotherapy, our knowledge 
of this subject would be enriched and 
suffering humanity would rise up and 
call us blessed. 
from dogma and the schools, he is 
enslaved by the drug-prescribing 
habit. Drugs are to-day presented 
in alluring forms and rapid succes- 
sion ; they come to us, not with the 
sounding of trumpets, but with the 
insidious claims of a few clinical 
tests of Prof. So-and-So and Privat- 
Docent So-and-So. Often we are not 
even vouchsafed information as to 
their method of manufacture. If 
their composition is given it is in the 
new chemical nomenclature, which 
to most of us is absurdly incompre- 
hensible. For instance, agathin, a 
new remedy extolled for neuralgia, 
is said to be the “ salicyl-alpha-meth- 
yl-phenyl-hydrazone. It is obtained 
by the interaction of salicylic alde- 
hyde and alpha-methyl-phenyl-hy- 
drazone.” 
If I have referred more freely to 
the application of water in this con- 
nection, my reason lies in the fact 
that it is the most powerful agent 
among physiological remedies, both 
for evil and for good, and the least 
understood and appreciated by the 
profession. The extract from Dr. 
Brand’s letter given above, and the 
rare application of hydrotherapy in 
chronic diseases, testify to the truth 
of this proposition. 
ABOLITION OF DRUGS. 
I plead to-night, not for the aboli- 
tion of drugs, some of which I value 
as highly as any one, but for a more 
methodical application of remedies 
like rest, exercise, diet, water, and 
proper environments, remedies which 
boast of greater antiquity than any 
medicinal agent, remedies which 
have demonstrated their value in all 
epochs of medical history and which 
to-day challenge the most searching 
investigation. 
Though the modern physician 
claims to have emancipated himself