J) E.Nrx*$TQf/(£j>.E) AN OPEN LETTER TO THE MEMBERS OF THE MASSACHUSETTS ! MEDICAL SOCIETY , ON THE i TRUE NATURE OF DISEASE. I BY EDWARD E. DENNISTON, M.D., KHINSTEIN, NORTHAMPTON, MASS. • - ■ :'(':■ BOSTON: A. WILLIAMS AND COMPANY, ' 135 Washington Street. 1875. 1 3,3 , a~v av r\ a i AN OPEN LETTER TO THE MEMBERS OF THE MASSACHUSETTS MEDICAL SOCIETY TRUE NATURE OF DISEASE. BY EDWARD E. DENNISTON, M.D., ERINSTEIN, NORTHAMPTON, MASS. BOSTON: A. WILLIAMS AND COMPANY, 135 Washington Street. 1875. Entered according to Act of Congress, in the year 1875, by EDWARD E. DENNISTON, In the Office of the Librarian of Congress, at Washington. Cambridge : Press of John Wilson and Son. We are induced to recommend Dr. Denxiston's establishment for the treatment of chronic diseases of various kinds, from a knowl- edge of the principles on which he proposes to conduct it. We believe it to contain all the advantages of similar establishments, and have confidence in the skill and judgment, experience and prudence, of Dr. D. to direct the application of the various reme- dial treatment, according to the exigencies of the individual cases. J. C. Warren, M.D. John Ware, M.D. George Hayward, M.D. John M. Warren, M.D. Edward Reynolds, M.D. M. S. Ferry, M.D. Jacob Bigelow, M.D. Jonx Homaxs, M.D. Willard Parker, M.D., New York. Boston, Feb. 29, 1848. AN OPEN LETTER. To the Members of the Massachusetts Medical Society. Gentlemen, — The preceding testimonial was handed me by Dr. Jacob Bigelow, twenty-seven years ago, to enable me to hold my position as a member of your association, somewhat outside the regular practice, and with the understanding that I should, at a proper time, give expression to the results of my observation and experience. I have been forty years a member of your Society. Fourteen years of this time were given to the regu- lar practice of the profession. It was extensive, and attended with more than ordinary success and reputation. The wear and tear of the work, how- ever, both upon body and mind, made me feel the necessity for rest and change ; and I had arranged to spend three or four months in Germany, and give myself the opportunity to visit the establishment of Priessnitz, whose fame was at that time being spread far and wide. But the rest came in a different shape. A severe injury to the left side of the chest, produc- 6 ing laceration of some of the internal serous mem- branes, and causing intense local and constitutional suffering, confined me to my bed and room for nine months. The gentleman whom I had taken as a partner, to attend to my business in my absence, treated my case as one of acute inflammation of the parts. The lancet was used until it could no longer be borne; and subsequently every ache and pain was met with relays of leeches to the chest and cuppings to the back, followed by blistering. During these nine months of illness, I was mercurialized four different times. I was kept constantly under the influence of large doses of opium, and, with all this, a starvation diet. I became reduced to a skel- eton, with night sweats, and as feeble and irritable as a sick infant. At this time friends insisted that Dr. Bowditch, of Boston, should be sent for. He advised that all medical treatment should be left off, and that I should take nourishment. To his advice I owe it that I have now the privilege of addressing you. Convalescence was slow, dragging through several years; and the frequent returns of intense neuralgia of the heart entirely unfitted me for a return to my former practice. These are the circumstances under which I took the charge of my present establishment. I am thus minute in the detail of my own case, because it fixed a train of thought, which had pressed itself upon me ■7 for years, as to the advantage or disadvantage of a course of treatment based upon a theory of inflam- mation. Born into and devoted to the profession; trained from sixteen years of age in a large provincial hospital, to which were attached two or three dispen- saries ; educated in Dublin and Edinburgh, — I was thoroughly imbued with the practice of the time ; and when, subsequently, I became the surgeon of the hospital and dispensaries referred to, which position I held for several years previous to coming to this country, I carried out thoroughly and earnestly that practice. There has always been, and there is now, a fashion in the practice of the profession, influenced by the course of its leading men; and my observation bears me out in the idea that they are not governed by any distinctive principle of law in their method of treat- ing so-called disease. I do not assume to sit in judgment; but I believe I am doing no injustice when I say that each one follows the impression that is the result of his training, study, and observation. In other words, the method is one of empiricism,— rational with the few, imitative with the many. The craving desire of the public, individually and col- lectively, is to be relieved from pain and suffering; and the pressure of this desire upon the profession urges the search for and use of means which palliate the symptoms for the time being, but have little 8 reference to their source or object. This is not satisfactory, either to the thinking portion of the profession or to those of the public who are looking on with critical eyes. The profession is just now in a transition state. A large proportion of its members is searching in the traces of disordered function for material which shall guide their future practice ; oth- ers, again, in the chemical laboratory, are earnestly endeavoring to find out so-called remedial agents, which may prove efficient in the relief of suffering; and both parties are combining to christen their dis- coveries with high-sounding names from Greek and Latin roots, and are breaking up into specialties. As a body, the medical profession may claim, without fear of contradiction, a record of disinterested, self-sacri- ficing effort in behalf of suffering humanity, beyond and above that of any other profession. It happens to them, however, possessed as they are of a com- paratively exclusive knowledge, acquired through centuries of hard study, to hold their views tena- ciously, to be unwilling to yield these fixed opinions to new and advanced ideas, and to be disposed to persecute any who step aside from the beaten track. Let me be understood as referring in this latter par- ticular only to those among us who are routine prac- titioners. Shortly after entering upon my duties as hospital surgeon, I was called upon to see a servant of one 9 of the high dignitaries of the Church. She was employed as seamstress and upholstress in the house. While standing upon a stool draping curtains, and using her mouth as a convenient receptacle for the pins and needles with which she was working, a larking footman seized her unexpectedly from be- hind, causing an involuntary gasp, which carried the contents of her mouth into the stomach. I found her unconscious, and covered with cold sweat. She had had two convulsive fits before I arrived. What to do was at first a puzzle; but thought wrorks rapidly in the professional head under such circumstances. To remove the pins and needles by an emetic would have complicated and intensified the mischief; the same objection held with regard to purgatives. Both were rejected as soon as thought of. I had her put into a hot bath ; and, as soon as consciousness was restored, I got her under the influence of opium, which I kept up for nearly three weeks. I confined her to bed in a cool, well-ventilated, dark room, sus- taining life with gruels and broths. In about six weeks after the accident she was up and able to attend partially to her duties. During all this period she complained of general malaise over the abdomen, and pricking pains throughout the track of the digestive canal. Nevertheless, her health and vigor steadily improved, and at the end of six months she was apparently as well as ever. Shortly after this 2 10 time my attention was called to a painful red welt Avhich had arisen above the crest of the right ileum. Matter was evidently forming in it, and I ordered it poulticed. When it had matured, I opened it, and found a cyst, filled with matter, and containing a pin and a needle, blackened and blunted both at the head and the point. This natural process of removing the pins and needles that had been swallowed continued through a period of two years. They appeared in various parts of the body, — behind the right shoul- der, on the inside of the thigh, on the outside, above the knee, and below the muscles of the leg. My reflections as to the conservative power, and my analysis of the processes by which the above results were brought about, have lasted me throughout my life, and have influenced not only my views and treatment of what is called disease, but also my apprehension of the law which produces the phe- nomena. My first experience in the practice of so-called " water-cwre," was at the " Round Hill Establish- ment," in the year eighteen hundred and forty-seven. I took the charge there of from seventy-five to ninety patients for a period of nine months. They were principally from the wealthy and in- tellectual classes, suffering from chronic ailments incident to their habits of life. Strict attention to the sewerage of the skin, through various appli- 11 cations of water; to the diet, both in quality and quantity ; to daily exercise and nightly rest, — brought about happy results in the direction of health. There were some cases of severe suffering; among the number, Colonel P----, who was the subject of chronic articular rheumatism, of many years' stand- ing. He was fifty-eight years of age, weighed two hundred and fifteen pounds, had worked hard as an extensive farmer, eaten heartily, and drank freely, all his life. He came to me with the most of his joints greatly enlarged and stiffened. He was unable to walk, save by the help of friends and crutches; and he had all the other symptoms incident to such a condition. The usual so-called " water- cure" appliances were had recourse to: two " drip- ping sheets," with general friction, twice a day; u packing " in a wet sheet for an hour, once a day, with subsequent washing and rubbing. In the in- tervals, wet compresses, protected by flannel band- ages, were kept upon the enlarged joints. These were frequently removed, and hand-rubbing given for several minutes. The quality of his diet was changed, and the diet cut down to the minimum de- mand of his system, and all stimulants were forbid- den. In six weeks after this course had been entered upon, a marked change was evident in his condition. He had lost fifteen pounds of flesh, and with it his bloated, engorged appearance. His 12 eyes were bright, his appetite and digestion good and natural; he slept well at night; and'although the swelling of the joints had not diminished, and the stiffness remained, he was full of rejoicing at the effect of the " water-cure" upon him, and very hopeful as to the future. Improvement like this continued for some time; and he was intending to be removed home, when one morning, at about three o'clock, I was suddenly summoned to his bedside with the statement that he was dying! He had been seized at one o'clock with a violent fit of shiv- ering, followed by intense fever and headache, rapid pulse, and stabbing pain along the spinal chord, with great soreness over the whole body; and, when I arrived, a violent attack of cholera-morbits had set in. The vomiting and purging continued at inter- vals for thirty-six hours with more or less intensity. A relaxed condition of the system with sweat- ing ensued, and he slept quietly for ten hours. Throughout all this I permitted the natural effort to have its course, not attempting to interfere or check the progress of action by any so-called remedial agencies. When he required nourishment, he was allowed to take simple, warm drinks, gruels, and light broths. During his quiet intervals, his abuse of " water-cure" and all connected with it, was as extreme as his previous exaltation. He expressed his decided intention to be taken home, " if the Lord 13 would spare his life long enough for him to reach there." I was seated at his bedside when he awoke from his prolonged sleep. He looked earnestly at me, and said, " Doctor, what the devil is the matter with my knees \" I examined them, and, sure enough, they presented themselves in a new aspect, — very much swollen, red, and tender, as were also one ankle and wrist; as pronounced a case now of acute articular rheumatism as I had ever wit- nessed. This state of things continued with more or less severity for several weeks, the swelling changing from one joint to another. A modified course of treatment of the same character previously mentioned was pursued with him. He slowly re- covered, with the additional loss of twenty pounds weight, and a reduction of the old chronic swell- ing of the joints of more than one-third, and with the ability to arise from his bed unaided, dress him- self, and walk about. His sober second thought, upon the facts of his case as they were now pre- sented to him, was favorable; and he decided to con- tinue under my care until I should tell him he could safely go home. During his subsequent stay of three or four months, he had two of these critical reaction- ary processes. They were less severe and less pro- tracted than the first, and were treated in the same manner. At the end of this period he left for his home. His weight wTas at this time one hundred 14 and seventy-five pounds. There was very slight swelling of the joints remaining, and not much stiffness. He could walk short distances with ease, and his health in every other respect was good. I was kept informed of his condition for several years, and he had no serious relapse. I was deeply impressed and interested by the suc- cessive phenomena developed during the progress of these cases. There was evidently a power, and, I must add, an intelligent one, at work, acting through a law, the operation of which was to bring about a change from disorder to order. The symptoms were those that are termed disease, and to check which, or to " cure," as it is more commonly called, every effort would have been used in the ordinary method of practice. Had these been solitary cases in my experience of the exercise of this power and the working of this law, they might have passed with only an occasional reminiscence ; but for a period of twenty-five years, during which a thousand pa- tients have been under my immediate observation and management, I have seen the operation of this law reproduced in two-thirds of the number, — in other words, in all who had become sufficiently vig- orous through the influence of treatment for the process to go on, and who had the patient persist- ence to wait for results. Now arises the question, What is this power, and 15 from whence does it emanate % Have we other evi- dences of its working for, and influence upon, what is called physical life"? Most undoubtedly we have. As anatomists and physiologists, we know it; but, as practical physicians, we give it only incidental notice. It is true that the physical life of man, the microcosm, is the result of the harmonious working of two lives, which, although intimately dependent upon and interpenetrating each other, are neverthe- less distinct and definite in their functions. I am aware that, in attempting to describe and enlarge upon the facts of these lives, I am adding nothing to your knowledge; but it is essential to my purpose. The life which comes into contact with the world and the things of the world, through its eyes, ears, and sen- sibilities, having the power of locomotion and appre- hension, referring its impressions to the central organ of the brain for inspection and action, may be called the voluntary life. Of this life we have cognizance and control. It is the dial upon which is marked with the utmost minuteness the working of the deeper- seated and more important organism, which is invol- untary and automatic. This automatic life is the same as, and part of, the great creative life of the world, and, like it, is in a state of constant, active conatus for the well-being of its subject. It stimu- lates the voluntary life, through its appetites and desires, to furnish it with needed material, — first, of 16 food, to manufacture blood, which, if of good quality and in sufficient quantity, forms the vital force; again, through the power which it exercises in the distribution of this blood throughout the body, stimu- lating the nervous centres, repairing the wastes, and eliminating, through the sewerages of the bowels, kidneys, and skin, the poisonous elements which constantly find their way into the circulation. It has also a central source, to which is referred its most minute movement, and from which it derives its power. The great semilunar ganglions, — the source and centre of life, — the stomach, the lungs, the heart, and the brain, with its appendages, are the agents of its work, the exponents and the expres- sion of its power. It is the source from which our emotional feelings radiate, the centre to which all their varied shadowings are referred. How numer- ous and delicate are these processes, and how much of the thing called health depends upon the perfect working of the machinery! This automatic power is determinedly hostile to all destructive influences upon the physical life ; and, in all its reactionary struggles in this direction, there is necessarily in- creased activity of circulation, and this issues in ache, ail, pain, or their grouping, upon the weak links, under whatever name recognized. With regard to that portion of the web of our organism to which the term " nervous system " is applied, I do not assume to 17 be able to add much to your knowledge ; and yet some- thing might be stated which would prove of practical importance. The habit is to separate the organism into different systems, and to attribute to each its own peculiar form of what is called disease, and to treat it accordingly. Now, this is a fallacy, and all the phrase- ology used in the connection is, to my mind, simply absurd. The organism must be looked upon as a whole ; and all its changes, with the phenomena which they develop, should be viewed and treated from that stand-point. If this view be correct, — and lam satis- fied that it can be demonstrated, — what shall Ave say of the practice which seeks to put an extinguisher upon the sanitary action of the vis vitce by interference with its designs ? The term disease is not difficult of inter- pretation. It means simply want of ease ; but in the past and now, even at this end of the nineteenth cen- tury, it has, through the want of a knowledge of its true nature, assumed an entity in the public mind, and also in that of the profession. The progeny which has been manufactured out of it is numerous and varied. It is a source of anxious dread to the race, — the spectre of the household circle, — the possible appearance of which among its members is anticipated with dismay; and when it appears, in whatsoever form, what confusion and commotion it begets ! What discussion of symptoms and names, and methods of treatment! And how is it met, 3 18 and how is it treated, by many of the profession \ As an enemy! The apothecary's shop is an arsenal for the greater number, and the drugs and chemicals the weapons of offence and defence. Each man car- ries out his own idea in trying to extinguish and get rid of the symptoms that present themselves. I have had a long personal experience of the effects of this course of management with what is called disease; and my observation has been extensive as to its results in the hands of many of my professional brethren; and I say, without hesitation, that the mis- chief produced by this method of dealing with symp- toms very much overbalances any possible benefit ever derived from it, as it has neither science, reason, nor common sense for its basis. It is, in fact, the product of a barbarous past in medicine. The conscious earth-life of the human foetus is inaugurated by the first rush of atmospheric air into its lungs. Not an agreeable event, if Ave may judge from the signs. This life means change, naturally, from its birth to its death, and always Avith more or less of suffering in the various processes. It means change, also, in the efforts to throw off inherited poisons, Avhich if not throAvn off fully and freely, the physical life cannot be perfect. Let me name among them small-pox, scarlet fever, measles, and whooping- cough, to Avhich may be added gout and cancer. The paroxysms of suffering through Avhich the race 19 passes toAvard this desirable end are, in esse, sanitary. True it is that many of those Avho are deficient in constitutional force succumb. This is but one of Nature's methods of sifting out the Aveak creatures of the earth. My experience of the many cases of chronic ail- ment that have come under my care shoAVS to me that seven-tenths of the number have not, or have but imperfectly, passed through these natural processes. The germs of disorder still remain Avith them. A subject of much importance in this connection is the decision of the question as to the advantage derived by the vicarious substitution of the vaccine for that of the natural pock. I have no doubt in my own mind of its baneful effect; but it will take a feAV genera- tions yet before the facts in this direction come so prominently forward as to interfere with or change the present practice. Aside from the inherited evils referred to, the race is constantly being subjected to poisonous influences through the atmosphere and other sources, and to manifold mischiefs arising from ignorance in regard to diet, exposure, and over-taxation. These conditions beget many and various forms of what is understood as disease, and there are equally varied methods of Avhat is called " cure." After all, the automatic organ- ism, or, if I may be permitted to use a name that will be better understood by the non-professional, " Mother '20 Nature," is the true curator, if the race could only understand the signs in the direction in which she is working, and Avould intelligently aid the object in view. In thus briefly stating the facts Avhich have come under my observation, the impressions they have produced, and the results of my reflections upon them, not as matters of hypothesis, but as standards which have guided my practice, I am entirely aAvare that I am not inaugurating neAv ideas. Hippocrates held something of the same view, as did also many of the fathers of the profession, as they passed along through the succeeding ages, each one reflecting it from his own peculiar form of thought. But, with all, the ideas were so vague, and so enveloped in mysticism, that they had very little, if any, practical value. One of my preseut purposes is to remind my professional brethren of the existence of a power old as creation, — self-acting, working through a law, — the deus-ex-machina of our life, as it is that of the world itself, — always beneficent, however rude the seeming of its operation may be; and I ask their attention to its methods and to its objects. I am satisfied, from the practical experience of many years, that the power Avorking through this law can be used to infinitely more advantage than by attempting to throAV obstacles in its Avay, or to antagonize its force. To be sure, it is sIoav in its operation, except in acute cases,—festina lente being its Avatchword ; but, 21 above all, it has this advantage, it is the incontro- vertible truth. It has no panacea, nor is there any miraculous jumping from one condition to another; but, given sufficient force, it is always sure and radi- cal in its operations. We physicians ought to be the true missionaries in this world. None have more favorable opportunities, rested upon and looked up to as Ave are. The education of the people at large in a knowl- edge of the laws that govern physical life Avould emancipate them from the dread of so-called disease, and enable them intelligently to meet the operation of the laAV of change ; and they Avould acquire through such knowledge the much-desired condition, health. This Avould also proATe to the profession a compass to guide them infallibly upon their course, furnishing at the same time a principle of action. I am hopeful, sanguinely so, that these vieAvs will in the future proATe a field of discovery for the benefit of the human family. I Avill noAV state my conclusions as to the advan- tages of what is called " water-cure" treatment in this connection. In doing so, it becomes necessary to examine the modus in quo by Avhich the automatic organism Avorks, not only as our creative " mother," but also as our friend and defender. I have said that she is always in a state of active conatus on our behalf. The presence of poisonous or hurtful influ- 22 ences is telegraphed on the dial of the conscious life, recording there significant signs, if they could only be read and understood. The vitalized blood is the material used, — the heart with its capillary circula- tion acting upon the neiTes, Avhich are the exponents of physical conditions, through their many ramifica- tions furnish the machinery by Avhich the conscious- ness is evolved. The effects of this process are always felt in the weak links, if there be any in the voluntary life; and there are few of us Avho have not many of them. All these outward signs and feelings are but the results of inward vital force and action, and are only to be gotten rid of by a removal of the deep-seated cause. To this end " Mother Nature " is always Avorking. All the conscious aches, ails, and pains of Avhich Ave are daily the subjects are evi- dences of this effort. There are two especial methods which she pursues in her Avork for us, using the same instrumentality that I have referred to. She transfers from organs, whose functions are necessary for the support of life, not only the inherited poisons mentioned, but the evils we manufacture for ourselves through lack of knoAvl- edge. Gout and rheumatism, in their manifold forms, are but the out-births of inward conditions, Avhich, if allowed to remain, Avould be perilous. All the forms of eruptive disease to Avhich Ave are subject belong in the same category; also malignant tumors. The arte- 23 rial circulation, stimulated by its various nerves, is the agent by which these changes are effected; and these changes are the results of its whole power acting upon a part. The signs of this action are marked upon our consciousness. As an example, the violent chill, followed by rapid pulse, intense fever, headache, severe pains, vomiting, with general distress and sore- ness, are the symptoms of the struggle which the automatic life makes to throAv off the poison of small- pox through the skin. Where there is sufficient vigor of constitution to effect this object, the subse- quent treatment of the case is simple and easy, and the subject of it takes a step upward and onward toAvard a more perfect health. Noav, in modifying the severity of such paroxysms as these described, the use of water in its varied applications — not as a special means of " cure" observe me, but as a medium of temperature from zero to a hundred and tAventy-five Fahrenheit, by Avhich the circulation can be influ- enced and directed — has proved of signal and be- neficent service (experto crede); and I foresee that it is to be the household remedy of the future, when made use of intelligently. It Avould not be difficult for me to enter into a detail of the fallacies of the present views of so-called disease, nor of the methods of so-called " cure ; " but it Avould not be in good taste, and might appear invid- ious. I therefore leave it to be inferred. The think- 24 ing portion of the profession recognizes the difficulty of the reception of an intelligent vieAv of the physical conditions Avith Avhich it has to deal. The public, as a Avhole, are bound down, as Gulliver was of old, by every hair of the head and every available part of the body, to the inoculated opinions of the past. The creatures of their feelings rather than of their facts, Avhen ache, ail, and pain set in, reason and common sense are turned out, and the cry is, relieve me from my sufferings. It is very sad to listen so constantly to this wailing cry as it arises from the race, age after age, generation after generation; and hoAV the good God, through our progenitor, Adam, is saddled Avith the responsibility of the infliction of this so-called suffering! If common sense \vere only exercised here, as it is upon other subjects, pain and suffering Avould be recognized as a birthright, a necessity, and a bless- ing. If the reason upon which Ave so plume our- selves as our distinctive human characteristic could be exercised in the investigation and analysis of the facts connected with this subject, and if we Avould accept and submit to the inevitable, using our knowl- edge and intelligence in modifying the severity of the processes of change, a neAV era Avould be inaugurated for the human family. Gentlemen, I salute you. E. E. Dennistox. Erinstein, Northampton, Mass., March 15, 1875.