Chapter 34

Every era has possessed its false prophet in religion, from the days of Mahomet to those of Joanna Southcot and Fanny Wright; not that the race commenced with the former, or has terminated with the latter; the records of history supply us with examples of "lying augurs," in every period previously to the career of the Impostor of Mecca, and our daily experience furnishes us with proofs that the tribe is by no means extinct. As in religion, so has it been, and still continues, in philosophy, and the whole circle of science: pretenders to excellence have started up in every age, and although their efforts in the cause of imposition have not been so splendid as the exertions of those who have made religion their tool, they have yet been sufficiently remarkable to excite the eager attention of mankind, and sufficiently profitable to reward themselves. Medical science in particular may boast of a numerous host of these worthies: it would far exceed the limits of this publication to trace the progress of the charlatan, through the records of ancient history; for the sake of brevity, a retrospective glance must not be directed beyond the fifteenth century, when the arch priest of "modern quackery" made his appearance upon the medical stage. In the year 1493, Phillippus Aureolus Theophrastus Paracelsus Bombastus de Hohenheim, was ushered into existence, and at a very early age announced his discovery, that the recognised principles of medical science were erroneous, and that in him alone was vested "the art divine, to heal each lurking ill." Possessing a panacea capable, as he boasted, of curing all diseases, and even of prolonging life to an indefinite period, this empiric made war upon the health of mankind, and at last, after a life of the most infamous debauchery, he died, in the forty-eighth year of his age, with a bottle of the "Elixir Vitae" in his pocket. The mantle of Paracelsus has been left behind, and a rich inheritance of ignorance, insolence, and vanity, bequeathed to a multitude of heirs; the value of the legacy, however, would have been trifling, but for the credulity of mankind, which renders these worthless possessions of inestimable importance: during the last century, in particular, these descendants have attained an eminence truly astonishing. Medicine is admitted to be one of the noblest sciences, as tending, in its practice, to relieve the most irksome restraints upon existence; it is acknowledged to be a science founded upon close observation, and so nearly allied to other sciences, that its pursuit is impracticable without them; that it requires years of patient toil to fathom its mysteries, and the undivided efforts of a mind to comprehend its purposes; and yet we are daily told of the most extraordinary cures, and of the discovery of sovereign remedies, in all cases and descriptions of disease, by individuals who have never

"Toil'd an hour in physic's cause, Or giv'n one thought to Nature's laws:"

By men, in short, who are incapable of forming one rational opinion upon the subject, and unprepared, by previous study or information, to detect or remove one symptom.

It is an old and apt saying, that "the wilder the tale, the wider the ear;" and experience proves, that from the nursery to the tomb, no legend is too marvellous for the faith of the credulous, and that in many instances, the more incomprehensible the story, the more confirmed is the belief.

In the numerous newspapers daily published in the United States, a list of cures are detailed with sufficient precision to satisfy the sceptical, and sufficient plausibility to convince the ignorant, while a string of medicines is set forth, of such unrivalled excellence, that no disease is protected from their action; the panacea of Paracelsus is rivalled, and every calamity that can afflict the body, from the crown of the head to the sole of the foot, is at once relieved. "Vegetable Powders," "Botanical Syrup," "Bilious Pills," "Jaundice Bitters," "Eye Waters," ointments, &c. &c. are proclaimed as veritable specifics by these veritable physic-mongers: no disease is too subtle, no train of symptoms too severe, for them to contend with; they only meet the foe to conquer, and confer an immortality on suffering humanity and themselves. Thus they flourish, the quacks of the day, the impostors of the multitude, and, perhaps, the dupes of themselves! But if Reason, that plain and simple attribute, in its uncontrouled state, unfettered either by prejudice or wilfulness, can be brought to bear on the question between them and mankind, how little will their claims appear! Reason, in the exertion of a capable authority, is taught to discriminate fairly, and test candidly, and must therefore refuse the evidence tendered by folly, or something worse, by which ignorance is bewitched. Will the man of reflecting mind, and of candid judgment, admit the claims of these pretenders, and match the speculations of avarice and ignorance with the conclusions of science? Impossible! Safety consorts with skill in every path of life; he would not trust himself on the wide ocean with a man ignorant of navigation; nay, he would not trust a bale of merchandise with him; and surely he will not abandon his bark of existence to the command of a charlatan, who knows nothing of the principles of the art he professes, and is altogether incompetent to steer clear of the numerous rocks and quicksands in the course of life; but a man of reflection and judgment is not a very common character; he is surrounded by hundreds who examine not for themselves; and are easily deluded, by the fairest promises, to surrender their opinions to another's guidance: these are the supporters of quackery, and the encouragers of those needy plunderers, who would render medicine a farce, that they might practice jugglery the better.

If the system of man resembled a machine, which, once in motion, continued an unvaried power, and retained an equality of force, merely requiring, when deranged, the tightening of a screw, the readjustment of a strap, or the addition of a quantity of oil, little knowledge would be required in the regulation of its functions; but when we find the constitutions of men as varied as their countenances, the affections of the body, numerous and diversified, never preserving identically the same characters in two cases, or requiring the same exact treatment in diseases, apparently of the same nature, we discover that something more than the artifice of the quack is necessary in their government and repair.

It would indeed be a Herculean task to administer the rod of correction to all the advertizing medical gentry of the day: it could be done, and with justice to the community; but it would be wearisome. A champion, however, has recently entered the medical arena, with whom we would fain contend, not only in the hope of conquest, but in the expectation that others may take warning by his defeat. With him we will now alone engage, and thus throw down our gauntlet.

A work has very lately appeared, professing to be a "New Method of Curing Dyspepsia, discovered and practised by O. Halsted of New-York." This publication sails in the wake of a tolerably successful practice amongst the dyspeptics of the day, who have resorted to the temple of our author "with faith sufficient to promote a cure." So long as this continued, all interference was of course out of the question, as every individual possesses an undoubted right to tamper either with his judgment or his money; but when this aspirer after dyspeptic fame leaves his concealment, and issues his discoveries and practices to the world, he invites the battery of opinion, and renders himself at once amenable to remark and investigation. A few words, however, on the subject of dyspepsia, may not be amiss, before we take leave to reply to Mr. Halsted.

This much abused term, is a compound of two Greek words, signifying "bad concoction," or bad digestion, _alias_ indigestion, and sufficiently expressive of a condition in which the aliments supplied to the stomach are not met by a vigorous and sufficient action for the purposes of health; but this definition, however just, is not comprehensive enough for the genius of mankind. That genius, which, in former times, has sanctioned the appellations of nervous disorders, and bilious complaints, as comprising nearly all others, has now selected the term of dyspepsia, as the covering for a multitude of real and imaginary woes; so that when an invalid approaches with a variety of symptoms, and a host of pains or whimsies, he is at once pronounced to be a Dyspeptic.

The book before us, commences with a short account of the organs engaged in the process of digestion, copied from a periodical work of the day, very good as far as it goes, and leaving nothing to be desired on the score of brevity: our author then pursues his task, by a detail of the symptoms of what he calls dyspepsia; from what work he procured these, or from what unhappy wretch he could gain such a list of grievances, as he describes arising from indigestion, does not appear; if they be in existence now, the sooner the one is burnt and the other buried, the better. It is evident that Mr. Halsted is unaware that dyspepsia occurs, in one of two ways; either as a primary affection, or as a symptom of other diseases; that he is unacquainted with the share the liver, with its biliary apparatus, the pancreas, the spleen, the mesentery, the omentum, &c. take in digestion, and of the symptoms occasioned by an affection of these organs; it may therefore be adviseable to devote a few lines to the consideration of these points, as well for the satisfaction of the public, as for his instruction and the improvement of his second edition. Dyspepsia, or indigestion in its simple form, occurs either as a disease of debility, or as a consequence of excess: the first arises from numerous causes, and seldom exists alone: the secretion of the gastric juice is not only impaired, for the office of no organ continues in a state of activity, all alike feeling the result of that general depression affecting the system at large: the second may be referred to the stomach itself, as a natural effect from over-feeding, or indulgence in spirituous liquors. Dyspepsia, occurring as a symptom in other diseases, appears under numerous characters, either from the effects of sympathy, or from an extension of the malady to the stomach itself. It may be readily granted that all the symptoms described by Mr. Halsted, take place, in consequence of an affection of the stomach, either primarily or secondarily; but to assert that they are the results of a bad concoction of the viands we eat and drink, and to act accordingly, is to misunderstand the meaning of a term, as well as the treatment of a disorder.

It is stated, in this work, that dyspepsia is Protean in its symptoms, but single and uniform in its nature; the very reverse is the fact; its symptoms are of a single character, and of an uniform attack, while its nature is variable and inconstant. A dyspeptic will complain of a want of appetite, a degree of squeamishness and irritability, eructations, heart-burn, pain in the head, stomach, and bowels, with costiveness; his tongue will be furred, and his pulse a little increased in strength and quickness. To use the language of Dr. Armstrong, "the most constant symptoms of dyspepsia, are a furred tongue, flatulence of the stomach, and fretfulness, or depression of spirits;" he goes on to say, "these may arise primarily from disorder or disease in the stomach itself, or they may depend upon an affection of the brain, liver, bowels, or some other remote or adjacent part." The nature of dyspepsia depends totally upon its cause, and where so many circumstances may occasion it, it is difficult to imagine one more variable. The important organs before alluded to, so necessary to the economy of life, are all liable to the most severe visitations of disease. Not to be too prolix, take, for the sake of example, the first on the list, the liver: both in the acute and chronic forms of inflammation of this viscus, how important a change is wrought in the digestive functions, how enfeebled does the system become during its continuance, and how futile would be the attempt to relieve the malady by merely attacking one of its symptoms! And so, of the other viscera, all marked when in a morbid state by peculiar characteristics, not only affecting their own action, but all the parts in their neighbourhood, the stomach as one of the great centres of the system in particular; and yet, with all these facts in review, are we presented with a list of ailments as dependant upon an impropriety in digestion, which may in all probability (at least the greater part of them) be traced to a source totally different. A careful discrimination of the origin of disease is as necessary as any after treatment, which can never, indeed, be applied with a reasonable chance of success without it.

Mr. Halsted recommends a change to a more temperate climate, travelling, regular exercise, particularly on horseback, and above all, moderation in eating and drinking; asserting, that if these means of recovery be neglected, things will inevitably go on from bad to worse. Astonishing! These new precepts, from the pen of such a distinguished practitioner, cannot be too highly extolled, and should be classed with the recommendation of old Parr; "keep your head cool by temperance, your feet warm by exercise; never eat but when you are hungry, nor drink but when nature requires it." Had the author stopped here, there would have been no occasion for a rejoinder to his work; for directions so admirable could only have obtained a ready compliance. In addition, however, to these usual modes of recovering health and appetite, we are put in possession of a few others, as purely original as can be imagined--but of these anon.

Mr. Halsted arranges dyspepsia in three stages; he has the incipient, the confirmed, and the complicated; in other words, dyspepsia in its commencement, in its continuance, and in its union with other affections. The two first may undoubtedly belong to dyspepsia, but the last, or complicated stage, is the one to which we must object; it is said, that this occurs when other organs are deranged, and a double set of symptoms produced; "when the patient will be said to die of liver complaint, an affection of the lungs, marasmus, dysentery, diarrhoea, or some anomalous complication of all these affections, conveniently classed by the Doctor when he renders his account to the sexton, under the sweeping term, consumption." The medical profession will doubtless appreciate the value of the connexion which Mr. Halsted is anxious to establish between the physician and the respectable officer who acts as the last gentleman-usher to mankind, and duly estimate the candid and gentlemanly mode of introduction of both parties to the public.

Dyspepsia, Mr. H. continues, is the original fountain from whence all this mischief, described in his third stage, proceeds; thus, according to him, a catarrh, pneumonia, and the numerous diseases attacking the respiratory organs, as "affections of the lungs," are occasioned by dyspepsia; the liver cannot be affected but by dyspepsia; marasmus proceeds from dyspepsia; dysentery depends on dyspepsia; and even diarrhoea must own dyspepsia as its parent. The effects of cold and damp, of obstructed perspiration, of scrofulous tendencies, and a thousand other causes, pass for nought; dyspepsia rears its head as the sole parent of ill, and little doubt can be entertained, that in the event of a man, a little weakened by sickness, falling and breaking his leg, this dyspeptic monitor would call the case dyspeptic fracture. Well may the poor patient who peruses the pages of his work be called "an unhappy dyspeptic;" and if he be not so already, he cannot read long, if his attention and conviction go hand in hand, before the discovery of such an accumulation of horrors, and all referred to his own person, will render him a fit subject for the author's experiments. Some of these symptoms are of too extraordinary a character to be passed over without notice: coldness in the head, ears, and eyes, difficulty of speech, and a jarring through the chest, numbness and coldness at the stomach, and sometimes a weight as if a lump of lead were there: if this be the case--

"Who breathes, must suffer; and who thinks, must mourn, And he alone is bless'd, who ne'er was born."

Then again, our author has been told by a sufferer, that he felt as if a number of wires passed up from the stomach to the brain, and there ramifying into small branches, communicated a sort of jarring or vibrating sensation to each particular nerve. This is a perfect musical case of a dyspeptic, who has a sort of piano-forte stomach; we might fancy him exclaiming in the language of Shakspeare,--

"This music mads me; let it sound no more; For though it have help'd madmen to their wits, In me, it seems, it will make wise men mad."

Then come "pains between the shoulders and in the small of the back, cramps, stitches, pains in joints, with universal soreness and weariness." This is as bad as the plague, a very wilderness of agonies. Heaven guard us from them! To crown all, the sufferings of Caliban under the magical touches of Prospero are applied to the wretched dyspeptic, who has "cramps by night, and side-stitches to pen his breath up; old cramps (one attack is not sufficient) shall rack him and fill his bones with aches, making him roar so loud, that beasts shall tremble at his din;" this is the very climax of bodily suffering--long may we all be preserved from the Halsted Dyspepsia!

Error in diet, and want of proper exercise, are correctly assigned as two great causes of this disease; the former as respects the quantity, quality, time and manner of taking food, and the latter as it affects persons of a sedentary habit. These causes lead to actual dyspepsia, or a bad concoction of the food in the stomach, from whence the evils described arise; and which are sufficient of themselves, without adding to the list those affections, dependant upon diseases of other organs, although occupying the stomach as their seat, and all of which our author has indiscriminately classed under _his sweeping term_, dyspepsia. A very common error of diet, as respects the time and manner of taking food, is not treated of with sufficient force, when its baneful tendency is considered:--the custom that prevails, of dining within a very short period, sometimes only a few minutes, and returning immediately to the avocations of the day; the food is sent to the stomach only half masticated, and the system directly subjected to exertion, during which, the process of digestion cannot take place. If we make a hearty meal, and at once proceed to labour of any kind, the food remains for hours in an unaltered state; whereas, if we give a short repose to our bodies, by assuming an easy posture, and partially dismissing the remembrance of past, and the prospect of future cares, allowing, in fact, the whole business of life a short rest, as far as may be, the stomach will perform its office with ease and certainty. Mr. Halsted devotes one section to the consideration "of the particular condition of the stomach in dyspepsia;" and as he confesses that doctors differ on this subject, he kindly lends his assistance to relieve their indecision, by roundly asserting "that it consists mainly, in a debility or loss of power of action, in the muscular coat of the stomach." That a feebleness of the system may affect the muscular coat of the stomach, is far from a novel doctrine; but the idea that dyspepsia _mainly_ depends upon this cause, is certainly as new as it is startling: the very meaning of the word would dispose us to consider that any want of action in the stomach, preventing the due concoction, or the breaking down of aliment for the purposes of nourishment to the frame, would apply to it, and, strictly speaking, it would; not that the muscular coat is alone, or the most powerful agent, in reducing the food to pulp or chyme; it is one of the many forces in the service of nature. It must be remembered that digestion, however well commenced in the stomach, is not perfected there; that, in the words of Dr. Mason Good, "it ranges through a wide spread of organs closely sympathizing with each other, and each, when disordered, giving rise to dyspepsia." After the formation of chyme, and the food has passed the pyloric orifice of the stomach, it undergoes a new process in the duodenum, when it is converted into chyle, probably by the action of the bile, although this is a point not absolutely determined by physiological experiment; even now, digestion is only half finished, the lacteals (a class of absorbing vessels particularly numerous in the duodenum, and also existing in the larger intestines) take up this fluid, for the purpose of conveying it into the thoracic duct, which terminates in the left subclavian vein, nor is the total process of digestion completed, until, in the language of the author above quoted, "it has been exposed to the action of the atmosphere, travelling, for this purpose, through the lungs, when it becomes completely assimilated with the vital fluids." Hence, although the meaning of dyspepsia must be restricted, as its derivations demand; the term, digestion, bears a much more extensive signification than it generally receives, and any error in its process may be properly denominated indigestion; however, Mr. Halsted regards the term dyspepsia as equivalent to indigestion, and we may, for once, adopt the same phraseology. Now, as digestion is of so complicated a nature, how will Mr. H. explain his reference to the muscular coat of the stomach as a chief cause of its derangement? Is he so admirable a pathologist as to discriminate, when called to a case of dyspepsia, whether, to use his own words, "it consists in a diminished quantity or vitiated state of the gastric fluid, in a morbid secretion from the inner coats of the stomach, or from a peculiar acid generated there; whether chronic inflammation of the mucous membrane of that organ, or a torpid state of the liver and a deficient secretion of the bile occasion it: it would appear that such conditions _may_ exist, and then produce their different symptoms, requiring a _modified_ treatment;" but it frequently happens that these cases, slight in themselves, determine principally to the stomach, and are not apparent to the keenest eye in any other organ upon the first attack. Besides, it is the practice of Mr. Halsted, when he discovers that the digestive apparatus is not originally in fault, but that a chronic inflammation of the stomach, or a torpor of the liver, prevails, to _modify_ his treatment; this, at all events, is new doctrine, to treat inflammation and torpor upon _modified_ principles. If, however, diagnosis is so slight an affair in his hands, let him, without delay, inform his countrymen at what college he studied, and what were his plans of improvement.--Pathology is a difficult science, and needs mentors to point out the best paths for its attainment.

The muscular coat of the stomach has undoubtedly its proper office to perform, and, failing in its functions, it may, in conjunction with other causes, lead to dyspepsia; but to fix upon this, in particular, is to negative the effects of other organs, and to deceive both your patient and yourself.