Chapter 35

One of the most important discoveries in this work appears under the title of "the state of the abdominal muscles during dyspepsia;" which is pronounced to be a very characteristic feature of the disease, never yet noticed by writers on the subject, or particularly attended to by physicians. It would certainly have been somewhat strange for medical writers to enlarge upon a symptom of one disease, which absolutely belongs to another; or for physicians to attend to what they could not detect; and it is equally singular, that this very characteristic feature should only have favoured Mr. Halsted and his patients with a visitation. Whenever the muscles of the abdomen are in a state of constriction, as described by him, the usual cause is spasm of some part of the intestinal canal, produced by _colic_, either of an accidental nature, arising from some acrid ingesta, which irritate the bowels without producing diarrhoea, attended with griping pains and distention, and _spasmodic contraction of the abdominal muscles_, with costiveness; or of a bilious form, closely allied to bilious diarrhoea and cholera (Gregory.) These are the varieties of colic which have been confounded with dyspepsia, particularly the first described; the symptom alluded to has little or nothing to do with the office of the stomach, but depends chiefly upon acrid substances, which have passed from that organ, to exercise their pernicious qualities upon the intestines; the sufferings of Mr. Halsted, so pathetically described, may at once be referred to a fit of the colic, which a due want of care rendered very frequent.

Pass we now to the treatment, premising that a ride in a stage-coach led to the discovery of its advantages, and taking care, at the same time, of our abdominal muscles, lest the exertion of laughter should occasion one of the muscular spasms so much dreaded by our author. The plan is divided into four compartments; tickling, pickling, ironing, and throwing up the bowels. The tickling is performed by gentle taps and slight pushes in the pit of the stomach. (Who could bear it? It would throw nine patients out of ten into convulsions!) The pickling, by wrapping up the patient from the chest to the hips with flannel cloths, wrung out in a mixture of equal parts of hot vinegar and water. (This at all events tends to _keep_ him.) The ironing, by spreading a coarse dry towel on the bowels, and passing over them "a bottle filled with boiling water, or, what is better, a common flat-iron, such as is used in smoothing linen, _heated as warm as can well be borne_, for fifteen or twenty minutes." Make an ironing-board of a patient's bowels! This is worse than all: a man might consent to be tickled and pickled--but to iron him for twenty minutes--mercy on us! the very thought is sudorific.

The throwing up of the bowels comes the last: fancy Mr. Halsted seated on the right side of his patient, and facing him; then placing his right hand upon the lower part of the abdomen, in such a manner, as to effect a lodgment (we quote his words) as it were, under the bowels, suffering them to rest directly upon the edge of the extended palm, and then, by a quick but not violent motion of the hand, in an upward direction, the bowels are thrown up much in the same manner as in riding on horseback, a sensation being communicated like that produced by a slight blow. (It is difficult to imagine who is entitled to the greatest admiration, the practitioner or the patient.) This treatment, it is said, will generally effect an increase in the strength of the pulse, a warmth in the extremities, and a gentle perspiration. So we should imagine: if such a mode of riding, with one's bowels in another man's hands, will not produce perspiration, what will? The position of the sufferer, during the last most remarkable process, may be occasionally altered, the practitioner taking his station behind him; or he may be placed with his back against the wall, whilst all these freedoms are taken with his bowels. Nay, more,--he may be instructed to perform the operation on his own person.

"Wer't not for laughing, I should pity him."

This, then, is the Halstedian treatment!

The former rules of quackery, reduced to the administration of sundry pills or elixirs, must be abandoned in favour of the manipulating and scouring process of the great medical wizard of the day, who relieves by a tap, and cures by a flat-iron; and although it may be difficult to conceive the chain of ideas by which the imagination can connect the bumpings of a stage-coach with the operations we have described, we may exclaim,--

"Your art As well may teach an ass to scour the plain, And bend obedient to the forming rein,"

as cure dyspepsia; still, we must yield our admiration to the novelty of invention, and to the ingenuity of application of these stomach and bowel working wonders.

It unfortunately happens sometimes, that the dyspepsia is connected with inflamed stomach, in which case the _punching_ practice is death. We have heard from eminent physicians, that several lives have, within their knowledge, been endangered by it. Moreover, the real indecency of the Halstedian process, particularly in the case of women, has greatly shocked even the medical observers.

Before we dismiss this book from actual review, we will devote a short space to its probable effect upon the public, and upon the best means of counteracting its tendency.

Man, like a child, is amused by a novelty, and "tickled by a straw." His "reason too often stoops not" to inquiry before a ready surrender, and what is least comprehensible will occasionally receive the readiest credence: bare assertion is admitted without proof, the rhodomontade of enthusiasts passes for gospel, and the "leather and prunella" of impostors are regarded as commodities of sterling value. No wonder, then, that success attends a certain race, who are willing to prey upon the infirmity of reason; that the mountebanks of former days are emulated by the quacks of the present time; that Mr. Halsted has met with abundance of patients, and a ready sale for his work: a hope of relief from disease acts as a stimulant to faith, but "Hope is a cur-tail dog in some affairs."

It is said of Dr. Cameron, one of the most remarkable charlatans of his day, that when reproached by a physician concerning his deception on the public, he replied, "Out of twenty persons who pass this house in an hour, nineteen are fools who come to me, whilst the one wise man applies to you--which has the better practice? Believe me, doctor, that although the wise seek the wise in your person, the fools will find me out." How exactly is this assertion fulfilled in the present day! The wise man, who values his health as his greatest earthly blessing, scorns to resign it to the care of one who knows not the value of the trust; who cannot comprehend the principles upon which it depends, the cause which deranges it; or discover the particular organ requiring assistance: common sense interposes a bar to any communication between a wise man and a charlatan; while the multitude will flock to the snare, or swallow the bait; first the gulls, and then the victims; the nostrums, injurious or poisonous as they may be, find ready mouths for their reception; the dogmas, willing ears; and the system of Mr. Halsted, ready sufferers. Is it not to be lamented, that a man who claims a caste above this multitude, will sometimes forget himself so far as to follow their route, heedless of the lines of Horace?--

"When in a wood we leave the certain way One error fools us, though we various stray."

He madly leaves the track of reason to tread in the steps of folly; but _he_ may perhaps retrace them, and if an injured, yet a wiser man. Not so the generality,--they pursue an _ignis fatuus,_ which, dazzling their perceptions as it lures them on, at last leaves them in the mire (from which no skill perhaps can extricate them) to curse themselves and their deceiver.

The exertion of medical science is sufficient for the removal of diseases capable of cure, and is unaccompanied by the risk of leaving others in their place: quackery, on the contrary, attempts what it cannot, from ignorance, perform, and frequently establishes a malady of more serious character than the one it professed to relieve. The medical man, aware of the structure of the human form, of the disposition and arrangement of its several parts in a state of health, is gradually led to a consideration of their condition in disease: that grand master, experience, enables him to discriminate between the cause and effect of morbid action; a long attention to the detail of practice gives him power over a list of remedies whose properties he has ascertained by observation; and in addition to all this, his daily thoughts are engaged in the investigation of sickness in its many forms, and, frequently, his midnight oil expended, while he peruses the observations, and profits by the researches of others. Again, the advertising quack is frequently an unlettered, never a well-informed man, at least on medical topics: his education, his habits, his purposes, are all foreign to science; the first has not been devoted to the accomplishment of a particular duty; the second have not received that polish, or acquired that delicacy so necessary in the hour of sickness and distress; and the third are directed solely to the purposes of gain, rather than to the noble aim of assisting his fellow-creatures; and yet such a character finds support. To the individual who can depend upon his abilities we may exclaim, "tibi seris, tibi metis," and so dismiss him to his fate.

After all that has been said of the exertions of the charlatan to abuse the confidence of mankind, particularly as far as dyspepsia is concerned, it is due to the medical profession, to state what claims they may fairly advance, to entitle them to the good opinion of the public, in the cure of this much talked of affection.

A physician, who understands what he is about, knows very well, when a case of this nature comes before him, that it may proceed from a variety of causes; that it may arise in the stomach from a want of digestive power, from the small intestines by a partial failure in the process of chymification; that it may depend upon the morbid action of the large intestines, or exist merely as a symptom of an affection in other organs. Sedentary habits, or irregularities of diet, are causes which may be supposed to act locally on the digestive organs themselves; but the history of a case will generally show that the derangement of the digestive organs is secondary. When it arises from local irritation, it can only be produced through the medium of the sensorium; when it is idiopathic, it frequently originates in causes which affect the nervous system primarily; such as anxiety, too great exertion of body and mind, and impure air; in many instances, the nervous irritation which has induced the disease, being trivial, is only kept up by the reaction of its effects. Thus says Abernethy, one of the luminaries of modern medical science.

The first duty of a physician, therefore, is to ascertain from what source indigestion proceeds, and to frame his treatment accordingly. To act upon one system of cure, like our friend Mr. Halsted, in a disease arising from such a variety of circumstances, would be as reasonable as applying splints to an arm, when the thigh happens to be fractured; but enough, we would hope, has been said to disabuse the mind of the public of a predilection for these pretenders. Dyspepsia is a disease that has existed for ages, and through ages has it readily been cured. In its simple form there is no mystery about it, and when it becomes complicated, it requires more than the knowledge of a quack to master it. Confidence in a medical attendant, and an adherence to his directions, will surely suffice now, as in former times; and if the public will restrain a longing after novelty, and abandon those "who rather talk than act, and rather kill than cure," in short, who work upon their prejudices by artifice, we shall hear less of dyspepsia, simply because it exists too frequently but in their own fancies. True, there is a certain class, with such mental, as well as bodily infirmities, who, worn down by depraved habits, or suffering under weakened intellects, will permit the wildest chimeras to haunt them; hypochondriacs may be met with every day, and these may be fit patients for the charlatan, or legally subjected to the tickling, pickling, and ironing of Mr. Halsted: extraordinary maladies may justify extraordinary experiments.

The absurd and improper treatment proposed in the work we have noticed, can afford but little hope to any but the hypochondriacal dyspeptic; he may fly to any measures, however desperate or ludicrous; for "a mind diseased no medicine can cure." Let others, however, who cannot plead a malady of the mind as an excuse for resorting to such practice, be informed, that in most of the affections arising from, or confounded with dyspepsia, it is unavailing, and may prove injurious. There are many diseases which it is impossible that Mr. Halsted can distinguish from dyspepsia, and to which he would apply his irons and bottles, towels and vinegar, at the risk of his patient's safety.

His views may be sound if adapted to the animal economy of a horse, but are certainly unsuitable to the constitution of a man.

We would say, then, to the public, in conclusion; be cautious how you trust your health and lives with those who neither comprehend the nature of the one, nor the value of the other--and who would exclaim behind your backs, with Shakspeare's Autolycus, merely altering the description of his wares:--

"Ha! ha! what a fool Honesty is! and Trust, his sworn brother, a very simple gentleman! I have sold all my trumpery; not a counterfeit stone, not a riband, glass, pomander, brooch, table-book, ballad, knife, tape, glove, shoe-tie, bracelet, horn-ring, to keep my pack from fasting: they throng who should buy first, as if my trinkets had been hallowed, and brought a benediction to the buyer; by which means, I saw whose purse was best in picture, and, what I saw, to my good use I remembered."

To the gentle pretenders themselves, we have but a few words to say at parting:--

"Out you impostors, Quack-salving cheating mountebanks--your skill Is to make sound men sick, and sick men, kill."

ART. X.--BANK OF THE UNITED STATES.

1.--_Report of the Committee of Ways and Means of the House of Representatives of the United States, to which was referred so much of the President's Message as relates to the Bank of the United States._ April 13th, 1830: pp. 31. 8vo.

2.--_Message of the President of the United States to both Houses of Congress._ December 8th, 1830.

When the President first presented the question of re-chartering the Bank of the United States to the national legislature, at the opening of the session of 1829-30, the measure was viewed very differently by different men. We do not speak of the vulgar herd of politicians, great and small, who approve or condemn indiscriminately all measures of the government, but of that more elevated and independent class, who ask nothing of any administration than that it shall do its duty; and who judge of its acts as they seem to be legal, useful, and wise. To some the president's course appeared to be highly objectionable. The bank charter had then six years to run, and, consequently, they said, neither this congress nor the next had any control over the subject. Nor could it furnish matter of legislation, they added, whilst president Jackson remained in office, unless he should, by being elected for a second term, give his sanction to a principle which he had pronounced impolitic and dangerous. To have brought forward the subject, under these circumstances, with no very doubtful intimation of his own wishes, was as unnecessary as it was unusual, and implied a want of confidence in those who were ultimately to decide the question.

To others, however, this early notice of the subject seemed to be justified by its importance, and they thought that the public could not be too soon engaged in discussing the merits of a question which in so many ways concerned the general welfare. Of this opinion seemed to be the committee of the house of representatives, to which this part of the message was referred, and which, after giving the subject a full consideration, reported in favour of renewing the charter of the present bank, and against the substitute for it which the president had ventured to suggest.

The subject being thus fairly before the people, and in fact undergoing a very thorough investigation in the public journals, it was expected that the president would be contented with having done his duty on the occasion, and, if not silenced by the gentle dissuasive of the senate, or the bold and uncompromising logic of the house, he would merely regret that truth should be so hoodwinked by prejudice, or that error should have found so many apologists and supporters in those august bodies, and that he would leave the question where it properly belonged, and where he himself had placed it--with "the legislature and the people." It was, then, with no little surprise, perceived, that the succeeding annual message, which is at the head of this article, had brought the same subject to the notice of the legislature, consisting precisely of the same individuals as before, when nothing was pretended to have occurred to induce them to change their former opinion, and when the only reason which had been given, at the preceding session, for inviting the consideration of what neither required nor admitted immediate legislation, no longer existed. Public attention had been fully drawn to the subject. The stockholders of the bank, who are profiting by the good management of the institution, and who naturally wish the charter renewed, had taken the alarm, and, trusting to the omnipotence of truth, had every where invited investigation and discussion--and all those who hoped to profit by the new national bank, or who felt themselves bound to second the wishes of the administration, had opposed the renewal of the charter, through the prints devoted to the same cause.

When the avowed purpose of the president had been thus completely answered, by his first communication to congress, it is natural to ask what could have prompted the second? Were the majorities in both houses of congress personally hostile to the president, or unfriendly to his administration; and was it necessary for him to defend himself from party prejudice by an appeal to the people? That could not be; for it is notorious that the president's friends, personal or political, are most numerous in both houses, and this advantage is a daily theme of party boast and congratulation. Were the chairmen of the respective committees his political opponents, and did they insidiously endeavour to bring his party into discredit for the purpose of advancing their own? But they were among his most zealous adherents--nay, it may be questioned whether there was a single individual in the United States to whom the president was more indebted for the vindication of his character before the people, than to Mr. M'Duffie, who wrote one of the reports;--unless it might be to Mr. Adams, when secretary of state. Was it then expected, that the house of representatives, which had disregarded his recommendation, would now approve his project? It is impossible that the president or his advisers could have believed they would carry their complaisance so far. They must have known that the subject would be referred to the same committee, composed of the same persons, as that of the preceding year, and who would be likely, if they reported at all, not only to support their first opinions by further arguments, but to express their disapprobation of a course so wanting in respect to the legislature, and so little calculated to promote harmony between the different branches of the government. As, then, we are compelled to give the negative to all these suppositions, we must infer that the object of this extraordinary course has been to influence public opinion. It seems essential to the views of the present executive of the United States, to put down the present national bank, and to erect another on its ruins; and this favourite purpose it hopes to attain by bringing the president's personal and official influence to bear on the question; and, under the forms of the constitution, to appeal from his party in congress, to his party in the nation.

On the dignity or good faith of this course we will not make any comment; but since the question is thus brought before the people, we will cheerfully meet it, and inquire how far the measure recommended by the president, against the opinions of the immediate representatives of the people, seems calculated to advance the public interest, or to promote a distinct and peculiar interest. We shall fearlessly, though temperately, examine the president's propositions, both as to the existing national bank and its proposed substitute; and we shall look at the subject with a single eye to the public good, for we have no other interest in the question than what is common to every citizen of the United States. We know that there is much good sense in this nation, and although there is a full share of prejudice too, yet no one need despair, that the former, if properly addressed, will eventually prevail.

That part of the Message which relates to the bank is in these words,--

"The importance of the principles involved in the inquiry, whether it will be proper to re-charter the Bank of the United States, requires that I should again call the attention of congress to the subject. Nothing has occurred to lessen, in any degree, the dangers which many of our citizens apprehended from that institution, as at present organized. In the spirit of improvement and compromise which distinguishes our country and its institutions, it becomes us to inquire whether it be not possible to secure the advantages afforded by the present bank through the agency of a bank of the United States, so modified in its principles and structure as to obviate constitutional and other objections.

"It is thought practicable to organize such a bank, with the necessary officers, as a branch of the treasury department, based on the public and individual deposits, without power to make loans or purchase property, which shall remit the funds of the government, and the expenses of which may be paid, if thought advisable, by allowing its officers to sell bills of exchange to private individuals at a moderate premium. Not being a corporate body, having no stockholders, debtors, or property, and but few officers, it would not be obnoxious to the constitutional objections which are urged against the present bank; and having no means to operate on the hopes, fears, or interests, of large masses of the community, it would be shorn of the influence which makes that bank formidable. The states would be strengthened by having in their hands the means of furnishing the local paper currency through their own banks; while the bank of the United States, though issuing no paper, would check the issues of the state banks, by taking their notes in deposit, and for exchange, only so long as they continue to be redeemed with specie. In times of public emergency, the capacities of such an institution might be enlarged by legislative provisions.