Psychotherapy

Serpents in Therapeutics.—Snakes and portions of snakes have been prominent features of deterrent therapeutics at all times. Headaches were cured by wrapping a dead snake around the head, or by the touch of a snake's skin, and sore throat by wearing a snake's skin around the throat at night. This seems one degree better than the custom, still common, of wrapping the stocking, that has been worn during the day, around the neck. In the chapter on Graves Disease, the use of the touch of a snake, or of a snake's skin worn around the neck, is mentioned. Girdles made of snake's skin or snakes themselves, were supposed to be good for colic and for various internal troubles, and were sometimes, among barbarous peoples, a sovereign remedy for the ills of pregnancy and assured the woman a safe delivery and an easy labor. Undoubtedly they lessened dreads by suggestion and the effort necessary to overcome repugnance. Some of the symptoms of the menopause have been cured in the same way. Rattlesnake oil has had a special reputation among mountainous people, where the snakes abounded, for the pains and aches of the old, and the vague joint discomfort, sometimes spoken of as rheumatic, but really due to various individual conditions. It is probable that in most cases the oil thus employed was not extracted from the rattlesnake, but was some ordinary oil palmed off under that name, and having its special effectiveness because of the thought associated with it.

Various portions of serpents are still in use, sometimes in the hands of physicians, though usually in popular medicine. I knew a physician in a small inland city who had a great local reputation for curing external eye troubles, and who owed not a little of it to the fact that the people in his neighborhood thought that he used rattlesnake oil as one of the ingredients for his strongest prescriptions. He was supposed to be able to dissolve even cataract by his remedies, and there is no doubt that in many cases of chronic indolent ulcer of the eye he was able to bring about a cure sooner, and have it last longer, than those of the regular profession who had not the advantage of this popular faith. He was careful to buy rattlesnakes from certain of the mountain people, who killed and brought them to him and who advertised the fact that they had such commissions from him. The stories were made all the more interesting by the fact that the doctor would not purchase dead rattlesnakes. They must be brought to him alive, since the therapeutic virtues can only be extracted immediately after death. A mountaineer with a couple of live rattlesnakes with him is always an interesting object and a fine advertisement. One would like to know what the doctor did with the snakes—that is, how he disposed of them without suspicion. Homeopathic physicians still have lachesis-viper venom in their pharmacopeia. Their remedies, however, if they really follow the dilution principle of their founder, can have an effect only on the mind, so that the use of lachesis is not surprising.

Repugnant Remedial Measures.—Quite in keeping with the use of deterrent remedies of various kinds are the recommendations to do certain things that involve great self-control, and the overcoming of repugnance, or fright, or the like. A favorite mode of preparing remedies in the Middle Ages was to gather the particular herbs for the prescription in a graveyard in the dark of the moon. The patient himself was supposed to gather them and to be alone when doing so, if they were to be effective. How much occupation of mind and diversion of thought would be afforded for timid people by the effort to overcome themselves to this extent! The occupation of mind alone and the concentration of thought necessary for the ordeal would be quite sufficient to divert many people from the centralization of attention on themselves, which is responsible for so many of their symptoms, or for that exaggeration of symptoms that aggravates the ailment.

Ordures as Remedies .—Among all primitive peoples we have the story of the use, as remedies, of ordures of various kinds, of repugnant portions of animals, of ground insects, of animal excrement and urine, and even of human excretions, of the blood of serpents, or eels, or carrion feeding birds, and the like. Ground lice and insects of various kinds are very common as prescriptions in the history of primitive medicine. They turn up here and there through the Middle Ages, and they are said to be still used in China. The more one knows about side-tracks in medicine, the more does one find of far-fetched repugnant materials vaunted as wonderful cures. Some of the substances employed are so disgusting that one does not care to mention, much less discuss, them. I have had a man tell me that, in a severe epidemic of diphtheria, he saved his children's lives when they were attacked by the disease, and the children of others were dying all around him, by blowing the dried excrement of dog down their throats.

There are certain popular medical practices that are related to these old traditions of deterrent therapeutics. In many manufacturing establishments, in spite of progress with regard to sepsis and antisepsis and the diffusion of information as to first aid to the injured, it is still the custom to put spittle on wounds. I am sure that every doctor has seen quids of tobacco used in this way. Even native-born Americans, who are not illiterate, are sometimes found using some deterrent material. I have known such a man use his own urine as an eye-wash for sore eyes, and the use of children's urine for such purposes is much commoner than might be thought. After all, it is only a generation since physicians used to taste urine in order to determine whether it contained sugar or not, and I have seen a country doctor even take between his finger and his thumb a little of the excrement of a child and apply his tongue to it, pretending of course that he obtained very valuable information this way.

Excretions and Secretions .—All the human excretions have formed the basis of vaunted remedies. Tears, on the principle that like cures like, were used for melancholia; nasal secretion to lessen respiratory difficulty through the nose; sputum for various mouth affections, but also as an application to external abrasions, and to the eyes, the ears, and the like. Undoubtedly patients were helped by many of these, not because of any physical effect, but because they felt easier as a consequence of the satisfaction of having something done for them, and the consequent freedom from solicitude which allowed nature to produce her curative reaction without interference. The greater the effort he has to make, apparently the more efficiently does he control this disturbing state of mind. This is the secret of many cures now as well as in the olden time.

Whatever good effect is produced in such cases comes, of course, from the persuasion that these substances will do good, and there must be a strong suggestion to that effect before the repugnance can be overcome. While we are prone to think the older peoples who used such materials commonly are to be condemned for ignorance and superstition, it is well to recall that human nature has not changed, and is still ready to be influenced in the same way. Brown Sequard's extract of testicular substance came in this category. We had a wave of organotherapy a few years ago, and we know now that whatever benefits patients derived from taking heart substance for heart troubles, and brain substance for brain troubles, and kidney for renal diseases, was entirely due to mental influence. The cannibal who eats the heart of his enemy, thinking that the vigor and courage of the other will pass into him, undoubtedly has for a time a power of accomplishment greater than before. Nothing acts so powerfully as suggestion of this kind to give renewed vigor and to enable us to tap sources of energy that we were not aware of in ourselves, and that enable us to accomplish what before seemed quite impossible, and even to bring about curative reactions.

Diseases Benefited.—Observe the classes of disease that were particularly relieved by deterrent therapeutics. Headache was one of these. All sorts of things were cures for headaches—the touch of the hangman's rope, or of an executed criminal, or some herb gathered in the graveyard in the dark of the moon, or pills made of the excrement of various animals. The forms of headache thus relieved would be those in which over-attention to self, rather than real headache, produced queer feelings in the head, though concentration of attention might exaggerate this into an ache. Foot troubles were cured by deterrent therapeutics. To wear the shoes of a dead person, especially of a murderer who had been hanged, would cure them. Colic was cured by pills of excrementitious materials, and by all sorts of other deterrent remedies. For instance, one well-known remedy was to wash the feet and drink the wash-water. The wash-water of little babies was a favorite remedy for the vague abdominal pains of old maids, and for the symptoms due to the menopause.

Deterrent Pain.—A striking illustration of a strong mental influence helping out a slight amount of therapeutic efficiency is found in the use of the actual cautery for medical affections. At a number of times in history most of the chronic pains and aches, the arthritises, the so-called gouty tendencies when localized, the rheumatic affections and especially the chronic rheumatisms, have been treated by means of the cautery. All of the neuralgias, many of the neuroses, all of the neuritises and a certain number of so-called palsies and paralyses, were treated successfully by this means. It is a very suggestive remedy producing a deep impression that now relief must be in sight. It became popular over and over again, though after a time it always lost its influence, and ceased to have the beneficial effects that it had at the beginning of its reintroduction.

During the second half of the eighteenth and the beginning of the nineteenth century the cautery became very popular. It was applied particularly in the form of the moxa. A cylinder of cotton was employed for this purpose, being set on fire and allowed to burn on the skin of the patient, producing a deep wound. The mental effect of this can be readily understood. Baron Larrey, one of the most eminent surgeons of the time, thought the moxa one of the best aids that he had in the treatment of many affections where the knife was not indicated. There were large groups of diseases in which it was almost a specific. Larrey employed it in affections of vision, of smell, of taste, of hearing and of speech. In many paralytic affections of the muscular system, in all chronic affections of the head, among which he enumerates non-traumatic affections, hydrocephalus, chronic headaches and many other affections supposed to be seated in the cranium. In asthma he was particularly successful with the moxa. Old catarrhal affections yielded to it. Consumption was frequently benefited by it. Most of the chronic affections of the uterus were benefited, as were also similar affections of the stomach. He considered that the moxa must be admitted, without contradiction, to be the remedy par excellence against rachitis. In Pott's disease, which he called dorsal consumption, it worked wonders. In sacrocoxalgia, in cocygodynia and femero-coxalgia he had excellent results with the moxa.

A glance at this list shows exactly the class of cases in which suggestion has always played a large role, and for which there has been, at various times, a series of specific remedies, medicinal, manipulative and surgical. Others extended the value of the moxa beyond these affections. Ponto found it valuable in gout, and in the various chronic affections which are sometimes grouped under the name chronic rheumatism. He insisted that the moxa could be placed on almost any part of the body, though the contra indications he suggests show how far the men of his time went with its use. Only these portions named might not have a moxa applied to them. It must not be used on the skull, on the eyelids, on the ears, on the mamme, on the larynx and on the genitals, though it might be applied to the perineum or the perineal body.

Deterrent Taste and Smell.—The disturbing effects produced by other senses besides those of sight have been used in the same way for the production of definite therapeutic suggestive effects. A number of the ill-tasting, almost nauseating drugs of the olden time prove to have very little real therapeutic efficiency in the light of modern clinical careful observation. This is particularly true of the herbs and simples. Many a disgusting preparation apparently owed all of its' good effects on the patient to the effort that was required to swallow it, producing such a favorable influence upon the mind, by contrecoup as it were, that the patient got better. A little girl said that cough medicines were nasty things they gave you in order to keep you from catching cold again. The sense of smell has been used in the same way. Valerian is probably an efficient drug in certain respects, but undoubtedly its efficiency is materially increased by its intensely repulsive odor. For many of the psycho-neuroses and neurotic conditions generally the ammonium valerianate is likely to be much more efficient than the strychnin valerianate, though probably the latter should be considered as more physically efficacious in its tonic properties. Asafetida, musk and some preparations of the genital organs of animals that used to be in the pharmacopeia, owed most, if not all, of their power, whatever it was, to the mental effect of their odor and the feeling of deterrence that had to be overcome before they were taken.

There is a precious therapeutic secret in this use of deterrent, repugnant, frightful materials which patients use to advantage under certain circumstances. It illustrates the influence of the mind over the body, and emphasizes the fact that such influence can be exerted in the full only when a deep impression is produced upon the patient. Whether this can be imitated without deceit, and without the use of undignified methods, must depend on the physician himself and his personality. There can be no doubt that there is a wonderful power here to be employed. It must be the physician's business to find out in each individual case, according to his own personal equation, just how he may be able to use at least some of it. It is well worth studying and striving for, because nothing is more potent for psychoneurotic conditions, and for neuroses on the borderland of the physical, than which no ailments are more obstinate to treatment.