Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling. You can do little with persons who are disposed to accept these curious medical superstitions. There are those whose minds are satisfied with the million-fold dilution of a scientific proof. No wonder they believe in the efficacy of a similar attenuation of herbs or potions. You have no fulcrum you can rest upon to lift an error out of such minds as these, often highly endowed with knowledge and talent, sometimes with genius, but commonly richer in the imaginative than the observing and reasoning faculties.
Holmes’s major message was a stern warning that heroic measures, overdosing, and mineral purges were foolish ways of treating disease. He told the students of a surefire cure for agues and rheumatism, a cure safer than purges or bleeding. He advised them to pare the patient’s nails, put the parings in a little bag, hang the bag around the neck of a live eel, and place him in a tub of water. “The eel will die and the patient will recover.” This was an extension of the message Holmes had been reading to medical audiences since his manifesto at the Massachusetts Medical Society in 1860: “Throw out opium, which the Creator himself seems to prescribe . . . throw out wine, which is a food, and the vapors which produce the miracle of anesthesia, and I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom—it would be the better for mankind and all the worse for the fishes.”
Ever since doctors raised blisters, plied cauteries, and overdosed cases of what they called “spinal irritation” with calomel, the compliance of foolish patients has been exceeded only by the zeal of foolish physicians. Overuse of calomel, the cortisone of the nineteenth century, had led Holmes to believe that the French were in advance of the English and Americans in the art of prescribing for the sick without hurting them. He far preferred their various tisanes and syrups to what he called the mineral regimen of bug poison and ratsbane so long in favor on the other side of the Channel, much as he preferred French cuisine to the “rude cookery of those hard-feeding and much-dosing islanders.” He asked whether calomel was not sometimes given by a physician on the same principle by which a landlord occasionally prescribes bacon and eggs—because he could not think of anything else quite so handy.
IF CALOMEL WAS THE MOST OVERPRESCRIBED DRUG of the nineteenth century, spinal irritation was its most overdiagnosed ailment. “Some shrewd old doctors,” Dr. Holmes told the Bellevue students, “have a few phrases always on hand for patients who will insist on knowing the pathology of their complaints. . . . I have known the term ‘spinal irritation’ to serve well on such occasions.” It had already served well for over half a century. The spine became a locus for general malaise in 1821. Dr. R. P. Player of Mansbury reported that when he pressed on certain vertebrae, patients complained of pain and were often surprised at the discovery of tenderness in one or another bodily part: doctors and patients were puzzled. Along came the first complete account of spinal irritation in 1828, given by one Dr. Thomas Brown of Glasgow. He noted that while the spine was at the root of the problem, so to speak, the symptoms were often expressed elsewhere. Some of Dr. Brown’s female patients displayed painful, tender spots (beneath the breast or under the sternum) of which they had not been aware until the examination. The morbid sensibility was chiefly in the skin: “The patient for the most part flinches more when the skin is even slightly pinched than when pressure is made on the vertebrae themselves. The pain is in the majority of cases more severe than in those of real vertebral diseases.”
Spinal irritation crossed the Atlantic quicker than the submarine cable. At one time or another, most of the eminent Bostonians had their turn. As the Yankee men went off to their countinghouses, the malady became practically epidemic among the city’s well-off ladies. The generic “madwoman in the attic” of nineteenth-century literature was given calomel or laudanum for spinal trouble. She tended to stay in the attic or a daybed for life, or until the end of the book. Spinal irritation was the excuse for ever more heroic therapy on the part of medical practitioners. Holmes reminded the young students that persons who seek the aid of a physician are very honest and sincere in their wish to get rid of their complaints, because they want to live as long as they can. But since they are desperate to stay alive at any cost, they accept that “heroic therapy.”
The great majority of patients subjected to singeing and scalding, to cupping and leeching for aches and pains of the spine, were women. Their folly persists today: a review of recent textbooks and journal articles documents that women constitute between 85 and 95 percent of sufferers from the same symptoms that were once ascribed to “spinal irritations”; in the twenty-first century the ailments are called fibromyalgia, total food allergy, and chronic fatigue syndrome. A history of what passes as psychosomatic disease confirms the notion, tawdry but true, that women in pain are everywhere hassled by men with promises. One need not be a feminist critic to trace the foolish practices of today to their roots in medical misogyny. History teaches us that social norms shape medical fashion and that medical fashion in turn shapes the symptoms that patients select. A prominent historian of medicine, Edward Shorter, suggests in his From Paralysis to Fatigue (1992) that “most of the symptoms of psychosomatic disease have always been known to Western society, although they have occurred at different times with different frequencies: Society does not invent symptoms; it retrieves them from the symptom pool.”
As was the case with spinal irritation, many patients with fibromyalgia or chronic fatigue syndrome are no doubt afflicted by an as yet obscure response to chemicals or viruses; new candidates propose themselves weekly. But real microbes eventually cause diseases that really hurt, that kill, maim, or provoke detectable bodily ill. That’s not the point of the psychosomatic argument. “The unconscious mind,” our historian tells us, “desires to be taken seriously and not be ridiculed. It will therefore strive to present symptoms that always seem, to the surrounding culture, legitimate evidence of organic disease.” The patient must present symptoms that the medical culture cannot reject. By hook or by crook, by stealth or by wealth, new symptoms arise that evade the doctor’s new gadgets.
THE DIAGNOSIS OF SPINAL IRRITATION and its treatment by “counterirritation” reached its zenith in Spinal Irritation (1886) by Dr. William Alexander Hammond of New York. He routinely found “multiple tender spots” in women suffering from spinal irritation and ascribed some of the cases to sexual excess or, so he was convinced, masturbation. In keeping with his contemporaries, he advocated treatment with “counterirritants” such as dry heat, scalding water, or croton oil extracts. Hammond had been for a short time surgeon general of the United States. He attained the distinction, unique for that rank, of being court-martialed. His trial occurred during the Civil War after acrimonious squabbles with Secretary of War Edward Stanton and bureaucrats of the career Medical Service. His chief problem, aside from a personal lapse in petty finance, seems to have been that he was too closely affiliated with the reformers of the Sanitary Commission.
But Hammond was able to recover from political infamy; eventually his reputation was cleansed and his rank restored by the Senate. He went on to become one of the founders of the American Neurological Association and also of the NYU Postgraduate Medical School, in the library of which his books are now quietly disintegrating. Hammond’s magisterial A Treatise on Diseases of the Nervous System (1871), the first American textbook of neurology, is an extensive tome, published a scant seven years after his fall from official grace. The treatise is filled with outmoded rituals and jawbreaking syndromes. Scattered among this dross are neatly described case histories and new observations, but the volume is tough slogging.
In contrast, Hammond’s other professorial book, A Treatise on Insanity in Its Medical Relations (1883), is only 738 page
s long and can be read like fiction—the stuff of Maupassant or William Dean Howells. The chapters on “hysteria” and “hypochondriacal mania” yield the richest lode of stories. Hammond’s characters include Eliza C., “who crowned herself with flowers, took a guitar, and announced that she was going to travel through the world. She got up in the night and washed her clothes in the chamber-pot. Then she had convulsions, mewed like a cat, tried to climb up the wall and finally fell into a state of stupor.” Brief, mad lives are recounted by the hundreds in this astounding compendium, including the intervention of astute Colonel Charles May of the U.S. Army, who—by means of bloodless, bogus surgery—cured a fellow officer “of the belief that he was inhabited by chicken bones.”
Poor Miss A.W., a patient of Hammond’s, had the habit of swallowing pins by the dozen. She later extruded these pins from her skin, her nose, and various nether orifices (surely the first documented case of pins envy). We also learn of a “young lady from a Western city” who had “grasped a large knife that lay on the table and would have killed her mother with it had it not been seized by her sister, who was present.” She explained this subsequently by saying that she had thought her mother “was a black man who was stealing her jewelry.”
Hammond shows warmth and empathy for his mentally ill patients, regarding them in the tolerant, bemused fashion of a Victorian author displaying his fictional creatures:
Kindness and forbearance, supported by firmness, will not altogether fail in their influence with even the most confirmed and degraded lunatics. Probably the most difficult class of patients to manage by moral means is that of the reasoning maniacs, and next to them those cases of hysterical mania which exhibit marked perversities of character and disposition. But even with such people the principles of justice and fair dealing will not be lost, and eventually an impression will probably be made on subjects incapable of being touched by other measures.
But woe to the patient who failed to respond to “moral means,” the talking cure. She—for it was usually a female patient—was in for leeches or counterirritants:
On the other hand, local bloodletting by cups or leeches is often a useful measure, especially in those cases in which there are pain and heat in the head accompanied with insomnia and excitement. A couple of leeches to the inside of the nostrils are remarkably efficacious in relieving cerebral hyperaemia [too much blood in the brain] and mitigating the violence of the physical and mental symptoms resulting from it. As to counter-irritants, such as blisters, croton oil, tartarized antimony, and the actual cautery, cases every now and then appear in which they seem to be of service. I have, however, several times aggravated the mental and physical symptoms of insanity by their use. I suppose the most generally advantageous agent of the kind is the actual cautery very lightly applied to the nucha [the nape] of the neck, but then the action in such a case can scarcely be called counter-irritant.
For simple hysteria, talking cures seem to work best, and it mattered not which learned profession did the talking or listening. A young lady of 20 began to wear “pads over the abdomen and gradually increased their thickness” until, confronted by her parents, she confessed to unwed pregnancy and declared a gentleman lawyer they all knew and respected to be her seducer. The outraged father offered the lawyer the alternative of “an immediate marriage or instant death from a pistol pointed at his head . . . the pistol, cocked, was very near his brain.” Only after he had unwillingly agreed to this handgun marriage did the lawyer have a chance to chat with his betrothed. Using measures less severe than leeches or cautery, the lawyer by his tact and the directness of his questions succeeded in exposing the fraud and obtaining a full confession. The marriage was canceled and Hammond was engaged to complete the cure.
Some of these vignettes can be read as drafts for the melodramatic or gothic novels of Hammond’s day; in this context, Dr. Holmes’s Elsie Venner comes to mind. But the anecdotes were intended to reveal neither the character of individuals nor the nature of the society in which they moved. Instead, only enough detail was given to illustrate the variegated clinical forms of hysteria or spinal irritation.
Spinal irritation or inflammation eventually became the basis of an organized religion: Christian Science. Mary Baker Glover Patterson Eddy suffered a small epiphany when she hurt her back in 1866. Her injury was an obscure hurt that seemed to mimic an injury received by Henry James the younger in 1861. She was literally struck by the notion that since “matter and death are mortal illusions,” one could overcome disease by exercise of mind. There is, in fact, a large area of agreement between this notion and those expressed by Henry James the elder in Shadow and Substance. What a Bostonian affliction! Poor Mary Baker Eddy was troubled all her life by “spinal inflammation and its train of suffering—gastric and bilious” to the point where her second husband had to carry her downstairs for her wedding ceremony—and back to her invalid bed directly thereafter. Sure enough, with the help of healing and the mind, she was soon able to climb all 182 steps of Portland’s city hall tower. Eddy and her followers were persuaded that Christian Science and its healers constituted the main line of defense against “malicious animal magnetism,” which was the main cause of illness and death. This not unpersuasive system of alternative medicine has continued to outlast its origins in spinal irritation.
As the last century wound down, rational France was again swept by medical unreason. Spinal irritation yielded to “hysteria” under the careful ministrations of Jean-Martin Charcot (1825–1893). Charcot began his career as an astute internist, and his clinical observations remain part of the literature of modern medicine. But once he turned to diseases of the mind, he became a Barnum of the mental wards. These days he is regarded as little more than a link between Mesmer and Freud. As with the ideas of Louis Agassiz, most observers agree in retrospect that there was more humbug than matter to Charcot’s theory; if his talents were clinical, his genius was theatrical. His clinical demonstrations at the Salpêtrière hospital were open to the public, and a generation of dazed, sick women was displayed to an audience of fashionable voyeurs. The sessions were in stiff competition with the boulevard theaters of the fin de siècle, and perhaps for that reason most of the clinical syndromes Charcot described, such as grande hystérie, are now believed to have been either fancied or staged.
A student of Charcot, Dr. Jean-Albert Pitres of Bordeaux, found that attacks of grande hystérie took their origin in—you might have guessed—certain tender spots. In cases of hysteria, Dr. Pitres was able to define a “demarcated spasmogenic zone” over his patients’ bodies (the small of the back, both armpits, and the bottom of the sternum) as well as over the ovary.
Sigmund Freud, who had traveled to the Salpêtrière to sit at Charcot’s feet, was also a devotee of the tender-spot doctrine. He described hysteria in terms that might astound not only feminists. His patient Fraulein Elizabeth von R. had such an area, and when Freud touched a sensitive spot on her skin, she cried out. He could not help thinking that it was as though she were “having a voluptuous tickling sensation; her face flushed, she threw back her head and shut her eyes and her body bent backwards.” In 1895, another of Freud’s patients, Frau K., had cramp-like pains in her chest. “In her case,” Freud told his friend Wilhelm Fliess, “I have invented a strange therapy of my own: I search for sensitive areas, press on them, and thus provoke fits of shaking which free her.” His patient’s spasmogenic zones, originally in her face, shifted to two points on her left chest wall—identical, Freud said, to his own spasmogenic points. But before we rush Freud to the wall for what we know to be the real meaning of all this, we might recall that the method we use to arrive at our conclusions was devised by him.
The remedy for all those myalgias, for all that accumulated pain and fatigue, was a century-long concentrated attack by male doctors on the female reproductive tract. More than half of the articles dealing with oophorectomy in 1889 described it as a treatment for mental disease; hysteria (from the Greek word for “womb�
�) has, of course, been traditionally attributed to disorders of the womb or ovaries. Other modes of therapy for spinal irritation or hysteria included cauterization of the clitoris, hysterectomy, curettage, cupping, electroshock, and arsenic.
But the diagnostic fancies of pressure points and tender spots followed by counterirritants and nostrums are not limited to the past. The folly persists today, as can be seen from the fibromyalgia literature. The presence of eleven or more of eighteen “specific tender point sites” together with widespread pain in the absence of radiographic or lab abnormalities suffices nowadays for the official classification of fibromyalgia. Doctors who believe in this diagnosis today elicit pain at the magic spots of their mainly female patients by means of either a pain-metering machine or “palpation with the pulp of the thumb or the first 2 or 3 fingers at a pressure of approximately 4 kilos.” One textbook expert of the 1990s suggests a variety of treatments for this syndrome under the general rubric “Counterirritant Therapy.” These include “a wide variety of popular or unusual therapies, including massage, heat, liniments, steroid injections, ethyl chloride spray, and acupuncture,” all of which he believes to be helpful in relieving pain and which sound very much like Hammond’s prescriptions for spinal irritation. Since the magic potions haven’t changed for over a century we might call this cult medicine rather than science. Our expert confirms that notion: “Factors influencing a choice of counterirritant technique will include simplicity, safety, and availability and economy on one hand and maximal placebo effect on the other.”
Women, and not men, will be subject to these measures for the therapy not only of fibromyalgia but also “irritable bowel” and “chronic fatigue syndrome,” the official criteria for which differ very slightly from those for fibromyalgia. One might therefore ask whether sexism, historical folly, or medical science is at work; homeopathy and its kindred delusions revisited, we might answer.
The Fevers of Reason Page 8