Physician and patient

by Worthington Hooker

I will speak first of the tendency to throw off disease, the vis medicatrix naturæ. I need not spend time in proving to you the existence of such a tendency. It requires not the exercise of any scientific acumen to discover it. It is obvious to the most superficial observer. And yet the extent to which it operates is far from being properly appreciated, even by medical men; and much less is it by those who are out of the profession. The changes which it produces are constantly confounded with the effects of remedies; and this is one of the chief sources of the errors which encumber the annals of medical experience.

The reader will see, as we proceed, that boast as doctors often will of their cures, as if they were wholly theirs, this vis medicatrix naturæ is the chief doctor after all; and she, good, kind angel, hovering over the bed of sickness, without fee, and often without even any acknowledgment of her services, saves the life of many a poor patient, who is near being drugged to death by some ignorant quack, or some over-dosing doctor.

That the reader may be somewhat acquainted with the extent of the influence which this curative principle exerts, I will cite some examples of its operation.

If some offending substance be present in the stomach, vomiting is produced, the substance is evacuated, and this organ, having thus relieved itself by an effort of nature, as it is commonly expressed, now goes on with the performance of its usual functions. In this case, the ordinary action of the organ is entirely reversed, in obedience to the curative principle. If an attempt be made to allay the vomiting before the offending substance is thrown off, it is an injurious interference with a salutary effort. Sometimes the effort is ineffectual, and needs the assistance of art. It is often difficult to decide whether vomiting is prompted by this curative principle, or is caused by irritation, which should be quieted by medicine. Want of due discrimination, either from lack of knowledge, or from carelessness, very often leads to errors on this point.

The operation of this principle is beautifully exhibited in the succession of the processes of inflammation. You see a swelling. It, after a while, begins to soften. There is matter in it, but it is not yet very near the surface. But soon, at some point, it comes nearer and nearer to the surface, the wall of the abscess thus becoming constantly more thin, till, at length, it opens and discharges. The discharge continues till the swelling is nearly all gone, and the remainder is absorbed, and the part is restored to its natural state.

Now, this is quite a series of processes, all contributing to one result, and it is presided over, or directed, by the vis medicatrix naturæ. The object of this series is a definite one; and each process does its part in effecting it, and does it commonly at the right time, and in the right manner. Just look for a moment at the complicated character of this apparently simple operation. Here is quite a large deposition of substance which is to be removed; and this is the object to be effected. Observe how it is done. The softening of the swelling is not a mere change of solid substance into a fluid, as if by decay, but it is the result of an active process, which we call suppuration. When this process is properly performed, good pus is made, or as the old writers in medicine rather quaintly expressed it, laudable pus. This process of suppuration, when it is well done, does not go on here and there in the swelling, making it like a honeycomb with a multitude of little abscesses; but there is a consent, an agreement of action by the vessels of the part, as really as if they worked intelligently. It is this consent of action which not only makes the line of movement in the abscess, but points it towards the surface, instead of giving it some other direction, laterally, or inward, upon some of the internal organs. But it is farther to be observed, that in this agreement of action, the vessels of the part do not all do one thing. Three different offices are performed by them in the different quarters of the abcess. While some of these little workmen are forming the pus, there are others thinning the wall of the abcess in the direction of the surface, by absorbing or taking up the substance there; while there are others still, in the rear, and at the sides of the abcess, depositing substance, in order to make a barrier to prevent the pus from being diffused in the surrounding parts. Each class of these workmen perform their particular work with even more exactness and harmony than would be expected of any company of intelligent laborers under the direction of a leader. The absorbents absorb together, the wall builders build together, and the makers of pus make pus together, and deposit it in a common reservoir.

But observe farther, and you will soon see an entire change come over the whole scene of operations. When the absorbents have completed their passage for the matter through the skin, the pus is gradually discharged from its reservoir, and the “occupation” of the pus makers is soon “gone.” The wall builders also cease their work, and while the vacancy becomes filled up by contraction and deposition, the wall of defense, so carefully maintained, so long as it was needed, is now taken up by the absorbents—workmen which seem to know just when, as well as how, to do their duty, and is emptied into the common circulation, to be discharged from thence with the general refuse, by the various outlets of the system.

The object of all this is the restoration of the part to its healthy condition, and it is effected by a principle existing in the system—it matters little comparatively by what name you call it. The name is simply expressive of a great, general fact, as the term gravitation is, and is not intended, any more than that term is, as an explanation of the nature of the fact indicated.

This same principle is in operation in all diseases, resisting them, hemming them in, and as they retreat, following hard upon their footsteps, repairing their injuries as well as it can. It is true that its efforts are often ineffectual, that they are sometimes overpowered by disease, that they are frequently perverted by injudicious interference, and that they are sometimes stimulated to a higher degree than is necessary, producing over-action, and thus making this conservative principle an instrument of injury, perhaps destruction. It would be interesting and profitable to illustrate these several points in the operation of this principle, but it is not essential to our purpose.

We will pass now to the consideration of the principle of self-limitation,[3] which we find existing in many diseases. These diseases have a regular rise and decline, including a set of processes, and a succession of symptoms peculiar to themselves. When they have once fairly begun, they cannot be abridged; neither are they prolonged beyond their natural limits, though they may, and often do, leave results behind them, which are sometimes mistaken for a continuance of the disease itself. The period of continuance is more definite and fixed in some of these diseases than in others, and there is a similar difference also in regard to uniformity of shape. Thus small pox runs through its course with more regularity of period, and with a more uniform series of phenomena than scarlet fever, which, though having a certain general character and average period, is extremely diversified in its degree of severity, and in its accompanying circumstances. The more simple and regular and definite any disease is, the more accurate can our observations be in regard to it, and the less apt are we to confound the effects of remedies with the natural changes that take place in its progress.