This section is from the book "The Home Hand-Book of Domestic Hygiene and Rational Medicine. Volume 2.", by J. H. Kellogg, M.D.. Also available from Amazon: The Home Hand-Book of Domestic Hygiene and Rational Medicine, Volume 2.
A few remarks on the general principles of treatment which should govern all who have any responsibility to bear in the treatment of the sick will be in place at this point. It is necessary at the outset to study the case with care, inquiring respecting the history of the disease as well as the previous history of the patient. Examine carefully into his present condition, interrogating every part of the organism so as to be sure of ascertaining all of the morbid conditions present as far as possible. Be careful to ascertain the cause of the sickness if it is possible to do so. When this is done, then institute measures for the relief of the patient. The following suggestions may be of service:
1. The first thing to be accomplished is the removal of the cause of the sickness when it has been ascertained, if it is of such a nature that its removal is possible. Sometimes this is not the case, but often it is. For instance, if a person has become sick from breathing an atmosphere filled with poisonous gases, or vapors from arsenical wallpapers, common sense would dictate that he should be removed from the poisonous atmosphere into one which is perfectly wholesome. If the illness is the result of eating unwholesome food or drinking water contaminated with germs, these causes should be removed at once. Even if the difficulty exists in the patients mind, as is not infrequently the case, especially in nervous diseases, something may be done to secure its removal by exerting upon the patient a proper mental influence. The importance of attention to the cause of the disease and its removal is generally very much neglected, though it is evidently a matter of primary importance.
2. Never apply or administer any remedy without a clear idea of how the patient will derive advantage from it, and without its being clearly required. Haphazard treatment always does more harm than good. The application of a remedy when there are no distinct indications for its use is likely to result in evil rather than good. When it is impossible to ascertain at once the real pathological condition, so that a systematic plan of treatment cannot be entered upon, do not adopt any plan of treatment, but study the case carefully, in the meantime administering only such remedies as are indicated for the immediate relief of the patient or the palliation of his symptoms.
3. A cardinal principle that should govern every physician or other person who engages in the treatment of the sick should be to act in harmony with nature; that is, to endeavor to facilitate the remedial processes which nature institutes and in many cases carries forward to a successful result. Be very careful never to hinder the efforts of nature by officious interference. It is a much safer error in the treatment of the sick to do too little than to do too much. While administering treatment of any sort, the immediate effect as well as the remote influence of the remedies employed should be very carefully watched and studied, not only for the purpose of securing good results with the case in hand, but in order to make the experience valuable with reference to the treatment of similar cases. In many cases, perhaps the majority, the thing to be accomplished by treatment is not to stop the morbid action which is in progress, but to modify or control it. In a great majority of cases, especially in acute diseases, the object of the morbid action is remedial. Nature is at work, endeavoring to free herself from obstruction, to remove obnoxious elements from the system, or in some way to remove existing causes of derangement and to restore harmony to the vital processes; but nature works blindly, she is not intelligent, and often destroys herself in the effort of self-preservation, by too great intensity of action. Hence, when the morbid action is becoming too intense, it should be checked by the employment of well-known means for lessening vital action, which have already been described and of which cold is the most useful and an almost indispensable agent in the treatment of nearly all acute diseases. When the vital action is sluggish or is of too little intensity for the accomplishment of the object desired, at least within a reasonable length of time, such remedies should be applied as will increase Or stimulate vital activity, for which purpose heat, electricity, and water properly employed, are among the very best of agents. On this account, the three agents mentioned are among the most indispensable remedies in the treatment of all chronic diseases, which are chiefly char acterized by insufficiency of vital effort. The effort should always be made to restore as far as passible the balance of vital activity in the different parts of the system, which balance is always destroyed whenever a part or the whole of the system is in a state of disease.
4. Since nearly all cases of disease, especially of acute disease, will recover if left to themselves, provided the vitality of the patient holds out until the remedial process is accomplished, it is in many cases of the very greatest importance that proper attention should be given to economizing and preserving the vital forces of the patient. Hence it is evident that depressing agents should never be employed when they are not distinctly and positively indicated. It is indeed fortunate for the present generation that the old-fashioned methods of treatment, the essentials of which were blood-letting and violent purgation together with mercurial salivation and other harsh measures of treatment, have gone out of fashion. It has been offered as an apology for the decline of the popularity of the remedies mentioned, among intelligent practitioners, that the nature of disease has changed, or the constitution of the people has changed. It seems to us that the latter suggestion is the true one, and in our opinion it is no wonder that the constitution of the present generation is decidedly different from that of the preceding, and that, as we have often heard said, "bleeding and purging are not well borne by people nowadays." The only wonder to us is that the people of the present generation have any constitution at all, with the exception of an individual now and then who is so happy as to be the descendant of some person who fortunately escaped the old-fashioned "mercurial course" of the last generation. The old idea that disease is a condition of excessive vitality was exploded long ago, and we are now waiting for the explosion of the modern fallacy, that all diseases, or a great share of them, are conditions of deficient vitality requiring stimulation carried to as great an extreme as was depletion in the old plan of treatment. The folly of the excessive-stimulant plan is still more clearly seen when it appears, as it does whenever careful and candid investigation is made, that the remedies employed as stimulants invariably operate in a manner directly opposite to the way in which they are intended to act. It has been most thoroughly demonstrated that alcohol, the most largely employed of the so-called stimulants, is a powerful depressant instead of a stimulant, that it destroys instead of creating force, and that it obstructs rather than re-inforces vitality. The proper plan to pursue in choosing remedies is to select those which will accomplish the desired result with the least expense of vitality to the patient, as by this means he will be given the best possible chance for recovery; and in case there is any doubt whether the application of certain remedy will do more harm than good, that is, whether it will hinder more than it will help the remedial process, or weaken the patient by lessening his vitality more than it will aid him "by checking the morbid process,-we say, whenever there is any doubt as to which of these two ways will be that in which a remedy will operate, the remedy should by all means be omitted, as it will be far safer to trust the patient in the hands of nature than to incur the risk of employing a doubtful remedy.
5. In the treatment of disease, four classes of cases, considered with reference to the results of treatment, come under consideration: (1) Those in which by proper treatment a complete and perfect cure can be effected; (2) Those in which the disease process can be checked, the patient made very comfortable, and his life thus greatly prolonged; (3) Those in which nothing can be done except to delay the progress of the disease and lessen the patients suffering; (4) Those which are not only absolutely incurable, but the progress of which can in no way be affected by treatment and all that can be done is simply to palliate the patients sufferings and smooth his pathway to the grave. Whenever a case is taken in hand for treatment it should be carefully considered with reference to which of the results described may be expected; and although the case may be evidently hopeless it should not be abandoned, but all should be done which can be done to meet the indications in the case, if not for cure, for the palliation of the disease. This plan has the advantage also that in not a few instances in which it has been pursued the unfavorable opinion which has been entertained has by the result been shown to be erroneous, since the patient has, in spite of all discouraging predictions, ultimately recovered. We have in practice met several cases of this sort, and have in consequence made it a rule of practice never to abandon a case so long as there is the faintest ray of hope of effecting a cure, and even when the last hope seems to be destroyed still to continue our efforts for the relief of the patient even though nothing more than mere palliation may be expected; and even in cases of this sort we have in some instances been most happily disappointed in seeing patients recover, notwithstanding the apparently hopeless character of their disease.