Jennings and Graham did not discuss crises and must have thought very little of them. Alcott, also, ignores their supposed need. I once asked Dr. Tilden what he thought of this assumed need for crises and he replied that, under rational care, they are of rare development. Trall discussed, but did not stress them. Walter and Page never stressed them. In general, I think it correct to say that Hygienists were not enamored by the doctrine that critical actions are always essential to recovery from chronic disease.

Dr. James Caleb Jackson was a notable exception to this rule. He laid great stress upon crises and the need for them. In the June 1857 issue of the Journal, he not only elevates water-cure processes to top rank in the care of the sick, but stresses the need for crises in the process of recovery. He discusses this subject at some length in his controversy with the allopaths, these having severely criticized and condemned the crisis-inducing practice. Declaring crises to be "harbingers of redemption," he proceeds to explain the why and wherefores of crises. He explained that medical men see no such crises in their practice because their modes of treatment are such that the life forces must war against them, whereas his methods of care (chiefly hydropathic) were most gratefully received by the body.

He explains that whatever the disease of the patient, "only treat the case naturally, that is, scientifically--not artificially, that is, empirically or quackishly--and before the patient gets well a critical state will show itself, and which will be from various causes, more or less severe, but in no instance dangerous, but, on the other hand, decidedly encouraging to the patient as well as to the physician . . ." He thought that under "natural" or "scientific" treatment (by which was meant water-cure) the body was so invigorated that it mounted a determined resistance to accumulated impurities, while under "artificial" (drug) treatment, the body was expending its energies so prodigally in expelling the drugs that it had no energy with which to evolve a crisis.

Dr. Jackson says that: "Four out of five of my patients have crises of some sort. Ninety-nine out of each hundred who have them are benefitted by them, or, to speak perhaps more correctly, are better after them." He also says that: "For my own part, I hail crises. They are like a finger-board at a cross-road . . . a crisis is like a light shining in a dark place-it makes darkness visible."

Explaining the forms that crises take, he said: "In the treatment of chronic disease, the crisis is quite apt to be the same disease in an acute form. Thus, chronic rheumatism is quite likely to show critical action in the shape of acute rheumatism, which latter is much more easily managed than the former and when overcome, the patient puts on good, sound, vigorous health." Boils, ringworms, rash, miliary eruption, diarrhea, diuresis, chills, fever, vomiting, headache, neuraligia, pains in the back and other such developments are listed by him as crises. The newer term for them is "reactions."

Crises were thought to be revivals of formerly suppressed acute disease--the suppression being done with drugs. In recovering from long-standing states of chronic disease, the crises were supposed to develop in inverse order of the occurrence of the development of the acute diseases with which the patient had suffered. Chiropractors will here recognize the origin of their notion of "retracing," which they borrowed from the nature curists. Dr. Jackson presents a case to illustrate this inverse order of critical developments.

He cited a male patient who suffered with "fever and ague" (probably malaria) seven years before coming to him. In the iterim the man had suffered with "bilious fever," dyspepsia, liver complaint, hemorrhoids and severe chronic constipation. He consulted Dr. Jackson for debility, this affecting chiefly the reproductive system--probably impotency. He says: "I placed him under treatment and his ailments took the back track and he had every one of these diseases over again, closing up with fever and ague. It took him nine months to get well, but he has not had a sick day since and can do very hard work and do it well. It is only fair to say that the appearance of these various ailments was symptomatic, lasting but a little while, but he passed over the ground retrogressively . . . and he closed his sickness at the beginning."

This is one side of the picture. There is no doubt that crises do occur in getting well of chronic diseases; but, so far as our observations go, they are not as frequent, not as orderly in their assumed retrogressive occurrence and not so absolutely necessary to recovery as the hydropaths contended. It is our opinion that in the majority of cases, at least under Hygienic care, excretion can take place through the ordinary channels of elimination sufficiently rapid that no crises are essential. The advantages supposed to be derived from what are called crises are at least of very questionable import; the disadvantages are often very many and distinct.

In the October issue of the Journal, replying directly to the statements made by Dr. Jackson, Taylor lamented the fact that both patients and practitioners continued "to overlook the great fundamental principles that underlie our system and, like the allopath, continue to seek health through some formidable operation." He pointed out that "health does not necessarily follow forced acts of elimination, however complete or long continued they may be, or by whatever means it may be effected, since this does not imply, on the part of the system, the ability of self-regulation of function."

He says that it was frequently asserted by water-cure practitioners that "all the virtues of drugs are embodied in this single substance (water), in its power to produce emetic, stimulant, anti-febrile and a host of other effects, rivaling the vaunted qualities of remedies set forth in the most approved pharmacopoias. Some argue for a verbal modification of this statement, in the distinction that one set of curative measures employs poisons while the other does not. This distinction becomes insignificant," he says, "when effects are regarded, in which we are really to decide which is least inimical to vital welfare, rather than upon abstract chemical quality."

He further said that "it is this reliance upon the use of water to produce these manifestations, not inaptly called crises, that is the cause of much danger to the perpetuity of the system of medicine that we employ, and though the ignorant and empirical use of these means be decidedly better than any other, because based on a higher fundamental idea, yet the practice should be carefully guarded lest it degenerate into a practice no better than the theory."

"No one will contend," he said, "that what is called Water Cure crisis is absolute health. The effects of aloes might as well be called health. In both cases the system does the best it can under the circumstances to repel unnatural impressions. Whether drugs or water be employed, the organs may suffer a depression of their vital capacities from the inordinate tax imposed upon them and when repeated impressions upon the sensory organs be the chief means employed, abundant injury can follow, if the means are in inordinate excess."

The skin is an expanded nervous organ, adapted to originate and transmit to correlative parts two kinds of sensory impulses, that of touch and that of temperature. Every sensory impulse, however slight, transmitted by any terminal nerve, however minute, even though not capable of effecting the consciousness, is still competent to occasion action in the nerve center connected therewith. The repeated application of extremes of temperature, either hot or cold, in the application of hydropathic measures, may thus easily reduce the functioning powers of the patient by as much as they waste his energies.

This depressing effect of water treatment was strongly emphasized by Dr. Robert Walter, writing several years later. But we are here interested in Taylor's analysis of the doctrine of crisis. He correctly traced these "water cure crises" to the accumulation in the blood stream of "secondary products" or "evolved products of organic change" that are retained due to the depression of the organic capacities. As we would phrase it today: enervating treatment, placing an added tax upon the nervous system, further checks excretion and the resulting increase in toxemia precipitates a crisis or a process of supplementary elimination. The crisis becomes necessary, not because the treatment has raised the body's resistive powers, as was and is taught in some quarters, but because the treatment results in increased toxemia.

"I regard the production of crises, whether by drugs or water," continues Taylor, "as an evidence of the impropriety of the remedial means employed, or of the method of using such means, and of a radical misapprehension by the physician of the mode in which health is maintained and acquired, unless, indeed, these effects are traceable to his cupidity." Further: "It is lamentable to witness the effects of these extreme purgative efforts, whether by means of drugs or water. The victim, sustained only by that paramount function of the puerile mind, credulity, buffets the injuries heaped upon him till they transcend physiological endurance and then, instead of the promised health, finds every sense converted into a means of deceiving the judgement . . ."

Coming to direct reference to Dr. Jackson's article, he says: "In spite then, of authority not altogether unknown to readers of the Journal, I maintain that, in the practice of Medical Hygiene, water is no 'medicamentum,' nor is it a `specific remedy for disease,' as distinct from whatever else is appropriate to the wants of the system . . . To maintain the opposite faith is a stronger implication in favor of specific medication than is often claimed by the more intelligent of any school of practice. Let us cultivate a willingness to let the doctrine of crises and specifics go to the partisans that rely most on them, the vendors of pills and balsams. Though 'four out of five get a crisis and get well after it,' as they would in the case of drugs, many of my patients recite the tale of such a getting well with deep sorrow."

The two views of crises, as they prevailed in Hygienic and near-Hygienic circles in the last century are, perhaps, not as antagonistic as they may at first appear. The differences seem to grow more out of differences in emphasis than of principle. If we exclude the forced crises that were so common under the heroic processes of hydropathy and think only of those spontaneous crises that occasionally arise in the course of disease, whether one is being treated or not, both views are the same. We know that when enervating palliatives and forcing measures are discarded, the crises are not as common as otherwise. Thus it was that the two views of the crisis, as we have here pictured, grew directly out of the opposite modes of care of the chronic sufferer.

Any influence or indulgence that further enervates and inhibits excretion will precipitate a crisis and this is as true of methods of treatment as of habits of living. The heroic use of cold application can precipitate a crisis (by inhibiting excretion) as certainly as can overeating or dissipation. In either event, while the crisis serves to free the body of a part of its load of toxins--hence, is beneficial--it does not succeed in restoring health for the reason that the enervating mode of living or treatment is continued. The thing that Dr. Taylor objected to most in his article was the practice of water-cure practitioners of deliberately seeking to induce crises. He recognized that they were doing this by reducing the functioning powers of the body and thereby increasing the toxic load it was carrying.

All of this serves to confirm our oft-repeated statement that had the early Hygienists given more attention to Jennings, Graham and Alcott and less to Priessnitz, Schrodt and Rausse, Hygiene would have fared better.