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Chapter 8 - The Two Distinct Branches of Western Scientific Medicine: Drastic and Subtle
"The great medical thinkers have all sought a rule or rules permitting correct interpretation of the primary data of experience. History shows that the search for interpretative rules can be conducted along two alternative lines. One is to emphasize the paramount significance of the specialized sensory data themselves...The other is to look for a higher order of reality assumed to be lurking behind the data of specialized sense perception...Any therapeutic system emphasizes one or the other of these approaches."
- Harris Coulter
POOR AND RICH MAN’S MEDICINE: FOLK VERSUS ESTABLISHMENT
Society has always been made up of the haves and have-nots. Both groups of people possess basic needs such as food, shelter, clothing, and medical care. The different economic demands and living conditions of the poor and rich have created two very different and distinct health care systems.
“Poor man’s medicine” is historically understood and referred to as folk medicine. The developmental pressures of affordability and accessibility on medical care for the poor-working class were affordability and the ability to remain on the job. Persistent health issues that required long breaks from work put poorer families at risk of starvation, loss of crops and animals, etc. The poor didn’t have the “option” to succumb to chronic illness, not when the alternative was loss of livelihood or even one’s life. No broad welfare or disability systems existed prior to modern-day social programs. If people didn’t work, they starved. There was no “leave with pay”, no vacation time, no workers’ compensation. Healthcare needed to be pragmatic, care had to be affordable, and interventions had to work well enough for the individual to work hard from sun-up to sundown.
“Rich man’s medicine” has always been and remains the medicine of those who hold positions of political, religious, and economic power–the establishment. The developmental pressures on the rich-care system have been more superficial since the welfare of the rich does not rely on daily physical labor. Treatment doesn’t need to be cost-effective either. In rich man’s medicine, treatment ultimately focuses on mollifying one’s psyche. Since performance capabilities aren’t the priority of the non-working class, rich-man’s medicine’s object is to provide comfort, palliate its customers. Establishment medicine pressures include appeasement of the elites, placating societal and intellectual sensitivities (what is in vogue or fashionable), and the ability to remain sedentary.
Historically, wealthy classes have valued leisure, and their healthcare requires lifestyle preferences to be considered. To put it crudely, all-too often the rich-man’s medicine clientele ask, “How can I sit on my ass, eat like shit, be comfortable, and look great?” Think modern-day cosmetic surgery: vanity measures to maintain a particular look, with minimal ongoing effort from the individual. Think anti-depressants, diabetes medications, and sleeping pills. Think antacids, laxatives, and gastric bypasses.
The persistence of these two such systems, of folk and establishment medicine, perpetuates societal separation along socio-economic lines. This often-unwritten rule of division perpetuates a distinction of modalities between those of the poor man’s system and those of the rich man’s system. Unsavory folk medicine labels further compound the division: superstitious, imaginary, unproven, dangerous, quackery, “snake oil,” placebo, unscientific.
There are two entirely unique systems of care in Western Scientific medicine. One is what most people are generally referring to when they use the term “Western medicine.” The other branch of Western medicine is just as well-known but often mistakenly attributed to the East.
WHERE FOLK AND ESTABLISHMENT MEDICINE DIVIDE
Establishment medicine is almost certainly readily understood by you. Folk medicine, however, deserves more explanation.
Folk medicine emphasizes treatments that are delivered primarily by hand and voice and through lifestyle modifications and nutrition. Items readily available, or affordable, like water and local plants were commonplace. If a root, leaf, berry, or bark from the neighborhood forest is required for the remedy, one needs only go collect it! The demand placed upon folk medicine was that it was easy to learn and perform, without the need for a drawn out and expensive education far from home. Expensive equipment which required support and maintenance was out of the question. Again, speech and touch have always been its preferred instruments.
The largest pressure in establishment medicine—was and sadly remains—economic gain for the providers of the technologies its practitioners employ. These suppliers not only include makers of drugs, surgical tools, and diagnostic instruments, but also include 3rd-party payors (whether public or private), and educational institutions. Regarding the former, governments and insurance companies love to receive money. The more medical care costs the more taxes national systems get to collect and the more seed money for the insurance agencies. Regarding the latter, as of 2022, a medical student can expect to pay in-state public medical school prices of approximately $157,080 for their four-year medical degree. If a medical student goes to an out-of-state or private school, their cost commitment jumps to $254,768 on average. A median, two-household collects an average of $70,000 annually in the U.S. The exorbitant medical education costs usually leave a family or student up to their ears in debt that requires many decades to pay off.
Women also commonly administered “poor man’s medicine”, whereas males historically dominated establishment medicine. Recognized folk modalities include midwifery, herbalism, herbology, hydrotherapy, manual therapy, and biofield modalities such as prayer.
These modalities largely fall within the purview of mothers and grandmothers or others within the community that have an adeptness for such practices. Remember Biddy Mason? She couldn’t read but could deliver babies and help heal people, and the local poor sought her out.
Poor man’s medicine has always relied on people rather than technology. Rich man’s medicine has always been focused on developing new technologies, like medications, appliances, diagnostic equipment, and robotic surgery, which don’t require a personal touch.
Poor man’s medicine often drives innovations that outperform advancements produced by the pressures of the rich man’s system. This creates a challenge for establishment medicine. To prevent the two systems from comingling, forming a new synthesis which could draw from the best of both worlds, measures must be taken against folk medicine. Sadly, ridicule, law enforcement, ostracization, and sham studies to prove folk innovations are “unscientific” are enough to maintain the divide.
The case study of Maria Theresa von Paradis, under the care of Franz Anton Mesmer, illustrates the differing approaches of these two distinct branches of medical care. And Dr. Mesmer broke the unwritten rule by bringing poor man’s methods into the establishment medicine world.
AN ILLUMINATING CASE: MARIA THERESA VON PARADIS
This case study is from the late 18th century and will demonstrate the two different branches in action.
The year is 1777, and the patient is 18-year-old Maria Theresa von Paradis. Fraulein Paradis was completely blind since the age of four. She was also a child musical prodigy, specifically the piano, and a close associate of Wolfgang Amadeus Mozart. Her family’s livelihood was dependent on two things: monies received from her performances and her father’s employment as ‘Secretary to Their Majesties the King-Emperor and Queen-Empress,’ As Fraulein Paradis’ fame grew, so did the family’s income and their ability to seek medical help for her. The Paradis family sought help for Maria’s blindness, eye convulsions, melancholia (depression), and “stoppages in the spleen and liver” that were allegedly the cause of her rage and delirium. In other words, Fraulein Paradis presented herself as completely out of her mind.
The Empress, also named Maria Theresa, not only arranged Fraulein Paradis’ musical education but also the decade-long treatments of an ophthalmologist, Dr. von Stoerck, the most startling of which involved electric shock treatments. Her father wrote:
They used electricity last year. More than three thousand shocks entered her eyes, and she had to endure a hundred at a time. The whole thing proved deleterious to her, resulting in agitation and spasms to the point where numerous bleedings were necessary to save her from utter collapse.
From her father’s account, we see drastic measures being used in what was then called heroic medicine, referred to here as Drastic Influence Medicine.
Drastic Influence Medicine, or DIM, consists of three main categories in which all of their treatments can be placed, those being pharmaceuticals, surgery, and heat.
Hippocrates, considered the “father of medicine,” penned the following in about 400 B.C., “hokosa pharmaka ouk iêtai sidêros iêtai, hosa sidêros ouk iêtai pyr iêtai (What medicines do not heal, the lance will; what the lance does not heal, fire will. What fire will not heal is incurable). This excerpt from the Hippocratic Corpus reminds us that DIM really only provides three options, they will either poison with drugs, scar you with a scalpel, or burn you with some sort of flame. Scar-burn-poison is how I summarize biomedicine’s modalities. I will revisit this topic in more depth in chapter 9.
DIM physicians bled Fraulein Paradis, purged her, and cauterized her. Her father recounts another treatment method employed whereupon Fraulein Paradis had her head covered in a plaster for two months. This made her uncomfortable, and she claimed she couldn’t breathe properly inside the mask. For all the barbaric measures endured, Fraulein Paradis did not improve with the DIM scar-burn-poison approach.
AN INNOVATIVE PHYSICIAN: FRANZ ANTON MESMER
On occasion, Dr. Mesmer crossed paths with the Paradis family and observed Fraulein Paradis in social settings. Dr. Mesmer was friends with Wolfgang Amadeus Mozart who had launched his career from Dr. Mesmer’s home. When Dr. Mesmer met with the Paradis family, he deduced that the problem was more with the mind and nerves of Fraulein Paradis. He was willing to use his novel subtle-influence method to treat her, having deemed her eyes capable of seeing.
Her parents agreed to work with Dr. Mesmer, who immediately stopped the harsh treatment methods: the bleeding, the use of electricity, and all other drastic measures. Fraulein Paradis and her parents all experienced the relief of this change, and Mesmer began the process of building rapport with his new patient.
Mesmer’s gentle method contrasted with the drastic measure she’d received previously. Like DIM, SIM operates according to three treatment principles. I classify them as equilibrate-optimize-support. Based on the available historical records, Dr. Mesmer massaged Maria Theresa’s bulging and painful eyes. This had a positive effect. In the words of her father:
On the second day, Dr. Mesmer caused an effect very surprising to those who saw it. As he sat beside his patient, he pointed his wand at the reflection of her face in the mirror. Then, as he moved the wand, she moved her head to follow it. She was even able to describe the movements of the wand…On the fourth day, she felt real relief and her eyes returned to their normal position. We could see that the left eye was smaller than the right, but the treatment gradually caused them to become the same size.
This is a notable testimony to the effectiveness of Subtle Influence Medicine: in a mere two days, Fraulein Paradis began tracking movements with her eyes, and within four days of beginning treatment, she had relief from the pain caused by DIM. Not only did Fraulein Paradis recover her sight, but her hysteria began to dissipate, and her trembling limbs stilled. She also experienced relief from sinus pressure. However, she experienced vertigo from the overwhelming sensory overload of pure darkness to light. Mesmer attempted to remedy her sensitivity by covering her eyes with a bandage until she was in dim lighting. Dr. Mesmer’s goal was Fraulein Paradis being accustomed to being able to see. The path to acclimating her to sight was also by using subtle measures to allow her body to regain its equilibrium with such a radical change.
THE ESTABLISHMENT TARGETS MESMER
Remember, the unwritten rule was that establishment and folk medicine should not cross. In the rich man’s world of Fraulein Paradis, Dr. Mesmer’s Subtle Influence treatment plan caused ripples. Dr. Mesmer’s methods and fame was spread by Herr Paradis writing accounts and having them published. As skeptical professionals asked to verify the results by examining Fraulein Paradis, Dr. Mesmer invited them to see for themselves.
Joseph Barth (1746-1818), a cataract specialist and professor of anatomy of diseases of the eye at the time, acknowledged on two occasions that Fraulein Paradis had use of her eyes. He later recanted these statements to avoid admitting that his methods were incapable of curing the girl and might drive clientele to Mesmer. Dr. Barth justified his refutation by stating that although she was able to see objects she couldn’t properly name them. Barth teamed up with Mesmer’s archenemy, Professor Jan Ingenhousz (1730-1799) in Vienna. Professor Ingenhousz was publicly challenging Mesmer’s methods and contesting the entire notion that Mesmer was able to cure anyone at all.
Trouble in Paradis’ treatment began with the parents causing a scene at Dr. Mesmer’s residence and makeshift hospital for live-in patients. As Mesmer sees it, loss of revenue from the young pianist becoming less of a prodigy made parental nerves take center stage. Mesmer imagined that her father didn’t want her to sink into obscurity after having such acclaim playing for nobility and making a handsome living, so he sought ways to bring her home from successful treatment.
Fraulein Paradis didn’t want to leave the care of Mesmer. Scandalous behavior ranging from her mother throwing Fraulein into a wall in Dr. Mesmer’s home to her father brandishing a sword was making care difficult. The incident rendered Fraulein Paradis once again without her sight and began a five-week treatment plan to restore her eyes again. Fraulein Paradis was making progress at a much slower pace. A visit home left Fraulein Paradis in full relapse. Tragically, she regressed to total blindness with all accompanying prior side effects and ailments. Mesmer admitted defeat to the emotional plague that raged from her home.
The whole ordeal was a giant scandal in Vienna, gossip spread like wildfire, Mesmer’s methods, character, and ethical qualifications were called into question. Character assassination remains a prominent establishment tool to attempt to stifle SIM practitioners even today.
A Dr. Ost, one of the Court physicians, is reported to have presented Dr. Mesmer with a letter from Anton von Stoerck (1731-1803). Von Stoerck was the chairman of the Commission of Investigation. His letter commanded Dr. Mesmer to terminate his fraudulent practice. Dr. Mesmer was dismissed from the Medical Faculty and instructed to give up his practice or leave Vienna, of which he chose the latter. These bullying tactics still happen today. Medical practitioners that operate outside of the confines of the establishment, beyond the auspices of “biomedicine,” regularly endure widespread criticism. Before moving on I’d like to share another example from the 19th century that also features Vienna.
IGNAZ SEMMELWEIS
Ignaz Semmelweis (1818-1865) was a Hungarian-born obstetrical physician who received his medical degree from the University of Vienna in 1844. After a little more than a year he was appointed Assistant Professor (chief resident) in the First Obstetrical Clinic of the Vienna General Hospital. The 1st clinic differed from the 2nd clinic in that the doctors who attended deliveries in the 1st clinic also performed autopsies during the same shifts. Soon Dr. Semmelweis noticed that there was another distinction between the two clinics. The maternal mortality rate in the 1st obstetrical clinic was 250% higher than in the 2nd clinic! The name given to the sickness which preceded the deaths was "childbed fever." Childbed fever is a distinct form of blood poisoning known today as puerperal fever.
The two clinics admitted on alternate days. As word got out about the higher mortality rate of the 1st, expectant mothers tried to avoid it. If one of them went into labor on a day when the 1st clinic was admitting some "accidentally" gave birth en route to the hospital and then submitted themselves for admission to receive the childcare benefits. Semmelweis was shocked to learn that these "street births" had a lower mortality rate than those delivered in his clinic, one as low as the 2nd clinic. He couldn't help wondering why the street was a safer place to give birth than his hospital ward. Sadly, it took a personal tragedy to illuminate an answer.
In 1847 Jakab Kolletschka, a forensic medicine professor at the university and close friend of Dr. Semmelweis, was accidentally stabbed by a student's scalpel during a postmortem examination. The autopsy of Dr. Kolletschka revealed identical findings to the autopsies of the women who died of childbed fever. Dr. Semmelweis theorized that some sort of "cadaverous particles" must have been on both the scalpel and the hands of the obstetricians and medical students attending the births. To test his theory, he mixed bleaching powder with water and had his doctors and students decontaminate their hands both before attending a birth and between them. Bleaching powder had only recently become widely available throughout Europe. A compound of chloride and calcium known today as calcium hypochlorite, bleaching powder was used to bleach cotton. Chlorine was not understood as a disinfectant at that time since the concept of infection developed many decades later. It can only be surmised, therefore, that Dr. Semmelweis believed that since bleaching powder effectively removed minute particles from cotton it may do the same from human hands. His hunch paid off and the maternal mortality rate in the 1st clinic plunged from 18% in April to only 2% after initiating hand washing – that's a 90% drop!
He greeted these findings with enthusiasm and eagerly shared his results with his medical colleagues. Many of his medical students helped him write letters, far and wide, to announce that a probable cure for childbed fever had been discovered. They were thrilled that they were providing a solution to the deaths 10s of thousands of women suffered every year throughout Europe. Sadly, their news fell upon deaf ears. The prevailing theory as to the cause of all disease at the time was Hippocrates humoral theory of a "bad mixture" of blood, phlegm, yellow bile, and black bile. Since the "cadaverous particles" theory didn't fit into their model it was resoundingly rejected and handwashing before and between deliveries was not instituted virtually anywhere. To make matters worse, Semmelweis’ remedy was to engage in a practice carried out by common folk while doing laundry!
Dr. Semmelweis and his students were flabbergasted. Their work was solid. The evidence clear. Semmelweis was not to be deterred, he had to find a way to get through to his colleagues. He was told to let it go but how could he? Only a monster could set aside what he had proven to himself and allow delivering mothers to die needlessly. His colleagues did not take kindly to his persistence. As a result, his contract in the 1st clinic was not renewed and he was subjected to both public and private ridicule. Not unlike Dr. Mesmer 75 years earlier Dr. Semmelweis was forced to leave Vienna altogether. He chose to return to his place of birth, Budapest.
Even back in Hungary Dr. Semmelweis found it impossible to gain employment. He settled for an honorary, meaning unpaid, position as the head clinician at a small hospital in Budapest. Upon arrival he found the childbed fever rates customarily high. He immediately instituted his decontamination procedure and the rate of maternal mortality dropped to less than 1%. Armed now with the additional evidence of a second study he renewed his campaign to convince his colleagues. Regrettably with the same result. Neither the other hospitals in Budapest nor those throughout Europe adopted his procedure.
Undeterred, Dr. Semmelweis chose a more thorough approach. He more fully developed his theory and presented his research findings in a full-length book. Etiology, Concept and Prophylaxis of Childbed Fever was published in 1861 and received considerable distribution. The outcome, he was criticized even more vehemently. Countless prominent European physicians publicly derided and criticized his proposals, including the renowned Rudolf Virchow (1821-1902) considered today "the father of modern pathology."
Dr. Semmelweis began to lose hope but how could he live with himself if he didn't continue his efforts. He turned again to writing letters, mostly to prominent obstetricians. Sleep was more and more difficult for Dr. Semmelweis to come by. His letters and conversations reflected both his anxiety and mental exhaustion. Not only did his colleagues accuse him of losing his mind but his family did too. Semmelweis was bringing embarrassment to both parties. Unbeknownst to Dr. Semmelweis plans were being concocted to eliminate their source of mutual humiliation.
Dr. Semmelweis seemed to take to heart the accusations of ill health. He, his wife, their infant, his wife's uncle, and a servant boarded a train destined for a famous sanitarium located in modern day Czechia. It was in the town of Gräfenberg and had been founded by Vincenz Priessnitz (1799-1851) one of the pioneers of subtle-influence medicine. Their first stop happened to be in Vienna. During the layover they were met by Dr. Semmelweis' colleague and close friend from his days in Vienna, Ferdinand Hebra. Dr. Hebra convinced Semmelweis to come see his own sanitarium not far away. Dr. Semmelweis, his uncle, and Dr. Hebra left his wife and infant in the care of the servant at the train depot.
The party arrived at what was allegedly Dr. Hebra's sanitarium, but it turned out to be a municipal insane asylum. As this discovery was being made by Dr. Semmelweis he also noticed that Dr. Hebra and the uncle had slipped away. Realizing he had fallen prey to a coordinated scheme, Dr. Semmelweis attempted to leave. Sadly, he was forcibly detained, severely beaten by several guards, and committed. He was placed into solitary confinement and no care was rendered to the injuries he sustained during the "admission." He died alone, from those wounds, 2 weeks later. In apparent ridicule, the cause of death written in German on his death certificate – pyämie (blood poisoning).
IT'S ALL VERY WELL IN PRACTICE. HOW IS IT IN THEORY?
Jokingly scientists will sometimes taunt a fellow researcher by saying, "It’s all very well in practice. How is it in theory?" Obviously, if something works in practice but lacks a developed theory, effective practice should continue nevertheless. If a satisfying theory is worked out, all the better. Dr. Semmelweis' colleagues seemed to have taken the joke about practice and theory as a valid truth. "If the practice doesn't fit prevailing theory, then throw it out!" seemed to be their rallying cry. Once again, the treatment of Mesmer is brought to our minds. Since the results couldn't be maligned, they chose to malign the deliverer of those results – Dr. Semmelweis.
Fittingly, this practice has been dubbed the Semmelweis reflex. It’s a fitting pejorative whenever someone is rejecting a potentially valid practice simply because it doesn’t fit prevailing theory or could be considered a folk remedy.
Do we really want to place intellectual gratification and class distinction above human life? Does it really matter if a cure doesn’t gratify one’s ego? Are we ready to move beyond these stifling notions? Are we ready to unleash unbounded innovation in the field of health and wellness? I hope so!
THE TWO BRANCHES OF MODERN WESTERN SCIENTIFIC MEDICINE
To take advantage of what each distinct branch of western scientific medicine has to offer, we must first realize that both branches exist; then, we can begin to understand exactly what each branch offers and how they are deployed.
You will recall in the account of Fraulein Paradis that the first efforts to affect a cure were quite drastic. The methods consisted of applying plasters, electricity, the administration of laxatives and diuretics, and bloodletting. The application of these initial methods was quite traumatic. Fraulein Paradis was left exhausted, discouraged, hopeless, and worse off. After these original applications her initial symptoms still persisted and new ones had been triggered. These initial administrations, at the time, were known as Heroic medicine. The term Heroic was used based on the Humoral Theory and went all the way back to Hippocrates. Humoral Theory had not yet been subjected to the scientific instruments that had emerged in the 17th century. Surely, it seems like Heroic medicine must have evolved, but has it really? Let’s look. |
