There are those who employ Hygienic care who have generally acquired the idea in some way that health is to be restored through some kind of experience that has received the technical appellation of crisis. So crises have come to be regarded not only as an essential concomitant of care, but often as the object of it and, hence, care is pursued in these instances with the production of crises as the desired end, never doubting that this is the most feasible way of acquiring health.

   Many Hygienists early questioned the validity of this plan of care and many of them, by the most acute analysis, showed that crises often have but an obscure connection with the causes of the patient's suffering. They said that the desire for crises is the result of false education, in which the profound virtues of drugs continue their hold upon the mind. The effects of drugs are to occasion disturbance, disease and a pathological state. The patient suffers an "operation" and the bettered condition that is supposed to follow is attributed to the effects of the drugs rather than to the continuance of the causes of life. One great error of the allopaths was that of converting the stomach and bowels into "critical organs," thus trying by violence to force a crisis upon one organ and compel it to carry off all the effete matter of the whole system. Carrying this thought over into the field of Hygiene, the mind of the uninstructed patient is intent on some important and new manifestation rather than on trying to secure the ordered harmony of the body by an insensible progression similar to that by which it was lost.

   The doctrine of crisis (that disease ends by crisis) is attributed to the legendary Hippocratis. Whoever may have been the authors of the ancient writings known as the Hippocratic Corpus, the doctrine is found in them. It would seem to have been applied largely, if not wholly, to acute disease; but when it was adopted by the Priessnitzian wash women, it was applied primarily to chronic disease. The crisis (not one but several) became essential to recovery from chronic disease and the watercure practitioners were very proud of their abilities to produce crises. For convenience of description, crises were divided into acute and sub-acute forms. Acute crises consist of febrile symptoms such as lassitude, fever, headache, chilliness and pain in various parts of the body, or increased discharges at some outlet of the body. When these symptoms develop, it is supposed that disease is in some way deported through the system, either through avenues previously opened or some new one.

   The second form of crisis consists of various types of skin disease, such as boils, pustules, rashes, ringworms and efflorescences of varied forms. The appearance of such symptoms was regarded as signifying a change of the feelings of the patient, especially with the effects of the irritant applications of drugs. Similar symptoms constitute the effects of drugs when administered with therapeutic intention and, so, the only principle involved is the choice of means whereby they are to be produced--that is, either a perturbed state of the physiological system which has been produced by drugs or by some other means of disturbing the vital functions in an unnatural way. But when similar symptoms develop from unknown causes or by accident, their occurrence is considered a grave matter, most imperiously demanding medical interferance. The crisis is now regarded, and rightly, as a pathological condition or disease.

   Thus it seemed to the Hygienist to be only relatively, and in a sense fulfilled by acute disease, that crises could be regarded as advantageous. They represent merely the best the organism can do under the impairing circumstances that have been imposed upon it and these conditions are never to be tolerated when we are aware of their existence and much less are they to be sought by artificial means. Under compulsion, the ordinary faculty inherent in the system becomes conservative and develops such unusual action as will tend to restore the lost physiological balance. The occasion of such tumultuous action is to be avoided and the action not to be sought. Though the two may end in harmony, we cannot regard it but as the result of an evil to be guarded against, and its occurrence is generally attributable to some unwitting mistake or accident that ought to have been avoided. Why, then, should we endeavor to produce a state of acute disease in trying to remedy chronic disease that at other times we ought to avoid. Dr. Taylor, discussing this very subject, said: "I have yet to find a case where it was really necessary to become sick in this manner in order to get well." He added: "Health, which is balance, can never hang upon such contingencies. The chronic invalid still lingers on through all the trials of his constitution, a martar to the conjoint folly of himself and his prescriber." He gave it as his opinion, without implying the existence of sinister motives on the part of others, that the stay of invalids in many institutions is often unnecessarily and tediously prolonged because of the pursuit of crises. He said that the credulous and unfortunate patient, frequently disappointed to find that the crisis, the sign of his deliverance, is but the seal of a new extension of his enthralment.

   It was the conception of many Hygienists that the idea that serves as the true basis of the program of restoring health is radically different from that which seeks deliberately to produce crises. The sensibilities and powers of the living organism do not require to be wrought upon in certain cases, nor in any case by causes of extraordinary power, differing totally from the fixed conditions upon which vital activities depend. In health, the congeries of vital parts of which the organism is composed act in harmony; this harmony is not to be restored by violence when lost. In the light of Hygiene, the restoration of the adjusting powers are not promoted by disturbing causes, derived from whatever source. The chief object of remedial care should be rather to restore the disturbed harmony of consensual parts. The conditions of this harmony or health are founded in nature and are not subject to the fitful variations that our ignorance or perversity respecting these matters would seem to imply. Hygiene, theoretically at least, interdicts disturbing causes, derived from whatever source. The resources of the prescriber are limited to just those principles and conditions as together evolve life and not sickness, only in some needful variations of their proportions. It fritters away none of the precious vital capacities for insignificant or inappropriate or useless purposes. It merely affords the proper scope and just direction while the obstacles that would circumvent the desired object are removed and health is silently and unostentatiously restored.

   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.