In this plan of treatment, we have a proposition to adopt mechanical measures- blood-letting-for the diminution of a congestion; chemical means-neutral salts-
for the solution of the exudation; and mechanical means again-diuretics-for the removal of the dissolved exudation from the blood.
But it cannot fail to attract the attention or every reader that this plan proposes to deal only with the results of disease-not with the disease itself- for the congestion is a primary results of the abnormal action of cell-wall, and the exudation which results from the congestion is a secondary result of the same abnormal action of the cell-wall. This is clearly shown by Dr. Bennett’s words already quoted, but which we again cite: “Not unfrequently the selective power of the cell appears to be lost, and the attractive power so much increased, that the liquor sanguinis is drawn out through the vessels, so that its fibrine coagulates in a mass outside of them. This result, preceded or accompanied by certain changes in the vessels themselves, and more or less stagnation of the current of the blood, constitutes the phenomenon hitherto described as inflammation.”
It is here most distinctly stated, and most conclusively shown, that the cause of the phenomena of inflammation lies behind these phenomena of congestion and exudation, and is to be found in a modification of that mysterious vital power of the cell-wall. It follows from this that a treatment which is addressed to these resultant phenomena, and not to their cause, must be but a palliative treatment. It can in no sense be called a radical or a rational treatment. To remove or assist in removing from the body or any part of it the results of morbid causes may alleviate suffering, may enable the patient to hold out longer under disease, just as pumping out a leaking ship may postpone the time when she will sink, may increase her changes of getting into port before she sinks, may thus in fact be the means of saving her. But as, certainly, pumping is only a palliative mode of treating a leaking ship-as the stoppage of the leak is the only radical treatment imaginable-so in the case of inflammation the only radical treatment would be one which addressed itself directly to the cell-wall, and in such a way as to restore to it the just amount and proportion of its now perverted “inherent attractive and selective power.”
It is evident that when this had been accomplished, congestion would cease to be produced, and in consequence of this cessation there would be no further exudation. It might now be within the province of Pathology to indicate some mechanical or chemical way of aiding or hastening the removal of the results of disease-the congestion and exudation-but this would be only a sequel of the curative treatment.
A curative treatment, then, must address, itself directly to the cell-wall, which is the ultimate seat of disease. And every method which is directed to the results of disease, which are the proper subjects of Pathology and Pathological Anatomy, must, of necessity, be a palliative method.
But, it may be objected, we are unable to plan any such curative treatment, for the reason that we do not understand the nature of this cell force, nor the nature of its perversion, in any case. To recur to our simile of the ship: it is sometimes impossible to find the leak, or, if its location be known, to stop it. Nothing remains but palliation. This statement, as applied to disease, is correct in only a few instances, the number of which is becoming continually diminished by the progress of science. It is true that we do not understand the nature of the cell force, whether normal or perverted. Neither do we understand the nature of chemical affinity, nor the modus operandi of chemical section. Yet we have an experimental knowledge of each, and we know the peculiar chemical affinities and reactions of a vast number of bodies.
In like manner we may learn the reaction of foreign bodies introduced into the circulation upon the inherent forces of the cell-wall. Reasoning upon the general physical law that “like effects are produced by similar causes,” we conclude that, if in any case, having introduced into the circulation of the healthy subject a foreign body, we observe the phenomena of congestion and exudation, with stagnation of the current of the blood, identical with those known to us as the phenomena of inflammation, then the peculiar inherent powers of the cell-wall must have been affected by this foreign body in precisely the same way (whatever it be) as that in which any accidental exciting cause of inflammation affects these forces. We thus discover re-agents which act directly upon the inherent power of the cell-wall, and we thus, by experiments upon the healthy, determine precisely the limits and direction of their action. This knowledge is rendered possible and exact by the science of Pathology, which enables us to trace out and analyze the results of internationally induced abnormal cell-action, just as it does those of accidental disease.
This is not a matter of mere speculation. It is well known to every physician that almost every drug, every substance in fact which is not a simple aliment, has, besides any chemical affinities it may possess for some of the secretions of the living organs, a certain peculiar power of modifying the functions of some of the organs of the body, a power which is inexplicable and is recognized only by its results. Examples of this power of drugs are found in that of Tartar emetic to produce changes which result in congestion and exudation, of Opium to produce changes which result in narcotism, etc. These, which are known as the specific properties of drugs, are evidently the properties by which they modify the forces of the cell-wall, and from which all observed Pathological (or Pathogenetic) and Pathologico-anatomical phenomena result.
And it is manifest that the specific modifying power of each drug can be surely ascertained, as an absolute property, by testing it upon the healthy living organism. And it follows as clearly, from all that has been said, that the application of specific drugs which have a direct action upon the cell-wall whose inherent forces are acting abnormally under the influence of disease, is the only direct and radical method of curing disease.
The task of finding out by what formula the specific action of drugs upon the the cell-forces of different tissues should be brought to bear upon the perverted cell-forces in any given case of disease, comes under the science of Therapeutics and lies beyond our presents province. It is the problem of the Therapeutics Law.
From all that has been said, the Relations of Pathology and Therapeutics may be deduced in a few words.
Physiology and Pathology themselves teach us that the science of Pathology can in no sense serve as a basis or foundation of the science of Therapeutics. They show us that whereas Pathology is the science of disease based on a theory of observed morbid processes, Therapeutics, when truly regarded, is a science of cure, based on a theory of cure and resting on a foundation of experiment. Although not the basis of Therapeutics, Pathology must yet be a most important instrument in the practical application of the science of Therapeutics.
The problem in the art of medicine being to apply to the abnormally acting cell-wall that remedial agent which is capable of acting directly upon it, and in such way as to restore its normal action, it is clearly indispensable that the physician be able to trace the morbific agent through all its complex resultant phenomena up to the original perversion of cell-force, from which the whole disorder springs; that he be able to analyze secondary and tertiary series of phenomena into their simple elements. And in this work pathology is the instrument of which he avails himself.
I cannot refrain, in conclusion, from rendering homage to that wonderful provision of genius by which, in an age when Pathology, as we understand it, was unknown, Samuel Hahnemann anticipated all that we have said, and all that the most advanced writers of our day have taught, respecting the scope and influence of PAthology in relation to Therapeutics.
The symptoms of the urinary organs in connection with the discharge of morbid urine would at one time have been regarded as the proper subject of treatment. But Pathology has now taught us to trace these symptoms back to the kidney, and beyond the kidney to the blood, and beyond the blood to the nutrition and the destruction of all the nitrogenized tissues. As DR. Carpenter remarks, “when, for example, the urine presents a particular sediment, our inquiries are directed not so much to the kidney itself, as to the constitutional state which causes an undue amount of the substance in question to be carried off by the urinary excretion, or which prevents it from being (as usual) dissolved in the fluid”. To confine the attention, therefore, in prescribing for a given case, to
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.