Science of Therapeutics


An extensive and thorough knowledge of Physiology, Pathology and Hygiene are indispensable to the physician to enable him to make that preliminary analysis of a case by which he will determine under what category the case belongs.


HOMOEOPATHY THE SCIENCE OF THERAPEUTICS BY DUNHAM

Homoeopathy claims to be “The Science of Therapeutics.” This claim involves the assumption that prior to the establishment of Homoeopathy on a scientific basis, Therapeutics, as a science, had no existence. It is incumbent on Homoeopathists to show the justice of this assumption. To accomplish this, it will be necessary to prove that such a science is possible, to demonstrate what its nature and conditions must be, and to show that medicine hitherto has not furnished the means for the construction of a science which fulfills these conditions.

It is the objects of this paper, first, to discuss the nature and conditions of the only possible science of Therapeutics, to show that these conditions are not fulfilled by what is called rational medicine, and to inquire in what degree they are fulfilled by Homoeopathy. And, second, to examine the methods by which this science may be most successfully studied and made subservient to the practical art of medicine.

But on the threshold of the discussion we are met by the necessity of defining the term Therapeutics. It will be found that, though still sufficiently comprehensive, it is used by us in a much more restricted sense than that which, in popular thought, is attached to it.

Therapeutics being etymologically the science of curing diseases, it would seem to comprise the entire function of the physician. It is evident, however, on slight consideration, that the medical man in general practice brings into requisition too great a variety of scientific knowledge to admit of comprehension under a single term. To show how great this variety is and at the same time to give an indirect definition and limitation to the term Therapeutics, let us analyze a series of cases which shall not be ideal cases, but drawn from records of actual practice.

The physician is called in haste to an elderly person whose only intelligible complaint is of great anguish in the praecordia, and which appears by its violence to endanger his life. If he be in immediate danger of death, the state of his affairs renders it desirable that his family should be informed of the fact and how long he will probably live. The prognosis is demanded, and its correctness is a matter of great importance. The medical man must rely on his knowledge of Pathology (1 Throughout this paper, as always by its author, Pathology is used with a meaning totally distinct from that of Pathological Anatomy. The former is the science of morbid processes and functions, and is abstract; the latter is the science of morbid organs and tissues, and is concrete. A corresponding distinction obtains between Physiology, which is the science of healthy processes and functions, and Physiological Anatomy, which is the science of healthy organs and tissues) for a conclusion respecting the nature, cause, and probable termination of he disease. With this, if it be a fatal case, the function of the physician ends. Yet how important may this function be to the survivors! Here is as yet no question of Therapeutics. It is merely a problem in the natural history of disease, which the physician regards just as a Naturalist would a problem in Physics, and just as if the idea of curing disease had never entered the head of man.

Again, he is called to a man who lies in an epileptiform convulsion. It is well known that convulsions may arise from the most various proximate causes. They may result from physical irritation of the nervous centers or of the extremities of the nerve-filaments, and in this case they will cease to recur so soon as the cause of irritation is removed; or, on the other hand, from modifications of the vital functions, such as are beyond our observation and which we can rectify only indirectly by the action of specific agents. The first problem before the physician is to determine by a study of the phenomena which the patient presents, to which of these great classes the case before him belongs. It is indispensable to determine this question, because the treatment of the case must depend directly upon it, in the former case it may be mechanical or hygienic, in the latter it must be therapeutic.

He determines, we will suppose, in the case before us, that the convulsion is eccentric in its origin and reflex in its nature, and he sees reason for suspecting that it depends on some cause of irritation in a nerve-filament of the lower extremity. He seeks, in the history of the case, and by a physical examination, for this irritating cause, and discovers that the patient had, years ago, received a gunshot wound in the tight. There is no evidence that the ball was ever extracted. A close examination seems to confirm the conjecture that it still lies imbedded in the muscles of the thigh. An exploratory operation is performed and the ball is actually found lying upon a branch of the sciatic nerve. It is removed and the patient has no more convulsions (1 This occurred in the practice of a distinguished Surgeon of Massachusetts).

In this case the physician’s knowledge of pathology enabled him to discriminate between the varieties of convulsion as to their proximate causes; his acquaintance with physiology familiarized him with the phenomena of reflex- nervous action and enabled him to detect the seat of the irritation, and finally his dexterity in practical surgery placed it in his power to cure the patient of a dreadful malady. But, in this case from beginning to end, Therapeutics was not called into play.

Again, the patient, a child of two and a half years, is subject to epileptiform convulsions, which occur daily, often twice a day. They first appeared when the child was fourteen months old and soon after it was weaned. They are now producing a very sad effect upon the child’s intelligence. The same question of proximate cause, which the case gave rise to, suggests itself, first of all, to the mind of the physician. Careful investigation satisfied him that there is probably a constant or a frequently repeated source of irritation in the digestive apparatus. What so probable cause of irritation in these organs as improper food? The question is put at once, “what food does your child take?” “Nothing whatever, except molasses-cake and milk.” “How do you make molasses- cake?” “There cups of flour,, one of butter, one of milk, one of molasses, one egg and a tea-spoonful of pearlash!” “Very bad for your child! Give it good wheat bread and milk and nothing else, except this powder” (of sugar of milk as a placebo). The diet of the child is thus reformed, but no medicine is administered and the case is carefully watched. For one week the spasms steadily decrease in frequency and in violence, at the end of that period they case and they never recur. (1 This case occurred in 1857. spasms. The child on good diet There has been no recurrence of is healthy.) Thus an abnormal state of things, which would certainly have had a fatal issue, is rectifited by the application of a knowledge of Physiology, Pathology and Hygienes; but Therapeutics has no part in it.

Errors in diet being perhaps the most numerous of all of which the community are guilty, instances like this might be accumulated to an indefinite extent. It is clear that a large part of a medical man’s practice is made up of similar cases, and consequently that a great many serious cases may be successfully treated without recourse to medicine-without the aid of Therapeutics.

Again, a patient presents herself with the following history: Within three months she has rapidly emaciated; her sleep is disturbed, her appetite gone; she has night-sweats; is prone to diarrhoea; takes frequent deep inspirations which fatigue her; has a dry, hacking cough; complains of extreme weakness and despondency. A careful physical examination fails to discover organic disease of thoracic or abdominal organs, nor does an investigation of her domestic or social relations disclose any source of mental or affectional anxiety. The case is perplexing as to its inducing cause, and the physician inclines to ascribe it to dynamic causes and to have recourse primarily to specific remedies for its cure, in other words, to call Therapeutics to his aid, when he discovers that the patient is nursing an infant of twelve months. Her milk is very abundant, but a microscopic examination shows that it is extremely deficient in oily matter. It is now clear that the patient is unequal to the drain to which nursing subjects her; she is suffering from consequent anaemia. It is ordered that she wean her babe at once. As soon as she does so, appetite returns, the cough and night-sweats disappear, and strength and flesh are restored. Now, it is true that, in such a case, the decline of vigor may be retarded, and after weaning, the restoration may be accelerated by a judicious application of Therapeutics; but it is unquestionably true that Therapeutics would play a very subordinate part, since no administration of medicines could be an offset to the drain which is exhausting the patient.

In case of similar exhaustion, facial Neuralgia of a regularly intermitting character sometimes occurs and bids defiance to Therapeutics, the patient meanwhile declining rapidly in strength and health until, medicine being perhaps altogether discarded, but the patient induced to wean her infant and thereby enabled to take hearty food, strength and flesh return, and the Neuralgic pains cease. In this case, also, the restoration may be accelerated by a judicious recourse to Therapeutics, but here too Therapeutics must be subordinate to Hygiene.

Once, more, a patient, who exhibits signs of depraved nutrition, complains of a burning pain under the angle of the right scapula, with a tight aching across the back between the scapulae. I fear that repeated prescriptions will fail to relive this burning pain unless the physician’s knowledge of pathology shall have suggested to him that the symptoms results ultimately from a too steady use of the needle with too rapid a motion, and unless his skill in Hygiene shall have enabled him so to order her mode of life as to combine due recreation and exercise in the open air with her necessary labor. Here, as in other cases, Therapeutics may of course come in and play subordinate part.

Finally, a patient has severe darting and aching in the shin, especially at evening, with coldness of the extremity, and, after the pain has lasted an hour, great sensibility to touch, relieved by warmth and by continued motion. This case has been treated by a variety of Therapeutic agents in the hands of several learned practitioners, but with no success. It is noticed that the patient, in the course of his business, incurs great exposure to dampness and cold. A woollen stocking is advised, and the enjoys ever after adopting it almost complete freedom from suffering, and which is rendered absolutely complete by a few doses of Rhus toxicodendron. It must be remarked that this remedy had been previously administered in every variety of potency and dose.

Instances of a similar character to these might be indefinitely multiplied. They go to show, not that medicines are vain or unnecessary, but that very many cases of severe suffering and even of what threatens to become fatal disease occur in general practice, which call for and are successfully met by the application of scientific knowledge apart from Therapeutics. They show that an extensive and thorough knowledge of Physiology, Pathology and Hygiene are indispensable to the physician to enable him to make that preliminary analysis of a case by which he will determine under what category the case belongs, and whether or not calls for treatment by medicines in part or entirely-whether it comes under the domain of Therapeutics or not. They show, moreover, that, inasmuch as Homoeopathy directly involves the science of Therapeutics alone, there is a large field which is occupied and cultivated in common by Homoeopathists and practitioners of the Old School. They serve in part, also to mark the boundaries of that field in which “Rational Medicine” may legitimately claim dominion, in which her chief honors have been won, and in which the great advances which she boasts of having made in the treatment of diseases within the last thirty years have almost exclusively been achieved-the field of Hygienes. It is fitting that we study for a few moments this territory of Hygiene, which is common to practitioners of all the varieties of Therapeutics faith and practice, this science on which, together with the science of Therapeutics, the whole are of medicine is bases its subjects, limits, conditions, and mode of growth.