SUGGESTION FOR “A MODEL MATERIA MEDICA”


An intelligent arrangement of drug-effects requires a knowledge of Anatomy, Physiology, Pathology and indeed, of many branches of a scientific education. Symptoms are not merely empty words, they mean something, and to determine that meaning one needs all the culture a complete education can afford….


TO deserve the title “model” a Materia Medica must be more than an abridgment restricted to a maximum of five pages to a drug. The limitation of a drug must be measured by its own capacity, not arbitrarily.

To meet all the requirements of a “model” each drug should be arranged with due regard to the following points:

1. Its officinal name, its place in natural history and its composition.

2. A concise statement of such characteristic features as are nearly or quite universal in its symptomatology.

3. A clear compact but complete arrangement of its symptoms, subjective and objective.

(a) These symptoms should comprise not only the effects of provings, but also such developments of provings and such merely clinical symptoms as are indisputably characteristics.

(b) As we depend so much upon the parts of the body affected, every attention must be paid to the localization of symptoms.

Let us dilate somewhat upon these several points:

1. That officinal names are needed is self-evident. Equally apparent is that euphony requires the adoption of a fixed pronunciation of drug names; and this can be utilized by proper syllabic marks.

The origin of a remedy is often very suggestive. So soon as it is known that Duboisia belongs to the Solanceae, our familiarity with the mydriatics of this order, enables us at once to interpret the dilated pupil and dry mouth of the new plant. When Bothrops is found to be an Ophidian, the general nature of its effects is almost pre-determinable.

Composition is often more suggestive even than origin. Two or more substances, which contain the same active principles, must, of necessity, possess similar properties.

A knowledge of the source and of the constituents of drugs, is all important, then, as it leads to an intelligent unification of the Materia Medica.

2. Before any schema of symptoms is devised, the drug should be prefaced with a concise statement, not of its vague generalities, as has been the custom, but of peculiarities which are essentials, and which, consequently, must enter the thought as qualifications of what is to follow.

3. But the chief task is that of arranging the symptoms of a drug. To render a work practical, it must be free from all verbosity, unnecessary repetitions and vague, unimportant symptoms. But condensation is so frequently effected at the sacrifice of valuable matter, that if we would avoid such loss, we must proceed cautiously and intelligently. Whenever in the provings we find two or more symptoms differing only in fulness of expression, we may select that on e which is nearest complete in phraseology. But if two symptoms, agree in the main, but offer in addition entirely different modalities, both must be employed.

In selecting symptoms which are local, those are preferable that are most characteristic, But since a drug, when fully proved, acts somewhat on nearly all parts of the body, completeness requires that all parts should be represented in the abridgment.

Clinical experience has taught us that local symptoms are of inestimable value. For instance guided by the splenic pains of Ceanothus, leucorrhoea has been cured by that remedy. Influenced by the sour stomach of Robinia, one physician learned to value that drug in ulcers on the legs. And so on indefinitely But since such indications are frequently derived from practice, we must not neglect clinical symptoms.

Our estimate of these latter symptoms should depend, it seems to us, upon their agreement with the provings, with the genius of the drug to which they are assigned, and also upon the reputation of the physician who reports them. If they disagree with the provings, they can form no part of a precise Materia Medica.

The clinical symptoms are most trustworthy, which are evident developments of imperfectly expressed provings; or, which have been so frequently confirmed as to have become indisputable facts. Xanthoxylum has not caused pains along the anterior crural nerve, and yet it seldom fails to relieve. But as it has caused neuralgic pains in the thighs, and also uterine and ovarian pains, we have a right to conclude that its clinical estimate in crural pains is just. Hepar as a remedy in suppuration has no foundation in provings, other than in certain subjective sensations, which led to its trial; and yet no one to-day, not even an Allopath, will deny its efficacy.

Having made choice of the material to be used, the next step is the adoption of a schema of arrangement.

All plans hitherto employed are open to the serious objection that they violently severe symptoms and so impair or destroy the natural sequence of drug-effects. We do not quite agree with those who assert that a remedy is of no use unless selected according to the order of its symptoms. Nor do we coincide with those who affirm that parts of one series of symptoms cannot be transferred to another series. For instance, if a drug causes headaches on the right side, worse from motion, and, in another prover, headache on the left side, with nausea, it does not follow that the qualifying phrase in the first may not also qualify the second, and vice versa.

It seems to us that the most efficient schema is one which begins, as we have already observed, with a description of the universal qualities of a remedy, which next considers symptoms as to their respective localities and concomitants, and which finally displays such rational combining of subjective and objective, physiological and pathological symptoms as will enable the reader to make practical application of them. It is useful to say that Hepar may be employed in that pathological condition known as pus formation; but it is more practicable to say that Hepar may be employed when, in addition to the presence of forming pus, there are also present throbbing pains, rigors and the extreme sensitiveness to touch, so characteristic of the remedy.

But, further an intelligent arrangement of drug-effects requires a knowledge of Anatomy, Physiology, Pathology and indeed, of many branches of a scientific education. Symptoms are not merely empty words, they mean something, and to determine that meaning one needs all the culture a complete education can afford. A “model” Materia Medica demands more than the vague statement that for instance, “slimy yellow mucus covers the tongue” if that so-called mucus is actually pus hanging from Steno’s duct!.

But, though very useful, the ordinary means of investigation employed by the old school are often too gross to fulfil the requirements of our molecular drugs. A thermometer will tell us whether or not a medicine taken is affecting the temperature; chemical analysis will reveal the nature of the red deposit in the urine, and the microscope will tell when the sputa contain pus-cells, lung-tissue, etc.; but we need psychology to teach us to estimate relations between mental and bodily symptoms; we need such delicate machinery as the volumenometer and the French graphic method of determining the separate and combined effects of cerebral, pulmonary and cardiac motions; and, above all, we need a firm reliance upon a Pathology which teaches not merely the ordinary course of diseases, but also such molecular changes as are set forth in the totality of the symptoms of a given case.

Lastly, to complete the schema, the several symptoms employed must be compared with one another that analogies and differences may be clearly seen; and three great discrimination is required. It does not follow that because a drug acts upon the heel (Natrum Carb. for example), that therefore it can cure the same symptoms when located upon the instep. Still, just as metastases are apt to take place in tissues of similar function, so are analogous parts prone to be affected by a drug. Reasoning from such premises, Arum Triphyllum, which causes rawness of the corners of the mouth, was successfully employed by Dr. B.F. Betts for a similar condition of the os uteri; and upon the same principle, drugs which disease the testicles have been used when the ovaries are affected.

In the hope of making ourselves better understood, and also in compliance with the instructions of the Chairman of Bureau, we essay an application of our several points to the study of Nux Vomica. At the risk of prolixity, we shall explain out steps by numerous annotations, observing here, however, that of course no such addenda should mar the pages of a fully-prepared “model”.

NUX VOMICA.

(STRYCHNOS NUX VOMICA)

Natural Order: Loganiaceae. It yields Strychnia, Brucia, Igasuria.

Nux Vomica owes its chief effects to the Strychna which it contains. It causes in small doses an increase in the heart’s action and a general increase of functional activity. In large doses, its action upon sympathetic nerves and also upon the spine, by which it induces an exaltation of reflex functions, leads to a train of symptoms, varying from a very characteristic over-susceptibility to impressions, to tetanus and trismus; also dilatation of the pupils, erection of the hair-follicles, tinnitus, sweat, marked rise in the arterial pressure, and finally death from tonic spasms of the respiratory muscles or from exhaustion. Paralyses are not direct effects, they arise only from exhaustion following the intense excitation. Cerebral and spinal softening have been observed post mortem after the patient had suffered from intense congestions.

E. A. Farrington
E. A. Farrington (1847-1885) was born in Williamsburg, NY, on January 1, 1847. He began his study of medicine under the preceptorship of his brother, Harvey W. Farrington, MD. In 1866 he graduated from the Homoeopathic Medical College of Pennsylvania. In 1867 he entered the Hahnemann Medical College, graduating in 1868. He entered practice immediately after his graduation, establishing himself on Mount Vernon Street. Books by Ernest Farrington: Clinical Materia Medica, Comparative Materia Medica, Lesser Writings With Therapeutic Hints.