SIMILIA SIMILIBUS CURANTUR



His “Biological Law” express this importance as follows: weak stimuli increase the effective activity of an organ, strong stimuli check it, and the very strong destroy this activity. Naturally between these are varying degrees of activity, corresponding to gradations in the intensity of the stimuli. I have repeatedly referred to the fundamental importance of Arndts law, especially as to its value in therapy, in my earlier publications, the first time being in the year 1887 in my treatise : “The Action of Drugs, ” in the 108th volume of Virchows Archive.

Every influence which diverts an organ or an organism from its physiological latitude in a positive or a negative sense, produces a condition digressing from the normal-a pathological state-a disease. How far this state will proceed toward development and thereby call attention to itself, depends upon the physiological importance of the organ and the extent to which its normal balance is disturbed.

Now, as influences of any sort which may be considered pathological in the usual sense of the term, affect the organs quite as successfully and act upon them quite the same as do other stimuli, the following conclusion is justifiable: Should two quite heterogeneous influences such as, let us say, a medicinal stimulus and a disease-causing factor, either an infection or a cold, afflict the same organ each at a different time, with an equal degree of intensity, and involving the same elements of the organ, then the result of the stimulation must be the same. It cannot be otherwise !.

The justification for this assertion is found in the well- established facts which modern medical science offers for our consideration. Thus we find ourselves in a much more favorable position than that of our ancestors. Owing to the state of science in earlier times, our forbears were obliged to be content with speculative reasoning in place of positive conclusions supported by knowledge. Thus may be explained the awkward and cramped line to reasoning followed by the scientific leaders in their efforts-which seem to fantastic to us today-to gain an insight into the development of pathological processes and changes in the human body and the relation they bore to the action of drugs.

The fact has been established that a condition due to drug stimulation and a condition due to illness can manifest themselves in the same way. We can indeed say : must manifest themselves! When we know that a certain organ is able to respond to the influence of a certain drug, then we may, with the help of our knowledge of the normal and of the pathological behavior of the organ, construct beforehand in a general way an outline of the result to be expected. This is factor which is not to be undervalued in its relation to the use of medicaments in general- medicaments taken in the broadest sense.

Inasmuch as pathology teaches us how every disease of an organ begins and how it develops, we can, assuming that we have this knowledge, be confident from the first as to what we may expect when we treat an organ with too large doses of drugs or continue the drug treatment too long. The unskilful or ill-considered treating with drugs must lead to organic ailments which in a given case can appear exactly like the illness for which the drug is used. Experience has taught this fact in the past and teaches it just as emphatically today and it really it self-evident. For example; Let us consider the treatment of a chronic catarrh by means of a so-called astringent. In a case of chronic catarrh, we have to deal with a disturbance in the circulation of the mucous membrane.

The disturbance-the immediate cause of the ailment-lies in an abnormal action of the vessels, especially in regard to their tone. Our problem is to change this condition back to the normal with the help of an astringent whose effect on the vessel wall we know. The astringent acts upon the smooth musculature of the vessel wall, causing contractions in it which by carefully regulated treatment can gradually, by means of exercise as it were, bring about a condition where the vessel walls, formerly relaxed, are restored to their normal degree of tension. In connection with this changes, we notice at first a decrease in the volume of the diseased mucous membrane and eventually the cure of the catarrh and all of the accompanying symptoms.

Now, what much necessarily and as a matter of course follow if one continues, blindly and without discrimination, in the use of the astringent? In place of an improvement, a fixation of the whose diseased state is the best that can be expected. One gains the impression as though the astringent had completely refused to perform its duty.

But, if one continually stimulants a muscle, especially as in this case, an unstriated muscle of the vessel wall-for only through the stimulating influence of the astringent on the musculature can we expect a change in its tone-then the final result of such unsuitable treatment must be the exhaustion of the muscle fibres. This is recognized through the decrease in tone. However, this is the condition that we had when we first began our therapy and now there is every indication that the pathological state against which we struggled has become stabilized.

In addition to the above it is important that we take into consideration the following: Suppose we should treat a perfectly healthy mucous membrane for a certain length of time with any astringent, the natural result must necessarily be the development of a catarrhal state which may vary in its intensity and symptoms according to the nature of the case, but which will certainly exist. If, in the course of time and with sufficient persistence, we succeed in bringing this about in a tissue which to begin with was perfectly healthy, we need not be surprised if we succeed in doing the same with a diseased tissue. When all is said, it is plain that in both of these cases we are dealing with a drug disease.

In treating a case of illness, the failure to consider this fact naturally leads one quite readily to make a change in the method of applying the astringent but the effect will, to say the least, be just as doubtful. Finally, a so-called nature healer happens in on the case. He allows the long-tortured organ to rest and orders the drinking of some sort of tea or suggests any other procedure to which he may be inclined in his therapeutical efforts. And lo! The catarrhal condition is cure, so far as it is possible, just because the vessels were at last allowed to be at rest. Of course, medical science has again accomplished nothing and “nature-healing” reaps great glory! A proper consideration of the conditions and the effect of drugs, as such, would easily have prevented this triumph.

The Hippocratic words : “Dia at homoia nosos gignetai” (Disease arises by means of similarly acting phenomena) have, I should say, been thoroughly studied in the foregoing paragraphs and their logic established. Apart from their general significance for all forms of therapy, medicinal and otherwise, excepting of course purely operative cases, they explain, incidentally, the appearance of new ailments frequently observed in patients while they are under the influence of drugs administered to them for quite another purpose.

Thus Nussbaum, a former surgeon of Munich-to give just one illustration-called attention to the fact that the internal administration of ichthyol containing sulphur, to people suffering from eczema, caused the eczema to disappear, whereas in such individuals as never had had eczema, the administration of the ichthyol caused that malady to develop. Up to now, one has explained this phenomenon with the word “Idiosyncrasy,” being no doubt unconsciously influenced by the Galenic philosophy. Today we know that continued overdosing of the system and in consequence, also the skin, with sulphur can and must lead to eczema; because with regard to the appearance of the eczema we have to do solely with the reaction of the skin to the sulphur stimulation.

In case of a more acute form of idiosyncrasy it is the same. The medicine taken by a patient is carried by the body fluids into all its parts. If it encounters any portion of the body whose resistance to the medicinal stimulus is especially low, then a reaction must of necessity take place. One is accustomed in such cases to speak of “secondary action” of the medicine. Strictly speaking, however, it is not a question of this, but rather of an usually sensitive reaction of an organ to the drug stimulation. The drug always remains the same. However, the reactive capacity of the organs varies to a great degree. But how-and with this question we reach the most difficult point in our discussion-are we to explain the fact that one and the same drug can induce an illness and then in the event of its being employed to combat this illness, or one presenting a very similar symptom complex, can also cure it?.

In order to answer this question, we must first establish the fact that the process of cure can originate only in the affected organs and must be carried through by them. In them, reposes the actual power for healing. Paracelsus had already quite correctly recognized and interpreted this fact when he said, concerning the process which comes into consideration when a “hot” ailment is alleviated by treatment with cold: “In such a case one should not ascribe the power (of healing) to the cold but to Arcanum.

W J Sweasey Powers