Is it permitted us as apostles of a great cause to be contented with the achievements of its pioneers, to look upon their writings as the last word? Have we a right to assume that we have discharged our responsibility when we have reaches a point where we are able to repeat the achievements of Hahnemann, or of Boenninghausen, or of Hering? Heave we a right to say that we have progressed if we have merely caught up with them?.
It is a law of life that nothing remains fixed; that it either moves forward or it retrogrades. If this is true, and if we have in no way surpassed the pioneers of the School, then it must be that the cause which has been entrusted to us has lost ground. Some may think this is a debatable question. My own opinion is that a great deal of ground has been lost.
In trying to determine the status of the School today we have but to compare the status of the two subjects, Materia Medica and the Philosophy of Therapeutics, with what that was, say fifty years ago. When we do this do we find anything that indicates progress? It is very doubtful. The standard works on these subjects are the works of the pioneers, not the works of the moderns. What has been produced during this century is no more than a restatement of what was said fifty and more year ago. There have been many additions to the materia medica, it is serve only to make it more cumbersome and more difficult. In no way is the arrangement of the subject matter any different from it is in the earliest works- proof, in my opinion, that we have not progressed.
Obviously the problem of the School lies with the problem of the materia medica, since this is the one subject which distinguishes it from other schools of medicine. What, therefore, we do with this subject determines the future of the School. If it is developed, as it easily may be, we are good reasons for fearing the outcome.
This being the situation, as I view it, it strikes me as being perfectly proper to ask: Is the subject matter contained in our works on drug pathogenesis all that it ought to be? That is to say, does it, comprehend all that is essential for a science? Who has the courage to make such a claim, or the ability to defend it! It would b e less difficult, I believe, to prove that the absolute essentials have been altogether left out. Having noted only effects, end-results, symptoms, entirely ignoring not only the conditions in which the processes originated which produced the effects, but the processes themselves, we cannot possibly claim that our works comprehend all the essentials for a scientific materia medica. Basic factors cannot be left out of any consideration and the results be science.
But this is what has been done, and now we find that the symptom arrangement lacks order, lacks connection, lacks sequence. When symptoms appeared, the order and sequence of their appearance, is all a matter of conjecture. We have no more than a bare statement of facts, overwhelming because of its size and stupefying because of its endless contradictions. Rational explanation of the symptoms is hopelessly impossible.
However, there is a ray of hope in even this seemingly hopeless situation; and it lies in the fact which was observed by every prover and mentioned, though casually, by every writer on the subject. Every prover observed that certain persons seemed to be more sensitive to certain drugs than to others. The significance of this was not appreciated by them, nor has it been by many others. To me this observation suggests more that is encouraging than the many thousands of doubtful symptoms that clutter up the record. That different constitutional conditions produced different effects clearly proves that symptoms are but one phase of the problem.
This shows that they are dependent upon something else for their being and for their special mode of manifestation in the individual. Indeed, this shows that in and by themselves they possess nothing of a fundamental character; that, as has been said, they are mere effects, end-results. This being true, it necessarily follows that when separated from the conditions in which they were produced they cannot be understood, cannot be correctly interpreted and the subject of materia medica cannot be successfully taught. The constitution, which means the morphology of the individual, is in this observation shown to be the fundamental factor in the problem and the symptom to be incidental, or subordinate.
But we have separated them from the conditions in which they were produced. This is what every lecturer on the subject does. According to this skill, training and slant of mind he selects certain symptoms of a drug, and with these he constructs what he is pleased to call a drug, and with these he constructs what he is pleased to call drug image. What he selects is entirely optional; there are no rules of order or conduct which he must observe. Likewise the order in which he puts the symptoms together is optional.
His own judgment is his guide. The image which he constructs is made as vivid as possible with story, clinical experience, emphasis, and paraded before the minds of the students. Lacking a knowledge of the basic conditions he is unable, of course, to describe these, or to tell anything of the order, sequence of relationship of the symptoms. What is presented is clearly an artificial and arbitrary creation- a plain fiction, in fact. That such a method must in the end prove a failure ought not be difficult to see. And some of us are beginning to see, and ready to begin to make amends.
But with what method? With microscope, test tube, X-ray and other highly specialized instruments we are digging deeper into the problem, of organic functions and reactions, finding more symptoms, and making a difficult problem more difficult. The modern laboratory has become a sort of “holy of holies” from which there is issuing a language which the man five or ten years our of college has difficulty in understanding. More and more is the human morphological equation being lost sight of.
But if this is the wrong way to go at the problem, what ought we to do?.
If I were to undertake to prove to you that organic function is possible without a physical organism, I wonder what would be your reaction? If you did not think me a little deranged mentally I should think that you were. Of course no sane person would attempt to support a proposition so obviously absurd. Nothing can be more clear than that organization is essential for function. Sight is not possible without an eye, or hearing without an ear, or breathing without lungs, or thought without a brain.
Without some kind of an apparatus life would have no means of manifesting itself. This is clear. But this implies something of deep significance. If organization is essential then it follows that the character of the organization determines the character of the functions. That is to say, what an organism does depends on what it has to do with. It is a well-established law in logic that the essential element in a proposition is the determining element. In biology this proposition, that character of organization determines character of function, is so firmly established that it is made the basis of every biological proposition. The whole science is made to rest on it.
Now, it is well known that individuals differ in their morphology. Not two have yet been found alike in growth and development in the total mass, in the relative proportions or in the intimate structure and chemistry of the organs. Quantitative and qualitative disproportions are found in everyone. Hence, according to the before-mentioned principle, there will be differences in the functions and the reactions as a necessity. The organic state will be the determining factor.
From this we see that differences in function and differences in reaction can be accounted for only when we understand the differences in the morphological state which lies at the root of their being and gives them their special form and color. It is a knowledge of these structural or morphological differences which alone enable us to understand why one person reacts to a given drug in one way and another person in a different way. Only when we understand these are we able to correctly interpret and explain symptoms.
It is admitted that with a stock of memorized symptoms and a repertorial method of one kind or another we are frequently successful in selecting the appropriate remedy, but such a method cannot possibly be defended on scientific grounds. Such a method takes cognizance of nothing but effects; the basic factors or the problem do not enter into the consideration.
But besides demonstrating that different types of individuals react differently to the same drug, provings have demonstrated one other thing of great significance, and it is this: Certain types that fail to respond to certain drugs will do so to others and under their influence will develop symptoms strikingly similar to those produced by others under the influence of other drugs. For example: Some years ago during a series of drug provings made on students in the SAn Francisco College one young man was found who could not be affected by belladonna though the drug was taken for a considerable time.
Later he was put under ginseng tincture. Within forty-eight hours to our great amazement he began to develop the most striking combination of belladonna symptoms imaginable-flushed face; injected sclera; sore throat, worse on the right side; throbbing headache; throbbing carotids, etc. So striking was the picture that three members of the faculty, not knowing that he was under the influence of a drug, made a diagnosis of acute tonsillitis, prescribed belladonna and ordered him to bed. These instructions were, of course, not followed. Ginseng? Yes, for they were subsequently reproduced in detail with the 3d, and again with the 6th potency.
I repeat, and desire to emphasize, that this experience has very great significance, and I am convinced that if what is suggested were fully developed that a great deal of light would be thrown on the problem of the materia medica. What this suggests to me is, that the symptoms complex of a drug by itself is wholly inadequate with the action of a drug when we have committed a certain number of symptoms to memory is an absurdity.
What science demanded was that we explain the reason for this unusual and unexpected reaction to these drugs; tell what was in the chemical and morphological makeup of this young man which made him unresponsive to belladonna and susceptible to ginseng and made him produce a combination of symptoms strikingly similar to those produced by others under the influence of belladonna. Had we been able to do this then we should have been able to scientifically differentiate the one drug from the other and scientifically account for everything that occurred. But this we were unable to do; we stood convicted of incompetence, which is what we all stand convicted of when we come to this matter of drug pathogenesis.
I realize that I am now expected to point out just how the subject of Human Morphology and drug pathogenesis are related and how a knowledge of the former can at once be applied in the study of the latter. I am sorry I shall have to disappoint such expectations. Before anyone shall be able to do this a great deal of diligent work in drug proving will have to be done, proving then with an eye to the problem of the morphology of the subjects used in the provings.
However, it may be possible for me to throw some light on the matter by telling you a little about an experience I had when I first began practice in the Hawaiian Islands some years ago.
One of the surprises i had immediately after I began my work was the regularity with which Belladonna failed me. With no drug did I believe myself better acquainted, and none was chosen with greater care; but always the results were nil. After many failures I began to give ferrum phos. for what were clearly belladonna symptoms, and to my surprise, with excellent results. The flushed face; red, shining eyes; injected sclera; throbbing headache; throbbing carotids; hot steamy body; very full pulse; dry mouth and throat, etc., were always there. Let me say in passing that in the tropics the people are invariably lymphatic and phlegmatic.
One day I discovered that the pulse of belladonna is invariably firm as well as full and that of ferrum phos. always soft and easily compressed. This I thought a rather flimsy basis on which to make a differentiation, but having nothing better it has to serve. Later I discovered something which gave me a broader and firmer basis, and which fully accounted for the character of the pulse of the two drugs as well as for other things. When compared morphologically we find the two types similar in two things and no more. First, we find that they have the same coloring, both being blondes, with fair skin, blue eyes, light or light-brown hair; and second, we find that they have an equally well-developed pulmonary, cardiac and arterial systems.
Hence the great similarity in the inflammatory symptoms. But when we come to study them further we find that the belladonna individual has combined with this pulmonary, cardiac and arterial development a strong development of the nervous system, while the Ferrum phos. individual has relatively strong development of the lymphatic system. Hence the conspicuous nervous symptoms- restlessness, excitability, wild delirium, etc. of the one, and the soft, flabby, relaxed suppurative tendency of the other. A knowledge of these morphological differences has served me wonderfully well through the years.
During my last fifteen years in ear work I never once had to do a paracentesis of the drum membrane nor did a single case of otitis media develop once I attribute to the fact that I never trusted to belladonna in any case where the lymphatic elements were strongly in evidence in the individual makeup; and these are always conspicuous where the inflammatory processes have a suppurative tendency. Belladonna is not a suppurative remedy, that is, a remedy indicated in the presuppurative stage of any inflammatory process. But ferrum phos. is distinctly so. Ferrum phos. is the acute to hepar and to calcarea carb.
Ginseng is differentiated from belladonna on the same ground as is ferrum phos., and from the latter it is differentiated on the ground of color; it is as distinctly brunette as ferrum phos. is blonde. The young man who made the splendid proving had hair and eyes as black as jet; a rather coarse but clear skin; a fairly heavy skeleton; well-developed muscles; full, round chest; a little more than full abdominal development. He was only a moderately good student, being rather lazy, good-natured and easy-going. As we were just beginning our morphological researches, it is not possible for me to describe these different types as fully as I should like. But this much is suggestive at least.
It will be granted, I am sure, that it is not possible to present in anything like a comprehensive manner the modern theory of human morphology in the time allowed me. Nor is it possible for me to describe the morphological method of examination adequately, give the measurements, the reasons for taking them, and tell how the data are interpreted. However, I trust I have succeeded in showing that the subject is one of fundamental importance; that it is directly related to the study of materia medica. I trust, too, that I have made the fact a little clearer that the unhappy situation the School is in at the present time is due to our utter inability to understand the materia medica and, therefore, to teach it.
The morphological method I am firmly convinced offers our only hope of not only improving the condition of the School but of really saving it from utter extinction. As Professor De Giovanni says, in speaking of this method: “It is necessary and cannot be substituted by any other.” Unfortunately, few as yet realize this. WE have tried to substitute another, and we have failed. We now find ourselves in a position that is, to say the least, discreditable.
To again quote Professor De Giovanni, while speaking of the medical situation in general: “The laity, as well as the students and the learned of the science, have grave doubts concerning the general medical clinic-doubts that are confined to no country, because they are met everywhere, and are almost sanctioned even by practitioners of medicine, who for this reason are the cause of the prejudices and errors which contrast with the progress of general culture”.