Individual variation in responsiveness to drugs is a fact too well known to require discussion; with it those who have made drug provings are especially familiar. However, with the cause of this variability no one is fully acquainted. Indeed most of us have as yet not a glimmer of a notion of the factors involved.
That this problem of variation has has deep significance when we come to study and teach materia medica, and even more when we come to prescribe, must be apparent to all. Explanation of symptoms and appraisal of symptom values is quite out of the questions unless one possesses a knowledge of the facts which furnish the background and which determine the special mode of manifestation of the vital processes in the individual.
In not two individuals are these conditions identical and in no two are the functions and reactions identical. And what is extremely significant is the fact, as examination shows, that variation in function and reaction is always in relation with and proportionate to the variation in the individual structural or morphological state.
The truth of this may become more clear by a brief, and admittedly sketchy, study of the pathogenesis of Carbo veg., and the morphological conditions which supply a suitably sensitive or susceptible state for the latent powers of the drug.
A careful reading of the symptom record discloses the fact that three conditions dominate the whole situation and play a part in every process-acute and chronic, local and general: (a) blood deterioration; (b) devitalization of the nervous system; (c) habitual venous engorgement of the mucous membranes, glands and parenchymatous organs. Apparently no matter what organ or part is affected or how it is affected, these three color the picture. And, moreover, they apparently have a common source, namely, suboxidation-habitual oxygen starvation with blueness, coldness and prostration as ever-present symptoms. The circulation of the lungs, heart and abdominal viscera is habitually impeded, the consequence being habitual venous engorgement in all the tissues and profound disturbance in the bio-chemical processes in the cell.
An obvious consequence of such state is, that every morbid process early takes on a serious aspect. It is always low grade in character. Inflammatory processes are always destructive. Dissolution of tissue cells by active ulceration is an early manifestation. Bedsores, with foul, grumous and acrid discharge; varicose and, gangrenous ulcers, with offensive, bloody pus, and burning pain; easily bleeding wounds, blood being dark, thick and grumous; surrounding tissues blue and cold, but with burning pains. These are some of the more marked characteristics of the Carbo veg. processes. When internal organs are affected very many of these characteristics are manifested.
For example, in the last stage of a pneumonia or in tuberculosis of the lungs when this drug is the similimum we find the expectoration is strikingly similar to the discharges from surface ulcerations. It will be thick, grumous, foul. The patient, though cold, will want the doors and windows open that he may get more air. He is literally dying for want of oxygen. He will have burning pains in the chest. Violent burning pain after cough and expectoration. The earlier these symptoms are manifested the more clearly is this remedy indicated. The fact cannot be too strongly emphasized that oxygen starvation is the chief factor in the entire pathogenesis. All the nerve centers are paralysed and all the cells are dying in consequence.
The mucous membranes, as has been said, are habitually engorged with venous blood. They are dry, swollen, bluish, even purplish in color and spongy to the touch. All proof of venous stasis. With this in mind it is not difficult to understand the character of the gastric functions. They will naturally be sluggish, retarded, with fermentation and gas formation. There will be heaviness and fullness, worse after eating; eructations; waterbrash; burning in the stomach and oesophagus; gastralgia; flatulence and other symptoms arising from faulty gastric secretions and delayed digestion.
All these symptoms will be aggravated by anything and everything that increases sub- oxidation and the consequent venous stasis. This cannot be otherwise, as we see when we realize that there is a direct though inverse, relation between the amount of carbon-dioxide in the blood and the activity of the gastric juice. That is to say, the greater the amount of the carbon-dioxide present in the blood the less is the amount of gastric juice secreted. Moreover, it is true also that the greater the amount of carbon-dioxide present the more acrid are the mucous membrane secretions and the ulcer discharges. A knowledge of this helps amazingly in interpreting the character of all the symptoms, no matter what they are or where produced.
But the Carbo veg. state of devitalization of the nervous system is not fully accounted for by the presence of the carbon-dioxide in this undue amount. In a large measure it is, of course. Yet there must be other factors in the case, for when we come to examine the must the other factors in the case, for when we come to examine the nux and natrum records, not to mention a number of other remedies, we find that sub-oxidation plays an important part in these also. But when we come to examine the nervous manifestations of these drugs we find that they are characterized by irritability and excitability rather than by prostration and even paralysis from oxygen starvation. Hence we must look for other causes.
What now, are the morphological characteristics of the individual most susceptible to Carbo veg.
Examination and measurement show that not only is the thorax deficient in circumference, but it is also deficient in all of its diameters-sagittal, bi-axillary and vertical. Moreover, we find the muscular development of the thorax very meager. These things devote deficient pulmonary development and function- respiratory insufficient; suboxidation; arterial deficiency, both quantitative and qualitative; venous plethora and stasis; habitual engorgement of the mucous membranes, glands and parenchymatous organs; sluggish and low grade processes; early breaking down of tissues, with easy haemorrhages of venous blood;marked suppurative tendencies; the characteristic gastric symptoms, and quite all the rest.
When we come to examine the nervous system morphologically we find deficiency in development quite as marked as it is in the thoracic sphere. Hence the explanation of the extreme prostration which characterises every Carbo veg. morbid process; and, too, the explanation for the difference between Carbo Veg., Nux and Natrum, though the latter have sub-oxidation from deficient pulmonary development quite as characteristic as Carbo veg. Nux and natrum have excessive development of the nervous system just the opposite to that of Carbo veg., hence the reverse in the character of the functions and reactions.
Let it be repeated, that the reactions are always in relation to the vigor of the functions and the functions in relation to degree of development, other things being equal. The nervous system in the individual susceptible to Carbo veg. being deficient in development the functions are deficient, and the reactions correspond. Add now, the influence of carbon-dioxide excess and we have no difficulty in understanding why the whole organism goes to pieces at once when assailed by a virulent morbitic influence such as will cause a violent diarrhoea, a dysentery, a typhoid, and the like.
The symptoms of special spheres will be found to be in keeping with the character of the organic development in those spheres plus those produced by the three general conditions above mentioned. For example, the bowel symptoms will be in keeping with the character of development of the intestinal tract. In those in whom the intestines are found deficient there will be constipation or a strong tendency to it, while in those in whom they are found excessive in development there will be a correspondingly strong tendency to diarrhoea. Accompanying the symptoms of the intestinal derangement will be those belonging to the general state.
The symptoms accompanying a derangement of the female generative organs show in a specially clear manner the influence of the general morphological state upon the local organs. The menses are too early and to profuse; menorrhagia and metrorrhagia; uterine atony; ichorous and offensive leucorrhoea; malignant ulcerations, with burning pains and foul discharge, etc.
It may be said, indeed has been said, that as we do or must, in the last analysis, prescribe on the symptoms, why study morphology.
It is not a question what we prescribe on, but a method which will disclose to the basic factors in the problem and make rational and complete understanding possible and accurate interpretation of the symptoms a certainty. Surely no one is so rash as to say that the more or less disconnected and fragmentary recital of sensations by a patient, not infrequently greatly elaborated for sinister reasons, can be taken at its face value, or that what are stated as facts are facts in the scientific meaning of the term, or that this approaches, except in a remote and uncertain way, the real and true basis of the condition. But without a knowledge of the individuals morphology the physician is largely if not wholly dependent on just such a questionable story; on such facts as a patient is able or disposed to relate.
Again, we must not lose sight of the fact that a given sensation or condition is never described in the same words by two persons of different type. By a volatile or lugubrious patient it is described in one way and by a reticent patient in another way, if described at all. The importance of a symptom is over emphasized by one and minimized by the other. In the mind of one it is certain to be plus in value and in the other minus. Of course it will be said in reply that it is up to the physician to distinguish facts and fiction, between wheat and chaff. But if he has no knowledge of the basic facts, which means the individual morphology, what guide has he for separating the wheat from chaff.
The charge has been made that the morphological method of materia medica study assumes to get along without the symptomatology; that the morphologist considers the symptoms of no particular value.
Only a person grossly ignorant of the method and of the theory of modern morphology will make such a charge. What the method aims to do is lead us to a knowledge of the conditions that are basic to the symptoms, to the conditions in which the symptoms have their origin and by which their special mode of manifestation is determined. The morphological method when carried out scientifically makes forgetting or ignoring of symptoms impossible. Symptoms are a part of the whole, and this method concerns itself with the whole, which makes it therefore quite different from the symptomatic method, which concerns itself with effects only.
And how a knowledge of the whole raises the physician above the level of the patient in knowledge of the real facts, and even above the physician who has only the patients more or less questionable story on which to base his judgment! The morphological method makes it possible for the physician to discover all the facts for himself and relieves him of the physician to discover all the facts for himself and relieves him of the necessity to depend on hearsay evidence. He becomes, with a knowledge of this method, truly master of a situation.
Modern morphology, as developed by Prof. De Giovanni, has for its foundation the related sciences of embryology, physiology, psychology and pathology. It clearly recognizes the fact of subjective states, but it does not content itself with merely this; it endeavors to find an explanation for them, for their variation in different individuals under different circumstances. And it seeks for explanations where they may only be found, namely, in the morphological state in which all have their origin, and frequently their sole cause, and by which their special mode of manifestation is determined in every instance.
Modern morphology takes the position that aside from a physical base subjective phenomena have no existence, can, in fact, have none. It takes the position the neither subjective nor objective physiological process are possible except in a physical organism. In this they are born and bred. Hence the necessity of studying the physical facts. Modern morphology does not lead us to become materialists and to cast aside as useless the dynamic elements in the problem. On the contrary, it intensifies our regard for them because it gives us a clearer understanding of their place in the scheme of things. Modern morphology makes us better and wiser symptomatologists through an understanding of its principles and their direct and immediate bearing upon all functional processes.