THE SCIENCE OF THERAPEUTICS IN OUTLINE


A proper understanding of the great therapeutic field, as mapped by these outlines, will clearly indicate to the practitioner when he is within the pale of one principle, or another, or of none at all; and may serve to keep him from vexatious questions, upon which societies of medical men are “rent and torn,” and from the performance of some hurtful and many useless acts, in behalf of the sick.


III.

GENERAL THERAPEUTICS.

[Continued from page 243] I come, now, to speak of the second grand division of the therapeutic field, where an appeal is made to the vital energies by means of pathogenetic forces.

I might, by numerous quotations like those already made from the writings of Hahnemann and Paine show that the advocates of all active treatment, which is not specially governed by chemical, mechanical, antiparasitic or hygienic principles, agree as to the necessary institution of an artificial pathological condition, which shall lead to the extinction of that already existing.

The pathogenetic action has been variously stated and explained by different writers, some calling it dyamic, or spiritual, and others vital, physiological, etc. Some writers1. (William R.Dundham., M.D., Theory of Medical Science, 1876.) have maintained that there is no such thing as medicinal force and medicinal action; that drugs have medicinal properties only; that while they may be the cause of certain symptomatic displays, they are yet devoid of inherent power.

They forget that all forces which we may employ, are but attributes or properties of matter, so far as our discernment goes, and that we can obtain no knowledge of them, whatever, while they are disembodied, or when simply potential. When they become actual by the presence of something to act upon, and when their immediate environment is favorable, we come to a knowledge of their presence and are able to study them qualitatively and quantitatively in the phenomena of their action.

Whatever the theory or philosophy entertained, all alike recognize a disease-producing property in the remedy and look to the signs of symptoms it may develop, in one way or another, for a knowledge of its special character and tendency.

The first step, in special therapeutics, the institution of an artificial disease, brings up a question of the greatest importance, namely:

What relation must the new disease bear to the old, in order that a cure may result?

A relationship, of some kind, there must be. Taking the disease, as presented in its symptoms and history, as the basis or standard, if we know the relation that the artificial affection must bear to it, in order that a cure may result, a faithful comparison between it and the affections produced by various medicines, should bring us to the right remedy. If that relationship is to be same in all cases, calling for medicines, in determining its character we arrive at a general principle in therapeutics paramount to all others.

In trigonometry, the mathematician has the same need of the relationship between the two sides, of his triangle, when he wishes to learn the third side. The two sides given and the angle between them, he has no trouble in finding the third side.

In looking over the means employed in medical practice, and the different theories entertained regarding their action, we find but four possible relationships between the affections they induce and the morbid conditions they are effected to remove, namely:

1. THE ANTIPATHIC – Where the same tissues or organs are affected, but in an opposite manner; the relation being one of direct opposition.

2. THE ALLOPATHIC – where the same tissues or organs are affected in a different manner, or where other tissues or organs are affected in some manner; the relation being one of general difference or indefinite diversity.

3. THE ISOPATHIC – Where the same tissues or organs are affected in the same manner; the relation being that of identicals.

4. THE HOMOEOPATHIC – where the same tissues or organs are affected in a like manner; the relation being that of similars.

Inasmuch as the allopathic relationship includes the antipathic – an opposite affection being also a different one from the original – it is hardly necessary to preserve a distinction between them.

1. ANTIPATHIC.

But it may be proper to say that, while an opposite affection may, in some cases, be induced, as a diarrhoea for constipation, somnolence for insomnia, warmth for coldness, etc., such things as opposites to scarlatina, to yellow fever, to whooping-cough, to pneumonia, and a host of other familiar, yet dreaded affections, are not thinkable; unless, indeed, entire good health be the universal opposite, which it can not be, since good health is the absence and not the opposite of any one of them.

And the constipation, to-day removed by catharsis, becomes all the more, obstinate to-morrow; the sleeplessness relieved by the narcotic to-night is the more troublesome the night following; and the cold feet, made warm by the hot bath, are surely colder thereafter. This return of the original trouble is due to the reactive energies of the organism, making sure resistance to all abnormal forces from without, a fact generally overlooked by the people and the masses of medical men.

The antipathic principle, contraria contrariis curantur, is thus a law of palliation merely, and, as such, available to a limited extent only in special therapeutics.

It cannot be claimed that all cures, affected by pathogenetic means are the result of opposite affections instituted; and hence the principle contraria is not general. Nor can it be maintained that any cures, complete and permanent, follow efforts to forcibly institute opposite affections of the organs or tissues diseased; and hence the principle contraria is not even a limited law of cure.

2. ALLOPATHIC.

The possibility of instituting an artificial affection, different from one existing in a given case, is not to be doubted; but a moments reflection must convince us that the relationship is nothing definite, or useful, as a principle.

Suppose a person were to specify the destination of a friend by simply saying, “he did not go to New York,” what would the information be worth?

The practitioner told to employ an agent, in a given case, known to induce a condition of suffering unlike that existing, would be in a singular quandary. He might render strict obedience by the exhibition of any one of a thousand different drugs, none of which had been known to induce a like condition. Hence, the allopathic relationship fails to be a principle, either general or limited, in therapeutics; nor can it supply a rule in medical art.

The practice usually denominated allopathic is based upon a multitude of limited and ever-changing theories, and upon the individual hints of empiricism.

Before passing on, I should mention that some writers have endeavored to show that, after all, the similar and the dissimilar are one and the same. Quite lately it was said –

“There are varying shades of difference, some of which are so slight as to amount to similarity, and some so great as to antagonism, which is only the greatest degree of difference; while similarity is merely the least or a less degree of difference.”

This speculative view of the subject presents a fallacy very apparent in practice.

Two things may be similar in some respects, and very dissimilar in others; but what is contemplated is that the totality of the symptoms or the characteristic features of the one case are like, or unlike, those of another case. There is no practical difficulty in deciding when there is such a similarity or dissimilarity.

Two men can not be said to be alike because they are of the same height, or same weight, or same color merely; nor unlike because they differ in those particulars only.

The relationship similar is quite definite and practical, while that of dissimilar is exceedingly indefinite and unsatisfactory.

3. ISOPATHIC.

The possibility of instituting an artificial affection, identical with one already existing, we must admit; but only in cases where the causa morbi is distinctly known to us , and where it is such that we can grasp and apply it in practice.

A brief survey of human ailments will convince us that their causes, almost universally, are either too obscure or too intangible for our reach and employment as remedies. In cases of poisoning, where the noxious material is distinctly recognized, we might be able to obtain and employ it-not to cure, not to antidote its own effects, but to increase them.

There can be no such general principle as that all diseases may be cured by the institution of the same disease, because its general application would be simply impossible. It might seem, however, that be simply impossible. It might seem, however, that it could be a principle of limited tenure and application, as some affections appear to be relieved by the agencies causing them.

For example, coldness of feet, from standing in the snow, may be removed by the direct and brief application of snow; and the lameness of muscles, over-exercised, may be relieved by their gentle use. But a proper comparison of the snow long enveloping the feet, clad in shoes, with the same article, directly and briefly applied to the naked feet, will reveal to us so much difference in the forces operating and circumstances attending, as to convince us that the relation between their effects must be more that of similarity than identity.

And so the gentle use of muscles must be considered more similar to , than identical with the severe or long-continued exercise which has occasioned the lameness.

There is a kind of isopathic practice, favored by some who believe that, a higher attenuation, or the finer particles, will antidote a lower attenuation, or the coarser particles, of the same drug.

Such persons seem to forget, if they have ever known, the fact that to attenuation of a drug is made up of uniform particles- that in a one-grain powder of the sixth trituration, for example, there are particles, varying in size from the smallest of that attenuation up to the medium, if not maximum, of the fifth and the medium of the fourth and minimum of the third. If, then, it be true that one attenuation antidotes another-that a medicine may thus directly contradict itself-in the same organism, the posology, as well as pharmacology, upon which the practitioner must depend, would present insuperable obstacles to his success.

The futility of such isopathy must be apparent to all, except the votaries of that mystic dynamism before which the methods and meters of science are only rank abomination.

And there is a yet worse form of isopathic theory and practice, favored by some who believe that, a disease may be removed by the use of its own products.

The absurdity of such a belief is equalled only by the worthlessness and obnoxiousness of the remedies to which it leads.

4. HOMOEOPATHIC.

It is admitted by all writers on the principles or theories of medicine, that many cures are effected by agents known to induce affections similar to those for which they are administered.

This recognition of the principle expressed in the terms similia similibus curantur, has often appeared in books, essays and editorials; but curantur still in the prescriptions made by all classes of physicians in all parts and ages of the world.

From the time Hippocrates wrote – “Vomiting is cured by vomiting” -down through all the centuries of medical history, writers have noted the removal of diseases by remedies known to induce similar diseases.

That the relation expressed by the term similar, between two affections of the human body, is concievable, and that it may serve as a guide in the selection of a remedy, when the affections producible by various remedies are known, no person, of even ordinary medical learning, will venture to question.

One affection is similar to another when the distinctive and most constant symptoms of the one are like those of the other. The similarity is not such as to establish an identity of conditions, nor a perfect equality, in any sense. The practical comparison, instituted, is between the exponents or symptoms of the disease, in the case presented for treatment, and those of the affections induced by the several agents from which a remedy is to be chosen. And the symptoms, to be thus compared, are not the subjective alone, nor the objective alone, but all of both, in any way and by any means discoverable.

Upon a through examination it is found that, the relationship, similia, not only points out right remedies in a large number of cases, as universally admitted, but that it does so in all cases susceptible of cure by pathogenetic means, or the institution of artificial affections. Aside from the use of palliative means, sometimes requisite, especially where no cure is expected,-

SIMILIA IS THE GENERAL LAW IN SPECIAL THERAPEUTICS.

It is not my purpose, in this sketch of outlines, to enter at any length upon explanations and proofs; but I may remark that the Homoeopathic law, at first regarded as a principle of limited applicability -as true and useful in certain cases-was discovered by Samuel Hahnemann to be of universal tenure and applicability in that department of therapeutics which I have designated as Special.

Looking back over accumulated medical records, he found that medicines, distinguished in the removal of certain well-marked diseases, had been known to induce similar affections when taken by persons in health.

Analyzing case with a remarkable keeness of perception and strictness of logic, he studied medicinal forces singly and in the various mixtures of polypharmacy, as to their influence upon persons sick and persons well, finding few apparent and no real exceptions to his law of cure.

And now, for seventy years, other practitioners, accepting that law as their guide, have been successful according to their faithful obedience to its demands in the treatment of the sick.

Every visitation of such well-marked and dreaded diseases as Asiatic cholera, Yellow fever, Scarlet fever, Epidemic dysentery, and Diphtheria, in fields occupied by the followers of Hahnemann, has had the effect to increase their reputation and to magnify the law Similia.

One who compares the history of the law of gravitation with the history of this therapeutic law, will be struck with the many points of resemblance. The first suggestion, the patient research in the records of the past, the positive tests, the practical applications, the unfavorable first impression upon the learned, the apparent exceptions, the absurd opposition, and the steady progress and triumphs, have been quite parallel in the two cases.

Newton said of his law –

“What the efficient cause of these attractions is I do not here inquire. What I call attraction may possibly be caused by some impulse, or in some other way unknown to us.

“I have explained the phenomena of the heavens and the sea by a the force of gravity; but the cause of gravity I have not yet assigned.”

Hahnemann said of his law –

“As this therapeutic law of nature clearly manifests itself in every accurate experiment and research, it consequently becomes an established fact, however unsatisfactory may be the scientific theory of the manner in which it takes place. I attach no value whatever to any explanation that could be given on this head.”

But in one respect there is a marked difference in the case. The law of gravity had its explanations and proofs in figures, by mathematical and astronomical demonstrations, and so escaped such fanciful and absurd explanations and proofs as, sometimes, have been thrust upon the world, by ignorant enthusiasts, in favor of the law Similia.

But I must hasten to the close of my sketch.

Taking the Homoeopathic principle or relationship, as the paramount law in Special Therapeutics it is proper to ask-What are its requirements?

In the solution of this question we must be led to all the subordinate principles of special therapeutic science.

I must here make a statement, rendered necessary by the misrepresentations of many writers, who say, that the proper understanding and application of the Homoeopathic law does not require a thorough knowledge of Anatomy, Physiology, Pathology and Diagnostics. How preposterous to suppose that a practitioner can make a proper examination of a case, presented for treatment, when ignorant of the field and phenomena of healthy life and the changes wrought by various morbific causes?

His comparison of symptoms-morbific on the one hand and pathogenetic on the other-taking in the superficial, the coincident, and the consequent, without distinction, would be as likely to lead him astray as to a choice of the remedy required; or, in other words, his similimum might be of a most inferior quality without his being aware of the fact.

The Homoeopathic system of therapeutics requires, in its practitioners, the best medical as well as general culture possible to men who practice the healing art.

MATERIA MEDICA PURA.

The first requirement of the law Similia in practical therapeutics is a Materia Medica, consisting of drug effects. or data, furnished by true and rigid experimentation with the different agents to be employed as remedies; such experimentation to be upon persons in health, and upon the lower animals, under circumstances and in ways best calculated to exhibit the pathogenetic character of the several agents fully and truly. The data, so furnished, constitute.

A POSITIVE SYMPTOMATOLOGY.

And this positive symptomatology embraces-

1. Subjective Symptoms; or, the abnormal sensations, emotions and thoughts of provers, male and female, in good health, free from counteracting or disturbing, influences, instructed in proper modes of observing, locating and describing their symptoms, all gathered in one place, favorable for the purpose, under the direction and close questionings of competent instructors; the number and character of the provers being such as to render them fairly representative of the average of the human family under similar influences.

2. Objective Symptoms; or, the abnormal appearances and products of the provers under pathogenetic influence, closely inspected by skilled observers, aided by all the means found useful in the study of similar affections in the sick, so as to determine their qualities and quantities, localities, times and peculiarities.

The drug-effects being thus obtained, the next important step is to have them so collated and published as to be at once accessible and clear.

One publication should present-

The Journals of the provers, their records of symptoms, as daily submitted to, and revised by, the skilled observers; together with a statement of the age, temperament, etc., of each prover. And before the record of the drug symptoms, should be given a record of symptoms noted in the case of each prover for five days before the commencement of the drug-proving, and while under the influence of certain doses of a non-medical substance.

Another publication should present-

A Digest of all the symptoms in the daily records except such as occured during the non-medicinal proving, or, again (the same) during the medicinal proving in the same person, and all such as occurred in the records of but one prover.

The symptoms appearing should be arranged according to the topographical chart in use by all the provers, and in the order of their occurrence, each one having a numeral attached, like the powers in algebra, to denote in the records of how many provers it had appeared.

And still another publication is required as an index to symptoms:

A Repertory, presenting together, under regional and qualitative headings, the several agents yielding pertinent symptoms.

And yet a fourth form of publication is required:

A Nosological Index, presenting together, under nosological headings, indicative of various affections, the several agents found to produce their characteristic symptoms.

These publications furnish an intelligible view of a reliable materia medica, such as required under the Homoeopathic law in the practice of special therapeutics. PATHOGENETIC POSOLOGY.

Before leaving the subject of materia medica, I must mention the leading principles relating to the size of dose in drug-proving.

1. In experimenting upon the healthy human body, so much of the medicinal matter must be capable of influencing and changing the action of some tissue.

2. No change of tissue action occurs without a previous change of tissue condition.

3. The kind or quality of change in tissue condition and action is governed by the quality of pathogenetic force employed.

4. The degree or extent of change in tissue condition and action is proportioned to the amount of medicinal force employed.

5. The potential medicinal force of a given drugmass is in proportion to the number of medicinal atoms is contains.

6. The actual medicinal force of the same is in proportion to the number of medicinal atoms made superficial, or free, for contact or absorption. And, looking a little further, we recognize some other principles of importance.

1. In experimenting upon the healthy human organism, so little of the medical matter must be used as will act medicinally, and not mechanically, chemically or toxically.

2. All drug matters changing the condition of living animal tissues by virtue of their bulk, weight or form, do so under the laws of Mechanics.

3. All drug matters affecting those tissues by virtue of certain decomposing or combining molecular forces, do so under the laws of Chemistry.

4. All drug matters affecting tissues in the lower animals, nearly related anatomically to man, so as to induce death or functional incapacity, do so under the laws of Toxicology; and information thus elicited, though comparative, is often of value in the extension and confirmation of drug pathogenesy in man.

It is well known that, often, the same substance, under different tests or circumstances, displays different forces or properties.

Iron, for example, is at once a mechanical, a chemical, a toxical and a medicinal agent. It is the province of experimental inquiry to determine when, and how, the one kind of force may be developed and employed to the exclusion of the others.

To tell where pathogenetic or medicinal action ends, and toxical, or chemical, or mechanical begins, in the case of a single substance, requires much experimental research and care.

J P Dake