THE SCIENCE OF THERAPEUTICS IN OUTLINE


I can only say that, it would please me greatly to lay aside the remedies now in use, especially the pathogenetic, if convinced that, the healing forces, now coming through various forms of matter, could come as well, or better, at our call, from the great source of all power, through the human touch, or voice, or look.


For the system, the outlines of which I am about to present, I use the term Therapeutics in its original and broadest sense. i take it as embracing all the means and measures, all the facts and principles involved in the direct or indirect removal of the causes, workings and products of all the health disturbances and injuries incident to mankind. In short, it covers the entire hygienic and curative effort of the healing art.

I being to the class which cannot rest upon the supernatural, and feels the daily need of something more reliable and forward- reaching than the simply empirical. I regard the scientific as the only rational and promising method of therapeutics.

The scientific method I understand as that, which gathers facts by observation and experiment, exercising all care and skill to separate the real from the species; and us that, which classifies the data thus obtained, till from them logically come the principles which point on before, leading the studious practitioner far in advance of his actual experience.

I have the utmost confidence in the coming unity of all educated and determined therapeutics, as of all educated chemists and astronomers, upon a basic of natural laws. RISE AND PROGRESS OF THERAPEUTICS.

It is my purpose here, to sketch the wider boundaries and some of the divisions and sub-divisions, of what may be regarded as the science of Therapeutics.

In doing so, I shall endeavor to represent exclusively the views of no particular author; but rather, the results of thirty years study and practical trial of the teachings of many authors brought into a concise, yet comprehensive, system.

The fruits of research and discovery, accumulating from age, to age can be the peculiar property of no individual, but must forever remain free to all who may choose to systematize or apply them in practice.

The time has gone by for heaven-revealed principles and heaven- ordained masters in the medical line. In place of priests, at medical altars, and dicta or dogmas in medical books, we now look for physicians trained by diligent study, and for principles logically deducted from facts.

We recognize no canon law in medicine; we must have laws of science.

In the progress of knowledge, concerning human ailments and their remedies, first came facts, isolated data, developed by human experience; and then came the groupings of data thus obtained, furnishing the elements of Pathology, or the science of disease, on the one hand, and of Materia Medica, or the knowledge of remedies, on the other.

The application of remedies for the relief of suffering and preservation of life, commencing with single experiences, became, through the same process of grouping or classification, the beginning of the science of Therapeutics. At first the observations regarding various diseases and injuries, were very meagre, embracing only the most obvious symptoms presented; and so, likewise, those relating to remedial means and measures were quite limited in their scope. giving only the commonest characteristics.

The therapeutics, as well as the pathology and the materia medica, was exceedingly brief and superficial, from the fact that therapeutic are sought only to apply, in each case, that remedy which had been most efficient in a similar case.

The comparison instituted called for no profound research as to the organs and tissues affected; not as to the causes of the positive powers or minute effects of the remedial means to be employed.

As the fruits of experience became more abundant, and their classifications more numerous and thorough, therapeutics grew apace, taking in more and more agents and influences from the different kingdoms of nature, and evolving one theory after another, and system after system, as shown in the history of medicine.

My present undertaking does not allow me to notice the various theories and systems which have prevailed, at different periods, in the medical world. Taking the best fruits of them all, so far as they have survived decay and come down to us, I desire to bring them into some systematic shape, in order that they may guide our way in the science as well as art of healing.

As the highest object of the medical profession is to employ the best means, in the most efficient manner, any arrangement of the principles deduced from medical, hygienic and surgical experience, at once simple and sound, must be a desideratum of no small value. Much confusion has existed, and still exists, as to the proper places occupied by different remedial measures, and as to the principles ho governing them; some writers adhering to one general law as sufficient for the whole domain of therapeutics, and others recognizing a number of laws of independent, if not co-equal, importance.

Some speak of remedies indicated, and also of “adjuvants,” always advancing the former to a higher rank and degree of importance than may be conceded to the latter. The “indicated” remedies they propose to use under the rigid requirements of “the law,” while the “adjuvants” seem to come in, if at all as the creatures and subjects of fancy, with no special laws for their guidance.

What I desire is to assign to every principle and every measure its own place and share of importance in therapeutics.

The tendency of the medical world, influenced by the asperity of controversy, has unfortunately been to extremes in favor of certain pet ideas and in opposition to all others.

Much error has thus been fostered, and many truths neglected.

Systems, once discarded, have dragged into long forgetfulness many good things, in one way or another, related to them.

It is the spirit of science, to-day, to espouse the cause of no theory to the entire exclusion of others, to engrave upon stone, as unalterable, no systems or creeds, but to examine the claims of all with an earnest desire to know the truth.

And the philosopher, as well as honest doer, now stands ready, not only to examine, but also to accept all that proves best, regardless of source. Assuming such as attitude, and in such a spirit, let us now look for the outlines of the Science of Therapeutics.

TWO GRAND DIVISIONS OF THERAPEUTICS.

Surveying the accumulated stores of medical experience, we are led, at the outset, to recognize a well marked line running through the great field, having on the one side all those means and measures which are relied upon to relieve suffering and restore health without the institution of a pathological condition, and, on the other, such as are employed “to institute those new pathological conditions which are most conducive to health.”

We might, very properly, designate one side of the field the Physiological, and the other the Pathogenetic or Pathological.

It is an obvious fact that, all the curative influences brought to bear upon the invalid, which are not disease-producing, must be governed, in great part at least, by the laws of physiology. the principles regulating the deficiency or excess of things requisite in health and dictating measures for the direct removal of the factors and products of disease.

Physiology has to do with the tissue pabula and excitants, as well as the whole environment, of healthy life, for its support and protection.

On the other hand, Pathology, and more especially Pathogenesy, as concerned in the employment of curative means, has to do with those influences which, in the language of Dr. Martyn Payne,1 “substitute one pathological state for another in the cure of disease,” or, as written by Hahnemann,” such as possess the power of producing in the human body an artificial disease.”

But, for practical purpose, I have preferred and already used, in my lectures before my class in Philadelphia, other and less technical names for the two grand divisions of the field of therapeutic practice, namely:

1 – GENERAL THERAPEUTICS. (Paines Institute p.665, edition 1847.)

2 – SPECIAL THERAPEUTICS. (Hahnemanns Organon, p.19, Third American edition.

In the first division are to be found all means and measures of which I have just spoken, as coming, chiefly, under the direction of the laws of physiology; while in the second division are those means alone, which are capable of inducing affections, “artificial diseases,” which shall supplant those existing, and then, themselves, yield to the recuperative energies of the organism.

II.

GENERAL THERAPEUTICS.

In looking over the grand divisions of the therapeutics field more closely, we observe certain interior lines, marking sub- divisions of more or less importance.

In attending upon, or serving, the sick or the injured, as indicated by the term Oepaneuw especially in the use of means not pathogenetic, we must recognize different kinds or classes of forces, each impressing and actuating the organism, or altering its circumstances, in ways peculiar to itself.

One class, having a wide scope; we may term –

1. HYGIENIC.

This embraces agents or influences concerned in the support and protection of normal life, such as –

a. Air breathed-is quality and quantity; b. Food eaten-its quality and quantity;

c. Fluids drank-their quality and quantity;

d. Clothing worn-its kind and quality.

e. Dwelling occupied-it character and situation;

f. Business followed-its character and influence;

g. Habits formed-their character and tendency;

h. District inhabited-its disease tendencies;

And each of these sub-divisions we find again divisible, as I will briefly indicate.

The air breathed. The research in physiology have discovered. with considerable exactitude, the properties of atmosphere requisite to health. The preponderance of one or another of its constituents has been found to result in disease and death; and so likewise the presence in it of certain vapors and impalpable contagia and miasmata. Again, the temperature weight, as well as the humidity and electrical states of the atmosphere, have been found to vary the conditions of human health, and so like-wise its stillness and motion. The therapeutist must recognize all these facts and prescribe accordingly, or, as directed by the most approved hygienic principles relating thereto.

The food eaten. Although the adaptability of the human apparatus for food digestion and assimilation is very great, and although in different circumstances men may live on vegetables alone. or meats and animal oils alone, there are, yet, certain kinds and qualities of food demanded, for the best development and support of the human organism, which may not be ignored.

Errors, in the selection and use of food, as to quality and quantity, and manner and times of eating, have, probably, occasioned more sickness than any other class of errors recognized in the wide domain of aetiology. The therapeutist who does not take notice these, and give need to the principles regulating them, is unworthy of his calling, however much he may know of medicines and their uses.

The fluids drank. Much of human misery, as well as human health, depends upon the fluids imbibed. Late investigations have shown quite clearly the tendency of the leading articles of drink in use among men-the good of some, the evil of many-so that beverage principle are not wanting. Immense good, in the restoration as well as the preservation of health, may be effected by the physician who recognizes and enforces these principles, in reference to water, tea, coffee and alcoholic stimulants among his clients.

The clothing worn. It is well known, among those who observe the progress of physiological discovery, that the bodily condition of man is variously influenced by the color, texture and cut, as well as the kind and weight of clothing worn.

The protection of the extremities, the allowance of room for chest expansion, the right action of the abdominal viscera, and the ready transmission of the fluids of the body, through their channels, as well as the preservation of normal temperature, must be provided for by the regulation of the clothing worn, according to principles now quite well defined.

The dwelling occupied. The search for the causes of sickness has led to the consideration of the materials composing the walls and floors of dwellings, and their provisions for light, heat, air and drainage, as well as their sites and surroundings.

The medical adviser must be prepared to consider the house of his patient, as to its probable influence upon health, and to prescribe necessary changes.

Business followed. Long observation and the gathering of statistics have done much to determine the comparative healthfulness and special tendencies of the various occupations followed by mankind. It is the business of the therapeutist to understand these, and to prescribe accordingly for persons under medical care.

A change, from one occupation to another, may be all that is required to restore an invalid to health.

Habits contracted. Under the influence of various and, often, morbid desires, habits are contracted and practices followed by individuals, much to the injury of health. Things hurtful have thus come into daily use, and things proper have been greatly abused or sadly neglected. Irregularities have crept in till life has become demoralized and destroyed. Cheerfulness has given way to gloom, and often the laugh of innocence to the moody silence of remorse or the shrieks of despair.

The medical friend and adviser must observe these, and devise measures for their correction.

Mental diversion for the worn-down student, cheerful company of the grief-ridden, and a pure life for the dissolute, may be of more importance than all the drugs in the materia medica.

District inhabited. Local causes of sickness are now quite successfully studied, furnishing the geography of diseases, the haunts and routes of travel peculiar to certain epidemics, and the measures necessary for the protection of health in different localities.

Every year more of these things are discussed in medical books land journals, as well as by the public press.

Boards of health and other organizations, as well as numerous individuals, professional and lay, are investigating and publishing facts and principles relating to public as well as individual hygiene.

Another class of forces, bearing upon the human organism, and called into use by its necessities, we may term the –

2. CHEMICAL.

This embraces all the agents employed under the especial direction of chemical laws, such as –

Elements requisite { a. When deficient.

{ b. When in excess.

Agents hurtful { a. Internal, requiring antidotes

{ b. External, requiring disinfectants.

It is hardly necessary for me to enlarge upon the divisions and sub-divisions of these chemical measures and means, now generally recognized in the domain of domestic as well as professional therapeutics.

The practitioner cannot afford to be ignorant of them, and especially of their proper uses, in the support and protection of human life.

It is not safe for him to proceed in the treatment of cases to which he may be called, till his diagnosis has informed him, if the causa morbi be a poison within, calling for an emetic or an antidote, or a poison without, calling for disinfectants, which chemistry alone may be able to point out. To prescribe “mint tea”, and “epigastric sinapism,” or “arsenicum album. in a case of poisoning by arsenious acid; or to prescribe “paregoric,” black berry tea,” or “croton tig,” where croton oil has been taken in excess, would enhance the reputation of the prescriber about as much as would his administration of “ammonia” or “lachesis,” to one asphyxiated in the bottom of a foul well, or of “dialysed iron” or “china pills,” to the pauper dying of the anaemia of hunger and thirst.

It is true chemists have dabbled much in things medicinal, putting forth remedies theoretically unsound and practically worthless. They have often overlooked the might and cunning of the vital force, while dealing with the human body and its organs, as so many combinations of elements, subject only to the laws which govern in the retorts and receivers of the laboratory.

This is not the place to review such errors, but I cannot pass without admitting their existence and saying that while advocating due allegiance to chemical laws, we must insist upon their practical confinement within the domain of chemistry.

Toxicology, with its wide gleanings and its generalizations, a great science of itself, brings to view a multitude of agents, antidotal as well as toxical, with which the therapeutist should be well acquainted.

We pass on to mention another class of forces acting upon the human body and upon its surroundings for the protection and restoration of health, which we must recognize as –

3. MECHANICAL.

This class embraces all such agents as bear upon the organism under the laws of mechanics, such as –

a. Force capable of changing the position of the body, or of some of its parts.

b. Force capable of changing the locality or the relations of the body;

c. Force that may overcome obstructions to the normal action of organs and motion of fluids in the body; or that may be required to increase such action or quicken such motion:

d. Force applied to reduce dislocations and fractures, to restore parts lacerated, and to correct deformities;

e. Force employed to remove foreign bodies from organs and tissues suffering on account of their presence; and again, to remove morbid growths and products, or parts of the body on longer fit of safe to remain.

In the divisions and sub-divisions of this class, we recognize the measures and means prescribed by the advocated of physical exercise-the walking, the riding, the climbing, the gymnastics, the massage, the health-lift, and also the means and methods of operative and reparative surgery, in all its extended and useful ministry.

This department of general therapeutics is wide and important, and its measures are exceedingly varied; yet they are all subject to the well-known laws of mechanics, and must be studied and directed from the mechanical, as well as physiological stand- point.

One more class I must present before leaving the field of general therapeutics, the –

4 ANTIPARASITIC.

This class embraces all agents employed for the destruction or removal of the parasites which live upon the human body, such as

– a. ANIMAL PARASITES.

b. VEGETABLE PARASITES.

The animal parasites are distinguished as

Epizoa, existing upon the exterior; and

Entozoa, in the interior of the body.

The vegetable parasites are variously distinguished and classified, according to their microscopical as well as more common characteristics.

There are cryptogams and fungi, spores and dust or germ-fungi, bacteria and micro-bacteria, etc.

The agents employed to remove these different pests of humanity are many and various, brought largely from the classes of which I have just been speaking; some being –

Mechanical, as the brush, the sponge, the scalpel, etc.

Chemical, as caustics, washes, ferments, etc.

Toxical, as santonin, andira, koosso, etc.

The medicinal treatment of parasites must be toxical, such as may sicken to kill them without seriously disturbing the body whence they are removed. The medication is not, then, primarily of the person or principal, but of the parasites, and must be governed by rules arrived at by observation and experiment in the parasitic field, limited or modified, of course, to suit the liabilities and requirements of the human organism.

The treatment of the conditions inviting and favoring the presence of parasites, calls for hygienic and sometimes medicinal means, under laws elsewhere considered.

Much discussion has taken place in regard to the order of cause and effect in the field of parasitic display, some writers claiming a systemic or constitutional disorder, resulting in local decay and parasitic occupation, while others have placed the parasites as causes, and the local or systemic disorders as their effects. I do not propose to enter upon such questions here, but it is proper for me to say that, the drift of modern discoveries, in such cases, is decidedly against the doctorine of abiogenesis, the generation of living organism, de novo, out of life less matter. The means and methods of disinfection, of stamping out the germs of disease, are daily coming more and more under the sway of recognized principles.

I have now spoken of four classes of forces, or means, the Hygienic, the Chemical, the Mechanical, and the Antiparasitic, as constituting the armamentarium of General Therapeutics; but I would not be understood as saying that they are so distinct and independent that they may not act conjointly or modify each others influence, while favoring the vis medicatrix naturoe, or even the vis medicines, of which I shall speak hereafter.

In conclusion of this part of my subject, I would say, that a review of the means employed in General Therapeutics, which I have presented in our line, will reveal two noteworthy facts- first, that they are of very great importance in the art of healing; and second, that they are all governed by certain laws.

To the therapeutist they are not simply “adjuvants,” nor creatures and tools of fancy, but legitimate and reliable and necessary means for the defense and restoration of human health.

Some practitioners, impressed with these facts, have limited their efforts to the use of one class of means, generally the hygienic, in the treatment of the sick, claiming to act upon the (absurd) principle “that nothing should be used in sickness not required in health.”

It will be observed that, I take no mention of the therapeutic power claimed by persons said to be “healers” or “healing mediums.”

As I have undertaken, to present forces or agents, such as we may grasp and direct, under the guidance of some known laws of nature-means discovered and understood by careful study, and not received as “spiritual gifts,” nor as the discoveries of “clairvoyance”-I leave that mysterious power for those to discuss, who are better acquainted with its character, laws and uses.

I can only say that, it would please me greatly to lay aside the remedies now in use, especially the pathogenetic, if convinced that, the healing forces, now coming through various forms of matter, could come as well, or better, at our call, from the great source of all power, through the human touch, or voice, or look.

J P Dake