The efficacy of Veratrum in the treatment of diarrhoea of an appropriate character, is universally conceded in our schools, and in my own practice. Veratrum has for many years been a frequently used and highly valued remedy for constipation in persons of all ages, but especially in infants and young children, in whom digestion appearing to be well performed, the evacuation of faeces appears nevertheless to be impossible because of the inertia of the rectum-a fact demonstrated by the circumstance that healthy stool can be procured almost at will by irritation of the rectum, as by the common practice of introducing into the anus a piece of oiled paper, or a rubber bougie. We have here the apparent anomaly of the same remedy equally efficacious in diarrhoea and constipation.
Nux vomica furnishes a similar example. Its efficacy in certain forms of constipation as well as of dysenteric diarrhoea, is well known.
Let us now, for a moment, examine a little more closely the nature of the functions, affecting which the alternate series of opposed conditions (which have been called primary and secondary) are mostly observed in drug-proving. 1st. They are such as in the nature of things are periodic and not continuous; characterized and qualitative correlative interchange among themselves. Thus, sleep is periodic, and capable of being supplemented to a degree by other forms of repose to the nervous system. The intestinal canal, the genito urinary apparatus, the skin, in so far as secretion and excretion are concerned, have periods of activity and repose; and the inactivity of one may be made up by increased activity of another.
And thus the function of any one of these apparatus may very widely at different times without a condition of opposition being established. For this reason, then the mere quantity of one of the excretions, or the degree in which any one of these periodic and convertible functions is performed, does not rank first among the indications on which the selection of a drug is to be based. If we now analyze the prescriptions of Veratrum and Nux vomica referred to, we shall find certain constant phenomena characterizing both the constipation and the diarrhoea, and which would determine the prescription almost without reference to the excretion. The Veratrum diarrhoea is uncontrolled and almost unnoticed by the patient, liquid faeces escaping with the flatus.
Here we have a paretic and anaesthetic state of the rectum and sphincter. The Veratrum constipation exists solely because the rectum does not perform its expulsive functions, and is not, as normally as it should be, irritated thereto by the presence of faeces. Here, likewise, is a paretic and anaesthetic condition; but Veratrum is not fully indicated in either case without the characteristic general symptoms-general depression of vitality, predominant coldness of the body, pallor and cold sweat of forehead or of the whole body on slight emotion or exertion; as, for example, on having a diarrhoeic stool, or making the ineffectual effort to a stool, if constipated.
Both the constipation and the diarrhoea of Nux vomica are characterized by increased but uncoordinated activity of the intestine evinced by tormina and tenesmus and frequent insufficient stools, so that the condition of intestinal action is the same, whether there be, as in one case, a minus, and in the other a plus, of excretion-and, indeed, in the Nux vomica patient, these conditions often alternate. These remarks and instances will sufficiently illustrate my conclusions, viz.:
That the appearance or non-appearance of opposed series among the symptoms of a drug depends chiefly, if not altogether, upon the dose in which the drug was proved; and that the question of the constant and necessary appearance of such series cannot be determined until experiments with a uniform and the least possible dose shall have been made by many provers with the same drug, an in the case of many drugs-and therefore that, 1st. although in our Materia Medica, as it now exists, pathogenesis do present certain series of symptoms more or less opposed, nevertheless (excluding the symptoms of the agony, which are not available in practice), inasmuch as these series of symptoms occur in different orders in different provers, according to dose or idiosyncrasy, no sound practical distinction can be drawn between them, based on assumed difference of nature, by virtue of which they can be designated respectively as primary and secondary. 2d.
That symptoms apparently opposed (not including those of the agony) occurring in a drug-proving are equally available as guides in the selection of remedies.
Coming now to the special subject of this paper, I justify the length at which the preliminary subjects have been discussed, by the suggestion that if I have shown that there is no basis for a division of drug-symptoms into primary and secondary, I have thereby shown the impossibility of a law of dose based on such a division.
Or, if admitting that in pathogenesis there do appear groups of symptoms apparently opposed, I have shown that these refer only to certain functions, and by no means embrace or could be made to include the symptoms of the entire organism. I have thereby shown that an alleged law of dose, based on the existence of these groups must necessarily be partial, and therefore devoid of that generality of application to the entire pathogenesis which alone would justify th appellation “Law,” and I claim to have shown these things.
