THE century now drawing to a close will pass into history as an era of wonderful advance. Never before has there been such ceaseless activity, such painstaking investigation in man’s efforts to discover and to control the forces of nature. Medicine shares in this spirit of discovery, and in the world of therapeutics the present is a period of great unrest.
In the Homoeopathic school this activity is displayed not so much in the addition of new therapeutic agents to our already extensive list, as it in a movement to systematize our present records of drug pathogenesy, to expunge that which is faulty, and to place what remains in a shape to be efficiently used. Faith in Homoeopathic methods was never stronger than it is to-day. It is this very faith that inspires the demand that the source of our therapeutics shall be reliable and authoritative. To this end effort is directed.
On the other hand, in the dominant school little confidence is shown in prevailing methods of treatment. new remedies are being energy sought, only to have brief title, to be as quickly abandoned.
This, also, is in keeping with the spirit of the day. Every new method of treatment that is introduced is submitted to test thousands of experimenters. If wanting in merit, it is soon rejected.
It is investigation of the nature indicated that gave to the medical world the synthetic antipyretics, which for a time enjoyed high favor. At last it was found that antipyrine has no power to control or to inhibit the heat-making process-it only promotes heat elimination. The salicylates have no specific action in rheumatism-they only obscure pain. With the fall of these two drugs form their temporary pedestal, less faith is reposed in the class of remedies to which they belong.
But investigators are not idle. Efforts, however, have taken another direction. After the lapse of a hundred years the medical world has turned its attention anew to methods closely allied to that discovered by Jenner, the treatment of disease by agents which are the products of disease. Inspired by the demonstrated success of Pasteur in the preventive treatment of rabies, experimenters are industriously working in this promising field. Necessarily, experiments are confined almost entirely to the lower animals, but the results obtained are, in many cases, definite, and gave promise that man may yet be made the beneficiary. In the lower animals infections diseases, artificially produced, that usually and fatally, may be led to a favorable termination by the injection of micro-organisms derived from other and similar infections diseases, or even by the injection of the micro-organisms of the same disease.
Again, it has been found that immunity to certain diseases may be conferred on animals by the injection of micro-organisms or their products-a state of immunity without which the animal would perish when attacked by the original disease. The injection of the blood-serum taken from and animal already in a state of immunity has been found to prevent the fatal effects of certain toxins when introduced into the system of the susceptible animal. A number of cases have been reported of recovery from tetanus after the injection of Antitoxin, a substance obtained from the blood of dogs artificially rendered immune to the infection of tetanus.
From knowledge gained by experiments of this class, it is probably that new and valuable methods for the prevention and cure of disease will be developed. The results already attained are striking and significant. They are in line with the work accomplished by Jenner and Pasteur.
Of new therapeutic methods none surpasses in interest that introduced by Murray, of England-the treatment of myxoedema by the administration to the patient of Thyroid extract. It having been conclusively shown by Mr. Victor Horsley, in 1884, that myxoedema is due to loss of function of the thyroid gland, Murray conceived the idea of treating the condition by the injection of Thyroid extract. In October, 1891, he reported his first case, which gave very satisfactory results. Since that time Murray and others have treated altogether a large number of cases, and it is now possible to form some estimate of the value of the treatment.
The method pursued, as first devised by Murray, was to inject subcutaneously a Thyroid extract, made by macerating the recently removed thyroid gland of the sheep, which is then treated with Glycerine and a weak Carbolic acid solution. A dose, consisting of from ten to twenty-five minims of this extract, is slowly injected beneath the skin. But, since the hypodermatic injections are sometimes followed by abscess, Dr. Hector Mackenzie, in October, 1892, adopted a modification of Murray’s treatment, which consists of feeding to the patient the extract, or even the gland itself.
It is found that the results obtained are fully as satisfactory as those following the use of the subcutaneous injection of the extract. To the present time the gland has been used in four different forms-as an extract, a powder prepared by desiccation of the extract, the raw gland, and, most remarkable of all, the gland after having been fried. Thus it would seem that the active principle contained in the gland is not destroyed even by heat. used in any one of the forms named, the remedy seems to be equally efficacious.
As a result of this method of treatment, many cases of complete recovery from myxoedema have been reported by competent clinicians.
The time required in order to bring about a cure varies in different cases from several weeks to several months or a year. At the end of the period all signs of the disease have disappeared; the oedema subsides, the face and hands become natural in size, the speech is restored, the spirits brighten, the temperature rises to normal, the skin becomes soft, smooth, and moist, and, most conspicuous of all, the previously bare scalp becomes covered with a heavy growth of hair. In a word, all lesions and symptoms of the malady disappear, and the patient is restored to perfect health.
The size of the dose of the gland or its extract, it is found, must be carefully regulated in order to obtain the best results. An excessive dose produces cardiac irregularity, syncopal attacks, and can even cause death. But, administered with the care that would be given to any other agent,it is safe and efficacious.
It may be announced that a specific for a heretofore incurable chronic disease has been found. There is but one qualification that must be made, but that is a serious one-the recovery is not permanent unless the treatment is continued throughout the lifetime of the patient.
But, notwithstanding this one disadvantage-the necessity for the continued use of the remedy-Murray’s method of treatment of myxoedema may be said to be a great therapeutic triumph.
The mode of action of the Thyroid extract in the disease in question would seem to be not difficult to understand. it has been pretty conclusively shown, by the researches of Mr. Victor Horsley, that the thyroid gland plays an important part in keeping the blood in normal condition and in maintaining the natural metabolism of the tissues.
The thyroid gland thus imparts to the blood some element or principle that neutralizes the tendency to the peculiar degeneration of tissue that occurs in the diseased condition known as myxoedema, and it is shown that this same element or principle can remove the degeneration after it has once occurred. The Thyroid extract and the gland, when ingested, evidently supplies to the blood the principle that is wanting by reason of loss of function of the gland in the victim of the disease.
It might be a satisfaction to be able to find some Homoeopathic relation of the remedy to the disease in this instance. But this can hardly be done. On the contrary, it seems to be an instance of the revival of an ancient practice under more scientific auspices, the treatment of conditions depending on damaged organs by the administration of such organs or their secretions. The method under consideration, therefore, is a marked example of the treatment of disease according to isopathy. The terms isopathy is applied to two distinct practices. One of these, and the one applicable in the present instance, is “the theory of curing a diseased organ by the use of the analogous organ of a healthy animal.”.
Hence, we must conclude that the treatment of myxoedema by the use of Thyroid extract is the practice of isopathy.
There is another therapeutic agent, of comparatively recent introduction, belonging to the class of those which are the product of disease action that is sell worthy of consideration at this time. Following the lead of Pasteur, investigation in this field is now very active and renewed attention is being given to the agent indicated. I refer to that which has been isolated and presented to the profession by Koch- Parataloid or Tuberculin.
Notwithstanding the premature announcement of the alleged virtues of Tuberculin and the extravagant claims made in its, favor, there is now evidence that would seem to indicate that it will yet prove to be a remedy of great value. If this be true, it will have a definite place in the Homoeopathic Pharmacopoeia. it is for the purpose of reviewing what has already been done in this direction that the subject is now brought to your attention.
The substance under consideration-Tuberculin-is, probably, the most powerful agent ever introduced into medicine. In describing its action, Hime says: “It is a tremendously powerful substance. An ordinary injection represents 0.001 mgr. of the liquid. This contains only about the 1-1000 part of active material, or about the fifteen millionth part of a grain. Yet this infinitesimal fraction can set the whole body of a man weighing two hundred pounds in such a state of change that the whole is raised to a temperature of 104 degree or 105 degree F. The weight of the mass thus affected is infinitely greater than that of the active agent, the exact proportion being about 1- 98,000,000,000.
No other substance known to medicine will, in so small a quantity, produce such profound effects. Atropine, Aconitine, Glonoine, and even the snake-poisons, in like minute quantity, would produce no perceptible systemic disturbances.
Tuberculin is a glycerine extract of a pure culture of the bacillus tuberculosis. And yet it appears that it is not identical with any ptomaine produced in the organism by the bacilli in the process of disease. Its exact character is not defined. The active principle seems to be closely allied to protein bodies. That it does not belong to the group of so-called to protein bodies. That it does not belong to the group of so- called Tox-albumins is indicated by the fact that it resists high temperatures and can be readily dialyzed. A precipitate is obtained by the use of 60 per cent. alcohol, which gives a snow- white mass that is almost pure Tuberculin.
This new possesses one property that adds much to its interest. The universal testimony is that it has an elective affinity for tuberculous tissue. Koch says: “There is a general consensus of opinion that the remedy has a specific effect on tuberculous tissue.” To this may be added the testimony of Virchow, who says; “It acts in a remarkably selective way.” Virchow further remarks: “Evidence of its specific power is found in the marked indications of inflammatory action around ulcerated areas and in contiguous lymphatic glands”.
In order to assign this powerful agent, Tuberculin, to its proper place n the homoeopathic Materia Medica-if it is entitled to any such place-two things must be determined: first, the nature of its pathogenetic effects upon the healthy; and second, its curative action when applied according to the indications of these pathogenetic effects.
Unfortunately, there have been no systematic “provings” of Tuberculin, and we must, for the present, depend upon the records furnished by a few experiments. it will be seen, however, on examination of these records, that the pathological effects of Tuberculin are more or less constant and uniform.
In the subject tuberculosis, the injection of a small quantity of Tuberculin is followed by a most profound disturbance of the system. There is great and rapid rise of temperature, and, as set forth by Virchow, increased destruction of tubercular tissue, with its absorption and dissemination throughout the body. This is accompanied by great aggravation of the disease from which the patient already suffers. But it is the effect of the remedy in the healthy subject that we are interested in inquiring into.
Koch relates the results of such experiments. The first subject was Dr. Kitisato, who, June 24th, received an injection of two milligrammes. Four hours after the injection an attack of coughing came on, which continued for three hours. Five hours later, or eight hours after the injection, the temperature was affected, and gradually rose from 97.7 degree to 100.94 degree F. The pulse rose form 72 to 92, and these symptoms were attended by headache, languor, and perspiration.
Dr. A. Wassermann received, June 25th, an injections of 3 milligrammes. In the course of eleven hours his temperature rose from 98.06 degrees to 101.66 degree F., and his pulse form 80 to
Dr. H. Mass received, July 13th, an injection of 4 milligrammes. In the course of the twelve course his temperature rose from 98.6 degree to 102.0 degrees, and his pulse from 72 to 100. He had slight rigors, a feeling of heat, perspiration and vomiting.
Dr. P. Guttman, July 28th, received an injection of 8 milligrammes. Within eight hours his temperature rose from 97.7 degrees to 102.56 degrees F. The pulse rose from 78 to 135. This was accompanied by rigors, heat and sweating.
From these records it may be seen that the pathogenetic effects of tuberculin are as constant and uniform as are those of arsenic, opium or other drugs with known specific action.
The character of its effects may be thus summarized.
After a period of about eight hours from the time of the injection, the reaction begins. First, there is lowering of temperature, followed by a rise, reaching its maximum in about twelve hours. Other constitutional symptoms are: chilliness or rigors, headache, pain in the back or through the body, nausea, vomiting, prostration. Another noteworthy symptom is that there is a short, dry cough, even in provings on healthy subjects, those whose lungs are sound.
Those symptoms subside after twenty-four or forty-eight hours. Provings have not as yet gone beyond the point here indicated. If pushed further, the indications are that it would produce most profound disturbance and even endanger life.
Let us now examine the records of the use that has been made of tuberculin by Homoeopathic physicians.
Reports of cases treated have been made by Drasche, of Austria; Furbringer, of Germany; Jousset, of Paris; Burnett, of England, and Arnulphy, of Chicago.
Drasche treated fourteen cases, six of which were improved and eight aggravated. Furbringer treated forty cases, three of which were cured and fifteen ameliorated.
Dr. Arnulphy’s cases are of exceedingly great interest, both because of the favorable results attained and because they include cases of acute tuberculosis.
The first case Dr. Arnulphy reports is of a young woman, 26 years of age. For six or seven months there had been slight symptoms of pulmonary trouble, consisting of dry cough and emaciation. Suddenly her symptoms became acute, and the disease made rapid progress. She showed great weakness, pallor, great emaciation and almost incessant cough, rapid breathing, temperature of 105 degrees F., profuse perspiration at night and abundant diarrhoea. Over the right lung the respiratory sounds were obscure. The left lung was much affected; at the apex there were moist rales, surrounded by a zone of sub-crepitant rales; at the base, bronchial bubbling rales. The diagnosis was acute tuberculosis and the prognosis grave, if not fatal.
Tuberculin was prescribed. From the first dose the cough abated, the breathing became easier, and in a few days the patient’s condition had so much improved in all respects that she was pronounced to be out of danger. Two weeks later she was cut, and shortly after left her home in Chicago and made a journey to the far west. The woman is still living.
Dr. Arnulphy reports four other cases, all of acute phthisis, which were treated successfully, most of which are as remarkable as the one already detailed.
As a result of his experience, Dr. Arnulphy remarks: Judging by the success achieved, I am justified in saying that the proper field for the activity of tuberculin is acute tuberculosis- precisely those cases which Koch and his followers persistently, and, from their standpoint, constantly refused to treat with the lymph, on account of the reaction that they dreaded.”.
Burnett, of England, reports a number of cases cured; but his records are so wanting in scientific precision that it is impossible to give a satisfactory summary of the results.
The question of great interest is: Is the action of tuberculin in the cure of tuberculosis Isopathic, or is it Homoeopathic?.
In order to answer this, it is necessary again to define the term.
Isopathy may be said to be “The treatment of disease by one or more of its own products”.
One lexicographer, in illustrating this definition, says: “Thus, smallpox should be treated by the administration internally of the various excretions”.
If Koch’s tuberculin has a curative action in tuberculosis- as would now seem to be established from be experience of those Homoeopathic physicians who have already reported on the subject- it follows that the action is isopathic, if the tuberculin of Koch is a product of the diseased process known and recognized as tuberculosis.
Let us see if this be true. Koch’s tuberculin is a preparation made from a pure culture of the bacillus tuberculosis. The bacilli used may be removed two, three or even one hundred generation from the original. A glycerine extract of the medium of culture is made; this is filtered through plaster- of-Paris, and from this an alcoholic precipitate is obtained, which, in attenuation, is the medicinal preparation employed in the treatment of disease.
That the preparation thus obtained is not a product of disease is evident. it is a product of the artificial cultivation of a certain bacillus, which may be removed a hundred generations-yes, a thousand, an indefinite number of generations from the original. It is not a product of disease; it is a product of the test-tube.
But if the product thus obtained were identical with the ptomaine produced i the lungs or other organs in disease, we could not them deny the isopathic relation of the remedy to the disease. But the evidence furnished by the pathogenetic action of tuberculin does not support this view. Burnett truthfully says: “If you alter some-what two things that are identical, then the identity becomes similarity”.
If the ptomaine produced in the system of the tuberculous patient were identical with that produced by the culture process followed by Koch, a minute quantity of it would speedily overwhelm the system. This does not occur. it is safe to say that the amount of the ptomaine produced in the system of the victim of tuberculosis is almost without limit. If this product were identical in nature with the tuberculin of Koch, tuberculosis would, in every case, be one of the most rapidly fatal of all diseases; the duration of the attack in every case would be but a few days, instead of weeks and months and years, according to its present history.
Of the artificial product, tuberculin, the 0.001 mgr. will produce the most profound effects upon the system, in a few hours raising the temperature from normal to 104 degrees or 105 degrees F. In the systems of those already affected by tuberculosis, its effects are even more disastrous. Now, if the product of the disease process and of the culture, process were identical, then the effects of the two should not differ in any respect whatever. The evidence adduced, therefore, supports the conclusion that the action of Koch’s tuberculin in the cure of tuberculosis is not Isopathic, but, on the country, that it s Homoeopathic.
Jousset says: “Homoeopathic only will be able to make intelligent use of tuberculin. We know that it is a powerful agent that has a specific action in tuberculous affections. We know why it is useful in phthisis; it is because, administered in a large dose, it aggravates in phthisis; it is because, administered in a large dose, it aggravates in phthisis. This is because the remedy is Homoeopathic to the diseased condition; that is to say, it is a remedy that will cure a diseased condition similar to that which it produces in the healthy subject. And since it is a Homoeopathic remedy, we know it must be indicated by the totality of the lesions and the symptoms. Consequently in order to complete its pathogenesy it is necessary to know in what class of cases of phthisis it is indicated and in what it is not”.
If the view that I have here set forth is correct, them the conclusion is warranted that the action of tuberculin as a remedy for tuberculosis is not an example of Isopathy. On the country, the evidence at hand would seem to indicate that its action is distinctly Homoeopathic. This being granted, then it must be accepted as true that Koch’s important discovery is but another illustration of the law of similars, and a notable demonstration of the power of infinitesimals in the cure of disease.