|MATERIA MEDICA AND THERAPEUTICS|
Homeopathic Materia Medica by Dunham
MATERIA MEDICA AND THERAPEUTICS
( )In the exercise of any art which involves the use of tools or implements of any kind, the first condition essential to success is this:
That the scope and limits of the art be clearly defined and well understood, in order that no attempt may be made to exercise the art under circumstances which do not call for it, and which would necessarily preclude success.
A second condition no less essential is a thorough familiarity with the tools or implements of the art; the origin, nature, powers and capabilities of each, and their relations to each other. This knowledge will teach us properly to select our tools according to the work we have to perform.
The problems before the artisan, then, are these:
The practitioner of medicine, in the exercise of his profession, performs many functions. He may act simply as a diagnosticator of disease, detecting and explaining the seat and effects of disease, but without undertaking to treat it. Or, if he undertake to restore the sick to health, he may act simply as a surgeon, employing mechanical means alone, doing, as the etymology of the word surgeon or chirurgeon implies, handiwork. Or, he may act as the chemist, antidoting by chemical re-agents, noxious substances that are acting injuriously upon the body. Or, he may act as hygienist, bringing the laws of physiology to bear upon the regimen of his patient, and so ordering his mode of life as to eliminate the discoverable cause of disease. Or, finally, he may act as a therapeutist, by introducing into the organism of the patient certain substances from the external world which have the power of producing special modifications in the condition of the organism; and by means of these modifications he aims to cause the diseased action of the organism to cease and to be supplanted by the normal healthy action.
It is only with the practitioner of medicine in his last-named capacity, viz., as therapeutist, or curer of disease by means of drugs, that we have to do in the study of the sciences of materia medica and therapeutics.
The practitioner of medicine, in this capacity, employs certain tools or implements called drugs. These are the tools of his art. The problems before him are to determine:
The first of these problems, viz.: When and under what circumstances are drugs to be employed in taking care of the sick ? has met with a variety of practical answers at different periods in medical history. At one time by a certain class of physicians, as is well known, drugs were universally and most lavishly employed in all cases of sickness. Another school in our own day goes to the opposite extreme of denying the power of drugs to control the course or result of disease, and altogether abstains from using them. Between these extremes there are all degrees of opinion and practice.
One might think that as this is a practical question, it might be settled by an appeal to experiment. But it is obvious that no experiments can be decisive, unless the experimenters agree upon the mode of making them. Two series of experiments cannot be compared unless their conditions are identical.
If one carpenter should use a plane to make smooth the surface of a plank, and another should use a gouge for the same purpose, these two artisans, on comparing results, would be found to have formed very different opinions respecting the efficiency of tools. Now, it is notorious that physicians have been altogether at variance in respect of the principles upon which drugs should be selected and the mode in which they should be used in treating disease. This will account for the unsettled state of the problem we are considering.
As has been said, there is an influential school of medicine—the expectant or physiological—which professes to abstain altogether from the use of drugs. Some advocates of this school argue, upon theoretical physiological grounds, that it is impossible for drugs to alter the course of action upon which the organism has entered in disease; that the organism must be allowed to carry out this course of action to its physiological conclusions,—indeed cannot be prevented from so doing. The fallacy of these arguments will be shown hereafter.
Others of this school point to the great successes of homeopathic and hydropathic physicians as proofs that drugs are a mischief and a mischief only. But this argument rests on the erroneous assumption that homeopathists use no drugs.
The legitimate conclusion from the successes of homeopathists and hydropathists is, that drugs unnecessarily and wrongly used are potent for evil; and the practical lesson to be drawn from this conclusion is, that it is a matter of the first importance to learn when it is necessary to use drugs and how to select and use the right drug for each case.
When called upon to take charge of a sick person, the first business of the practitioner is to make a diagnosis,—in homely words, to find out what ails the sufferer. The prognosis follows upon the diagnosis, and may be called a part of it. In doing this the practitioner observes the objective condition and surroundings of the patient, hears his subjective symptoms from the patient himself if he is able to state them, or from his friends; and listens to the previous history of the case He inquires into the previous habits and occupations of the patient, ascertains whether he has been subjected to exposure or fatigue of mind or body, has been in the way of contagions or miasms of any kind, has been guilty of excesses or subjected to privations. Again, he looks for indications of any taint of constitution, any morbid diathesis inherited or acquired. In this way he endeavors to add to direct observations of the patient's present condition a knowledge of the predisposing and exciting causes of the disease under which he is laboring. Upon these data he forms his diagnosis. And up to a certain point his treatment is governed by his diagnosis. If, for instance, he finds the patient lying at the point of death from a mortal wound, or from cerebral apoplexy, or from whatever cause, he can do no more than communicate to the friends his diagnosis and prognosis, his view of the nature of the disease and his prediction of its course and termination, and leave the patient to their kind offices. Or if he find a wound, a fracture, a hernia, his diagnosis will be made accordingly; and, whatever his prognosis, he will employ the appropriate surgical means for closing the wound, adjusting the fractured parts, or reducing the hernia; and herewith, if there be no complication, his business will come to an end. Or if, again, he find as the exciting cause of the disease, some violation of the laws of health, his first business will be to cause this violation to cease. If it have been an error in diet, the diet must be regulated. If an unduly small or unduly great amount of exercise, this must be corrected; if an improper exposure to heat or cold, light or darkness, this must be adjusted; excesses must be curbed, deficiencies made up. In a great many cases, such an attention as this to the hygienic needs of the body will suffice to restore the patient's health. In every case it is to be the first concern of the physician ; for, you may be well assured, without this care all administration of drugs will be in vain.
How to do in detail all that has been briefly alluded to as the duty of the practitioner in certain specified and in all similar cases, will be taught from the chairs of surgery, physiology, chemistry, and theory and practice. But from each of these chairs save that of chemistry, and, above all, from the chair of pathology, it will every day be taught that in a large number, I might say in a large majority, of cases of sickness, no amount of attention to the hygienic needs of the patient will be sufficient to put an end to his illness and restore him" to health. Should his habits be regulated with the strictest observance of physiological laws, there will still be observed in him a diseased action of the organism, which, unless arrested or changed into a healthy action, will result in some kind of injury or deformity of one or more organs of the body, or may result in death.
Now, since in the case supposed the procedures of hygiene have failed to effect this necessary change of the morbid action into healthy action; since, although the conditions and surroundings and diet and habits of the patient are just what they should be, nevertheless the disease continues to progress and to injure or even destroy the organs of his body, we must either leave him to his fate, trust to nature to cure him — a cruel step-mother, as I shall show, sometimes called kind and benignant, but only so because less cruel than a false and monstrous system of therapeutics, now happily declining,— I say we must leave him to his fate, or else we must find some particular means of bringing to bear on the diseased organism an influence capable of converting its morbid action into healthy action.
An influence of this kind is that which is exerted by drugs. Cases requiring the exercise of this influence,—cases in which hygiene has failed, or in which experience has shown that hygiene will fail, to arrest the morbid action of the organism,—these are the province of therapeutics, these are the cases in which drugs should be employed.
This may be made more clear by illustrations. Suppose a case of inflammation of the lungs. The patient is seen in the first stage, that of congestion. The physician ascertains the exciting cause, which has probably been undue exposure to cold winds or to a wet atmosphere, conjoined to a predisposing weakness of the lungs. All means are at once employed to adjust the temperature of the apartment, so as to supplement the deficiency of heat, by which in part the malady was induced. Experience has abundantly demonstrated that this care will not be sufficient to restore the lung to its normal state. Pathology teaches that in this stage the capillaries of the lungs are gorged to their utmost capacity; that the blood has almost if not altogether ceased to course through these capillaries; that the lining membrane of the air-cell in the part affected has ceased to perform its normal function; and that if this state of things continue, the membrane of capillaries and air-cells will assume a new function and will pour out an exudation which will fill up and obliterate the air-cell. If, in this state of things, we could bring to bear upon the patient some influence capable of acting just exactly upon the part affected by the disease, and of so acting as to resolve this stasis and set the blood in motion again; thus to relieve the gorged capillaries and to restore to the membrane of the air-cell the peculiar power which nature gave it, this influence would promptly effect a cure. It is an influence of this kind which we exert when we give a drug which is a specific for any diseased condition. And the object of the science of materia medica is to discover drugs which possess properties of this character, to ascertain the particular properties of each drug, and to learn how to give each drug in just those cases in which its peculiar properties will enable it to exercise such an influence as has been described.
If, in the case of inflammation of the lungs which has been supposed, we know of no such drug, but leave the case to nature, as the saying is, why then, either the inflammation and the consequent exudation are so extensive as to consolidate a larger part of the lung than the patient can spare, and death follows; or else after a long and tedious illness the exudation ceases to be poured out, and then becomes more or less completely absorbed again. This absorption, however, is rarely complete. The lung is left more or less consolidated and unfit for purposes of respiration, and more or less prone to the formation of secondary abscesses or of a nidus for the deposit of tubercle, while the patient goes forth again more or less a cripple in his respiratory organs.
Such is the benignity of nature, to whose curative power we are counseled to intrust our patients rather than endeavor to produce specific cures by means of drugs.
Let us meet, at once and for all, this question of nature as the great curer, superseding all the appliances of art.
How does nature amputate a limb ? First she rots the skin, then she rots the muscles, then she rots the fasciae and the vessels and the nerves, leaving them hanging out from the stump ; last of all, after a long period, the bone, becoming dead and brittle, by some happy chance gets broken off. There is left a conical stump that will not bear to be touched, that will not tolerate an artificial limb, that is a torment to the patient, if indeed the months of suffering which the operation involves, or the drain of the constant discharges have not before this time carried him off. Compare this process and result with the expeditious amputations, the convenient stumps and the shapely and helpful artificial limbs of modern surgery ! Dr. John Ware says that "the business of the medical practitioner is to stand between the patient and his friends and prevent the latter from interfering with the processes of nature !"
He would not think of applying this doctrine to the case of amputation! But he can be justified in applying it to cases of internal disease only on the assumption that he has as yet no knowledge of any better method than nature's. If this be so, then it should be stated as a fact affecting present time only, not laid down as a principle to hold good forever!
How does nature relieve a non-inflammatory congestion of the lung ? By opening a blood-vessel into one of the air-tubes and causing an haemoptysis. We very well know the ordinary sequelae of pulmonary haemorrhage, and how few are they who escape its termination in consumption! Is nature to be imitated in this?
How does nature cure a surplus of acid in the blood? By deposits in the joints, inflaming their synovial membranes and destroying the function of the joints, or by deposits in the kidneys or bladder causing nephritis or cystitis or calculi, or both. Shall we, from a superstitious devotion to nature, withhold ourselves from seeking out a better mode of cure?
It may be objected that this is not a fair statement of the doctrine which is, that we are to imitate nature, not in her mode of eliminating the proximate cause of the disease, but in the fact of its elimination. This reduces nature's teaching to the simple lesson that we are to "get rid of what annoys us," leaving us to find out the ways and means. So axiomatic a piece of advice as this would hardly seem to call for the admiration which has been expended on "nature, the great healer of diseases!"
The manner in which it has been proposed to imitate nature in the cases alluded to is this: Whereas in case of pulmonary congestion, she abstracts blood from the lungs, the doctors take it from the arm; whereas she gets rid of the excess of acid in the blood by pouring it into the joints and the kidneys, the doctors neutralize it by introducing an alkali into the blood.
But the result of this indirect imitation of nature does not differ much from that of a direct imitation. The cause of the pulmonary congestion being left unaffected, this congestion continues to be produced, notwithstanding that the doctor abstracts blood from the arm to relieve it. The continued congestion exhausts the patient by interfering with respiration. The doctor at the same time exhausts him, taking away his blood to cure the ever-reproduced congestion. Between disease and doctor the patient dies! And in this termination, there is still an imitation of nature! For does not nature put an end to the life of every living creature ?
Let us take a higher view of these matters. Let us take a lesson from the Creator alike of ourselves and of that which we call nature!
Man comes into the world the most helpless of all living creatures, the feeblest, apparently the least provided for. If we look no higher than to the operations of external nature, we should say that his race must perish from off the earth, a victim of cold, of starvation, of maladies to which more than any other creature he is subject. The very opposite of all this happens. Every apparent law of nature is controverted. Man, the feeblest creature, dominates the earth. Every animal is subject to him. The three kingdoms of nature, throughout the globe, minister to his needs. How comes this contradiction ? By the exercise of the intellectual faculties with which man has been endowed, man the feeble becomes mighty. Naked, he clothes himself with the spoils of animal and vegetable creation. Surrounded by crude food,, yet unable to digest it in its natural state, his inventive faculties contrive for him the means of converting raw flesh and crude vegetables into delicate and savory nutriment, for which he gathers condiments from the ends of the earth. An easy victim of a host of miasms, he is endowed with intelligence to discover and with energy to procure, from distant climes if need be, specific remedies for the cure of every malady and the alleviation of every physical suffering. That he has to some extent succeeded in applying this intelligence to this beneficent end, is a guarantee of a success that may increase until we shall have a remedy for every ailment.
That we hitherto lack a great number of specifics, this fact, instead of throwing us back into that stolid reliance upon nature, that stolid submission to the ills of our original state which is characteristic of the unenlightened savage, may well incite us to renewed exertions in this path of investigation and discovery so fruitful of blessings to our race!
To return now from this digression, we perceive that our first question may be answered as follows: Drugs are to be used in cases in which disease persists after the employment of such mechanical, chemical or hygienic means, or all of them, as the laws of physiology may indicate, shall have proved ineffectual or insufficient to change the morbid action of the organism into a healthy action.
The employment of drugs must always be secondary and subordinate to a resort to hygienic measures.
Having thus determined when drugs are to be employed, viz.: when, after the exciting causes of disease have been removed, the disease still persists, and when some special influence from without the body is needed to bring it back into the way of healthy action, we come now to the second problem, viz. :
What is the nature of drugs in general, and how to ascertain the nature and properties of each particular drug.
The organism is made up of organs which perform their functions by virtue of a susceptibility which the tissues of which they are composed possess to certain stimuli which are necessary to life, and which are called general stimuli. These general stimuli are light, heat, electricity, air, moisture, aliment. The tissues of the lung are endowed with a susceptibility to the atmospheric air which acts as a stimulus to them, and under the influence of which they perform the function of respiration. If this stimulus be withdrawn, the lungs cease to perform this function, and the animal perishes. If the quantity or quality of this stimulus be much altered, the function is performed in an unnatural or diseased manner, and sickness results. Heat is also a stimulus to the lungs as well as to other organs. Aliment is a stimulus to the digestive apparatus. Instances of this kind might be multiplied.
Now, it is well understood that when one of these stimuli has been in excess or in deficit, and consequently the function of the corresponding organ or apparatus comes to be abnormally performed, it will often be sufficient to re-adjust the proportion of the stimuli, for the organism to recur to its normal condition. To accomplish this re-adjustment is the task of the science of hygiene.
But, furthermore, it is also well known, as has been already stated, that hygiene, though it may with perfect nicety re-adjust the proportions of the general stimuli by virtue of which life goes on, is not always able by this re-adjustment to restore the organism to its former healthy condition. The organ or apparatus, which, through some deficiency or excess or perversion of some stimulus or other, became diseased, will often remain diseased after hygiene has corrected the disproportioned stimulus. Permanent disease exists, and hygiene has done all it can do.
In this state of things we are powerless unless we can bring to bear upon the diseased organ some influence which may have the power to directly convert its diseased action into the pristine healthy action. This, it will be conceded, is the desideratum and this must, in some way or other, be accomplished. The substances in which such influences reside are what we call drugs.
We now perceive the two requisite conditions for the successful employment of drugs in treating sickness.
1. We must possess substances which are capable of exerting such an influence upon the different organs of the body as to be able to produce definite changes in the mode of action of these organs: and
2. We must know how to apply this knowledge of the action of drugs to particular cases of sickness.
As a consequence of what has been said, then, a drug may, in general, be defined as being any substance which is capable of changing or definitely modifying the mode in which any organ or system of the body performs its functions, or of changing or modifying the tissues of the body.
The study of materia medica is the study of the nature and properties of drugs. Mow, then, are these to be ascertained? It may not be unprofitable to glance briefly at the history of the materia medica at this point.
There was a time when it was supposed that the properties of drugs were indicated by their physical properties, their color, odor, shape or taste. Thus, aloes, from the yellow color of its solution and from its bitter taste, was conceived to act pre-eminently upon the liver.
This was the famous doctrine of the Signature, most groundless and fanciful, and yet, like every other visionary notion, it was not without some semblance of support in analogy.
The chemical properties of substances furnished another supposed means of ascertaining their supposed properties as drugs. If they were to be employed as chemical re-agents in the cure of disease nothing could be more rational. But it must be remembered that we know but little about the chemistry of disease; indeed, that chemistry deals only with the results of organic action, while we aim, by the action of drugs, to modify organic action itself. Furthermore, experience shows us that sub-stances possessing analogous chemical action produce very different effects as drugs. And, finally, when we come to the vegetable kingdom, we find the chemical composition and reactions of the different varieties to be nearly identical, while their action upon the vital organism is as various as could be imagined.
But leaving the history of materia medica, let us ask ourselves again what it is that we seek? To find out the properties of substances that we suppose to be drugs, to ascertain whether substances which we are investigating be really drugs or not, I. E., whether they be capable of modifying the action of the organs of the body. What method so direct, so simple, so certain, as to test them on the living body; not on the lower animals, for these are often variously affected by drugs; but on the human beings for whose benefit they are to be employed as medicines.
But shall they be tested on the sick? This might be regarded as hardly justifiable, or if it were justifiable, it would be difficult to draw an inference from the action upon one case of sickness respecting its action upon another case of sickness; since each case of sickness is different from every other case. And then again, if we were to gain knowledge of drugs only by experimenting on the sick, and this knowledge were to serve us only in case we should meet a similar case of sickness again, our knowledge would be always too late to be of service. We should know well what had happened, but should have no store of general knowledge ready for any case that might occur.
It is a general rule in physics, that when we try an experiment we should have every element that enters into the experiment in as normal a condition as possible. This can only be done if we experiment on the body in health. Accordingly, all trustworthy and useful knowledge of drugs has been obtained by experiments upon the healthy subject.
Such experiments are what we call provings of drugs. They are made by greater or less numbers of independent observers. The coincidences of effects observed by independent provers are cheering evidences of the correctness of this method. By the application of physiological knowledge to the results of these provings, a more or less complete appreciation of the action of a drug may be gathered.
It is in this way that we ascertain the nature and properties of drugs.
The special method and importance of drug-proving will form the subject of a future lecture.