|STUDY OF MATERIA MEDICA|
Homeopathic Materia Medica by Dunham
STUDY OF MATERIA MEDICA
( )In our last lecture we discussed the nature of the sciences of materia medica and therapeutics, defining the one to comprise a knowledge of the properties of drugs, and the other a knowledge of the method of using drugs to cure sick people.
We then discussed two of the three general problems which present themselves to the medical practitioner in his capacity as a curer of disease by means of drugs. These were:
1. Under what circumstances of sickness he is called upon and required to resort to the use of drugs in treating disease.
2. The means of ascertaining the properties of drugs. To this second problem I wish to devote a few more words, for I greatly desire that you should very clearly understand the impossibility of acquiring a definite and complete knowledge of the absolute and positive properties of drugs in any other way than by provings upon the healthy subject.
Observations of the action of drugs upon the sick teach the properties of the drug in relation to the organism when in that particular abnormal condition, but give us no absolute knowledge of its constant action upon the organism. Yet we can have no science of therapeutics without some such knowledge of the constant and uniform properties of drugs.
If we give mercury to a patient laboring under Bright's disease, we find that an exceedingly small quantity produces a very powerful and remarkable effect, and such an effect as we see from mercury under no other circumstances.
Now, this knowledge would be of service to us if we should contemplate giving mercury in another case of Bright's disease ; but it would not help us at all if the question were whether or not we should give mercury in some other disease, as for example, pericarditis. And yet you will perceive that one great essential of a science of therapeutics is, that it shall enable us to predict the effect of the application of a drug in a new case; to know beforehand what effect we shall be able to produce; and by this knowledge to select a drug capable of producing the effect we desire.
Now, on the other hand, if a dozen or a hundred healthy persons take mercury, the effects produced on them are, with the exception of slight differences depending on the idiosyncrasies of the provers, identical. This method then enables us to gain an absolute knowledge of the constant and uniform properties of drugs in their relation to the living organism.
If now, having gained this knowledge, we could advance a step farther, and find out what relation the effects which a drug produces on the healthy subject bear to those symptoms of disease which the drug is capaole of removing, we should possess the elements of the much desired science. For, then, having the symptoms of the disease before us, and knowing the relationship which these symptoms bear to the effects of a drug capable of removing them, we could select our drug with A PRIORI certainty of curing our patient.
Having thus considered the problem of the general nature and properties of drugs, and the method of ascertaining these properties, we come now to the third problem: How to use drugs.
Let us suppose that by the method already pointed out, viz. : experiment on the healthy human subject, we have gained a tolerably accurate knowledge of the properties and powers of certain drugs to modify the action of the organism.
Let us further suppose that a sick person is under our charge, in whose case the resources of hygiene have already been exhausted and to no purpose. His regimen and food have been regulated as well as could be desired. Still he does not recover. The interposition of some influence from without is needed to restore him to health. In short, drugs are required. We know the properties of a variety of drugs, their action on the healthy subject. The question now is how, on the basis of this knowledge, shall we select a suitable remedy for the sick man? How shall we apply our knowledge of the action of the drug on the healthy subject, so as to know what drug to select for this particular case of sickness? We demand, in other words, a principle or law for the selection of remedies. The selection and administration of remedies constitute the science of therapeutics, as the investigation of the properties of drugs constitutes the science of materia medica; and the principle or law of which we are in quest would be the great central principle of the science of therapeutics, just as the law of attraction is the central principle of the science of mechanics, and the law of the diffusion of light is the central principle of optics. It is impossible to conceive of a science (properly so called) without some such fundamental principle. A collection of facts bearing on therapeutics might be made which would be an interesting historical RESUME of what had been done in the past, but which would be of but little or no service to the physician in the treatment of any new case,—which would not enable him to predict the result of treatment in a new case. And yet there are some medical men who deny the necessity for any therapeutic law and rely only on unmethodized experience. Of these we shall presently speak at greater length.
I wish now to speak of the physiological school, so called, as that which makes, just now, the loudest claims to exclusive possession of the truly scientific method of treating diseases. I shall speak of it at. some length, because it is of the greatest importance that you learn as early in your studies as possible to analyze closely and fearlessly all claims and pretensions of this kind, and that you learn to distinguish clearly between assumptions and facts.
The physiological school scoffs at a therapeutic law, because a law of this kind is empirical, and does not rest on a rational understanding of the causes of disease. And this is true. It is likewise true of physics. The laws of the attraction of gravitation, and of the diffusion of light and of chemical affinity, in definite proportions, are empirical laws. They do not rest on a rational understanding of the causes of the phenomena with which they deal respectively, for, in truth, we know nothing about the causes of these phenomena, and have never been able to find out anything about them. These laws are simply inductions from a multitude of observed facts. But the physiological school undertakes to find out the causes of the phenomena of disease; to trace the symptoms of disease back to their ultimate origin, and then acting on the general principle, "remove the cause and the effect will cease," to remove the cause thus discovered and so cure the disease.
We have shown that in matters of hygiene this is possible and is the true method. It would be the true method in therapeutics if it were possible. But it is not possible, as we shall best show by an example.
Suppose a fully developed inflammation of the lungs. The rational symptoms are: heat of the skin, accelerated and hardened pulse, difficult respiration, oppressing pain in the thorax, dry cough, tough, rusty expectoration. The physical signs are: dullness on percussion, bronchial respiration, and on the margins of the dullness, fine crepitation. The pathological condition is: locally, a deposit of fibrine in the air-cells and tubes, consolidating the lung; and generally, a marked excess of fibrine in the blood. Now, the physiological school assumes this general pathological condition to be the essential cause of the disease; to lie at the foundation of all its symptoms; and it therefore proposes, as the method of cure, to get rid of this pathological condition, viz., the excess of fibrine in the blood and the local deposit of fibrine in the lung. To accomplish this several means may be resorted to, which, though apparently different, are the same in principle. Blood may be abstracted from the arm. This will diminish the quantity of the circulating fluid, and thereby diminish the actual, although not the relative, quantity of fibrine. But as the quantity of the circulating fluid must always be the same, water is poured into the vessels from the surrounding tissues or from the intestines, and thus the blood is really diluted. All other antiphlogistic or derivative methods or medicines act in the same way. But does this method reach the real ultimate cause of the disease ? By no means. In health the blood does not contain too much fibrine. How came it to do so in disease ? This leads us to the question: Where is the fibrine manufactured, and how came so much to be made, or by what means is fibrine generally removed from the blood, and how happens it that it is not more rapidly removed ? To these questions the physiologists can return no certain responses as yet. But if they could do so, is it not obvious that in order that the blood should contain, too much fibrine, there must have been either too much made or too little consumed. Now, if either of these be the case, how unwise to think of rectifying matters by merely conveying away the surplus. It is like endeavoring to pump out a leaking vessel while the leak is still open. The pumping out is only a palliation,—can never be a cure. The cause of the disease must lie in the secretion of the fibrine. But this process is conducted, as you learn from the chair of physiology, through the agency of a structureless cell-wall, and by a process of which we know, and can know, absolutely nothing. It is an ultimate fact, a part of the fact of life. Such are all the ultimate causes of disease. And as diseased organic action is merely a modification of healthy organic action, as disease is only modified life, we can never hope to attain a knowledge of the real causes of disease, and can never base a therapeutics on the rational method of removing the cause. We must fall back, as all investigators of natural science have done, on an empirical science and an empirical law.
The great majority, however, even of the old school of medicine, regard a therapeutic law as a great desideratum, as something essential to the constitution of medicine as a science.
But to return to our patient. How shall we determine what drug to give him? We have probably made a diagnosis, and given to the collective symptoms which he presents some name of a disease, although, if we have much experience at the bedside we shall undoubtedly have remarked that though the same name may be given to a large number of apparently similar cases of sickness, yet in reality no two of them are in all respects alike; indeed they often differ very widely. This is because the peculiarities of the individual patient are superadded to the general symptoms of the disease under which he is regarded as laboring.
But. having formed our diagnosis and given a name to the case, we might recall from the annals of medicine a number of cases to which a similar name had been given, and which had been cured by such or such drugs. Now, there is a school of medicine, and it includes some very brilliant names, which teaches that such clinical experience as this is our only trustworthy source of therapeutic knowledge, that we must gather up reports of cases and analyze them, find out what mode of treatment cured the greatest number of cases, and adopt this as the right mode.
Louis, in Europe, and Bartlett and La Roche, in this country, are the representatives of this methodical or numerical school.
Now, it will be easily shown, I believe, that while this method may be better than nothing, while it may answer as a make-shift until some better be discovered, it is very far from being in any true sense a science of therapeutics. One objection is this: Its aim is too low. It aims to cure only a majority of cases of any disease; for it avails itself of a method that succeeded only in a majority, not in all; it does not provide for the minority that were not cured by this favorite mode of treatment. It makes no provision for the investigation of the reason why it was that the mode in question failed in a certain number of cases, although it succeeded in a majority. And yet this failure could not have been accidental. There are no accidents in nature. There must have been some good reason for the failure, a reason to be ascertained by investigation and so turned to account as to diminish the minority, and finally altogether to eliminate the failures.
This point may be illustrated by example. If we gather the clinical records of intermittent fever, we shall find that a large majority of the cures recorded were effected by cinchona or its derivatives. The methodical school would therefore pronounce cinchona the cure for intermittent, still a minority of cases will be found which cinchona failed to cure. There must be a good reason for this failure, and a true science of therapeutics should make provision for the searching out and the finding of this reason. The science of the methodists makes no such provision. The highest ideal of the methodists, then. would be to cure a majority of the cases intrusted to them. This is too low an ideal to satisfy a reasoning creature.
To find out this reason why cinchona, which cures so many cases, yet fails to cure other cases bearing the same name, one must evidently examine carefully the cases cured, on the one hand, and the cases which failed to be cured, on the other hand, in the hope of finding some traits of difference among the many features of resemblance. It will be found that such points of difference exist; that while the symptoms of chill, fever and sweat may exist in all, thus entitling all to the generic name of intermittent fever, there are, nevertheless, minor differences between the two classes of cases sufficient to make them quite distinct. Thus, for example, some cases have thirst, while others have none. Some have gastro-intestinal complications, while others have none. Or, complications of other organs or systems may exist. We thus see differences in cases grouped under the same nosological name. But as yet this does not help us to a reason why cinchona should cure some of these cases and not others. And yet this is the very "pith and marrow" of the question. This is the all-important question for solution. For it is obvious that if we could find out why cinchona cures certain cases presenting certain symptoms, we should know with certainty whether to give cinchona of not in a new case. We should have established a relation between cinchona or its properties and the symptoms presented by cases of sickness. Such a relation is a law. We should then have discovered the great desideratum, the therapeutic law. What we seek to know then is this: What relation is there between the physiological action, the absolute properties of drugs, as ascertained by provings on the healthy subject, and the symptoms of disease? We have shown that the properties of drugs, in the sense in which we use the term, are accurately ascertained only by the symptoms they produce on the healthy subject. The question, then, may be expressed as follows: What relation subsists between the symptoms which a drug produces on the healthy subject and those which it will remove from a sick man ? If we could answer this question, we should know what drug to select for our sick man, who has been waiting for a prescription while we have been discussing this subject.
Very long ago, an answer was given to this question in the words: CONTRARIA CONTRARIIS OPPONENDA, which means that the relation of contrariety or opposition should exist between the symptoms of the patient and the symptoms which the drug that we are to select to cure him is capable of producing. This was assumed to be the natural solution of the question. It was argued, and still is argued, that if a patient be heated, he seeks that which will cool him ; if thirsty, that which will make him not thirsty; if constipated, a laxative; if loose in the bowels, an astringent, etc., etc.
The objection to this proposed law is twofold: .
1. It rests upon a confusion of ideas. The procedures of hygiene are confounded with those of therapeutics. In hygienic treatment the problem is to find out which of the natural general stimuli necessary to maintain health has been deficient or in excess or perverted, and to restore or regulate it. By this method, if there be too much heat, from this stimulus having been in excess, the obvious remedy is a diminution of the supply. If thirst spring from a too sparing supply of water, it is obvious that this must be made up, etc. And the test of a successful judgment in such cases is the cessation of the symptom. So in the case of constipation, if the impacted faeces act merely as a mechanical irritant, as a foreign body in the intestine, their removal by direct mechanical means or indirectly through an irritation produced in the intestine by drugs, is purely a hygienic procedure, and may be effected in accordance with the law CONTRARIA CONTRARIIS.
2. But when we come to symptoms which result not directly from abnormal supply of stimuli, but from a modification of the vital forces, and which consist in alterations of sensation, of function, of tissue, how can we find the contraries, the opposites of these symptoms ? What symptom produced on the healthy subject by a drug can be the opposite or contrary of a sore throat, of a gastralgia, of a toothache, of a miliary rash, of a delirium, of a nausea, of a small-pox pustule, of a scarlatina eruption, of a varicose ulcer ?
No more words are needed to show the absurdity of the maxim viewed in this light,—the impossibility of the proposed law. But it may be said that this interpretation does not do it justice. It may be urged that we are to seek not the contraries of the symptoms themselves, but the opposites of that physiological or pathological state which gave rise to the symptoms.
In considering the subject from this point we shall be able to pronounce an opinion at the same time upon another principle of therapeutics, that indeed which is at the present day regarded with almost universal favor, — the method, it may be called, of treating diseases upon general principles.
This method ignores any therapeutic law, its possibility or necessity. The reliance of this method is upon pathology, by means of which science it proposes to ascertain the interior changes in tissue and structure, which lie at the foundation of, and give rise to, the symptoms of the patient, and thus get a rational appreciation of the symptoms. It studies the symptoms produced by the drug in the same way. After having formed a theory of the conditions which produce these symptoms respectively, this mode of treatment proposes to select a drug capable of producing a pathological condition opposite or contrary to that which gave rise to the symptoms of the patient.
Except in words, this method does not differ from that which we have discussed. Instead of opposing symptoms to symptoms directly, a theory is formed respecting each series of symptoms, and these theories are opposed to each other.
Using the word symptom as we do, in its broadest sense, to include every fact that can be ascertained or observed by the medical practitioner, both objective and subjective, the symptoms of a patient comprise all that can be known respecting the patient's disease. To theorize upon the proximate or ultimate cause of these symptoms is not to add anything to our knowledge. It is indeed interposing an hypothesis, the probable result of which will be to lead us astray. In no possible event can it facilitate the cure.
Let us suppose a case: A patient presents a series of symptoms, among which paleness, palpitation, want of appetite, loss of strength, perhaps haemorrhage from various surfaces, are prominent. These, with the other symptoms, furnish all that can be ascertained about this patient. Physiology and pathology enable us to comprehend how these symptoms are connected with each other, and with certain states of the solid and fluid tissues of the body; and thus these sciences enable us to form a diagnosis and a prognosis and to institute a hygienic treatment. But when we come to therapeutics, if we adopt the method of treating on " general principles," we shall say, the blood is deficient in red globules, hence the paleness and palpitation. The serum is in excess, hence the anasarca and the loss of strength. There are laxity and flaccidity of the surface membranes, and of the muscles and nerves, hence the haemorrhages and the debility.
The indication is to give a remedy which will increase the red globules and will give tone to membranes, muscles and nerves.
This sounds wise and practical. But on analysis it proves to be mere verbiage. The pathological statement is a mere restatement of the symptoms, adding nothing to their force or significance.
The indication may be reduced to this simple general indication: Give a drug that will cure the patient,—a thing we all wish to do. We know of no drug that will, in the healthy subject, increase the red globules of the blood; nor can we ever know a drug that will give tone to the healthy membrane, muscle and nerve. For what do we mean by tone? Nothing more nor less than healthy normal condition. Can any drug ever produce this condition in a healthy subject? Can we reproduce what is already in active existence? It is manifest, then, that this method is, after all its parade of science, its pathological analysis, its indication, and its appeal to general principles, nothing else but the raw and crude resort to unmethodized, empirical experience. Iron, which in the case supposed, would of course be the drug selected, will in reality be chosen, not because its symptoms sustain, or their hypothetical, pathological cause bears, any relation of contrariety to the symptoms of the patient or their hypothetical, pathological cause; but solely because it was found out in some manner unknown that iron would cure such cases; and manifold experience has corroborated the discovery. Just as it was found out that cinchona would cure intermittent fever and mercury syphilis. The fact that iron cures the case, and that iron is a constituent of the red globule, is a mere curious coincidence. But unless a law should be induced from such experience, we have shown that the experience alone cannot serve as the basis of a science of therapeutics.
It is clear, then, that the relation between the symptoms of a disease and the symptoms of the drug that will remove them, cannot be that of contrariety or opposition.
How may we ascertain what it is if indeed there be any fixed relation?
If we had no knowledge of any drugs that almost uniformly cure certain diseases, it would be almost impossible to find an answer to this question. But, fortunately, we possess several drugs of which we know by long and often-repeated experience, indeed by common consent, that they do cause the disappearance of certain definite groups of symptoms. Now, is it not probable that if we avail ourselves of these facts, and if we prove some such drug upon the healthy organism, and compare the symptoms thus produced by it with the symptoms which we know it to be capable of curing, we shall thus at last, after a number of such trials, arrive at a knowledge of the relation which exists between the symptoms which a drug can produce on the healthy, and those which it can remove in the sick ? This relation, if constantly observed, would serve as a therapeutic law. For, by provings upon the healthy we have it in our power to ascertain the symptoms which every drug is capable of producing. We can have thus an armament in reserve to meet any symptoms that may present themselves in a patient. And there is no limit to the extent to which this may be carried.
Now, this has actually been done with respect to all the well-known and conceded specific medicines, and indeed to nearly all known drugs. It has been observed that a constant relation exists between the symptoms which a drug will produce in the healthy subject and those which it will cure in the sick. This relation is that of similarity.
It is not necessary to adduce at this time instances in corroboration of this statement. They will occur during every lecture of this course when we come to the study of individual drugs.
From the fact of this constant relationship of similarity springs the therapeutic law which I believe to be the universal and only one,— SIMILIA SIMILIBUS CURANTUR. Diseases are to be cured by drugs which are capable of producing in the healthy subject symptoms similar to those of the disease in question.
The homeopathic materia medica is made up, theoretically at least, of the objective and subjective symptoms produced upon healthy persons by drugs, taken with a view to ascertain their physiological or pathogenetic effects. I say theoretically, because our materia medica being as yet incomplete and imperfect, whereas the exigencies of practice are as wide and various as the distribution and the diseases of the human race, we are under the present necessity of supplementing our pure provings by observations of the action of remedies on the sick (called clinical symptoms), by toxicological records which are involuntary provings made in a rougher way than we could desire, and even by hypothetical conclusions from the scanty data of incomplete provings, as, for example, when from the action of a drug upon the mamma we infer its effect upon the ovary, etc., etc. The necessities for the temporary expedients will be less frequent in proportion as we are able to carry forward the development of the science of materia medica. This is a work which requires much time, labor and self-sacrifice of those who engage in it, and several generations must pass away before the science will have attained tolerable completeness. Were it never so complete, we are called upon to deal with bedside problems that would severely tax its resources. And we are compelled to base our prescriptions frequently upon clinical observations, upon analogies, upon some trivial symptoms in some region of the body quite remote from the pathological center of the disease; certainly such cases as these most brilliantly illustrate the value of our grand therapeutic law, which leads us to success through many dark places on which pathology would shed no light. Nevertheless, as students of science we cannot but desire that our materia medica should be as complete, and should present us pictures of drug diseases, as numerous and varied as the maladies for which we are called to prescribe; as workers in the domain of science, we cannot but determine to give ourselves to this task of developing the materia medica. It behooves us then to examine our present materia medica, and mark where it is weak and defective, that our earnest efforts may be given first to those points. Before specifying some of these points, let me speak for a moment of others on which I think the materia medica is strong, since by these we may exemplify the characteristics of a serviceable pathogenesis.
I consider that in its account of the action of drugs upon the alimentary canal as compared with other regions, the homeopathic materia medica is reasonably complete and definite. As regards the stomach, the symptoms of drugs are, in general, so clearly stated that we can distinguish, as Dr. Hirschel has shown in his prize essay on cardialgia, the neuroses from the various organic affections, and in each of these departments it is not often necessary to hesitate long in the selection of the remedy.
If this be true of the stomach, it may be still more emphatically stated of the lower portions of the alimentary canal. Among the points upon which the symptoms of the materia medica give data which enable us to distinguish the indications of one drug from those of another, may be named: the sensations and pains, both those felt by the patient irrespective of his actions, and such as are induced by motion, touch, etc. ; second, performance of function ; third, contents of the intestine, as evidenced by evacuations; fourth, symptoms attendant upon evacuation.