It is maintained by homeopathists that there are but three possible relatious subsisting between the symptoms of disease and the specific effects of remedies. The first is opposition, the second resemblance, and the third heterogenity; consequently there are but three methods of removing disease by the use of medicine, namely: Antipathic, Homeopathic and Allopathic.
The antipathic method of curing disease consists in the use of appliances or medicines that produce effects of a nature opposed to the symptoms of the disease, and hence the axiom "Contraria contrariis opponenda." Hippocrates entertained these views, and may be regarded as the founder of this doctrine; for says he, "All diseases which proceed from repletion are cured by evacuation; and those which proceed from evacuation are cured by repletion. And so in the rest, contraries are the remedies of contraries."
Much of the practice in vogue at this time is based upon this principle. Purgatives are exhibited to relieve constipation; cold is employed to alleviate the effects of burns or scalds; narcotics to abate pain, etc.
Homeopathic physicians object to antipathic remedies; they assert that, although the primary effects of the agents named may produce phenomena opposed to the disease, yet their secondary effects are similar to those which they are exhibited to remove. They maintain that the primary effect of opium is constipation, but its secondary effect diarrhea; the primary action of purgatives is followed by constipation. These secondary effects do sometimes follow the administration of remedies, though this can not be considered the rule but the exception. Thus diarrhea is of very uncommon occurrence as a result of the administration of opium; and though constipation may, and often does follow the use of purgatives, yet it is by no means an invariable result.
The homeopathic method of practice is that founded by Dr. Hahnemann upon the maxim "Similia similibus curantur," or in exhibiting remedies capable of producing effects similar to the disease for the removal of which it is given.
A few of the many examples claimed by the homeopathists as evidences of remedial agents producing effects similar to those of the disease for which they were administered, and by their so-called secondary effects proving curative, may serve to illustrate the doctrine which they maintain to be the only true one.
They assert that white hellebore has cured patients attacked with violent cholera, and yet it caused a disease similar to cholera, when exhibited. In a disease attended with great sweating, which occurred in England, called the "sweating sickness," it was treated successfully only by the use of sudorifics. Purgatives will cure the dysentery; tobacco occasions nausea and giddiness, and relieves the same; senna occasions colic, and is one of the remedies for this disease; ipecacuanha cures dysentery and asthma, because it produces hemorrhage and asthma; belladonna causes a sense of choking and horror of liquids, with fixed and sparkling eyes, and propensity to bite attendants—in short, a disease having the semblance of hydrophobia, which it is said this agent has cured. Opium relieves lethargy and stupor by converting it into natural sleep, and the same agent is a cure for constipation. The vaccine disease protects from smallpox upon the same principle. Cold, either in the form of snow, cold water, or some freezing mixture, is found to be the best application to frost-bitten parts. In scalds or burns, relief is obtained by exposing the part to heat, or by the application of heated spirits of wine, or oil of turpentine. We can not better illustrate Hahnemann's views of the action of remedies, than by giving the language of Pereira. "The medicine sets up in the suffering part of the organism an artificial but somewhat stronger disease, which, on account of its great similarity and preponderating influence, takes the place of the former, and the organism from that time forth is affected only by the artificial complaint. This, from the minute dose of the medicine used, soon subsides and leaves the patient altogether free from disease; that is to say, permanently cured."
Hahnemann conceives that the secondary effects of medicines are always injurious, therefore he recommends that no more be given than is absolutely necessary to cure the disease. Proceeding upon this principle, he has reduced the doses of medicines to such a minute state of division, that in many cases no human intellect is capable of appreciating the slightest influence from their administration. Many of them, when exhibited in full or ordinary doses, produce effects scarcely appreciable, and when reduced to the millionth, quintillionth, or even decillionth part of a grain or drop (the usual dose being large, say one or two drachms of the powdered article, or sixty drops of the tincture), how they then can exert any controlling influence over a disease that is grave, if they do so, as is asserted, is a mystery incapable of being solved by finite minds. To give credence to such a doctrine requires a stretch of imagination that we imagine few possess.
The method of obtaining these minute doses consists in reducing the solid to a powder, and mixing one grain of it with ninety-nine grains of sugar of milk—this is called the first attenuation; the second attenuation is obtained by mixing one grain of the first attenuation with ninety-nine grains of sugar of milk; and the third by mixing one grain of the second with the same quantity of sugar of milk, as before. In this way Hahnemann proceeds to the thirtieth attenuation. Alcohol is the diluent of liquid medicines, and the attenuations are obtained in the same manner—that is, by mixing one drop of the mother tincture or liquid with ninety-nine drops of water, and in this manner continuing the dilutions up to thirty, as in the case of solid substances.
The annexed table shows the strength of the different attenuations:
First attenuation,—one hundredth part of a grain.
Second attenuation,—one thousandth part of a grain.
Third attenuation,—one millionth part of a grain.
Sixth attenuation,—one billionth part of a grain.
Ninth attenuation,—one trillionth part of a grain.
Twelfth attenuation,—one quadrillionth part of a grain.
Fifteenth attenuation,—one quintillionth part of a grain.
Eighteenth attenuation,—one sextillionth part of a grain.
Twenty-first attenuation,—one septillionth part of a grain.
Twenty-fourth attenuation,—one octillionth part of a grain.
Twenty-seventh attenuation,—one nonillionth part of a grain.
Thirtieth attenuation,—one decillionth part of a grain.
The minuteness of the dose is carried to the same extreme, as seen by the following table, as presented by Pereira:
Charcoal, one or two decillionths of a grain.
Chamomile, two quadrillionths of a grain.
Nutmeg, two millionth of a grain.
Tartar emetic, two billionths of a grain.
Opium, two decillionths of a grain.
Arsenious acid, one or two decillionths of a gr.
Ipecacuanha, two or three millionths of a gr.
In modern homoeopathy the decimal is used in the place of the centessimal. Thus a first trituration would be one of the remedy to nine of sugar of milk; the second one of the first to nine more of the sugar; the third one of the second to nine of the sugar, and so on. Dilutions are made in the same proportions without reference to shakes, and thirty one-ounce bottles, with thirty ounces of alcohol, would be sufficient to carry one drop of a remedy to the thirtieth dilution; and a thousand bottles and a thousand ounces of alcohol would carry it to the one-thousandth, which they mark M. Increasing the potency of a medicine by trituration or shaking, is now generally abandoned.
Such are the doctrines, and such an outline of this farfamed system of infinitesimal practice.
The principal facts urged against the doctrine, may be embraced under four heads:
1st. Many of our most certain and valuable medicines do not act homeopathically; sulphur does not produce scabies, nor does cinchona, or any of its preparations, give rise to intermittent fever; and yet these agents are used with great certainty for the removal of the diseases named, and no one questions their utility. Andral took quinia without contracting intermittent,—and who has seen that disease, or one similar to it, follow the use of cinchona? We have often employed it, without ever witnessing such results. It may be urged, however, that the diseased state which previously existed, precluded the development of that disease. Nor have we ever seen scabies follow the use of sulphur; but, perhaps, the homeopathist might say the existence of a previous morbid state acted as a barrier to its occurrence. Acids and vegetable diet cure the scurvy, but they never produce a disease analogous to it.
2d. Pereira asserts that many homeopathic remedies would increase the original disease, as acrids in gastritis, cantharides in nephritis or cystitis, or mercury in spontaneous salivation.
3d. The doses in which these agents are exhibited, are so exceedingly small, that it is difficult to believe they produce any effect on the system, and therefore we would suppose that the reputed homeopathic cures are clearly referable to a natural and spontaneous effort of the system, aided, perhaps, by strict attention to diet and regimen.
4th. Homeopathia has been put to the test in numerous cases, without the least perceptible improvement or change in the nature of the disease, and this under the immediate inspection of some of the most eminent members of that system of practice. "Andral tried it in 130 or 140 patients, in the presence of the homeopathists themselves, adopting every requisite care and precaution, yet in no one instance was he successful." Recently it has been put to the test, in some of the European hospitals, in a large number of cases; a given number of cases being treated homeopathically, and the same number of cases (all being similar) being left to the unaided efforts of the system,—regimen and dietetic rules alone being enjoined,—and the results were not very dissimilar in the two classes of cases.
If these be facts, the attenuated system of practice adopted by Dr. Hahnemann, can not be one upon which the practitioner of medicine can place reliance with any degree of confidence in diseases of a formidable character.
Whether we regard the homeopathic system of practice as wholly negative in its effects, or as positively curative, it matters not, so far as its merit is concerned. That it possesses merit, we do not feel at liberty to deny; but whether of a positive or negative character, is a question about which there is much dispute. So far as the rules of dietetics, as enjoined by homeopathists upon their patients are concerned, we have never seen any that surpassed, if, indeed, equaled, those which they have adopted. And so far, all will admit that their system of medication is positively useful and curative; and may we not inquire, is not much of the success which they claim for their practice, to be fairly and justly ascribed to this cause? Does not that rigid regimen, that scrupulous avoidance of every article of diet of an oppressive or indigestible character, leave nature free to act, and does it not invite her to assert her own prerogative?—does it not leave the vis vitae, the vis medicatrix naturae unoppressed, unobstructed, and independent, by which her powers rally, and she throws off disease, and abnormal action is arrested? May we not reasonably account for many cures in this way? We think it is not unreasonable to award much credit to this system of practice, upon the grounds above named. Then if it be not regarded as positively curative in this respect, so far as a system of medication is concerned, yet it is important for the reason that it leaves nature free to act and rid herself of disease, and is, therefore, to be regarded as a highly valuable mode of negative medication. Do we not daily see febrile and inflammatory diseases relieved in this way without a particle of medicine; every one of conmmon observation knows this to be an indisputable fact. How often do we see many of the most obstinate diseases relieved by the unaided efforts of the system. We have often seen patients recover, who we believed to be dangerously ill, but who, from an aversion to drugs, a fear of poisonous agents, penuriousness, or some other cause, did nothing of an active character. Then may we not truly say, nature is all-powerful in throwing off disease. If, then, nature effectually eradicates a vast number of diseases, and those that baffle the skill of the most experienced physicians, even when called at an early hour in their course, and aided by the best of care, may we not reasonably conclude that recoveries would be very numerous if no physician of any kind was called, and no medicine administered.
May we not reasonably and justly conclude, from what has been just stated, that the attenuated form of medication—the infinitesimal doses, often receive credit when none should be awarded to it; that their influence is imaginary and not real; that they exercise no positive curative agency in many, perhaps not in any case in which they are administered, but in which it is ascribed to them; that their effects are negative, and that the powerful influences, benefits and advantages, claimed to follow from the exhibition of the millionth or decillionth part of a grain of charcoal, common salt, or of silex, or sand (and all other agents when administered in a form so attenuated), and carried out according to the doctrines of Hahnemann, are but an imposition on the credulity of the people, which must be apparent to any one who investigates the subject. Does it not seem to be practicing upon the expectant plan wholly? Does it not seem to be a mere placebo—the bread-pills, or colored-water exhibited in a new form. To believe that a dose of the most simple agent so minute that it is entirely beyond the conception of the human mind, exercises such a powerful control over the human system when in a state of disease, requires an imagination so acute (it seems to us) as it falls to the lot of but few mortals to possess. As well may we imagine that the millionth or decillionth part of a grain of our daily sustenance, taken three times a day, will be sufficient to sustain life; that it will support the wants of the animal economy, and maintain all the varied processes of secretion, excretion and innervation, as that a similar amount of salt, charcoal, etc., will effect great sanative changes upon the human body when in a state of disease.
Although we can not repose confidence in the Hahnemannian system of medication as a whole,—as a positively curative system,—but must regard it as a negative one, yet we are fully satisfied it will be of great good to the medical profession, and to mankind generally. "We have long since been fully persuaded that too much medicine was used—that the patient was too frequently and too largely dosed with drastic, corrosive, or poisonous drugs, without any definite object or welldefined reason in view on the part of the physician. Less medicine will be found to be to the advantage of patients, and physicians will learn from the homeopathic system to administer it in smaller quantities, to give it less frequently and with a definite object in view, and above all, to repose more confidence in the recuperative powers of the system, when untrammeled by the use of nauseous, and often oppressive and disease-creating drugs. In this light we view homeopathy as positively advantageous, and as calculated to bring about, or aid in bringing about an important reform in the practice of the healing art.
We regard the principle of "Similia Similibus Curantur," as laid down by Hahnemann in the administration of medicine, as true in some cases, but not as being an infallible or invariable rule, by which the physician is to be governed in all cases. Disease was treated upon this principle long before the day of Hahnemann; but when disease is treated in accordance with this axiom, the remedy, in order to prove effectual, is best given in sensible doses.
The allopathic or heteropathic method of cure is based upon the exhibition of remedies which produce phenomena neither similar to, nor exactly opposite to those of the disease. It consists in curing disease upon the axiom "Contraria Contrariis Curantur.".
By this mode, a cure is effected by counter-irritation or antagonism; in other words, by establishing an artificial or secondary disease that shall displace the primary one. This practice is based upon the influence which one disease is known to exert over another; as, for instance, the supervention of diarrhea during the progress of some other disease, with a subsidence of the original disease, apparently the result of the diarrhea. Occurrences of this kind undoubtedly first prompted the use of agents producing alvine evacuations in similar cases. Cutaneous eruptions sometimes appear and are soon followed by the disappearance of an internal disease existing at the same time; and the disappearance of the eruption is often followed by some internal disorder. These occurrences then point to the use of blisters and other revulsives, with the view of establishing an artificial disease.
One disease seems to modify another, then, by establishing a new point of excitation—an artificial disease; thus by securing an increased nervous and vascular afflux to that part, the original disease is modified or subdued. The maintenance or duration of the primary disorder depends upon the concentration of nervous and vascular afflux to the part secondarily affected; now it is evident that if a new point of excitation is established, in proportion to the concentration there, or to its localizing influence, must be its power to derive from and weaken the force of the original disease.
Many of our medicinal agents prove curative, by exciting a stronger irritation than exists at the location of the primary disease, the effects of the remedies being produced in another part of the system, and in a different tissue. There are but few remedies but what act to a greater or less extent in this manner. Thus all the appliances brought to bear upon disease, make new impressions, modify the old ones, and change the sensation, action, or function of some organ, tissue or part, by which the original morbid condition is altered or subdued; in other words, they exert a relative influence over disease, or cure it by conversion, or by the production of a new pathological state that subsides as soon as the action of the agent ceases its operation.
In the present state of our knowledge of the action of remedies, and the laws governing the animal economy, we can give no satisfactory theory or hypothesis of the manner in which this cure by revulsion or counter-irritation is accomplished. Dr. Parry advances the theory that most diseases consist in, or are attended with local determination of blood, and that it is a law of the human constitution that excessive morbid determination to two different parts shall not exist in the same person at the same time. This will not explain, however, even admitting the proposition, why the secondary excitation and determination detracts the circulation from and relieves the parts primarily irritated. Again, we have attempts to account for it, by the supposition that the system only generates a certain quantity of nervous force in a given time; in disease, the part affected receives much more than its normal proportion, and by a secondary excitation this surplus is determined to the point last affected, and thus the original disease is much mitigated.
These are hypotheses which it would be unprofitable to pursue further, but we may notice with much advantage the laws which appear to govern the action of such remedies as come under this head, and which affect the secretions. These have been arranged by Müller as follows:
1. The increase of a secretion in a tissue, a, which is less irritable than the organ b, is incapable of producing a diminution in the secretion of the latter; hence, for example, artificially excited secretions from the skin, as by a blister, in the neighborhood of the eye, in inflammation of the latter organ, are of no service, because the eye is a more irritable part than the skin.
2. An increased secretion in a certain tissue, a, can not be diminished by exciting the same secretion in another part of the same tissue, a; on the contrary, such a procedure would rather increase the secretion from all parts of the tissue than diminish it, because the relation which exists between the different parts of one and the same tissue is that of sympathy, not of antagonism. Hence, a discharge from the generative or urinary organs can not be arrested by an artificially excited diarrhea.
3. On the contrary, the secretions of tissues which do not belong to the same class of structures often antagonize each other. Thus, increase of the cutaneous secretion frequently induces diminution of the secretion of the kidneys. In summer, the cutaneous exhalation is more abundant, and the urinary secretion proportionably scanty; in winter, the reverse is the case. Effusion of watery fluids into the cellular membrane and serous cavities is attended with dryness of the skin and diminution of the urinary secretion, the quantity of which is observed to increase in the same proportions as dropsical effusions diminish. Suppression of the exhalation of the skin by cold gives rise to mucous discharges from the intestinal and pulmonary mucous membranes.
4. It is only toward the termination of consumptive disease that this relation of antagonism between the secretions ceases to exist; when, in consequence of the relaxed state of the tissues, all are at length increased in quantity. In the colliquative state that precedes death in phthisical patients, colliquative diarrhea, profuse sweating, and dropsical effusions take place simultaneously.
5. When one tissue is excited to increased action by an impression made upon another, either the secretion of the two must have been in some respects similar, as in the case of the skin and kidneys, both of which have the office of excreting water from the blood; or the organ thus excited must have had a predisposition to morbid action, which is the rational explanation for the circumstance that the impression of cold produces in one person an affection of the mucous membrane of the lungs; in another a disordered secretion of mucus in the intestinal canal.
Dr. John Brown maintained the doctrine that all living beings are endowed with a peculiar principle, which he terms excitability, and that serves to distinguish them from inanimate bodies. "The agents which support life are termed exciting powers, and these, acting upon the excitability, maintain life; in the language of Brown, they produce the effect called excitement." Those agents that modify the excitability, and produce a greater or less degree of excitement, are termed stimulant powers; these are either universal or local. When the exciting powers act moderately, health is produced; when they act with too great energy, they cause indirect debility.
He arranged all diseases under the two divisions of sthenic and asthenic, and maintained that all remedies acted as stimuli; so that we had only to increase or diminish their force according to circumstances, for they differed from each other in little more than the degree with which they exerted their stimulant power. He also maintains that they could not cause exhaustion of the excitability except by excessive action, or by producing previous overexcitement.
In answer to this theory, it may be said that many, perhaps all of the narcotic and sedative agents produce exhaustion, without occasioning any apparent excitement previous to this effect. Such is the case with digitalis, hydrocyanic acid, and many other agents that might be named. It is utterly impossible to ascribe death (when they occasion it) to any previous excitement which they produce. Agents which prove most destructive to life, seem to exert the least excitant influence over the animal economy. It can not be said that agents which exert no obvious excitant influence over the system, or those which produce no immediate or unmistakable impressions upon the organs of our bodies, are less curative, or produce less mistakable effects upon the system, than those that possess clearly excitant powers.
The great majority of our medicines, says Pereira, act neither as stimulants nor sedatives merely; they alter the quality of the vital actions, and this alterative effect has been quite overlooked by the Brunonians.
Doctrine of Contra-Stimulus.
This doctrine is but a modification of the Brunonian theory. It was first advocated by Rasori and Borda, and subsequently by Tomasini and other distinguished Italian physicians. According to this doctrine, there are but two classes of medicines—stimulants or hypersthenics, and contra-stimulants or hyposthenics. "The first exalt, the second depress the vital energies."
This hypothesis obviates one of the objections to the Brunonian theory, since it recognizes agents that do positively possess the property of reducing vital action. From these positions it will be seen that contra-stimulante, or depressing agents, are indicated in all cases of exalted organic action; and stimulants are demanded in all depressed states of the vital forces. Although the general principles of this doctrine are correct (providing we take a correct view of the pathology of disease), yet the deductions drawn from them are fallacious in many respects. Wine and other alcoholic liquors are stimulant, and to relieve the inebriation which they occasion, contra-stimulants, say the advocates of this theory, must be employed; yet who uses the digitalis, or hydrocyanic acid, to relieve that state of torpor which those liquids produce? Or do those who are in the habit of resorting to the use of tartar-emetic and the lancet, in high febrile or inflammatory action, employ them to relieve intoxication ?
Many agents denominated contra-stimulants, act locally and primarily as stimulants, as in the case with the majority of cathartics. Some of the narcotics (as the opium) act primarily as stimulants, and secondarily as sedatives, providing the dose is sufficiently large. Many agents, and even whole classes of remedies, exert neither a primary stimulant, nor a secondary contra-stimulant influence over the organs of the body, to which we can ascribe their curative powers. This is especially the case with tonics, astringents and alteratives. The advocates of this doctrine are by no means agreed as to the action of certain agents, for some regard cinchona as stimulant, and others as contra-stimulant.
Cold is the most powerful contra-stimulant, if carried to excess, and yet how vigorous the reaction, how violent the inflammation that often follows its moderate application to the system. From this it will appear that the broad ground of stimulant, or contra-stimulant, as advocated by them, and as applied to therapeutic agents and influences, is based upon an erroneous foundation. Agents the most dissimilar and opposite in their effects are grouped together, while those possessing analogous properties are separated by the founders of this doctrine. "They judge of the nature of a disease," says Pereira, "by the effect of the curative means, and of the virtues of medicines by the nature of diseases. So that if a disease now supposed to be sthenic, should hereafter prove to be asthenic, the medicines used to relieve it would immediately pass from the class of contra-stimulants to that of stimulants."
As fallacious as are these doctrines, one truth has been derived from this source, and this is the tolerance of large quantities of some remedies by the system, when laboring under disease. In febrile and inflammatory action, when the grade of excitement is high, patients can bear much larger doses of some agents without causing evacuations, than under other opposite states of the system. Under the circumstances named, much larger doses of emetic or cathartic substances are required to produce their ordinary effects, than when the grade of excitement is less vehement. From this ic appears that the state of excitement increases the tolerance of the remedy.
Chrono-Thermal System of Medicine.
The system of medicine advocated by Dr. Samuel Dickson, styled the Chrono-Thermal, assumes the position that all disease is a unit; that unity of morbid action is the type of disease; that this morbid action in all diseases is one and identical, and that this is intermittent fever; in other words, all diseases assume periodicity.
In presenting an epitome of this system of medicine to our readers, we can not do better than to make such extracts from the writings of Dr. Dickson as will give a clear idea of his views. The doctrines advanced by him, though peculiar, convey much truth, and we can not but think that their perusal will gratify and prove instructive to our readers.
The following are the positions assumed by Dr. Dickson on the subject of health and disease:
1. The phenomena of perfect health consist in a regular series of alternate motions or events, each embracing a special period of time.
2. Disease, under all its modifications, is, in the first place, a simple exaggeration or diminution of the amount of the same motions or events, and being universally alternative with a period of comparative health, strictly resolves itself into fever—remittent or intermittent, chronic or acute; and all local affections, or structural lesions, occurring during its progress, are but incidental occurrences, not original maladies.
Dr. Dickson terms all remedies "chrono-thermal, from the relation which their influence bears to time, or period, and temperature."
Disease, according to this system, is much simplified, and is amenable to a principle of treatment equally simple. A disease partakes of the nature of ague throughout all its modifications; those agents best calculated to relieve that disease, according to this theory, will be found most effectual in removing the same disease when it presents itself under some of its diversified forms, although not recognized ordinarily as being allied to ague.
Hippocrates announced, says Dr. Dickson, more than twenty-three centuries ago, the unity of morbid action, and that the type of all disease is one and identical. These positions Dr. Dickson maintains with great enthusiasm, and proposes to prove "the unity of all morbid action, and the unity and identity of the source of power of various agencies, by which disease of every kind may be caused or cured."
Disease is an error of action, says he; a greater or less variation in the motion, rest and revolutions of the different parts of the body, reducible, like the revolutions of health, into a systematic series of periodic alternations, in the course of which the matter of a structure occasionally, by its atomic changes, alters its natural character and chemical relations; so much so in some cases, as to become even completely decomposed and disorganized.
Again he remarks: "The human body, whether in health or disease, is an epitome of every great system in nature. Like the globe we inhabit, it has in health its diurnal and other variations—its sun and shade—its times and seasons—its alternations of heat and moisture. In disease we recognize the same—long chills and droughts—the same passionate storms and outpourings of the streams, by which the earth at times is agitated—the matter of the body assuming in the course of these various alterations, changes of character and composition, such as abscesses, tumors and eruptions, typical of new forms, as mountain masses, earthquakes and volcanoes. All these, too, like the tempests and hurricanes of nature, intermitting, with longer or shorter periods of tranquillity, till the wearied body either regains, like our common mother, its wonted harmony of motion, or like what we may conceive of a world destroyed, becomes resolved into its pristine elements."
"The actions of life in health are all, as you have seen, periodic, and however, or by whatever caused, their morbid modifications, termed disease, are periodic also."
Although he assumes that ague is the type of all diseases, yet he accounts for the differences met with in the different forms of disease, by saying that all agues are not equally perfect. The different stages may, and often do, vary in duration: the bolder features or symptoms may be all more or loss subdued; the intermission, or immunity from suffering, instead of extending to a day, or days, may be only an hour or two in duration. This disease is now no longer ague. Physicians change its name to remittent fever. All the different grades of fevers—as remittent, continued, typhus—as well as the innumerable varieties of other diseases, are but shades or modifications of the same disease, although christened or baptized by a new name.
"Call the symptoms ague,fever, or what you please, constitutional disturbance is the prelude to every disease, the precursor of every kind of local mischief; though in numerous coses, if not in all—more especially after repeated paroxysmal recurrence—superadded phenomena appear, and these last may be either functional or organic—and in some instances they are of a kind so grave and important as to throw the constitutional symptoms for a time altogether into the shade. Some part of the system, in a word, may be so much more prominently implicated than another, as to become the chief feature of the case—functionally, if the motions be only anatomically altered—organically, if the part in question be threatened with a change in its structure tending in any way to its destruction or decay."
"The causes of all disease can only affect the body through one or more of the various modifications of nervous perception. No disease can arise independent of this; no disease can be cured without it."
Among the agents which he styles chrono thermal, and occupying a prominent rank, is the cinchona. This agent he regards as valuable in gout, rheumatism, scrofula, scurvy, diseases of the bones, gangrene, etc., as well as in a multitude of other diseases assuming periodicity, and he refers to corroborating testimony to sustain his position. Prussic acid is next in importance to the bark—this he esteems exceedingly valuable. Opium and the salts of morphia occupy the third rank in the list of chrono-thermal agents, and next to them alcohol, wine, and malt liquors are noticed. These act beneficially, or the reverse, says he, in no other manner than by changing the temperature of the brain.
Musk, valerian, camphor, silver, zinc, arsenic, asafoetida, nux-vomica, strychnia, iron, copper, with a large number of agents from the vegetable kingdom not noticed in this place, with various other appliances, are all denominated chrono-thermal remedies. They are employed with a view to destroy the periodic character of all diseases, and with a view of expelling them from the system.
Such is an outline of the chrono-thermal system of practice; and although some of its features do not accord with the doctrines now styled orthodox, yet there is some truth in them. Upon taking a general survey of the innumerable diseases to which our bodies are subject, every one must see at once the tendency there is to exacerbations and remissions, thus constituting the periodicity which Dr. Dickson maintains all diseases assume. The periodic character of many being irregular as to time, intensity, duration, etc., does not seem to militate against the doctrine in question. The fact that exacerbations and remissions do occur, although irregular, goes far to prove the truth of one proposition of our author. As to the agents used, it may be questioned whether all those named, and those in general use act as antiperiodics. It may be said, however, that they lessen exalted organic action, and subdue or break down the exacerbation, and thus exhibit their claim to be ranked with anti-periodics.
Although the "water-cure treatment" had been employed to a limited extent as an auxiliary remedial measure long anterior to the days of Priessnitz, yet to him belongs the credit of introducing it into general use as an independent curative system.
As an independent course of treatment (all drugs being rejected), we think it erroneous; but as an auxiliary to other means of cure, there is no doubt but that it is one of the most efficient that can be adopted.
The efficacy of hydropathy is fully recognized by Dr. Pereira, who remarks: "The cold-water cure, or hydropathy, though not yet admitted, by the medical profession, among the legitimate means which may be beneficially employed in the treatment of diseases, undoubtedly includes powerful therapeutic agents." He further says: "It does not confine itself to the use of cold water only, but includes dry sweating, diet, exercise, and regulated clothing."
Prof. Carpenter remarks that the hot-air bath, in some cases, and wet sheet, as used by hydropathists, act powerfully as diaphoretics, and will probably be more extensively employed, as the importance of acting on the skin, as an extensive collection of glands, is better understood.
Prof. Williams says: "The reaction which follows the judicious use of cold, as a therapeutic agent, may prove serviceable not only in resisting the further influence of cold, but also to remove congestions and irregularities in the circulation from other causes, and to excite in the capillaries and secernents, new actions which may supersede those of disease."
Dr. Edward Johnson, in his work on hydropathy, says: "In examining the subject of hydropathy, we are first to consider it as one great whole, consisting of many parts, as the wet-sheet packing, the blanket packing, the dry sweating, the vapor sweating, cold baths of various kinds and different degrees of power; clothing, systematic exercise, and regulated diet. In inquiring into its mode of action, therefore, we must first look to its general effects as one whole. These, I presume, will not be disputed by any one. They are to strengthen the digestive functions; to cool the system; to increase the appetite; to allay excitement; to purify the blood; to strengthen the muscular fiber of the heart; to quicken the action of the skin (which is to the hydropathic treatment what the stomach and bowels are in the drug treatment; to overcome internal congestions; to restore and augment all the secretions and excretions; to accelerate the change of matter, and thus renovate the tissues of all the organs, and to invigorate the vital principle."
Again, Mrs. Nichols remarks: "It prescribes a pure and healthy diet, carefully adapted to the assimilating powers of the patient; it demands pure air and strengthening exercise, with other moral hygienic conditions. The applications of water, according as they are made, are cleansing, exciting, tonic, or sedative. Water clears the stomach better than any other emetic, produces powerful and regular evacuations of the bowels, excites the skin—the great deterging organ of the system—to throw off masses of impurities, stimulates the whole absorbent and secretory systems, relieves pain more effectually than opium, dissolves acrid and poisonous matters, purifies the blood, reduces inflammation, calms irritation, and answers fully all the indications of cure; to fulfill which, physicians search their pharmacopeias in vain. The proper application of the process of the water-cure never fails of doing good. Its only abuses come from ignorance. The water-cure physician requires a full knowledge of the system, and a careful discrimination in applying it to various constitutions, and the varied conditions of disease." Hydropathists are opposed to all medicines, at least many of them. "Unassisted nature, where there is a large stock of vitality, may triumph over both disease and medicine. The success of the homeopathic practice shows, that the less medicine taken, the oftener nature asserts her rights. But the water-cure equalizes the circulation, cleanses the system, invigorates the great organs of life, and by exciting the functions of nutrition and excretion, builds up the body anew, and re-creates it in purity and health."
For medicinal purposes, soft, fresh, pure spring water is always to he preferred. Lime-stone water, or water containing saline matter in solution is not so good, and even soft water—as rain-water, if it has been standing in tanks or cisterns—is less beneficial.
The modes in which water is employed as a remedial agent are numerous; we may notice, with advantage, the plunge-bath, the pouring-bath, the dripping-sheet, the douche, the sitz-bath, the wet-sheet pack, and the blanket-pack.
The plunge-bath consists in immersing the entire person in the ordinary bathing apparatus. In all cases the head should be wet before applying the water to the surface.
The pouring-bath consists in applying a suitable quantity of water to the surface, by expressing the water from a sponge, or by pouring it from a suitable vessel upon the body.
In using the dripping-sheet, the entire body is to be enveloped in a sheet dipped in cold water while the patient is standing; at the same time rubbing him briskly outside of and with the sheet. This bath is much prized in febrile diseases, but it is obviously inappropriate when the patient is much reduced, or in the advanced stages of disease.
The douche is applied by dashing cold water upon the surface of the body, or by directing a stream or jet of water from a force-pump, or by an affusion of water from a hight varying from five to twenty feet, letting it fall on different parts of the body; the full force of the douche not being allowed to fall upon the head. This is powerfully excitant, and often proves eminently serviceable in certain forms of chronic disease, as in spinal and nervous affections, in tumors and rheumatic swellings, as well as in many other cases.
The sitz-bath is a highly efficacious mode of applying water in some diseases. It consists in seating the patient in water at first tepid, but by degrees diminishing the temperature to its natural standard. The water should completely cover the pelvic region, which may be done in the absence of the proper sitz-bathing apparatus, by substituting the ordinary wash-tub, with a suitable amount of water. It is employed as an excitant and tonic to the pelvic viscera and bowels, and as a derivative in diseases of the brain and superior parts of the body.
The shallow or half-bath is similar to the other; the patient is seated in shallow water (say three or four inches deep), and rubbing the body, or being rubbed by an attendant. It is esteemed beneficial in febrile and congestive states of the system.
The wet-sheet pack is said to be the most powerful and universally applicable mode of applying water in the cure of disease, and consequently has been denominated the sheet anchor of hydropathic practice. It is extensively employed in nearly every variety or stage of disease. It is especially useful in febrile diseases, to diminish the excessive heat of the surface, lessen exalted action, equalize the circulation, promote perspiration, relieve pain, subdue spasms, remove obstructions, and secure tranquillity, which usually is succeeded by a profound and refreshing sleep. It consists in spreading one or more comfortables and two or more blankets upon a bed or mattress, over which a sheet that has just been dipped in cold water and wrung until no more will run from it, has been spread. Upon this the patient is to be placed, being divested of his clothing, and the wet sheet wrapped closely around the body, so as to bring it in contact with every part of the surface, the face excepted. Then the blankets are to be tightly wrapped around him, and over these comfortables, blankets, or a light feather-bed may be thrown. If very weak or chilly, heated bricks or bottles of hot water may be applied to the armpits and to the feet. If the reactive powers of the system are sufficiently strong artificial heat is to be avoided. If the head ache, a towel dipped in cold water is to be applied. In this condition the patient should remain until reaction is complete, and warmth fully established. In most cases the patient sweats freely. If uneasy and nervous, the covering may be removed at any time, when immersion or affusion of cold or tepid water should be immediately resorted to. This rule is not to be violated, except in high grades of inflammatory action, when one wet sheet after another is to be applied in quick succession.
The blanket-pack consists in the application of dry blankets, instead of the wet sheet, until perspiration is excited, when some one of the cold baths is to follow, succeeded by brisk frictions with the coarse towel, flesh brush, or dry hand, in order to excite the skin and produce a healthy and vigorous reaction. If the strength will admit, he should rub himself vigorously in all cases.
The reader must not understand that the baths are always to be cold, as in the earlier days of the water-cure. We employ them at all temperatures from 30° to 180°. The temperature of the bath is adapted to the condition of disease, and it is a little singular that nearly the same effect follows from brisk sponging with water at 32° and as hot as can be borne.
Ablutions, affusions, etc., when applied to the surface in febrile and inflammatory states of the system, serve to depress the exalted action, act as sedatives to the circulation, diminish the temperature of the body, promote perspiration, and break up that morbid association of action upon which the continuance of disease seems often entirely to depend.
It is also a very powerful means of revolutionizing the system in chronic affections. The shock, the new and powerful impression which it imparts to tens of thousands of nervous fibrilla and capillary vessels, spread out on that extensive, highly sensitive and strongly sympathizing tissue, the skin, is indeed great, and we must at once recognize the utility and immense importance of these applications to the surface. The shock which it imparts to the whole nervous system is calculated to secure a vigorous reaction, if properly applied; to arouse all the secretory and excretory organs of the body, impart new vigor and energy to languid and atonic organs, augment muscular and nervous activity and power, and yet calm irritated action, and secure tranquillity when the nervous and muscular equilibrium is interrupted. In these ways it increases the vital forces, and stimulates the recuperative powers of the system; hence it may be said to be one of the most important alteratives and tonics of the materia medica.
We have thus given a synopsis of the most prominent theories advanced upon the subject of practical therapeutics. In each of these we find some truths, but in all much error. The main difficulty with all of them appears to be that their originators did not pay sufficient attention to the facts of pathology, or if they did this, that their reasoning was based upon the action of remedies that we would not consider curative under any circumstances.
To properly understand this subject, it is necessary that we fully understand the pathology of disease, the reasons why the system, or a special organ, deviates from its normal healthy action, the causes that produce this, and the changes in structure that are occasioned by it. Knowing this, we should then carefully observe the means by which nature removes diseases, recollecting that the all-wise architect who formed our bodies to meet every requirement of our existence, was not forgetful that they would be subject to disease. Can man be more wise than his Maker? If he can not, why then should he try to add something to that which was before perfect; why should he try to create new eliminating organs, to make a laboratory of a man's sanguineous system, trying by means of poisonous chemical agents to counteract a materies morbi of which he knows nothing? In the next place, the therapeutist should carefully choose such means as will assist nature in relieving herself of disease, by acting in the same manner and exciting the same parts and organs, as do relieve the system of the morbific matter, when the natural powers of the system are the physician.
We would strongly impress it upon the mind of the reader, and especially upon the student, that no man ever yet cured a disease, nor ever will. All that any can do is to assist nature in effecting a cure. How often do we hear physicians talk of healing wounds, as if the entire process depended upon their skill, when, with their utmost efforts, they could not produce a single cell, fiber, or even a fluid similar to the coagulable lymph which is the basis of repair.
What then is the province of the physician? The following propositions, laid down by the eminent German physician, Hufeland, express our views of it:
1. Art sometimes can take away the whole disease by removing the exciting cause, and so dispense with the internal curative process of nature, e. g., by removing a foreign body, a poison, a gastric accumulation which produces the disease, etc.
2. The vital power is sometimes too exalted, and its operations too impetuous and violent;—so much so, that it may consume itself or injure noble organs. Here art can effect that degree of reduction and depression which is requisite to bring on a perfect crisis, and to prevent dangerous occurrences.
3. On the other hand nature may not have sufficient power, to perform the internal curative process. Here art interferes, raises and makes up, by suitable and strengthening remedies, the deficiency; and thereby only renders the internal cure possible.
4. Art can remove obstacles, which render the curative process of nature difficult or impossible. Under this head falls the important point of a proper diet, quietness in febrile diseases, guarding from the influence of impure air, injurious aliments and the like.
5. Art can support nature in combating particular forms of disease, by appropriate remedies conformable to the malady.
6. Art can assist nature in the commencing crisis and bring it to perfection.
7. Finally, there are morbific matters and conditions of which unassisted nature can not get rid, e. g., the syphilitic virus, mechanical lesions, etc. In such cases the assistance of art is indispensable, either for improving the quality of that matter by means of agents counteracting its virulence, or for lending mechanical or surgical assistance.
Such is the province of the art of healing, and such are its limits. The physician must not pretend to be magister, but minister naturae, her servant or rather assistant, her ally, and friend. He is to go with nature hand in hand; and in performing his great task, he is not to forget that it is not he, but nature that operates;—regard nature, be always guided by her, and never interfere to disturb her.
With this introduction we propose to give our views of therapeutics, and in doing this we shall consider it under the three heads named above. First, the general pathology of disease. Second, the means by which nature removes disease. And third, the mode in which agents act upon the system.
The American Eclectic Materia Medica and Therapeutics, 1898, was written by John M. Scudder, M.D.