The Action of Remedies.
Selected writings of John M. Scudder.
The strong point of this editorial is that medicines do act and that the specific medicationist may know when to prescribe them to get a definite result. How they act was of less importance to Dr. Scudder, and is to others, than the fact that, when properly prescribed, they will cure. His study through life, chiefly by means of rational empiricism, to determine conditions in which they could be prescribed with assurance of curative or palliative results, was one of the greatest contributions to modern medicine. See also previous editorial titled "How Do Specific Remedies Act?"—Ed. Gleaner.
THE ACTION OF REMEDIES.—Some persons seem to think that we should be able to explain how remedies act in the cure of disease, and the question is frequently asked about some of the new remedies, "How do they act?" The same thing is shown in a different form by non-believers in small doses, by the exclamation, "I don't see how they act;" assuming that they do see how the large doses of the common medicines act.
Now I confess that I can not explain how remedies act in the cure of disease, and I do not think it necessary that we should know. Sufficient for us if we know the fact that they have a definite and certain action in definite and certain conditions of disease. If we are able, on examination of the sick and our knowledge of drugs, to determine a definite relation between the disease and the remedy, we should be satisfied.
To illustrate, we may first take the well-known animal poisons, the virus of the rattlesnake, the virus of the mad dog, and the virus of smallpox. They are all protein bodies, containing the very same elements as the food we take for dinner, or the tissues that cover our bones; and give them the same fluidity, neither your chemist nor your microscopist could detect a difference in them. Yet the first destroys the life of the blood in a brief period of time; the second expends its influence upon the nerve centers, and surely though slowly destroys; whilst the third develops a similar poison, and is expelled by the pustular eruption upon the skin. We know the simple facts by observation, can we tell how?
Let us take the two alkaloids. Morphia and Quinia, as an example. Our chemist will tell us that they are formed of the same inorganic elements, in very nearly the same proportions (Morphia C17, H19, NO3; Quinia C20, H24, N2 O2). Can any one by looking at the constituents tell why or how the one influences the brain to produce sleep, and the other to give strength, and to antidote the malarial poison? We know the simple facts by observation, that they do act in this way, and by care we may determine the disease in which they will cure, but the how and why is just as far beyond us as it was the first day they were employed in medicine.
Supposing we take Podophyllin of the class cathartic, Eupatorium of the class diuretic, Asclepias of the class diaphoretic, and Ipecac of the class emetic, can you tell why or how these act on the special parts, and in these special ways? You can not, though you have witnessed this action for years, and have learned when it will prove curative. All that we know is that these drugs have an elective affinity for these parts or organs, and that they act in a definite manner.
You say then (possibly) that there can be no science of medicine, as we can not even tell how the simplest remedy acts. (?) Let us see about this. We have a science of Botany which is deemed quite perfect, and worthy the name. What does it consist of? Of nothing but a series of observations which has determined a relation between plants, and has classified them in genera and species, according to the structure of leaves and flowers. But no man pretends to know how or why the materials of which the plants are composed group themselves in these forms. We know the fact of plant life, but the how we never shall know. We have a science of Astronomy, and it has attained a perfection that would have astonished the wise men of the olden time. The! astronomer calculates the orbits of sun, planets, satellites, stars, determines their magnitude, their distance, their density, weighs them, and gives you the number of pounds; and the chemist will, by the aid of the spectroscope, give you the elements that enter into their composition. But he will not tell you whence they came, how they came, or why they came.
There is a point beyond which human observation and human thought can not go, and this point in medicine is reached when we have faithfully observed the phenomena of disease, the action of remedies, and determined the relation between the one and the other. How the remedies act to cure disease we do not know and can not know, and it is of far less importance to us than the simple fact that. they will cure.
I could not give a plausible guess why a few doses of triturated charcoal, not a grain in all, should check a severe hemorrhage. And yet I know the fact as well as I know that the sun rose this morning. As an example—Thomas French, a man weighing over two hundred pounds, stout and full blooded, came to me complaining that he was having repeated hemorrhages from the nose that was rapidly exhausting him. It had been going on for some days, and the means employed had utterly failed. His face was pallid, the pulse soft and weak, extremities cold. I gave him ten grains of triturated charcoal to be taken in grain doses every three hours. There were three ineffectual efforts at hemorrhage after commencing the powders, but it was effectually stopped the second day. ! Now if this was but a single case we would think but little of it, but I have repeated it scores of times with the same result.
Can you tell me how or why Belladonna relieves congestion of the brain? I know the fact that it does cause contraction of capillary blood-vessels because I have seen it as Brown-Sequard did, in the field of the microscope, and I have seen it as he did not, hundreds of times in the relief of the unpleasant symptoms showing congestion in disease. I know the fact, but I do not know how or why.
I know that Rhus in very small doses will cure most serious diseases, and that it will give relief in a very short time. I can point out the cases, and can tell another how he may know them, but I do not know how it acts, and never expect to.
I know the fact that the most minute dose of Graphites will restore the reproductive function in women, and act as a "blood-maker" so rapidly that her cheeks will have a rosy flush in a few days, and her strength will be so increased as to enable her to take active exercise, when she has been hardly able to get from room to room. All that she has taken of the medicine you could put in your eye without endangering the sight. I can point you out the case in which the remedy will prove curative, but I can not tell you how it acts.
Now let me ask a question. Which is the most profitable to you, to theorize on how a drug acts, or to describe to you the symptoms of disease which show where it will cure?—SCUDDER, Eclectic Medical Journal, 1876.
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"As a rule, it is best to employ remedies singly, or in simple combinations of remedies acting in the same way."—Specific Medication, p. 27.
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The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.