How Shall We Study Materia Medica?
Attention was called to the fact that dose is an important element in therapeutics, and especially to the fact that many drugs exert a directly opposite influence in large and small doses. If this is ascertained with reference to any drug, then the therapeutic indications are plain. If we know the action of the large dose, and its influence upon parts and functions, we conclude that the influence of the small dose is directly opposite. Given, a disease showing the symptoms of structural and functional drug disease (large dose), we at once think of small doses of the same drug—because in small dose its influence is opposite.
In other instances the action of the drug is the same in kind both in small and large dose, and knowing this kind of action, we oppose it to the disease showing opposite symptoms. There are quite a number of such drugs, and some of them are quite valuable remedies, there being no danger of mistakes from dose. Homoeopaths employ the first class, but have little use for the second, as will be obvious to the reader.
Again we find drugs producing some peculiar symptoms which do not form a part of, and are not recognized in the ordinary nosological classification of disease—symptoms which may be absent or present in many diseases, and still have no seeming reference to their origin, progress or duration. They are peculiar drug symptoms, and they are peculiarly Homoeopathic. No good comes from shutting our eyes to the truth, whatever may be its origin, or whoever its discoverer, and I would quite as soon credit Hahnemann with a discovery, as Galen or Bennett.
Again, we find that certain drugs will prove curative in disease presenting peculiar symptoms, which these drugs will not produce. These symptoms may he absent or present in any disease, without seemingly affecting the origin, progress, or duration, indeed seeming to have no relation to the pathological processes. Here the physiological proving gives no information—our knowledge comes from experimentation in disease, and the direction of experiment is an accidental suggestion.
A few illustrations of these methods of study will prove interesting and profitable. They will be selected from the more common remedies, and so described that the reader may add them to his working Materia Medica.
It is well to take Quinine as the first drug, as upon its "similia," so we are told, the whole structure of Homoeopathy rests—Hahnemann discovered Homoeopathy in the fever of Cinchona.
The physiological effects of Quinine are correctly given by Pereira, as I have proven on my own person, and in five other cases, and as the experience of seventeen years continued use shows:
"Excitement of the Vascular System, manifested by increased frequency and fullness of pulse and augmented respiration. Furred tongue, and other symptoms of a febrile state, are also observed.
"Disorder of the Cerebro-Spinal Functions, indicated by headache, giddiness, contracted, in some cases dilated pupils, disorder of the external senses, agitation, difficulty of performing voluntary acts, somnolency, in some cases delirium, in others stupor."
All fevers, when measured by the thermometer, are periodic, the diurnal variation of temperature in the type called continued ranges from 2° to 4° and the febrile action from Quinia poisoning shows every shade from intermittent to continued, and is not usually the typical intermittent.
But the reader will notice that we do not use Quinine as a remedy during vascular excitement, except there is a very evident want of a stimulant to the sympathetic and other nerve centers. It is the direct stimulus we want, and it has reference not to the apparent excitement, but to the real depression. The remedy will produce a fever, and it will cure a fever; that it produces a fever shows that its action is directly upon the functions involved in fever; that it cures a fever is because it gives that stimulus necessary to the normal performance of function, and we employ it when such stimulus is necessary.
This property called antiperiodic, is something we know little about, except so far as we know the facts by experimentation in disease.
Taking Ipecacuanha as the second example, we have a very good illustration of the first proposition, that the action of the small is the opposite of the large dose; and knowing the poisonous action we may predicate the curative
"If the powder or dust of Ipecacuanha be applied to the eyes or face, it acts as an irritant, and causes redness and swelling of these parts. Inhaled, it irritates the respiratory passages, and in some cases brings on difficulty of breathing, similar to an attack of spasmodic asthma."
In but moderate doses continued for a long time, I can grow an irritation of every mucous tissue in the body, in some situations going on to inflammation.
In small doses it cures this very condition, and is the remedy for acute inflammation of mucous membrane. Irritation of muscular fibre underlying the mucous membrane is another symptom of its physiological action, and to this also it is a remedy. Not, however, to the irritation of atony, as in the majority of cases of asthma, for here in place of proving curative, it increases the disease.
Tobacco is another very fair example of this action:—"Its most remarkable effects are languor, feebleness, relaxation of muscles, trembling of the limbs, great anxiety, and tendency to faint. Vision is frequently enfeebled, the ideas confused, the pulse small and weak, the respiration somewhat laborious, the surface cold and clammy, or bathed in a cold sweat." A distressing sensation of sinking at the pit of the stomach, is a characteristic symptom.
Given, these symptoms as a group, or the most characteristic of them, and Tobacco is a very certain remedy when given in small doses. The best preparation of Tobacco for medicinal use, is a tincture from the fresh leaves, ℥viij. to proof spirit Oj.; macerate, express and filter—dose, gtts. x. to xx. to Water, ℨiv.; a teaspoonful every fifteen minutes to an hour. Of the dried Tobacco leaf, ℥j. to dilute spirit Oj. is sufficiently strong.
Hyoscyamus is another example, though not quite so marked. Faquier says, " Henbane causes headache, giddiness, dimness of sight, dilatation of pupil, a greater or less tendency to sleep, and painful delirium. In some cases these symptoms are followed by thirst, nausea, griping, and either purging or constipation; and in a few instances febrile heat and irritation of the skin are induced."
Given, a case of headache, with giddiness and dimness of sight, and Hyoscyamus will prove curative. Given, a fever, with the same symptoms, and Hyoscyamus will prove a valuable remedy.
Taking examples of the second class, those whose action is the same in kind, whether the dose is large or small, we have a large number. And I will endeavor to select those in which the action is not topical, but from the blood.
Jalap is a good example. Its action is that of an excitant to the gastrointestinal canal in any dose. In large doses it is a painful and drastic purgative, in small doses continued it causes irritation.
Nux Vomica is perhaps the best example. In the most minute quantity it is a spinal stimulant, as it is in the largest dose, and the entire range of its use is as a stimulant to the spinal and sympathetic centers. Possibly, this assertion may be modified by saying that in small doses the effect is not so much stimulation, as it is the prompting to normal functional activity.
The characteristic symptoms produced in health by Nux Vomica are of the muscular system, showing the influence of the drug on the spinal cord: "A feeling of weight and weakness in the limbs, and increased sensibility to external impressions (of light, sound, touch, and variation of temperature), with depression of spirits and anxiety, are usually the precursory symptoms. The limbs tremble, and a slight sense of rigidity or stiffness is experienced when an attempt is made to put the muscles into action." Then comes the convulsive action of the voluntary muscles, increasing as the remedy is continued.
I have italicized the symptoms resulting from Nux, and which met with in disease are cured by Nux.
But in moderate doses continued for some time, Nux Vomica is an excellent example of the third action, producing certain peculiar drug symptoms not readily accounted for, by the usual theory of its action. And, which symptoms being found in disease, the drug becomes a remedy.
Thus, if the drug is continued for a length of time, it will in many cases cause an unpleasant colic with pain pointing at the umbilicus; pain in right hypochondria; and in women at the menstrual period a peculiar dysmenorrhoea. To these when observed as the result of disease, the Nux is curative. It will also give a peculiar sallowness of skin, with relaxation of connective tissue; a large tongue, with yellowish coating; and again, for these in disease it is a remedy. Thus whilst we see that the physiological action, as well as the influence in disease is that of a spinal and sympathetic stimulant, there is enough of similia to give the drug value in Homoeopathic practice.
If we examine Arnica, we find that it "quickens the pulse and respiration, and promotes diaphoresis and diuresis," and shows the properties of a stimulant to the ganglionic nervous system. It is for this purpose we use it in disease, and knowing the action of the drug, we can use it when this stimulant influence is desirable.
Furthermore, it appears to exert a specific influence over the nervous system, causing headache, giddiness, and disturbed sleep." These are the results of large doses, and due to over-stimulation. Here should come in the Homoeopathic similia—when we have the peculiar sore or bruised headache with giddiness and disturbed sleep, give Arnica. It is an excellent indication, probably the best there is for the internal use of the remedy, but they don't say so. To show what they do say I quote Jahr's Repertory:
"Arnica—Stinging, creeping, or laming and bruised pains in the affected parts; pains as if sprained, contused, hurt; red, shining, hot swellings; a number of small boils; the lower parts of the body feel cold, the upper hot; tensive pressure in the forepart of the head, as if the brain were squeezed up in a lump; itching, tearing or stitching in the head; immobility of the scalp; one cheek is hard and swollen; creeping in the face, nose, scalp, lips and gums; toothache as if the teeth were sprained and loose; white-coated tongue; foul smell from the mouth; foul eructations; vomiting of coagulated blood; spasmodic pressure in the stomach; splenetic stitches when walking; fetid flatulence; frequent small mucous stools; nocturnal enuresis; brown urine with brick-dust sediment; inflammatory swelling of the scrotum and spermatic cord; haemoptoe with discharge of bright-red blood or black lumps; stitches in the chest, especially when coughing or moving about; fetid breath; stitches in the region of the heart, with paroxysms of fainting."
The Eclectic Medical Journal, Vol. XXXIV, 1874, was edited by John M. Scudder, M.D.