Whilst physicians have talked of "science in medicine," of "scientific medicine," they have held to the opinion that there was nothing more uncertain than medical practice. They have even gone so far as to say that in giving a drug no man could absolutely predict its effect upon the patient. The practice of the day has fully borne out the statement, for there is nothing so uncertain as the ordinary drugging; and of the work of the majority of practitioners we might assert with Oliver Wendell Holmes—"It would be better for mankind if all the medicines were at the bottom of the ocean, though it might be worse for the fishes."
We believe that we are reaching a reign of law in the medical profession, and to that end will make certain propositions which I hope may convince the reader, or at least cause him to look over the subject carefully.
1. The law is absolute that "like causes produce like effects," and is as true in medicine as it is throughout the universe.
2. A cause is a force which, acting upon matter, sets it in motion (or modifies its motion), or changes its form; and this motion or change of form we call an effect.
3. The effect follows the cause, but that which follows is not always to be regarded as the effect. The post hoc is to be distinguished from the propter hoc by careful observations of the force applied and the effect produced in different cases.
4. A medicine is to be regarded as a force which will modify motion, set up motion, or change the form of matter, in the human body. In these respects it is a tangible thing, susceptible of observation, and its action and result formulated. If any one is inclined to dispute that medicine is a force, let him take two or three grains of podophyllin, or a drachm of lobelia or jalap, and await the course of events. What is true of one remedy is true of all remedies, and violence or activity through a large quantity, or by some specially acrid quality, is not necessary. A minute quantity of hydrocyanic acid, glonoine, or any of the more intense poisons, will prove this. It might also be proven by the fraction of a grain of syphilitic or small-pox virus, introduced into the circulation.
5. The force of a remedy is for the time being locked up in it, as is the case in coal, wood, gun-powder, nitro-glycerine, etc., and is set free in the body by decomposition or recomposition, as is the force in the articles named.
6. The effect is the motion or modification of motion, or change in the form of matter in the structure of the body; the result of the force of the medicine.
7. We employ medicines to cure disease, and we employ them because they contain a force which opposes diseased action, aids the body to remove disease, or aids the natural processes of life—all looking towards the condition we know as health.
8. Now we may postulate our problem thus: A medicine or remedy is a certain force, which acting upon a living body, is a cause, health, or some change looking toward it, being the effect. If one notices the proposition carefully, he will see that something is wanting, and that this something is the condition of the body which is to be acted upon. This we will call the "tertium quid," or the third element in a rational system of medicine.
9. With this we may make our problem read: With a known remedy and a known condition of the body, the result must be certain, for we have all the elements of nature's law that "like causes produce like effects."
10. The difficulty in practical medicine has been that we have worked with unknown quantities. Physicians have not known their remedies, and they have not observed the conditions of the body as determining the remedy, and the result has been uncertain and frequently unfortunate.
11. Let us consider again that medicine being a force, its action upon the body may not be towards health, but the reverse, even though under right conditions the medicine might be good. Steam as a force is a good and useful thing when tightly applied, but the piston that does good work in manufacturing is not so good when it crushes a man's leg or body; or the steam which propels the boat is not so good when it bursts the boiler and blows up the people.
If now we take some examples from our every-day work we may see these abstract propositions easier. In all these matters one wants to see things clearly, and be able to prove them by his experience.
Let us take an ordinary problem in nature as an example of this method of reasoning. The earth moves arouud the sun in a definite orbit, which we are now able to measure with the same accuracy as a line of railroad from Cincinnati to Chicago. This has been determined, not by chain or compass, but by pure reason. This may be postulated in the following manner: a, the sun,as a force; b, the weight (specific gravity) of the earth; c, the attraction of other bodies in our solar system; d, motion in this well defined orbit the result. The earth has so moved as long as these conditions have existed, and will so move to all eternity, if the conditions continue to exist. It is only a fair example of the law that "like causes produce like effects."
Let the first example in medicine be—a, aconite, the force; b, a small frequent pulse, the condition of the body (tertium quid); c, the effect, health.
To put it in a different form let us say—a, aconite expending its force in lessening the frequency of the pulse and giving a right circulation, and reducing the temperature to 98°; b, condition of the body, a small, frequent pulse, temperature 104°, arrest of secretion; c, result, the pulse comes down, the temperature is reduced, and because of this, secretion and other functional activities are established, with a return to health. Acouite the cause, health the effect.
The second example shall be—a, quinine (the force); b, periodicity (the condition); c, health (the effect).
Any one who has had an experience with quinine, and has used it in a rational way, will see the truth of the eleven propositions in this example. Our patient may have an ague with its chill, hot stage, sweating stage, and intermission, repeated day after day. The periodicity (the condition) is marked, the remedy (quinine) possesses the requisite force, and the result is a cure. In a second case our patient has a severe fever, every function is deranged, and his life is impaired. We observe it closely and note the distinct remissions, and say "periodicity" (the condition), quinine (the force), and the result (effect) is health. Or, third, our patient has an inflammation of the lungs, every symptom being clearly pronounced; but, as we observe the case closely we again observe the exacerbations and remissions, and we say, periodicity (the condition), quinine (the force), the result health. You can multiply such cases from your experience.
Let us take as a third example—a, podophyllin (the force); b, full veins, full tongue, full face, full abdomen (the condition); c, health (the effect).
It will not do to mistake the condition with reference to the remedy. Thus we would make a very common mistake if we said "constipation" (the condition), for the patient might have a pinched face, small red tongue, and an irritable stomach and bowel, and the result would be, an increase of disease.
Taking this remedy again we might say—a, podophyllin (the force); b>, fullness of face with dizziness and headache (the condition); c, relief from these unpleasant symptoms (the effect.)
As a fourth example we will say—a, sulphite of soda (the force); b, a broad pallid tongue, dirty (the condition); c, relief from all the disease (the effect).
Sulphite of soda has cured many different diseases—that is different according to the received nosology—but if the physician has noticed, they have all had something in common, and this something is the broad, pallid tongue, with a dirty coat. Not that it will cure every case with this symptom, for there may be something beyond this, or something additional may be necessary. While we cure some diseases with one remedy, a very large number require additional ones, for there are several things that need be done.
Baptisia gives us a fair example of—a, the force; b, a full purplish-red face, the expression of condition; c, cure, the result.
Take Gelseminum, the force; a flushed face, bright eyes, contracted pupils, restlessness, general headache, the expression of condition; the result, relief of unpleasant symptoms or cure.
Or, Macrotys the force; uterine pain, with sense of fullness and tenderness the expression of disease; result, cure or relief.
Or, Collinsonia the force; an uneasy sensation as of a foreign body in the rectum, with heat and contraction, the expression of condition; result, relief, and it may be cure. Of course this cure is usually one of hemorrhoids, but it may be something else, frequently ovarian or uterine.
Or, Santonine the force; retention of urine (acute, as in the fevers of childhood, or in women after childbirth), the condition; result the urine is passed.
Or, Belladonna the force; dullness, inclination to sleep, the expression of disease; result, relief and cure.
Or, Rhus tox. the force; frontal headache, starting in sleep, sharp pulse, redness of tip of tongue, the expression of disease; result relief, and cure.
I have given sufficient examples to show the application of the eleven propositions to the diagnosis and treatment of disease. The reader can follow it out at his leisure, bringing examples from experience to establish the truth of each one of them. Right reason is quite as profitable in medicine as in other professions or pursuits, and we will never have a "science of medicine" until physicians are willing to use it and rely upon it.