On the Action of Sedatives.
Selected writings of John M. Scudder.
The study of the Special Sedatives formed one of the earliest fragments of Professor Scudder's studies, looking toward a practice of Specific Medication. Though the latter was not given in its entirety to the profession until 1869, Dr. Scudder had since 1859 been teaching it to the classes of the Eclectic Medical Institute to such extent as he had satisfactorily completed the subject.—Ed. Gleaner.
ON THE ACTION OF SEDATIVES.—There have been very grave errors held and taught with reference to these remedies, as indeed there has with nearly or quite all of the Materia Medica. And it is a thousand times easier to teach such error than to overcome it and replace it with the truth.
One principal error is, that the action of the sedative should be speedy, like a cathartic or emetic, and like impressive on the beholder. This is a very serious mistake, for it either leads to the administration of large and poisonous doses, or the physician loses faith in the efficacy of sedative medication, and discards this whole class of remedies.
This error had its growth principally in the early use of veratrum viride in the treatment of acute inflammatory diseases, in which large doses were used to advantage. Thus an acute inflammation of the lungs or bronchiae, or a brief sthenic fever from cold yield readily to tincture of veratrum in doses of ten or fifteen drops. The influence in this case is that of powerful emesis or catharsis, bleeding to syncope, or the nausea of tartrate of antimony.
Necessarily such an action would prove injurious in zymotic diseases, and in inflammations of an asthenic character. The vital activities are here so low that they will not bear with safety so great a depressant, and I am satisfied that much harm has resulted from this use.
The action of these remedies, like many others, is double; a medicinal action (it had better be called a curative action) in small doses, a poisonous action in large doses. It is the last action, unfortunately, that too many physicians invoke from the use of medicines.
In both cases the action is upon the sympathetic system of nerves, and not only influences the circulation, but all the processes that are presided over by this portion of the nervous system. Thus secretion, nutrition, and waste of tissue are directly influenced.
The influence of large doses (poisonous) is to depress this nervous system, and hence every process directed by it is impaired. He who has only seen the diminished frequency of the pulse as the evidence of this action has seen but a part. There are cases in which the result is increased frequency, until finally the heart's action ceases. This influence, but rarely observed from veratrum, is not uncommon from aconite, and from gelseminum and digitalis. But in the case of veratrum, the slowness of the pulse corresponds with an impairment of the circulation, which, though not so marked in sthenic diseases, is a prominent feature in asthenic.
The medicinal action of all of these remedies improves and gives freedom to the circulation, at the same time that it lessens its frequency, and aids in re-establishing secretion, nutrition, and all other vital functions. I contend that this is accomplished by relieving the sympathetic nervous system from the influence of the cause of the disease, and by increasing its power. In other words, that the influence of sedatives is stimulant rather than depressant; that they increase the power to live rather than diminish it.
Necessarily such an action is slow, as it is certainly curative. He who expects, in severe diseases, to produce sedation in a few hours, or a day, had better continue the use of cathartics, emetics, and other means of indirect sedation. They are only used to advantage by those who are willing to wait, and associate the gradual sedation with the like gradual giving way of disease.
Using them in this way, the practice of medicine becomes a real pleasure, and has a success not otherwise obtainable. I believe I can say without boasting, that I have had as large a general practice in the past ten years as any other physician, and a much more successful practice than any of my acquaintances, and I attribute my success to the discarding of the old antiphlogistic practice and remedies, and the employment of these and other specific medicines. So radical has been this change with me, that in a practice of forty thousand dollars the past five years, I have not used one ounce of Podophyllin, nor its equivalent of cathartic medicine.
I think there is no mistake but that specific medication will be the practice of the future, and he who wishes to obtain the greatest success will turn his investigations in that direction.— SCUDDER, Eclectic Medical Journal, 1868.