How do Specific Remedies Act?
Selected writings of John M. Scudder.
In reply to this question Dr. Scudder gives it as his opinion that medicines act chemically, physically, and vitally, and recommends a close observation of the relationship of drug action and critical diagnosis.—Ed. Gleaner.
HOW DO SPECIFIC REMEDIES ACT?—We have had a dozen or more of letters asking this question, and whether or not such remedies are purely empirical. Do we use them because some one has employed them before in similar cases, and found them beneficial; or can their action be explained in a rational manner?
It will be observed that these questions can not be answered directly, because they deal with the mystery of life, which we can not unravel. They can not receive a satisfactory solution to every one, because their action is silent and slow.
Knowledge is from two sources: from perception, and from the action of the mind. The one comes through the senses, and is the result of observation; the other comes from the use of reason, and deduces knowledge by analogy, sometimes working from known facts, sometimes through hypothesis and theory.
Thus in therapeutics we have, first, the empirical knowledge of remedies. A number of observers find that a certain effect always follows the administration of a certain drug, and we conclude from this that the drug is the cause, and the effect will always follow its administration. But the curative effect only follows when there is a definite condition of the system, or a definite disease, so that there is an element of definiteness introduced into the problem, which now resolves itself into this—"The exact condition of the person being determined, a remedy will always have the same effect."
We not only require that observers shall have recorded the action of drugs, but that this be premised by a careful analysis and record of the conditions of disease. This gives us a rational empiricism, which, as it is reported with accuracy from time to time, so as to associate the drug and its action as cause and effect, gives us a tine science of therapeutics. For science is but the knowledge and classification of facts.
The difficulty in medicine heretofore has been that the empiricism was very crude. It did not think it necessary to have an exact knowledge of the body acted upon, as it did not believe it possible to have an exact knowledge of the body acting. In our time, however, much attention has been paid to critical diagnosis, and thus the exact condition precedent to the administration of a drug being known, its influence could be accurately determined.
Remedies may be said to act in three ways—chemically, physically, and vitally, but many time's it is impossible to distinguish between them and determine in which way a medicine acts. If we administer a salt of Soda when a patient has a pallid white tongue, or an acid when the tongue is a deep-red or dusky, the action is evidently chemical. So it is when we administer the Alkaline Sulphites, the Chlorates, and Permanganates. This action can be extensively traced, and its careful study must greatly advance scientific medicine.
The use of common salt as an emetic, of the cathartic salts to act upon the bowels, of water as a diluent, of baths, heat, etc., are examples of the physical action. This influence may be greatly extended, and will undoubtedly repay careful study. Nearly all the advantages of the water cure, and of the Swedish movement cure, are to be ascribed to a correct understanding of physical laws, and their application to living bodies.
The vital action of remedies is not so easily examined, and we are forced to draw conclusions from comparisons of known facts and from analogy. The majority of the remedies we think specific act in this way. They act in small doses, and imperceptibly to our senses. We give the medicine and the effect follows with certainty, but without any of that vital functional disturbance that made the action of medicine so prominent in the olden time. Some of these act directly upon the blood, and hence upon functional activity and upon structure—examples will suggest themselves to the reader. Some of these act upon the process of waste, increasing it, and, passing out through the excretory organs, stimulate them to activity. Others, and the largest number, influence vital processes through the nervous system.
A few of these influence vital processes through the brain. Opium may be taken as an example of these. Others, through the spinal centers, of which Nux Vomica and Strychnia, Hydrocyanic Acid, and Ergot, may serve as examples. A still larger class influence the strictly vegetative functions through the sympathetic nervous system. As examples of these, we may take Veratrum, Aconite, Belladonna, Cactus, etc.
All that we want to make our practice successful is a rational empiricism, as was first described. If we know that a certain remedy will produce a definite effect in a given condition, that is the sum of practical knowledge. The only advantage to be derived from the attempt to analyze this action comes from the close study we give it. Let us recollect that there are two elements in a rational or scientific practice, accurate diagnosis, and an accurate knowledge of the effects of medicine.— SCUDDER, Eclectic Medical Journal, 1870.