We have already insisted upon the necessity of specific diagnosis if we are to expect definite curative action from medicines. This is a very important element of specific or direct medication that many physicians do not seem to understand. When we speak of specific medication they get the idea of an absolute cure for disease according to our present nosology, and say there is no such thing as a specific medicine. They expect to guess at the name of a disease, and find a remedy that will fit their guess-work. To suit such, a medicine must. be like a blunderbuss, scattering its shot all over the field, giving a probability that some will reach the mark.
Direct medication, on the contrary, requires specific diagnosis. We must know exactly what the departure from health is, and knowing this we may select a remedy which will correct it. As was remarked before, the physician must have first a thorough knowledge of healthy life, and be able to recognize it, or any departure from it. Thus Anatomy and Physiology are the true basis of direct medication, for it we do not know the healthy structure and function, it is not possible that we can know the diseased structure and function.
We have a very simple rule for measuring the departure from health, and it is easily applied. It is in one of three directions—excess, defect, or perversion—above, below, or from. If we can measure disease in this way-, the desired remedial action is at once suggested—if in excess it is to be diminished, if defective it is to be increased, if perverted it is to be brought back to the normal standard. In a majority of acute diseases, we will find these departures so clearly marked that the diagnosis and treatment are very easy.
But as there are many elements that go to make healthy life in man, so there are many that go to make the sum of disease. These will be found in varying combination, yet in most cases there are certain prominent lesions which may he regarded as standing first in the chain of morbid phenomena and upon which the others rest. If we can find remedies which will reach and correct these, the disease is at an end, and the natural restorative power of the body soon gives health.
The most simple form of specific medication is where a single remedy is sufficient to arrest the process of disease. As when we prescribe Collinsonia for ministers' sore throat, Drosera for the cough of measles, Belladonna for congestive headache, Macrotys for muscular pains, Hamamelis for hemorrhoids, Phytolacca for mammary irritation, Cactus for functional heart disease, Staphysagria for prostatorrhoea, etc. This use of remedies gives great satisfaction in the treatment of many diseases, and we are led to wish that the practice of medicine could be resolved into the giving of such specifics.
Not quite so simple, but yet very plain is the second form of direct medication, illustrated by the following examples. A heavily loaded tongue at base, with a bad taste in the mouth and fullness in the epigastric region, demanding an emetic. A uniformly yellowish coated tongue from base to tip, relieved by Podophyllin or Leptandrin. A pallid tongue, coated white, calling for a salt of soda. A pallid large tongue, with a moist pasty coat, demanding the alkaline sulphites, say sulphite of soda. The deep re(l tongue and mucous membranes with brownish coatings, demanding the use of acids, say muriatic acid.
Quite as plain, but not so easily and directly reached by medicine, is the need of a good condition of the intestinal canal for digestion and blood making, and associated with it the recognition of the need of certain restoratives that may be necessary to normal nutrition and functional activity. These are essentials in the treatment of every form of disease. In acute cases, it is required first to rid our patient of functional disease before we can fully establish digestion and nutrition, but in chronic disease it will many times stand first, and must always be associated with treatment for local lesions.
The complement of this is, treatment to increase the removal of old and word-out tissues, and thus relieve the solids and fluids of material that must necessarily depress functional activity. Probably we have as little positive knowledge of remedies that increase retrograde metamorphosis, as of any other class, still they are being studied, and in time we will be enabled to use them directly. Remedies that increase excretion are in common use, and form a very important part of our practice. From the earliest periods of medicine, the fact that disease is destructive has been recognized. Destruction of the material of our bodies, necessarily leaves the debris either in solids or fluids, and experience has shown that it can not remain in the body with safety. Hence the common use of those agents that stimulate excretion from skin, kidneys and bowels.
But there has been a failure to appreciate the true nature of these processes, and from this has flowed a very great deal of bad practice. These processes are strictly vital processes, carried on by delicate organisms under the control of the nervous system. As they are the basis of life, we may well suppose that nature has guarded them on all sides, and that they are the true centre of life. The doctor of the olden time has looked upon them as mechanisms to be powerfully influenced by remedies. He powerfully excites the stomach and intestinal canal as a means of derivation, and works upon the skin and kidneys as if secretion from them were a purely physical process. Thousands of lives have been and are being destroyed in this way. Any one who will take up Huxley's Physiology, and read the clear and simple description of this apparatus for digestion and waste, upon which our lives rest, can not but be satisfied that the common practice of medicine is a very great wrong. A man lives, because he has the power of renewing his life day by day. Take away this power and he will die in a brief time; take it away in part, and you have lessened his power to that extent; take it away for an hour, for a day, or for a week, and his power to live is weakened to that extent.
When we regard these processes as strictly vital processes, in highly developed organs, under the control of a most delicately adjusted nervous system, we will be in a position to use remedies to aid vital action. Studying the condition of the stomach and intestinal canal in this light, we will see how a direct stimulant, or tonic, an alkali, an acid, a remedy that will relieve nervous irritation, or one that will give increased innervation, will in different cases be an aid to digestion. Looking farther, we will see the necessity, in one case of histogenetic food, in another of calorifacient, in one of iron, in another of phosphorus, etc. It is just as much specific medication to be able to select the proper food for the sick as it is the proper medicine.
One or two examples of this may not be out of place. The past winter I was called in consultation, in a case of continued fever in the third week. The treatment, so far as medicine was concerned, had been very judicious, but the food had been starchy, and for a week the patient had been able to take very little. He was failing fast, and stimulants and tonics were used without advantage. The most striking features of the disease to me were: the feebleness of the heart's action, the want of respiratory power, and the evidences of a general failure of muscular power—in all other respects the patient was in good condition. I advised enemata of beef-essence, and its internal administration in small quantities frequently repeated, and a suspension of all medicine. The effect was marked in twenty-four hours, and the patient speedily recovered. In the early part of my practice I had occasion to call Dr. William Judkins in consultation, in the case of a lady who had incipient phthisis developed from menstrual irregularity. She was very feeble, and I had been giving her freely of the bitter tonics, stimulants and animal food. The old Quaker remarked, if thee will stop the medicine and stimulants, and give her fatty matter she will recover—and the result justified the old doctor's skill in diagnosis. I have had to take this advice twice in the past eighteen months, from other parties, when I should have recognized it myself; in both it was the one thing necessary to success.
With regard to excretion, we must be thoroughly impressed with the fact that it is wholly a vital process, and not a process of straining. When we come to understand that a secreting organ is continually growing secreting cells, and that these withdraw from the blood the worn-out materials of our bodies, we will be in a position to use remedies with better success. Evidently it is possible to so over-stimulate or over-work an excretory organ, that this function of cell-production will be very much diminished or altogether arrested. Just in this proportion must secretion be impaired or wholly arrested. The best remedies to increase secretion are those that act mildly and stimulate vital function.
Thus far direct medication is very plain sailing. All can succeed with it, yet successes will be in proportion to the physician's acuteness of observation, and to some extent upon his knowledge of remedies. But beyond this we have a field that requires a very thorough knowledge of vital processes, accurate observation, and an extended knowledge of remedies. We study not so much the grosser manifestations of disease, but the more delicate shadings and combinations, and our therapeutics requires that we have a most intimate knowledge of the influence of remedies upon the human body. In this field of study the physician will find a beauty and certainty in the practice of medicine that will give zest to investigation, and as it is pursued he will find greater and greater success.