The Theory of Specific Medication.
I take it for granted that the reader will concede that all agents employed as medicines act either upon function or structure, and that this action to be curative must be opposed to the processes of disease. This proposition seems so plain that it requires no presentation of facts in proof, yet it is well to give it careful consideration, and arrange such facts as may have come under the reader's observation in its support.
If the action of a remedy is to oppose a process of disease, evidently its selection will depend—first, upon a correct knowledge of the disease, and second, upon a correct knowledge of this opposition of remedies to it.
It is a law of the universe, "that like causes always produce like effects," or to reverse it, "that like effects always flow from like causes." Therefore, if we can determine the opposition of a remedy to a process of disease in any given case, we have determined it in all like cases. And, to make use of this knowledge subsequently it is only necessary that we be able to determine the exact condition of disease, when we very certainly expect to obtain the same curative (opposing) action from the remedy.
In describing this action to another, it is necessary—first, that we so observe and group the signs and symptoms of disease, that he may get the exact idea of the pathological condition to be opposed. The skill required is in diagnosis, and necessitates a very thorough re-study of pathology, ignoring to a great extent, our present nosology. To facilitate this study, the author has published a work—" The Principles of Medicine "—which embodies his views, and will serve as a basis for specific or direct medication. Much that might be deemed necessary in this monograph, will there be found in its proper connection, and we have not deemed it desirable to separate it and reproduce it here.
Many persons are in error in regard to our use of the term specific. They think of a specific medicine, as one that will cure all cases of a certain disease, according to our present nosology, as pneumonitis, dysentery, diarrhoea, albuminuria, phthisis, etc.; and a person looking at the subject in this light, and guided by his experience in the use of remedies, would at once say there are no specifics.
We use the term specific with relation to definite pathological conditions, and propose to say, that certain well determined deviations from the healthy state, will always be corrected by certain specific medicines.
A disease, according to our present nosology, may be formed of one, or of a half-dozen or more distinct pathological changes, bearing a determinate relation to one another. We do not propose to reach all of these by one remedy, except in those cases in which one lesion is primary, and the others result from it. But on the contrary, we propose a remedy for each pathological feature, using the remedy for that first which is first in the chain of morbid action, and that second which stands second, and so on.
As an example, we analyze a case of fever, and find it to consist of a lesion of the circulation, a lesion of innervation, a lesion of secretion, a lesion of the blood, and a lesion of nutrition; each of these is regarded as a distinct element of the disease, but in the order named,—the one depending upon the other to a certain extent. A remedy that will rectify the lesion of circulation, will sometimes be sufficient to arrest the entire chain of morbid phenomena—as we notice in the simple fevers. Or a remedy that will correct the lesion of the blood—this being primary and the cause of the various morbid processes,—will be a specific for all, as when quinine arrests an intermittent or remittent fever.
But in the severer types of disease, we find it necessary to use a remedy or remedies for each pathological feature. Thus, we employ one to correct the lesion of circulation, one to correct the lesion of innervation, special remedies to increase secretion, to correct the lesion of the blood, etc. Instead of one remedy to arrest the disease, according to the ordinary use of the term specific, we employ a number of different agents, which are none the less specific, for they meet distinct features of the diseased action.
To employ remedies in this way, it is requisite that we analyze the disease according to what we know of pathology, determining definitely the elements that go to form it, and their relation to one another.
And secondly, that we know the direct influence of remedies upon the human body, both in health and disease; that we use them singly or in simple combinations; that we do one thing at a time that first which is first, that second which holds the second place, and so on.
If one expects to obtain the advantages of specific medication, he must not associate it with indirect medication. The direct sedatives, with free podophyllin catharsis—veratrum in pneumonia, with nauseants, blisters, etc., are incompatible. Success comes from one or the other alone. If I use direct medication I use it alone, and if I use indirect medication I use it alone. If we propose to treat a case of croup with Aconite, we do not use nauseants; if we propose to cure a case of cholera infantum with Ipecac and Nux Vomica, we do not want astringents.
But we go further into the analysis of diseased action as expressed by symptoms, than many suppose. The success of direct medication comes from the definiteness of diagnosis—determining the exact condition of a function or part.
To illustrate, it is not sufficient in selecting a sedative to know that the pulse is frequent, using alike Veratrum, Aconite, Digitalis, Gelseminum, or Lobelia. Frequency is but one element of the lesion: and we have to determine in addition the strength or weakness of the circulation, the degree of obstruction of the capillary circulation, and the condition of the nervous system that controls this function. Thus, where there is strength with frequency we employ Veratrum; feebleness with frequency, Aconite; excitation of the nervous system with strength and frequency, Gelseminum; atony of the nervous system and tendency to stasis of blood, Aconite and Belladonna; feeble impulse from the heart, without capillary obstruction, Digitalis, etc.
It is not sufficient to know that the tongue is coated, indicating an impairment or arrest of digestion. We make this secretion give us the history of blood lesions, as well as of gastric and intestinal derangements. We learn that pallid mucous membranes with white coat demand alkalies; that deep red mucous membranes and brown coat call for acids; that a dirty-white, pasty coat requires the alkaline sulphites, etc. It is not necessary to continue this illustration further, for the reader will see by the above that the specific medication requires specific diagnosis, and that it will be successful just in proportion as we become skilled in this.
It is true that almost any one can use Veratrum and Aconite successfully, for the conditions are so prominent that they can not be mistaken; or any one may successfully prescribe Aconite in sporadic dysentery from cold; Ipecac in the diarrhoea of children; Collinsonia or Hamamelis for hemorrhoids; Collinsonia for ministers' sore throat; Cactus for heart disease; Pulsatilla for nervousness; Staphysagria for prostatorrhoea; Eryngium Aquaticum for cystic or urethral irritation; Apocynum Canabinum for dropsy, etc., etc. These remedies have an extra value attached to them, because the conditions indicating them are so easily determined.
Yet the reader will learn with surprise that ten years since, with but one exception, not one of these agents were used for the purpose named. In 1860, 10 lbs. of the crude root of Collinsonia supplied the market for a year; now one house gets in 10,000 lbs. for the year's supply.