Diagnosis.

Selected writings of John M. Scudder.

Specific Diagnosis versus Nosological Diagnosis is one of the cardinal tenets of the practice of Eclectic specific medication. The tendency in American medicine was to place great store on nosological classifications as had been done in the latter part of the eighteenth century by Cullen, who gathered all the published nosologies prior to his time and then presented his own and greatly improved scheme. This was a splendid achievement, but it contributed little to facility in the selection of remedies, for no relationship between conditions of disease and drug force could be derived from such studies. Dr. Scudder maintained that there was a definite relationship between known drug action and known conditions of disease as manifested by symptoms, and upon this theory based his justly famed Specific Diagnosis.—Ed. Gleaner.

DIAGNOSIS.—Any one who expects to succeed well with direct or specific medicines will have to restudy diagnosis. As we have had occasion to say, time and again, remedies are specific to pathological conditions, and not to names of disease. It requires that we discard nosology, in so far as these names are supposed to indicate methods of treatment, for under one name we will have grouped the most diverse pathological conditions.

If the reader will think for a moment, or refer to the older works on practice, he will see that the principal object has been to give a name to disease, and chiefly in a nosological plan. The therapeutics that followed was with reference to this name, and was composed of certain empirical formulas that had been thought beneficial in such cases.

The Homeopath takes different grounds; he cares very little about a nosological classification, and just as little about the pathology of a disease. His therapeutics are wholly governed by symptoms, at which he prescribes, so that the treatment of a disease will depend wholly upon its symptoms, and will be most diverse in different cases of the same disease. In so far as symptoms indicate conditions, he may prescribe judiciously, but just so far as he ignores physical signs of disease, his practice is imperfect. This is conceding that he uses remedies in efficient doses, which in the higher potencies we deny.

To get a clear idea of disease, that is, departure from health in function and structure in all parts of the body, it is essential that we have clearly before our minds a standard of health; to obtain this I regard the most important study of the physician. It is not knowledge from books, telling us that normal life is thus and so, but it is the perception of this life through our own senses— something that we have determined by our own touch, sight, or hearing, and repeated so; often that we have educated our organs of sense to a definite standard—which we call health.

Coming in contact with physicians, as I do every day, I am surprised at the want of knowledge in this direction. Their attention has been wholly directed to disease, and very many have so far lost the perception of health that they would hardly recognize it when met with. But more frequently the perception of a healthy standard is so feeble that it is constantly fluctuating, and there is no fixed point to measure disease from.

The young practitioner, especially, should commence anew the-study of what health is, and what it is based upon. When we think of the circulation we want to grasp the entire idea of the influence of the heart, the arteries, the tissues, the veins, the governing nerves from the sympathetic, and the indirect innervation from the spinal system. When we think of respiration, of digestion, of secretion, of nutrition, or of any functional activity, we desire to grasp the entire function in the same way. It is thus by educating the senses to perceive, and the mind to grasp the sum of perceptions and draw conclusions from them, that we are able to accurately determine deviations from the normal standard.

The rule by which we measure pathological changes is very simple and easily applied. Every deviation from health may be classified as an excess, defect, or perversion—taking the normal standard, it is above, below, or from.

A disease, according to our present nosology, is made of several functional or structural derangements; some of these may be excess, others defects, others perversions. If we have not thoroughly analyzed it we may regard it as a whole in excess, as a whole in defect, as a whole in perversion.

It will be noticed that as soon as we have made this analysis of disease, a rational treatment is at once suggested. An excess calls for such remedies as will reduce it to the normal standard. A defect, for such remedies as will bring it up to the normal standard. A perversion, for such remedies as will change it back to the normal standard. We do not measure the sum of vital power in these cases, for in disease it is always below the state of health. Neither do we claim that excess of functional activity is evidence of excess of power, for it sometimes springs from debility, and always entails loss of power. Thus this view of the pathology of disease does not militate against our cardinal principle, "that disease is an impairment of vitality."

But going back to our former subject, the necessity of grasping the entire evidences of a lesion at once, in order to get an accurate knowledge of it, let us make an example of the circulation of the blood. We feel the pulse to determine the condition of the circulation, but if we only get an idea of time we can not make a rational prescription for the lesion. We require to grasp the idea of time, of force from the heart, of volume, and of freedom of circulation. We may have an excess in time, but a defect in force, in freedom, and in volume. Or we may have an excess in force with defect in freedom, or an excess in volume with defect in freedom.

Let us see what the therapeutics would be in these eases. If we have an excess of time and force we give Veratrum. If we have an excess of time, but defect of force and freedom, we give Aconite. If the defect of force was very marked we would give Lobelia or Digitalis. If there was evidence of an enfeebled capacity in the blood vessels, giving congestion, we would give Belladonna. And if the defect was in the muscular power of the heart and arteries, with defective spinal innervation, we would give Nux Vomica. Now, though some of these remedies have been regarded as the antipodes of each other, they are all special sedatives, if we have the condition for their action. That is, they all diminish the frequency of the pulse, and influence a normal circulation of blood, with regard to time, force, volume, freedom, and we may add, equality in all parts of the body.

Now, it is possible to analyze every function in the same way, and if we do not thus analyze it we run great risk of being led into error. It does not do to say that "the tongue is coated," and expect the hearer to get an idea of the condition of the digestive apparatus or of disease. True, with many, it only means that the patient is to be purged. We want to know a great many other things when we look at the tongue. For instance, its form:—is it broad and thick, it is evidence of deficient innervation from the sympathetic—elongated and pointed, it tells us of irritation of stomach and bowels. Its color:—is it pallid, wanting color, we have the evidence of a deficiency of the alkaline salts of the blood—is it deeper in color (dusky), it is evidence of an excess of the alkaline salts of the blood. Its coating:—is it clear white, seeming a part of the mucous membrane, it indicates an inflammatory condition— is it a pasty-white fur, the use of alkalies and antiseptics, as Sulphite of Soda—is it brownish or dark colored, the use of acids with antiseptics, indicating sepsis of the blood. This is but a portion of the analysis, but sufficient for an example of the necessity of grasping the whole of the indications of disease.

If we have functional disease of the skin, of the kidneys, of the bowels, we must make the same critical analysis to determine the real condition upon which such deficiencies depend. If we have a lesion of digestion and blood-making, it may be composed of quite as many parts, and will require the same close examination and analysis. So it is with every functional lesion, and if we had space to give examples we would find it so with every structural lesion as well.

Now, as we did not give Veratrum whenever we found an increased frequency of the pulse, neither would we give Podophyllin whenever we had constipation of the bowels, or Acetate of Potash whenever he had diminution of urine. The remedy must be selected with reference to the condition as determined by the whole evidences of disease.—SCUDDER, Eclectic Medical Journal, 1870.

The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.