The Single Remedy.

W. L. LEISTER, M. D., Associate Editor American Medical Journal, St. Louis, Mo.

In its evolutionary course and progress the Eclectic school of medicine is nearing a final ideal in the selection and exhibition of the single remedy to contravene definite pathologic phenomena. In its seventy-five years' existence it has discovered and developed and brought to relative perfection a great many remedial agents which, it would seem, without initiative by this American school, must at this late day remain unknown to the general profession.

The trend of thought and study by advanced physicians is in the direction of disparagement of the practice of combining a number of complex drugs. We take much pride in the fact that members of the Eclectic school are coming rapidly, to this view, and are extending at least moral support to the efforts being so diligently projected by our leading pharmacists and journalists. Reform medicine, in its early years, was remarkable for crudeness of means. Like practice prevailed in considerable measure down to the beginning of the second or middle epoch, when a revolution in the study of disease and its treatment was brought about by a few courageous spirits who recognized the need of deeper study of morbid physiology and a clearer analysis of the agents used and a higher knowledge of their application.

The single remedy and the small dose have become a tenet of the third or present epoch of Eclectic medicine. It was necessary to a correct understanding of the modus operandi of medicines that circumscription in number exhibited in any given case must needs be exercised. So long as several drugs entered into a prescription no correct decision as to predominant energy could be pronounced.

The notion was held by many, indeed it is held now by some, that each ingredient of a compound represented one unit and the aggregate of these the requisite sum to correct the morbid condition. When the prescriber must resort constantly to combinations, the inference is excusable that he is not certain of his footing; that he is undecided as to a correct diagnosis; or, that he is lacking in knowledge of the action of remedies decided upon, and especially that such prescriber is ignorant of any organic change wrought when several drugs, each of complex organization, be combined. Chemists assert that most vegetable agents—such as are used by physicians, are composed of numerous elementary bodies, each of which is found to possess distinct and often (if not usually) divergent properties. It is, therefore, reasonable to conclude that when several medicines enter a prescription, the liability to form other, and mayhap, harmful bodies, is considerable.

It may be recalled by those who read "Stringtown on the Pike," the fascinating story written some years ago by Prof. J. U. Lloyd, that one of the prominent characters in a tragedy made use of a vegetable tripodic compound which proved to be an insidious but slow poison. If either one singly, or any two or the three drugs were combined no poisonous energy would be developed. It has long been the contention of some chemists that certain nontoxic vegetable agents would, on being combined with others, result in the promation of a poison. Even the mixing of certain articles of food within the stomach has resulted in the formation of ptomaines.

This feature of medical investigation—the consideration of the single remedy—is confined almost wholly to that branch of the profession which it pleases some to stigmatize "irregular." It seems to be left to our school to push this feature of improved practice and well and truly are many of our leading minds exerting best efforts to accomplish such desirable end. Oslerian medical nihilism receives no sympathy from earnest, honest delvers after final knowledge of the curative powers of our rich American materia medica.

COMMENT:—The above carefully written and most excellent article, should impress upon the minds of those who have not previously given the matter much thought, the importance of studying each drug separately, and determining with positiveness the exact phenomena, or group of symptoms which it will control. It is clear to any thinking mind, that no other course of drug study will ever prove successful. As I have often stated we find it necessary at times, to give at least two, sometimes three remedies in combination. This is not done in order to get their united effects on any one condition. It is done because there are plainly present, two or three distinct symptom groups, which we know to be met by the two or three remedies prescribed. Let the study and observation in the direct lines, by all of our readers, be made, with more care than ever before.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.