Classification of Remedies.

I have been in doubt in regard to the best plan of arranging the remedies in this study. Evidently the old classification will not serve our purpose, for it deals with indirect action; and the influence of remedies in poisonous doses. We have not advanced far enough to make a new classification; at least, to make one that would facilitate our study. I have, therefore, concluded to take up the different articles in alphabetical order, and so far as possible make a brief review of our entire Materia Medica.

When a remedy has no especial value, it will be named so; and when it seems to have a specific action, not fully determined, this will be pointed out for future experiment. Self-deception is a very unprofitable pursuit, and great care will therefore be employed to insure accuracy, and no statement made unless pretty thoroughly proven.

The best preparations, and the best process for office manufacture will be given, also the form in which we deem it desirable to use them.

When we have thus given the Materia Medica a review, we will be better able to make a classification.

Some suggestions. however, as to the general indications for treatment, and use of remedies, may not be out of place, and will serve as a further illustration of our idea of specific medication.

In all acute, and most chronic diseases, our examination of the patient and our therapeutics will take this order

1. With reference to the condition of the stomach and intestinal canal—bringing them to as nearly a normal condition as possible, that remedies may be kindly received and appropriated, and that sufficient food may be taken and digested.
2. With reference to the circulation of the blood, and the temperature—obtaining a normal circulation as regards frequency and freedom, and a temperature as near 98° as possible.
3. With reference to the presence of a zymotic poison, or other cause of disease—which may be neutralized, antagonized or removed.
4. With reference to the condition of the nervous system—giving good innervation.
5. With reference to the processes of waste and excretion—that the worn-out or enfeebled material may be broken down and speedily removed from the body.
6. With reference to blood-making and repair—that proper material be furnished for the building of tissue, and that the processes of nutrition are normally conducted.

These are general outlines for the study of disease, and the action of remedies in antagonizing it, and may aid in giving direction to our study, and enable each one to make a classification of remedies for himself. A brief consideration of each one, with examples of the application of remedies, though it will be a repetition, may be of advantage to the student.

1. The condition of the stomach is of first importance in the treatment of disease. It must be in such condition that it will receive remedies kindly, and permit their speedy absorption, in order that. they give us the desired results. Surely, it is not difficult to see the necessity of this, if we take no further view than to obtain the curative action of remedies. If the stomach does not receive a remedy kindly, is irritated by it, we can not expect ready absorption, or the complete curative action. If the stomach throws out its juices, which digest or decompose a remedy, we can not expect its curative action. It the stomach is secreting mucus in large quantity, if it is in that condition in which it is but a receptacle or retainer, then we can not expect the ready absorption of remedies, and will not get their curative action.

   We are accustomed to specify two conditions of the stomach, which may he tolerably easily determined by constant symptoms, and which should always be corrected. These are :—
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   1. Irritation of the stomach, marked by a reddened (bright) tongue, elongated and pointed, with sometimes reddened and erect papillae. It is accompanied with unpleasant sensations of constriction, and tenderness on pressure over the epigastrium. There may be nausea, retching, or vomiting; and in the severer cases, when prolonged, an irritation of the sympathetic, and finally of the spinal and cerebral nervous systems.

      Its treatment takes precedence of everything else, for until removed we can not expect the kindly or definite action of remedies.

      The remedies employed for its removal are minute doses of Aconite; small doses of Ipecac or Lobelia; Hydrocyanic Acid, or better, a preparation of the bark of the Peach tree; Rhubarb; Bismuth. These may be aided by the external use of the cold pack, hot fomentations, or rubefacient application, and sometimes an enema to remove the torpor of the lower bowel. From twelve to forty-eight hours, is usually the time required to effect it.

      But, the reader may ask, why if remedies are specific, name so many for the relief of so simple a pathological condition as gastric irritation? The question is pertinent, and we will endeavor to answer it. Each of these remedies has a direct action in this condition, and each may be relied upon as a remedy. We choose the remedy, however, with reference to the association of diseased action, and in some cases one will be found best, in others another.
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   2. The atonic stomach, with increased secretion of mucus, and sometimes with considerable accumulations. It is marked by the broad tongue, heavily coated at its base, bad taste in the mouth, and feeling of weight and heaviness in the epigastrium. The symptoms are distinct, and can not he mistaken.

      When the condition is pronounced, in severer forms of disease, there is no means which will reach it so directly and speedily as an emetic. It needs to be prompt and thorough in action, not producing debility or leaving the organ irritable. If not requiring this, we may accomplish the same object by the use of the Alkaline Sulphites, followed by Nux Vomica.

      We have many minor lesions that can not he classified under these, to which we will find single remedies specific. Thus in simple nausea and vomiting, without irritation, we prescribe Nux Vomica. In typhoid disease, with tumid mucous tissues, the Baptisia. Increased mucous secretion with irritability, Oxide of Zinc. Imperfect gastric secretion, Hydrastis. Increased mucous secretion with impaired functional activity, minute doses of Podophyllin, etc. *

      * See Practice of Medicine, page 27.
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2. We recognize the fact, that just in proportion to the variation of the circulation and temperature from the normal standard is the severity and activity of disease. The more frequent the pulse, and the higher the temperature, the more active a zymotic poison, the more rapid the progress of local or general disease, and the less able the body to protect itself, or expel the cause of disease. The rule here is absolute, and there is no variation from it.

   In therapeutics we find—that just in proportion as the circulation and temperature can be brought to, and maintained at the normal standard, just in that proportion are the processes of disease arrested, and vital processes re-established.

   These facts must surely have been noticed by observers, and we can only wonder that they have never been clearly stated, and practiced upon.

   If we take as an example a case of fever, we will find that remedies that will reduce the pulse to a normal frequency, giving freedom to the circulation, will reduce the temperature, and that just in proportion as this is accomplished, the febrile symptoms disappear, and the various vital functions are re-established. If we maintain the circulation and temperature at this point, the fever must certainly cease.

   In acute inflammation, the rapidity of the local disease and destruction of tissue, is in the ratio of frequency of pulse and increase of temperature. Just in proportion as we get a normal circulation with reference to frequency and freedom, and diminished temperature, just in that proportion the inflammatory process is arrested.

   In asthenic inflammation we find another element in the pathology of the disease—a want of vital power, either in the whole or in the part. This must be antagonized by appropriate remedies. In others there is a zymotic or animal poison, which must be antagonized, destroyed, or removed.

   In chronic disease the law is just as absolute as in the acute. Given, any disease of function or structure, with a pulse maintained constantly above 100 beats per minute, and a temperature above 100°, and the patient must die. The disease, as a general rule, will run its course rapidly to a fatal termination just in proportion to the extent of this deviation.

   Recovery from chronic disease never takes place until the circulation and temperature approximate a normal standard. In any given case, the probabilities of cure are as the possibility of bringing and maintaining the circulation and temperature at the standard of health. The first evidences of amendment are announced by a diminution of frequency of pulse and a better circulation of blood, and by an equal temperature of the body, approximating 98°. These seem like dogmatic statements, and many will he inclined to dispute them, because opposed or not named by the common authorities on medicine, but it only requires observation without prejudice to prove each position.

   We may claim then, that remedies influencing the circulation and temperature, toward the normal standard, are the most important of the Materia Medica.

   In very many cases the lesion of the circulation is a basic lesion, upon which others arise and are continued. When this is the case, the remedy that gives us normal circulation removes all the diseased processes which rest upon it. Thus we will find that arrest of secretion and excretion, lesions of innervation, of waste and nutrition, as well as the intensity of zymotic causes, are in proportion to the rapidity of the circulation. Conversely, as the pulse comes down to the normal standard, and the blood circulates freely, just in that proportion we have a restoration of the secretions and excretions, better innervation, better digestion and blood-making, and a more active waste and repair.

   Have we remedies that influence the circulation directly, giving a free and equal circulation, with diminution of frequency? Many of our readers will have asked this question before this, and answered it in the negative. Certain remedies will have been recommended to them as special sedatives, which they have used without the good results named and expected. How is this? It is a common failing with physicians to expect a desired result too soon, and endeavor to force it by large doses of medicine. This has been a common cause of failure in the use of Veratrum and Aconite. Others have purchased worthless medicines, which will readily account for the failure. Taking the article of Veratrum alone, and excepting Norwood's Tincture, nine-tenths that has been sold was wholly worthless as a medicine.

   The theory with regard to the action of the class of special sedatives was erroneous. They were regarded as depressants, and diminished frequency of pulse was supposed to depend upon their depressing influence upon the heart. It was the common error of large doses and poisonous action. All of these remedies are active poisons in large doses, and death occurs in all by cardiac syncope. In the cases of Veratrum, Digitalis, Lobelia and Gelseminum, slowness of pulse is a prominent symptom of the poisonous action. In the case of Aconite, extreme frequency of pulse is produced by the poisonous action.

   In medicinal doses (small), the influence of these remedies is that of a cardiac stimulant, and is undoubtedly through the sympathetic system of nerves, which controls the entire circulation of the blood—not only the action of the heart, but of all the blood-vessels to the most minute capillary. I contend that this influence removes obstruction to the free circulation of the blood, as well as gives power to heart and muscular fibre of arteries. As obstruction to free circulation is removed, it requires less effort to move the blood; as the power of moving the blood is increased there is less necessity of frequency of contraction upon the part of the heart.

   As a rule, the time required to effect sedation will bear a distinct relation to the time required for the development of disease, and its average duration. Thus in an acute fever or inflammation from cold, the influence of the sedative may be promptly obtained, and the disease speedily arrested. In continued fever, the accession of the disease (in most cases), is slow in proportion to its duration and severity. Here there are grave lesions of function, possibly of structure, and we expect to obtain the influence of the sedative slowly.*

   *See Principles of Medicine, pp. 219, 264. The Eclectic Practice of Medicine, page 94.

   Whilst each of the remedies named as arterial sedatives, Aconite, Veratrum, Digitalis, Gelseminum, Lobelia, exert a direct influence in this direction, they are not equally valuable in all cases. The two first are pre-eminently the sedatives, their action being more definite and stronger, and adapted to a larger number of cases. The special adaptation of each to special forms of diseased action is named in the description of the remedy.

   The temperature bears such a constant relation to the frequency of pulse, and general condition of the circulation, that a remedy which will correct the one will also correct the other. Thus we find in practice that just as we bring the pulse to the normal standard by the use of an arterial sedative, in the same degree we reduce the temperature. This is the case in chronic as well as in acute disease. For instance, in a case of phthisis we find a temperature of 101° associated with a pulse above 100 beats per minute; if it is possible to bring the pulse down to 80 the temperature comes down to 98° and a fraction. If this can be maintained we find a cessation of tubercular deposit, and a reparative process set up in the lungs.

   We have some special means to influence the temperature, outside of the remedies acting upon the circulation. A full description of them would be out of place here, but may be found in my Principles of Medicine, p. 40.
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3. The field of therapeutics embraced in our third proposition is very large, and will well repay careful study. Whilst zymotic causes have been recognized in many of the severe acute diseases, but little has been done to determine their character, or the means to antidote them. Possibly the observations of Prof. Polli, with regard to the influence of the Alkaline Sulphites, was the first important step in this direction.

   The presence of such blood poison is readily detected, and we have advanced so far in our knowledge of remedies, that in many cases we can select the antidote with much certainty. I do not wish to be understood as claiming that we have any remedies that will immediately unite with all of a zymotic poison in the blood, destroy it, and at once restore health. Such an influence could not reasonably be expected. But we have remedies which, introduced into the blood, will antagonize the zymotic poison, as it comes in contact with it, arresting its septic influence, or wholly destroying it. In some cases they act rapidly, in others slowly, but in all, if properly selected, with great certainty.

   The principal remedies of this class are the Alkaline Sulphites, (Sulphite of Soda being in most common use) and the mineral acids. The rules for the selection of the one or the other of these are quite simple, and very definite:

   In any given case presenting a pallid tongue, with white, or dirty-white, pasty coating, use the Alkaline Sulphites.

   In any given case presenting a deep-red tongue with brownish coatings, or deep-red glossy tongue, and dark sordes, use mineral acids. In some cases we employ Sulphurous Acid, but in the majority, Muriatic Acid.

   Of our indigenous Materia Medica we have but one remedy that markedly possesses these properties, and it possesses it in high degree. This remedy is the Baptisia Tinctoria, which may be used in either of the cases named, but is especially valued in the last.

   The reader will bear in mind that the activity of a zymotic poison is in exact proportion to the departure from normal function. With a rapid pulse, high temperature, and arrest of secretion, its development is rapid and its devitalizing influence marked. Or in the rare opposite case of congestive intermittent and cholera, as the circulation is enfeebled, and the temperature lowered, its progress is rapid.

   Hence, in order to antagonize a zymotic process, it is necessary, so far as possible, to obtain a normal circulation and temperature. This proposition can not be too strongly insisted upon. In a given case, the circulation and temperature being favorably influenced by Aconite and Veratrum, Sulphite of Soda exerts an immediate and marked controlling influence over the fever poison. Whilst if it had been given without such preparation it would have had no influence at all, or but slight influence.

   Some causes of disease are destroyed and removed by remedies that increase waste and excretion. Preparations of Potash and Soda, especially the alkaline diuretics act in this way. There are some organic remedies that exert a direct influence upon causes of disease, modifying or destroying them, as may be instanced in the action of Phytolacca in diphtheria. This action, however, in the majority of cases, is feeble.

   Causes of disease acting in and from the blood, are frequently removed by stimulating the excretory organs. Some are removed principally by the skin, others by the bowels, others by the kidneys.

   The cause of periodic disease, whatever it may be, plays a very important part in the diseases of some localities. Antagonize this cause, and the disease ceases, or at least is very much modified. Hence in the treatment of the diseases of the West, antiperiodics become the most important remedies.

   Quinia is a true specific, and may be taken as the type of these remedies. It fails frequently, possibly it is administered nine times where its specific action is obtained once. But it is not the fault of the remedy, but of the doctor. If the diagnosis is correctly made, and the system is prepared for its administration, it will rarely fail, even when given in a single sufficient dose.

   I am satisfied that the study of the direct antagonism of remedies to causes of disease, must advance the progress of rational medicine. It is possible, and I deem it probable, that such research will give us remedies controlling all zymotic disease in its early stage.
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4. The human body is a complex structure, united in functional activity by a nervous system. As this exerts a controlling influence, we should expect that its lesions would form a very important element of the study of pathology. This has not been the case, however, and we find pathologists and therapeutists giving it but very little attention. It is a wide field for study, and its cultivation will greatly advance medical science.

   A few suggestions may not be out of place here:

   Those functions which we have been accustomed to speak of as vegetative, are associated together, and to some extent governed by the ganglionic or sympathetic nervous system. It comprises digestion, blood-making, the circulation of the blood, nutrition, and secretion and excretion—these are the essentially vital functions, in the performance of which man has life. If they are properly performed, he has healthy life, if there is an aberration in either of them, one or more, he has diseased life. Is it possible to have disease, without a lesion of one of these ? I think the reader will say it is not. If this be so, then this ganglionic system of nerves must play an important part in every disease.*

   * See Principles of Medicine, page 306.

   Control and association of these vital processes being in the ganglionic system of nerves, we would naturally expect it to furnish the readiest means of reaching them and correcting their lesions. If there are remedies then that influence the ganglionic nerves directly, and through them the vital processes of the body, they must become our most direct and important therapeutic means. It is in this way that a large number of specific remedies act, as I believe. The sedatives, Aconite, Veratrum, Gelseminum, Lobelia and others, as Cactus, Belladonna, Eryngium, Phytolacca, Hamamelis, Pulsatilla, etc, very certainly produce their effects through it.

   The association of the spinal-cord with the sympathetic brings vital functions in relation with our conscious life, and through its superior expansion the brain, adds suffering from disease. Conversely, mal-conditions of conscious life are reflected through this association and influence vital processes.

   Whilst, therefore, it is very important to reach lesions of vegetative life directly through the ganglionic system of nerves, it is no less important to control any disease producing influence that might be extended from the cerebro-spinal centres.
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5. Lesions of waste and excretion are elements of every disease. In some they form a principal part, in others in less degree, but in all they require to be estimated in diagnosis and therapeutics. They range themselves under the common classification of excess, defect, and perversion, and usually it is not difficult to determine their character, and select means that exert a direct influence.

   Constant waste is a necessity of life, as is constant removal of this waste. If the materials of the body are not broken down and removed as they have served their purpose, the body is old, imperfect, and has lost functional power to this extent. If the material is broken down and removed to the blood, but not carried out by the excretions, we will have an impairment of life from its presence in the blood. I have given this subject full consideration in my Principles of Medicine, pp. 116 to 185, to which the reader is referred.

   Too rapid waste of tissue is sometimes an important element of disease, requiring care in diagnosis and the application of remedies.

   A perversion in waste and excretion is a common element of disease. In the breaking down of a protean body, it passes through many phases, and in its metamorphosis, it assumes forms that are noxious to life, if they have any degree of permanency, or are in any considerable quantity. Lesions in retrograde metamorphosis are therefore to be estimated, and remedies which influence it become important.

   We have already noticed that many causes of disease act in and from the blood. They are zymotic poisons, or animal matter undergoing change, and influence the blood and life in different degree, in proportion to their quantity, and especially in proportion to their activity in setting up the septic process. These may be antagonized or destroyed in many cases; in others the natural process of retrograde metamorphosis is stimulated, and they are transformed into urea and other innocuous bodies fitted for excretion by kidneys, skin and bowels. Means that increase the activity of these excretions are frequently sufficient for the removal of such causes of disease.
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6. The necessity of regarding the nutritive processes during the progress of disease, is now admitted by all advanced physicians, and insisted upon by such writers as Chambers, Anstie, Bennett and others. Experience has conclusively proven that proper food with good condition of the digestive apparatus, without medicine, give a success in the treatment of the graver acute diseases, that was never obtained by any other method of treatment.

   As we have already seen, the condition of the stomach and digestive apparatus is of first importance in all forms of disease, and its lesions demand first attention in our therapeutics. We have shown that this was essential to the successful administration of remedies, it is no less necessary that the patient may take and appropriate proper food.

   The administration of remedies that increase functional activity of the digestive apparatus, or aid in the digestive process, are sometimes important means. The selection of appropriate food, and the use of restoratives is supplemental to this. The object is to place the digestive organs in good condition to receive and prepare food for admission to the blood; to furnish such material to the blood as may he necessary for its perfect organization, and for the renewal of tissue.

Specific Medication and Specific Medicines, 1870, was written by John M. Scudder, M.D.