By John Hutchinson, M.D.
Modern Medicine has a very wide and a very definite aim. This aim is to understand fully the causes of disease, the exact vital disturbance, and the precise effects to therapeutic agents. Laboratory investigations penetrate in some measure the secrets of life in general, or its functions in particular. There is abundant disposition to ask why, to learn how, and to reach conclusions.
But the mystery of medicine is real, even though it has also been exaggerated. No extent of laboratory technique and demonstration can do away with a certain mystery that attaches itself to vital processes. Therefore Medicine will remain forever an art. We practice that art in the scientific spirit.
We take to the laboratory for examination and study many specimens obtained from the patient himself. The analysis may tell us all there is to know about his material condition. Where upon a diagnosis is established, and the etiology confirmed. Perhaps a curative agent is revealed, and duly accepted.
Then we have a class of cases in which the routine is not as productive. There are patients who have had this attention repeated at different times for as many different attacks of illness. In a sense ill health has been cumulative. Now one diagnostic appellation will not suffice. It is a chronic case, and there are many diagnosis, whatever may have been the first or later aetiology. There has been a succession or a sequence of disturbances here and there throughout the organism (loosely speaking) and the tissues affected have not returned to the normal.
Still another class of cases seeks cure. This third class is a very large one. These patients are not only afflicted with bodily and material ailments that may be discussed in laboratory terms; they have multiple ills that seem to belong to an immaterial foundation. Just as the neurasthenic suffers from a multitude of distresses presenting no tangible morbid basis, so these sufferers are manifestly ill of such distuned, latent, but inherent forces, that our coarser methods of diagnosis are inadequate.
Without doubt the greatest factor against success in these cases is failure to grasp it until it is dug for, and often tiresome digging is unrewarded. Instead of the nugget, we find nothing but debris.
One significant reason for this is that our worst chronic cases come to us with a history, either covered or confessed, of protracted drugging. It has been the patent medicine or the acceptable prescription of a good doctor, depended on and so repeated without authority, or a favorite “tonic” that has been consumed ad libitum.
Our knowledge of drug effects, tonic tolerated, and reactionary, informs us of the results to be expected from such habits. Furthermore, we know in detail of a finer-line syndrome manifested by sensitive patients who are peculiarly susceptible to a given medicine. Attention is being repeatedly called to the untoward effects of drugs on sensitive organisms, and the conclusion advanced that such are due to personal idiosyncrasy. If so, are such human beings more numerous than formerly? And, if so, why?
The local irritating effect of standard solutions of phenol and mercuric chloride, systemic poisoning from the use of hair wishes, throat wahses, and skin lotions, dermatitis from chloral and the bromides, the diarrhoeas of ferrum, and the ear disorders from quinine are a few random illustrations of crude causation which are recognized sometimes. When they occur unrecognized, or when, in fact, other subtler effects of the drug persist unseen, the consequences are far more disastrous. As an instance, there are babies who are reared on cathartics; they develop a good share of the chronic adult patients. In these circumstances the exact cause of a condition may appear inscrutable.
Drugs can be administered properly and safely only on the basis of initial, primary, cumulative, and chronic action. The toxic action may be known, but it is not sufficient. Sudden death is only one kind of death. There are many other kinds and the causes are none the less sure because unknown. The newly-discovered forms of radiant energy are just as destructive in the hands of the tyro as they are useful under the control of him skilled in their employment.
The mixed and complicated cases of sickness that present themselves at hospital clinics and to the general practitioner or the specialists are due in large proportions to the chronic impress of one or more drugs improperly exhibited or intemperately used. This state of affairs is the more serious for the reason that its origin is not always obvious at first; neither can it be discovered without patient and persistent analysis.
When a patient presents a symptomatically that corresponds to some of the well-known drugs, let us say, Quinine, Mercury, Strychnine, or Morphine, it is not easy to decide on his case. The cause is not apparent. There is so much the matter with him that we must first choose the best diagnosis out of several that clamors for place. A physician hesitates to announce his diagnosis as “Strychnine.” Yet, that it must sometimes be.
I wish to illustrate what I mean by citing examples of a series of cases in this department of study:
First, the case of a young mother of five children. Her age was thirty-six and she looked no older. His life was happy, her husband indulgent, her children beloved, herself occupied with wholesome interests. For several years she and been subject to nervous breakdowns, in fact, ever since the birth of the fifth child. She had had more or less constant treatment for a “weak heart,” and she and she had become deeply impressed with the gravity of her complaint. Her dependence had been upon Strychnine sulphate in the usual dosage, and her condition had become one reflecting the perfect image of this drug. All her symptoms were those of its chronic effects. They had supplanted whatever could have been the original primary malady.
Second, a man of forty-five, single, strong, of good habits. Complains of strained knee, left. The history is not very clear, but the knee is painful at night, in damp weather, after taking acid drinks, and there are suggestive concomitant symptoms Treatment is of no benefit. I asked him how much Calomel he had taken in his life. He replied that he had taken none. On May expressing surprise, and asking why not, he explained the mother was greatly opposed to the medicine, it having done her much harm. This mother died of a disease the dated from his birth or a little earlier.
Third, an unmarried woman of fifty. She has passed through the experiences common to her sex at this age. For ten or more Years she had been loyal to medical science – perhaps too impartially loyal. Hyperesthesia characterizes all her discomforts. She is intolerant of any degree of annoyance. Her facial expression is a shadow of that characteristic of certain habitues. There is no question about gastric crises. It is impossible to find record of all the medication she has had in the past decade, but it is probable that drugs of one certain class, the opiates, have been well represented in her case.
Fourth, a girl of seven years, thought to nearly moribund. Unresolved pneumonia of right lung. After improvement was established, and the lung clearing somewhat, periods of chill, fever, and sweat, painful joints, swollen finger tips, persistent laryngeal cough, pain in ears, and other symptoms presented a syndrome unmistakably pointing to previous intolerance of former Medication, which was confirmed in respect to one drug, Quinine.
In medicine whatever is true is also easily verified. Verification must be appreciated as easily as the propositions of any natural law, Avogadro’s, for example. In this law we have five propositions to establish one result: (1) Gases (2) Two or more (3) Equal volumes (4) Same temperature (5) Same pressure (Result) Equal number of molecules:- Equal volumes of gases under the same conditions of temperature and pressure contain the same number of molecules.
In the representative clinical cases cited in the foregoing, we have (1) Drug diseases (2) Four different ones (3) Equally complete symptoms complex (4) Symptoms actually caused by the drug (5) Symptoms actually curable by the same drug, (Result) Demand an appropriate dosage of the same remedy:- Any drug disease presenting a definite symptom complex of a particular drug may be cured with a highly-potentiated preparation of that drug.
That first case herein submitted was cured with Nux vomica, the second case with Mercurius dulcis, the third with Morphine sulphate, and the fourth with Cinchona, all in extremely high potencies of these different medicines.
These four great drugs invite our attention in this respect. Their symptomatology is wide and well-known. Strychnine, Calomel, Morphine, and Quinine produce astoundingly bad effects unless properly prescribed. Many patients continue their use for months and even years, after seeing the physician who first made the prescription. In time the cumulative effects have produced a drug disease. Drug diseases are sometimes impossible of cure, in the sense of restoration of the system to normal and natural function.
When correspondence is found between the complete symptomatology of the patient, and that of the drug in question, give your patient one of the highest potencies of this drug. It is the remedy. In three days after the exhibition of one single dose it will be seen to be the remedy for that case. Sometimes repetition is not required, but if required it must not be made while improvement is still in progress. Do not repeat until improvement is at a standstill.
There are several trustworthy preparations of high potencies. Among such may be mentioned those of Jennichn, Skinner, Fincke, and Tafel. In any event they should be secured from a standard pharmacy.
Only four medicines have been referred to as causative. Obviously they do not complete the list. In a crisis it is desirable to determine the history of medication. If it can be ascertained that the remedy to which the symptoms point has been taken in crude form, even though other medicines have also been taken, we may be assured that this medicine is the one to which this particular patient is especially susceptible, and therefore the one that from the influence of this drug. The human system is never drug proof. Some bodily, mental, or moral expression is sure to follow the exhibition of any drug or any remedy.