ARTICLE XIV.

RATIONAL THERAPEUTICS.

BY C. M. GOULD, M. D., OF RIVER FALLS.

Member of Committee on Materia Medica and Therapeutics.

That the practice of Therapeutics can never, in the strict sense of the term, become a science, is a well established fact. This is due more especially to the idiosyncrasies, habits and temperaments of people than to the variableness of drugs, though the latter forms by no means a small factor. Therefore, as we cannot rely implicitly upon medicine, we must understand the natural history of disease and the peculiarities of individuals, as well as the nature and action of our remedies.

We have ascertained that any agent which disturbs the balance of the human economy causes diseases, as for example, medicine administered to a healthy man. We have been taught, and our own observations and experience verify the teaching, that specific diseases must be self-limited, and medicines administered in such cases simply modify the severity of the symptoms. These diseases run their course and obey certain laws in their development and decline. The physician must work with nature.

We have also learned that the natural course of disease is modified by the peculiarities of the individual, by climate and surroundings, that forms of disease vary as regards characteristic symptoms and intensity as in variola and scarlatına; each case is a study by itself. Similar causes produce different results upon different persons.

We must, as doctors, guard against doing harm in all cases. We should always seek to sustain nutrition until the morbific cause of disease has been removed or exhausted. We have now reached an age in which depleting measures are abandoned. The tendency of to-day is to build up instead of deplete, as in former days. The inordinate doses of calomel and jalap of fifty years ago have been

supplanted by a sustaining treatment; and surgical sentiment has changed as well. Now venesection is seldom practiced, and recommended only when a profound impression must immediately be made, as in pueperal convulsions and the apoplectic form of sunstroke. Fifty years ago it was considered the sine qua non. Meigs still adheres to its employment in many cases, especially in puerperal convulsions, but as convulsions have many causes, even in the puerperal state, aside from increased vascularity of the nerve centers, we adopt other methods for their relief. We employ chloroform, or if the bowels are constipated, causing reflex irritation, we administer an enema of soap suds. If there be intense irritation of the vagina or cervix in dry labor, we relieve by immediate delivery. Again, uræmia, occurring late in pregnancy, may be the cause, the limbs becoming œdematous and the urine scanty and albuminous. We seek to eliminate; venesection diminishes all the vital forces except absorption. Sunstroke may produce cold; the patient is pulseless, and his pupils are dilated; here venesection would be homicide. Another may be of the apoplectic form; pupils contracted, full, bounding pulse; here it is allowable and will accomplish much good. Where it was customary for our worthy predecessors to employ venesection we now resort to the use of sedatives, sinapisms and hydragogue cathartics, because we think we have a better understanding of the phenomena of reaction and have learned the action of medicine.

We seek to obviate the tendency to death by all the means within our power. We enter into the presence of disease. Now we must summon to our aid the knowledge acquired by study, observation and experience. We examine the case carefully, thoroughly, earnestly. We diagnose, consult our materia medica and adapt our remedies to the indications.

We ascertain by experience that to be successful practitioners, we cannot treat by "rule or rote" but must act according to the exigencies of the case, ever on the alert for complications. We do not treat pathological anatomy but the individual patient.

In disease the normal functions of all organs are disturbed, there is generally prejudice against food. But the development of anorexia is not an indication to withhold nourishment. On the contrary, we feed our patients abundantly to supply waste and imbue them with greater strength to resist death. A sick man lying in bed

requires more food than a well man in bed. The greater the febrile condition, the greater the need of nutrition. Craving for particular kinds of food are not always for the kind best suited to the condition of the patient, but they frequently furnish a good criterion. A little German patient, in the latter stage of typhoid fever, cried for milk and potatoes, utterly reíusing all other food. The father finally acceded to his wish and fed him milk and potatoes plenteously. The little fellow recovered, and the turn in his favor commenced simultaneously with the accession to his demand.

We recognize starvation as a relative term and progressive in its action. Its manifestations may go along with the manifestations of disease, as in typhoid fever. It is frequently the case, in fact it is nearly always so, that in sthenic fevers, for the first few days, patients will loathe food and should not be urged to take it. But the little ones, the infants, with whatever disease, must be fed, and abundantly. We know that in early infancy the gastro-intestinal glands are undeveloped and in consequence the mother's milk is the only proper and natural food. Dr. Burns says one part of milk, two of whey, one of sugar and one of cream, is a fair substitute for mother's milk.

The intestinal glands, becoming developed when the child is seven or eight months old, Liebig's food, consisting of milk, malt, wheat flour and Bicarbonate of Potassium is good. Statistics show that seven out of ten children die before the end of the first year, when artificial food is substituted for mother's milk. Ninety per cent of this mortality can be accounted for by the fact that instead of feeding to an infant at the age of one month, a pint and a half, and at the age of three months, a quart in twenty-four hours, which it is able to digest, only a teacupful is given in the same time. Starvation is the result, and we note as indications of it, eruptions on the skin, blebs, ulcers, erythema, progessive emaciation, moanings and restlessness in sleep.

I claim that there are only two conditions in which mothers are justified in bringing children up by hand; 1st, when the mother has no milk, and 2nd, when the mother's mammæ are diseased. We might pursue the subject of progressive starvation to the end of our paper but as it is somewhat foreign to our text we will hasten to consider the way by which medicines cure diseases or modify them. We first ascertain if possible the cause of the malady, then seek

to remove, destroy, neutralize or antidote the physiological effects. We eliminate the cause by evacuants, or if not successful in so doing, sustain the nutrition. We neutralize as in acidity or alkalinity of the stomach. 2nd, We dilute the cause as in case of ingested irritant poisons. In fevers we give copious draughts of water, the urine becomes less concentrated and mental disturbances are thus often alleviated. 3rd, We seek to antidote effects and use sedatives for the purpose of controlling convulsions. The cause may remain, but the effect is antidoted. We employ mercury in primary syphilis when affecting the skin and mucous membranes. Iodide of Potassium in secondary, when the fibrous tissues are involved. Revulsives as diuretics in colds and blisters in Pneumonia, emmenagogues, sitz and foot baths in Amenorrhoea. Of all the methods employed, antidoting is the one most often used.

For reasons before stated, medicines act differently upon different individuals, and upon the same individual at different times; therefore, a physician relying implicitly upon any rule or rote for the successful treatment of his patient will often be disappointed with the result, and ere long his mental horizon becomes clouded with doubts. His general demeanor betrays his lack of confidence in himself. His patients soon learn to share his scepticism, and no longer greet him with happy expectancy. They have lost faith in their physician, even as he has in the potency of his draughts. He has overlooked, forgotten or ignored the inherent and external opposing elements: he has not treated the individual. Of all scepticisms, medical scepticism is the most disastrous; let us seek to avoid it by all the means within our power. Despite our most earnest efforts, however, doubts will occasionally confront us; many times we are disappointed; results opposed to those we expected are reached. Let us investigate. It may be that we are attempting to remove the cause of a disease, when we should rather employ such agents as will antidote the effects. Perhaps we have given too little attention to nutrition, and have lost sight of the constant metamorphosis of tissues. Perhaps we have mistaken functional derangement for structural degeneration, and early regarding the case as hopeless, have failed to apply the proper remedies. It is our duty to employ every method, and use every means to bring to ourselves a proper knowledge of the true condition.

The busy general practitioner, and especially the Country Doctor,

has little time it may be to devote to microscopy. But let the physicians of each country or district form themselves into associations and do as we are about to do in our part of the state; give that department entirely over to one competent member, to him send your specimens for examination, and pay him for his work. The result, will soon be patent to all.

There are many means which suggest themselves even outside the realms of Bartholow & Wood. The manner of the physician, his deportment, not only in the sick room, but in the office, and on the street. Any and every where, he should be a gentleman. He should, on the other hand, carry about with him no air of mystery, nor seek, on the other, to advertise himself. Moving among his fellows, honest, faithful and upright, as ready to serve the dweller in the cabin as the governor of the state, he should never allow any consideration to stop between him and the welfare of his patients. Their interests should always be his first consideration.