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are certain to occur if Nature, unaided, is required to cure the disturbance of function, the disease, that ensues ? Will Nature eliminate the lead that causes the Burtonian line, or does she not rather wait for Art to come in with her sulphur, or her iodide of potassium, to expel the enemy, who had effected so secure a lodgment that she alone would never have mastered him ?
These are some of numerous instances that may be already alleged as indicative of the means by which we may rationally aid Nature in the treatment of disease; while especially the last two are brought forward to show that nature, or, in other words, the physiological forces of the system, do not suffice to restore health to the sufferer. We look forward with confidence to the time when the range of Art will be still further increased, and her relation to Nature still more accurately defined. But of one thing we are as certain as Sir John Forbes could desire us to be, that unless, in all our remedial administrations, we consult the laws of physiology, and seek to avail ourselves of the inherent powers of the constitution to remove disease, we shall ever fail to be masters of our art, and shall go about, ourselves blind, seeking to direct the blind. The real question in therapeutics is, what can Nature, do unaided I can she do it in the most expeditious way alone does she require some artificial assistance, or is she altogether unable to restore health without the intervention of art? In the above instances we have sought to illustrate some of the ways by which we may assist nature. Undoubtedly, in the majority of diseases, Nature--that is, the physiological processes tend to remove disease by restoring the natural balance of the powers ; in many she does so inost expeditiously, if left to herself; in many the processes may be facilitated if we adopt the hints which the balance and the test-tube afford; in some she appears overcome by the noxious influence, and to succumb, unless a powerful antidote be administered, which, by neutralizing the poison, enables the physiological influences again to assert their power, and to restore the balance of health.
We are tempted to place before the reader a formula by which we have sought to make clear to ourselves and to students the various points of view under which we may regard diseased processes, and which has appeared to us to facilitate the rationale of our therapeutical applications.
If we represent the normal constituents of the body by a, b, c, d, e, and assume that in health they occupy the relation to one another of a + b + c + d + e, disease may be regarded as taking place in one of three ways, which may as readily be represented by an algebraic formula. Either the constituents are simply deranged, and they come to occupy a different mutual relation; or an elision of one or more of the elements may take place; or thirdly, a foreign element may be superadded. In the first case the different forms of disease may be as numerous as the changes that can be effected in the relative position of the elements, and instead of the formula, a + 6+ c + d + e, we may find them in the relation of a +d+e+b+c, or of 6 + d +c+e+a, and in many others. It is manifest that, if anywhere in the treatment of disease, this category will probably be the one in which we shall find. the most numerous instances of what Sir John Forbes terms the power of Nature in curing disease, -that is to say, that the interference of medicinal agents will be less necessary, because, by placing the patient in a proper condition as regards noxious influences, by allowing the powers of his constitution to find their proper balance, the derangement of the constituents of health will be rectified. It becomes a question for further inquiry, whether it is not a due and legitimate prerogative of Art to ascertain that Nature is able to achieve certain results, when the conditions are granted, and to grant those conditions. We are willing at once to confess that since our first initiation into the mysteries of medicine we have abhorred the doctrine that our art consisted exclusively in the administration of pills and potions. To return.
Our second category—that in which an elision of one or more of the elements occurs—would be represented thus, b + c + d + e, or a + b + e, or let E represent the elements in their normal strength and order, the above two instances would stand thus respectively: E - A, and E - (c+d). The inquiry to be made in this case in regard to therapeutics would be, whether the powers of Nature would be adequate to restore the deficiency, or whether it would be requisite to supply the element which we found wanting by artificial means, or, in other words, by drugs. There can be no doubt that here again the physician will often do little more than place Nature in a position to work out her own salvation ; but at the same time he may, by the judicious administration of the deficient element, materially expedite the process. To take a familiar instance. The blanched lip and the pale tongue of an anæmic patient challenges us to prescribe a salt of iron, because we know that element to be wanting to restore our patient to health. By hygienic means alone, by fresh air, improved diet, and cold sponging, the system may be enabled to take up from the food the necessary iron without medicines; but we all know that either we cannot place our patient in circumstances in which the hygienic means are available, or that the process is very tedious, and will be much expedited by the administration of five grains of the ammonio-citrate of iron three times daily, half-an-hour after meals. Then, naturally, both the patient and the physician agree that the citrate of iron shall be taken.
In our third category we place those forms of disease in which we discover a new element superadded to the normal constituents. This can be nothing else than a poison, which may be of an organic or an inorganic character. The formula here would be (a + b + c + d + e) + scor + y; or, representing the normal elements collectively as E, the formula would stand E + x or + y. The duty of the medical man here would manifestly be first to recoguise the presence of the x or y, and then to determine upon its best mode of elimination. The same question arises as was put before. Do the powers of Nature suffice to produce the desired effect, or do they not? No one, we think, will affirm generally that they suffice ; while probably every medical man of experience will readily admit that in many instancos the unassisted powers of Nature will secure the elimination of the x or the y. But we claim for the medical man the right to place Nature in the right position to develop her own powers, and we all know that the intervention of the physician for that purpose is often most essential, as Nature does not herself always assert her right to be heard in her own cause. Were it otherwise, probably neither Sir John Forbes' book nor this Review would have been written. On the other hand, it is unnecessary to quote instances in proof of the statement that unaided Nature-i.e., Nature without physic, sensu strictiore-is often inadequate to secure the elimination of x or y, and that without the eliminant, x or y will continue to infest our patient's tissues, racking his nerves, exhausting his vigour, turning his muscles into fat. There may be a medium between these two extremes ; we may know that Nature will suffice to remove the poison, but we know also that in its passage through the system it will leave an indelible impression, or that much time will be wasted by the process; and we have an agent at hand which will accelerate the movement of the elements, and secure a more rapid evolution of x or y, shall we therefore not employ it because Nature might have carried out the work alone ? Not to allow the employment of the drug under such circumstances would be tantamount to a wilful rejection of the boons accorded to us by Him from whom Nature has her source. Omne simile claudicat, and a limp may probably be discovered in any and every theory that was ever proposed; therefore we guard ourselves against the charge of representing all diseased actions by the above formulæ. Before concluding this brief exposition, we would merely add, for the benefit of any one who may be tempted to follow out our method more into detail, that the three categories would, even theoretically, necessarily often pass into one another ; thus, whether an element were deficient, or a new one superadded, in either case the remaining elements might change places in a manner represented by the first category; or an element might be wanting, while a foreign constituent were superadded; it is clear that by going into a detailed comparison between individual forms of disease and the formulæ, we should often meet with very complex arrangements; these we have at present nothing to do with, as it is not our wish to dilate upon a mathematical representation of disease, but simply to show the point of view in which we regard the various demands made by diseased processes upon the therapeutical interference of medicine.
We think that by the above analysis we have rendered to ourselves more clear what may be expected of Nature in Sir John Forbes' sense, what of Art. Still, before proceeding to a further examination of Sir John's riews we would protest against that assumed antithesis being made a ground of accusation against the medical profession at large. Many there undoubtedly are who think that without medicine no disease can be well cured; but we feel satisfied that the great bulk of all educated members of the profession-and, thanks to modern progress, we may hope that that comprises the majority of all its members--consider themselves rather as ministers and interpreters of Nature than as Titans who are engaged in a constant warfare with her vicious manifestations. That interpretation may often be erroneous, but the attempt to discover it argues for the fact that the medical man does not desire to place his art in contrast with Nature.
If we are right in assuming these remarks to apply very generally to medical men of the present day, we by no means assert that such tendencies have always prevailed; the fact that they did not prevail some years ago, in this country at least, was proved by the animated opposition which the enlightened views of Sir John (then Dr.) Forbes excited when put forth in 1845, in an article On Homeopathy, Allopathy, and Young Physic. Twelve years are but a comparatively brief space of time in the development of a nation, or of an important integral part of a nation, yet any one who is conversant with the feelings, and views, and the general state of education of medical men, during the last twenty years, will, we think, bear us out in the opinion that, scientifically and ethically, great onward strides have been made. We cannot but believe that the courageous advocacy by Sir John Forbes of views in much opposed to the prejudices of a large class in the profession, have contributed not a little towards the reformation of the drugging system. Most sincerely do we thank him as a benefactor of his profession and of mankind. At the same time we are constrained to admit that we are far from arriving at that goal of certainty which we all desire to attain; and we would willingly enlarge our knowledge of the relative powers of Nature and Art in the cure of disease. Sir John appreciates the difficulties that impede the attainment of this desirable end, but speaks more lightly of them than we think the case justifies.
“The main obstacles . . . . lie rather in the circumstances under which the subjects are presented to them than in the subjects themselves. When we have the proper field for investigation before us, there is very little difficulty in obtaining a positive and accurate kuowledge of the power possessed by Nature in relieving and curing diseases. The phenomena to be observed are neither very numerous nor very complex; the facts are easily obtained, and the deductions are both facile and sure. All that is requisite to insure a positive and pure result is, in the first place, to take care that no artificial interference disturbs the organic processes going on; and, in the second place, to observe and chronicle progressive events. It is a case of simple observation throughout; no sifting of premises, no elimination of causes, no grouping or balancing of effects being requisite to insure a just conclusion. The just conclusion—the exact valuation or appreciation of the power wder examination is cnunciated in the simple fact indicating what has been the issue of the organic processes constituting the disease. The sum total of beneficial modification of the morbid processes, whatever it may be, whether amounting to a complete or an imperfect cure, must be acknowledged to be the exclusive work of Nature; in other words, of the conservative powers inherent in the living body.” (p. 25.)
The author admits that there are difficulties in finding the proper field for study; but this we do not regard as so serious a difficulty as the determination of where medicinal interference commences, and where it ceases. All writers on materia medica claim baths, hot and cold, as belonging to the armamentarium medicorum; the regiminal physician would probably claim them as coming within the pale of regiminal treatment, though we should be inclined to assert that the natural man abhors the cold bath, and only learns to love it by degrees. The application of ice externally and internally is a powerful remedy, but may belong to either party; poultices to the surface or the mucous membranes (in the shape of mucilaginous beverages) are instances of a similar kind; ripe fruits, raw or cooked, are regiminal, but their acids and neutral salts administered in solution would be eschewed, because they would come to the house by aid of the apothecary's boy. We quote these instances in no spirit of levity, but to show that the question is not in reality so much one to be settled by two opposing parties the medicinal and the reginjinal physicians—but that the inquiry to be prosecuted must and may be carried out contemporaneously by all who are anxious to elevate the science of medicine, and place it on a sure basis. No humane physician would consent to watch the progress of a case of neuralgia under purely regiminal treatment, when he knows that a grain of morphia will arrest the pain and give rest to the sufferer; nor would he allow a patient's health to continue to deteriorate because he did not choose to administer a drachin of the oil of male fern for the removal of tænia which infest his intestine. These, and numerous other instances of a similar character, would have to be eliminated before fixing either the diseases or the drugs which were to form the subject of study. Thus the question necessarily becomes more and more narrowed, and at last we arrive at the conclusion that what we have to investigate is rather how much or how little influence individual drugs are able to exert upon certain diseases than that we declare ourselves followers of this or that banner. When we examine the author's statements with regard to the “instruments of the medical art," we gather that, although so powerful an advocate of an essentially regiminal treatment of disease, he by no means despises or rejects the exhibition of drugs; thus, in speaking of alteratives, he says, “the class contains some remedies of positive and evident power;" he lauds opium and its products, as being "some of the noblest instruments of the medical art," and says that "the class contains a good many other agents of analogous though inferior value.” Of genetica he says that the “ class contains only three or four drugs, but they possess a positive power of greater or less extent.” Scarcely a class is passed in review of which not something more or less favourable is said; we doubt much whether a physician who believes may we not say knows that he has command of a remedy of “obvious and admirable power," would refuse to allow his patient all the relief the drug can afford, in order that he might test whether the unaided powers of Nature sufficed to remove the disease he labours under.
The reader will naturally inquire into the manner in which the author of the book under consideration reconciles the apparent contradiction involved in his all but unlimited faith in the powers of Naturo to cure disease, on the one hand, and his laudation of drugs, as exhibited in our last remarks, on the other. We will quote his own words in reply, merely premising that Sir John terms the system he advocates, Auxiliary or mild treatment, rational expectancy.
cophia modification of the indirect physiological method of treating diseases more especially acute diseases), I regard as at once the most philosophical.