EUGENE H. PORTER, A.M., M.D.

CH. GATCHELL, M.D.

GEORGE W. ROBERTS, PH.B., M.D.

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IT

A MODERN INSTANCE.

T IS, fortunately, becoming more and more the fashion among scholars and medical men to reserve decision upon disputed points and conflicting theories until the evidence is all in, thoroughly sifted and analyzed. Sincerity of purpose and candor in statement characterize the teachers, thinkers and leaders of the medical profession much more to-day than thirty years ago. Then, odium medicum was powerful and partisan prejudice and bias prevented, in great measure, either impartial investigation of unpopular doctrines or honest admissions of the very narrow limits of knowledge in most important questions. But now, while enough partisan spirit remains to make impossible, on the part of the allopathic school, any formal or general recognition of the truth of the homoeopathic law, the steady advance of science has brought about an open confession of ignorance as to how drugs act.

Those weaklings of the homoeopathic school who have fancied that allopathy offered a solid scientific platform for wavering feet to stand upon, will be benefited by a perusal of the extract given below. Because the allopathic school has in the past by reason of position, power, numbers, money and age, wrought great improvements in and even revolutionized certain collateral sciences, has perfected methods of investigation and research, and has reared. up a brilliant class of students and laboratory workers, it would be natural to infer that the science of therapeutics had advanced likewise. And it is this belief vaguely held by forgetful or poorly in

formed homoeopathic physicians, that has led to much of foolishness and disaster in the employment of drugs to cure disease. What the old school thinks it knows about the action of drugs, and why it prescribes certain drugs in certain cases, and why certain results are to be expected, may all be learned in the following mournful but very definite confession of W. H. Gowers, M.D., F.R.S., taken from an address delivered October 11, 1895. It will be noted that "rational therapeutics" is treated with extreme disrespect, and, in fact, is practically kicked out of doors.

"One other phase of modern therapeutical thought is to me a mystery. It is the contrast which is often drawn between the empirical and the rational in the use of drugs, and the disparagement of the former in comparison with the latter. Possibly it is a result of the influence of the scientific training which now dominates medical education. Beneficial as this training is, its influence may acquire a momentum that carries the effect too far, and, indeed, its influence may spread too widely for the good of those whose life is to be devoted to the hard and often routine work of applying knowledge. The intense love for pure science begotten in the better class of medical students of the present day, warm with the ardour of youth, makes them slow to sink into the grooves to which they are predestined, and hinders their perception of that which they might gain and see therein. Not only is the empirical not positively irrational; it is doubtful how we are justified in considering that a truly rational element is absent from the empirical. The term "rational therapeutics" is applied to treatment in which a drug is given with success in accordance with preconceived ideas or with a theory. The theory may turn out quite wrong, although the result is the same. What, then, becomes of the rationality? In empirical therapeutics a drug is given because it is found by experience that in the particular condition it does good. Often we cannot even guess why. But the fact remains, and surely to act upon observed experience is as truly a rational proceeding as is action upon a theory which may be incorrect. After all, the medicinal treatment which can be based upon any definite theory is small. How seldom, moreover, can we use a drug to advantage which was discovered save by the purest empiricism. In not one drug in twenty, perhaps not one in fifty, of those of most certain service, can the use be traced to anything excep unguided experiment. Our knowledge of these drugs, derived from the past-and often from the distant past-must be assumed to be the result of experiments innumerable, perhaps continued through the long tens of centuries in which the human race has lived among surroundings which alike compelled and suggested endeavors to counteract disease by every available means.

* * * * We smile at the popular herbal remedies. But it is to these that we owe the majority of our most useful drugs. I cannot conceive a therapeutist surveying a list of the chief drugs on which we depend in our daily work and do not depend in vain-without a sense of wonder and perhapsof humiliation. If we go through all the drugs on which we most rely we find the same story. Even in the case of those which are the latest additions to our resources, we find that, with very few exceptions, their use arose from what

we must regard as pure empiri icism. It was by accident that the local anaesthetic influence of cocaine was discovered. The unexpected results of simple experiment afforded us the chief use of antipyrin; and that which is perhaps the greatest practical discovery of modern times in the influence of drugs or disease--the use of bromides in epilepsy-was the result of a chance observation of its use on an allied state-also empirical. To this day we are without any rational perception of its mode of action or of the reasons for its use in given cases.

*** I have, indeed, tried to frame a definition of rational therapeutics which I could illustrate by examples. I will not say that I have wholly failed, but my success is not sufficient to let me submit it for your consideration. But the attempt has impressed me with a doubt as to the propriety of considering that a theory, to explain an empirical discovery, makes the therapeutics rational. It is very easy to frame a theory of the action of a drug, and it is easy to extend this theory to the nature of the disease in which the drug does good, and at the same time to ignore the many other possible ways in which the effect may be produced, and so to build from a small and uncertain foundation an edifice which some new knowledge may reduce to that which most builders call "rubbish." When I recommend a drug I am often asked, "How does it act?" Occasionally I can give some inadequate reason, but I am generally compelled to answer, "I do not know; it is often useful in this condition." Sometimes I can add, "There are several ways in which it may act." Sometimes I am obliged to say, "I have no idea how it does good." It has not been my privilege to add much to our therapeutical resources, but the few agents I have recommended have been based on pure empiricism. A few days ago I received a pamphlet from a distinguished French physician, Dr. Féré, who confirms the statement which I made sixteen years ago regarding the occasional service of borax in epilepsy, a confirmation which many others have furnished. In inveterate cases which do not yield to bromide, borax sometimes does good that is definite and distinctly greater than that which bromide produces in those cases. But I cannot say why. It was one of many things I tried, simply as a peasant might try in succession a number of herbs. Further, the diminution in the tendency to the distressing pains in locomotor ataxy which is caused by the regular administration of chloride of aluminum is so distinct that I have little doubt that the time will come when this drug will find a place in the Pharmacopoeia. But I had no better reason for trying it than the fact that arsenic is a metal and so is aluminum. Of the rational we have here no trace, although I should take objection to the difference involved in the application of the epithet 'irrational.'"'

Dr. Gowers states that he failed in his endeavor to frame a definition of "rational" therapeutics, that he could illustrate by examples. Certainly in the light his own address throws upon the subject, his failure is not singular. He could not define because the term is not definable. There is practically no such thing as "rational" therapeutics.

It may be remembered with advantage also, that for many years. the allopaths have denounced homoeopathy because no explanation

was offered of the precise manner in which drugs cured when prescribed according to the rule. Dr. West, in his letter to the London Times recently said that "the rule of similars states an opinion, nothing more. It explains nothing, never did explain anything.” But the rule, as the Monthly Homeopathic Review very justly remarks, does not state an opinion but a fact. It is true, however, that the rule does not explain and never has attempted or been held to explain the action of a drug in curing disease. Can the allopaths explain how drugs act when administered according to their latest theories? Dr. Gowers says with emphasis that" after all, the medicinal treatment which can be based upon any definite theory is small." They can no more explain the action of drugs upon the human organism than we can. But there are some things that we can explain that they cannot. We can explain to the average mind what drugs will likely prove curative in certain diseases and why they are likely to do so. When a new disease arises, when its symptomatology is known, we can explain to the physician what drugs are likely to cure it, and when the symptomatology of a drug is ascertained we can explain what diseases are likely to be benefited by its exhibition. Homœopathy presents facts, allopathy offers theories. The one knows of no definite relationship between drug effects and disease effects; the other has bridged the "wide and deep gulf which has always been fixed between the pharmacologist laboring to elucidate the subtle actions of drugs upon the complicated and intricate human organism, and the therapeutist struggling to apply these results to the successful treatment of disease.”

Let this modern instance of candor on the part of our opponents teach us both to frankly confess our own short-comings and keep us away from the quicksands of "rational" therapeutics.

A New Department.-Not satisfied with the notable achievements of the past, the managers of the Rochester Homœopathic Hospital have taken another long step forward. We learn from Dr. E. H. Wolcott that arrangements have been made with Charles W. Dodge, Professor of Biology in the University of Rochester, and Dr. H. W. Hoyt, the Hospital Pathologist, to conduct experiments and examinations in Bacteriology at the hospital. The examinations for the Board of Health, which furnishes all necessary apparatus will be made there and Dr. Hoyt, prepared by special study and work, will carry on the work for the hospital. Suitable rooms have been provided, and it is expected that with the incoming of the new year the hospital will be engaged, not only in the care and treatment of the sick, but also in investigating the causes of disease in a practical and scientific manner. This new departure cannot be too strongly commended or supported. It is a step in the right direction. Work of this kind must be done by the homœopathic school if it would keep pace with modern scientific thought and progress. And when around this laboratory, newly established, there shall arise other important departments of research and investigation, including a College of Drug Proving, then will the best and highest needs of the school be nobly met. We congratulate the homoeopathic physicians of Rochester on this advance and shall look for a steady growth and development of the new department.

Dr. Wm. E. Quine, Secretary of the Illinois State Board of Health, gave a two hours' talk in Cook County Hospital amphitheatre on the evening of November 23d. His subject was "Why am I not a Homœopath?" and the audience was strongly representative of the new school. He admitted that Hahnemann abolished the lancet and made medical men think, but claimed that had Hahnemann not done so some one else would; in other words, the old school doctors would not have remained blanked fools forever. He thought that those Homoeopaths who stand high in public esteem and confidence, obtained their training in old-school colleges and hospitals, and that they practice regular medicine largely-not homœopathy, and to such men it is due that Homoeopathy is alive to-day. Only a few-and their number is decreasing-believe in the Homœopathy of Hahnemann. The American Institute of Homœopathy declares that it has no creed and stands on the same platform as the American Medical Association, so there is no real difference between them. He ridiculed the theory of dynamization but admitted that Calcarea Carb high is preferable to mediæval dosage and blood letting. In conclusion he deplored the division in the ranks of medicine, and looked hopefully forward to the day when all should stand under the same (his) banner, think the same (his) way, and the name "physician" (Regular, of course) should suffice for all. In other words "the lion and the lamb shall lie down together," but the lamb will be inside the lion.