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we will find that each drug has a peculiarity which underlies all its symptoms. After this our key-notes may be of service—not before. For example, "a mild and tearful disposition” is not enough of itself to call for pulsatilla, nor is the side affected in tonsilitis of prime importance in calling for phytolacca. And yet these are time-honored key-notes.
On the other hand, the man who knows his materia medica seems to be tempted to change his medicines too frequently. He is constantly seeing new indications that call for new remedies. Sometimes he is almost as bad as the key-note man, except that he has more symptoms at command.
And this leads me to what I consider to be the source of the whole trouble. The beginner is confronted with a list of symptoms for each drug just about as interesting to read as the catalogue of a library. He is told that each of these symptoms is produced and cured by a given drug, so when he meets one of these symptoms he is persuaded to give the corresponding drug. But did any prover ever present only one symptom? Decidedly, no! He or she presented a group or groups of symptoms.
Now then, why would it not be rational to group these symptoms, and instead of firing a whole lot of meaningless words at a student, give him a general idea of the drug's action first and let the details be filled in later?
Dr. Deschere spoke at our last meeting of the value to the student of the comparative study of drugs. If I may be allowed to say a word or two on that question, I would suggest that the drugs be grouped, not according to any botanical, chemical or mineral order, but according to their therapeutic action. For example, place drugs acting on the nervous system in one group, those acting on the respiratory system in another group, and so on. Give a general idea of the action of each first, and follow with the systomatology as we So far as the actual method of prescribing is concerned, if a phy
good knowledge o fthe materia medica his prescribing will be accurate, according to his experience and to his ability to profit by his experience. A man must have a certain amount of both. the recent special meeting of the County Society, I can vouch for
The Benninghausen method, so ably exploited by Dr. Allen at from personal experience. I think all of our great prescribers of the past have used it. The rising generation, I fear, do not know much about Benninghausen. A knowledge of the materia medica must come first, however, for Bænninghausen will not give that. This
now study it.
sician has a
method is limited to some extent, though, because Bænninghausen's original work contains but one hundred and twenty-five drugs. Dr. Allen's recent enlarged edition contains something more than two hundred and fifty, still several hundsed short of the total number
In answering a criticism of this later work, Dr. Allen said that he could not make the book as full as he would have liked, because clinical verifications were so few in our journals of the present day. This society is doing something in that line, and its work should receive greater publicity.
As an additional step in that direction, I have at odd times gone over my records and noted where any why I have used a particular drug. From these composite notes I have made a sketch of the clinical value of the drug as it has served me. I have already prepared several such skeches, and with the permission of the society will, at some future time, be pleased to present the result of my work with some one of them. What I have done may have no special value in itself, but some such scheme, followed out and reported by a number, would have an incalculable value.
In answer to some of the criticisms made in the discussion of this paper, criticisms that may occur to readers of it, I wish to say that I had no idea of proposing any “short-cut" to the study of the materia medica. Any such idea had not occurred to me for I do not believe short-cuts to be possible.
My objection to the "key-note" method is this: If a student begins by learning “key-notes” he may never get any further in his studies; in fact, I believe many so-called Homeopaths never have progressed any further. If a man knows his drug thoroughly he will of necessity know its key-notes. If a key-note prescription cures, then a study of the case will disclose other symptoms of the drug used. Were it otherwise, where would the "totality of the symptoms” come in? Key-notes are nothing but isolated symptoms.
I must reassert my belief in the individuality of drugs, an individuality which I believe to be just as marked as it is in the case of persons. As we get to know our friends and acquaintances by association with them, so we must get to know our drugs. The peculiarities of the one may be as hard to put into words as are the peculiarities of the other.
Homoeopathic prescribing pre-supposes a knowledge of the hemeopathic materia medica. There is so much poor prescribing that it would seem as though the methods of teaching and of studying the materia medica must be at fault. That is why I have assailed the key-note method, and why I have advocated comparing drugs therapeutically. Every physician must make mental comparisons of different drugs every time he makes a prescription.
Some of my critics assert that drugs cannot be compared by their action on the various systems of the body. I believe they can. However, that was merely a suggestion as to one therapeutic way in which drugs might be compared. Compare them by their action on the tissues, or in any other way, therapeutically. That drugs are or are not related chemically or botanically does not of necessity imply that they are related therapeutically. Nor does the dissimilarity of their origin mean any dissimilarity in their therapeutc action. For example, aconitum and ferrum phosphoricum therapeutically are related. Yet the first is a plant, the second à mineral.
A CASE OF ECLAMPSIA.
By GAYLORD PETtit, M. D.
NOWING eclampsia to be one of the most troublesome things
medical men have to contend with, and knowing eclampsia with hemiplegia to be a rare combination, I place before the profession the history of a case which I attended a short time ago. At 10 o'clock A. M. Saturday, Oct. 23, I was called to see Mrs. W., a pregnant woman, forty-four years of age. I found her dressed and half reclining upon a couch, groaning with pain, which was so severe she could scarcely answer my questions. The pain, she told me, was all upon the left side of her head, and though she had had headache upon the same side before, she had never had one as severe as
Her head had ached since the Sunday before, but not very hard until the day before I was called to see her. Bowels were regular and plenty of water had been passed; she thought she had passed too much water the last two months. There were no labor pains. Her last monthly period had begun Jan. 10, and her pregnancy had been uneventful except that she had not felt as well for a few weeks as she did at first. She had felt irregular pains from time to time, but none she called regular. At the time of my call she complained of the pain in her head only. Pulse was 108, but steady; temperature 103 deg. She had had a chill that morning lasting a half hour, but there had been no other chills.
This was all the information I could get from the patient. Her husband said she had been doing her work, with the help of her daughter, the same as she usually did when pregnant. A few days before she had told him she was not feeling well, and he told her to see a doctor, but she declined to do so. She had had ten children, seven of whom were living; also two or three miscarriages. She had always been a hard-working woman, and during this last pregnancy had done washings and ironings for her neighbors. Per previous labors had been exceptionally easy. Her husband also told me that her mother had been taken with a terrible pain in her head during her change of life, which occurred when she was thirty-eight years of age, and after some hours of suffering, had expired.
From a neighbor with whom my patient had been intimate I learned that she always suffered with swollen legs and feet when pregnant, the last time more than ever, and that she had complained a good deal of weariness for two months, although she had been up and at work. She had also told this friend that she had felt no motion to speak of, for two weeks, except "a feathery feeling across her abdomen." I ordered her put to bed, and on internal examination I found the cervix and adjacent parts soft, the internal os admitting two fingers. I found the position to be L. O. A., but head high and not engaged. I ordered hot bottles at her feet, cold cloths on head and a thick covering; belladonna every half hour.
At 12 o'clock I found her completely unconscious, with arms and legs continually in motion in a circular manner from back to front, from above downward, hands clenched, thumbs in palms, face pale and covered with a hot sweat, as was the whole body; eyes open. Pulse 108; temperature 104 deg. No change in genitals. Ver. vir. was given. At this time I noticed she gulped up a good deal of wind of a very foul odor.
At 4 o'clock there was an increase in all symptoms, resulting in complete paralysis of the left side, the left eyeball turned to the left and fixed, the pupil dilated and unresponsive to touch or light, the right eyeball turned to the right, the pupil dilated, but the eyeball would move slightly when the eyelid was raised. Both lids were closed at this time.
Tongue was dark colored, at times protruded to full extent, at times drawn far back in the mouth and teeth tightly closed. The right arm and leg were still going in the same manner. Head directed to the right, respiration very stertorous.
At 6 o'clock Dr. S. W. Hurd was called in consultation. Atropine sul. 1-60 hypodermically was given, which quieted the patient
some for an hour or so. The administration of chloroform was attempted, but abandoned because of the dyspnoea. At 9 o'clock another injection of atropine was given with no perceptible change. We then decided to attempt delivery. The genitals were cleansed and all antiseptic precautions taken. I then inserted my hand into the vagina and after twenty to thirty minutes had dilated the womb with my fingers to the size of a silver dollar. Dr. Hurd then took a turn and succeeded in dilating enough to apply the forceps. The sac was punctured, an ordinary amount of water escaped, and after several attempts the forceps were applied. While dilating I noticed three feeble contractions, but no change had taken place in the status of things since my first examination in the morning. After the forceps were applied a steady, strong pull began by first one and then the other, until at 11 o'clock the child was delivered. It was a girl with a large head and weighed eleven pounds. It was dead, and, judging from the amount of maceration, had been so for at least a week or ten days. I delivered the placenta, which was very soft, and cleaned out the womb, which was full of clotted blood. During delivery, the patient was more quiet, but breathed very deeply; pulse remained the same. The patient was then treated as is usual after labor, and the medicines ordered continued. Pulse and temperature when I left at 11:45 were unchanged, the breathing somewhat easier. At 8 o'clock the next morning I was informed that she died at 1:30 A. M., but that there had been no change in her condition until a few minutes before she stopped breathing, and consciousness had not been regained.
That this was a very grave case is not to be disputed ; that it was a very rare case is not to be disputed, and in my mind four factors enter into the cause, each more or less responsible.
First, the patient in all probability suffered from albuminuria.
Second, the heavy lifting and other hard work experienced by her during the washings and ironings which she did caused a partial separation of the placenta with hemorrhage, followed by the death
of the child.
Third, the amount of toxic material in the blood.
From this case one great lesson can be deduced, and that is, that no woman should go through pregnancy without the care of a conscientious, painstaking physician to look after her, and we should always try to impress this fact upon all our patients.