PART I.

GENERAL THERAPEUTICAL CONSIDERATIONS.

BEFORE entering into a study of the action of drugs upon the living body, it is necessary that the student should possess a clear idea of what the word "therapeutics" means, that he should comprehend fully the reason why resort is had to drugs, and, more important than all, that he should grasp the limitations which govern the administration of remedies.

Two unfounded ideas have been put forward by certain persons -one being, that medical therapeutics is useless; and the other, that this branch of medical knowledge is not advancing with so great a stride as are pathology and surgery. The individuals who deride the use of drugs in disease belong to one of two classes: either they have never tried them or have used them wrongly.

The statement that therapeutics is to-day less advanced than are pathology and surgery is readily answered by a denial; for the therapeutist is able to treat successfully many diseases of which the pathologist knows nothing, and is obliged to rest his treatment on empiricism simply because he cannot tell how his drugs act if the pathologist cannot tell him in what the disease consists. Rheumatism and syphilis are good examples of this very point.

In regard to surgery, every one must recognize the extraordinary advances made in this branch of medical science, yet comparatively few realize that it is solely by the proper use of drugs that all its triumphs are possible. The definition of the word "therapeutics” in Billings's Dictionary is: "That branch of medical science which treats of the application of remedies to the cure or alleviation of disease"; and practically the term is almost universally used to signify the employment of drugs for such purposes. The credit for the introduction of new instruments and operations may be accorded to surgery, but the discovery of new drugs must be accorded to therapeutics. We find, then, that ether and chloroform began to revolutionize surgery more. than sixty years ago, and that corrosive sublimate and other drugs have revolutionized it once more within the lifetime of every one who reads this book. Cocaine has changed the entire aspect of eye surgery and other minor operations, and has immediately averted an enormous

amount of pain and suffering which the surgeon could not mitigate, much less remove, in the absence of its influence. To the accusation of backwardness the therapeutist can well reply by asking the champion of any other branch of medical science to put forward one discovery which equals antipyrine or acetanilid in power to relieve pain; and last, but by no means least, he can point to those triumphs of modern therapeutics the use of suprarenal gland as a vasoconstrictor, of thyroid gland for myxedema, and of antitoxin for diphtheria.

The man who does not believe in the proper use of remedies for the cure of disease lacks the very keystone of the arch upon which all medical investigation rests, for the ultimate aim and object of all medical thought and effort are the cure or alleviation of disease. Like every other thing requiring a thorough knowledge of its component parts, methods of treatment are often much abused by the careless and ignorant, but are a power for good in the hand of the properly educated physician. Further than this, therapeutics is the only universally used part of medicine, for each and every branch must resort to it, and the most expert operator who fails to treat his cases medicinally with equal skill will have worse results than he who, though bungling in his surgery, yet uses drugs intelligently after his operation is finished.

Homœopathy depends upon more than one reason for its existence. If infinitesimal doses are given, the patient is satisfied that he is receiving medicine, and Nature often produces her most rapid cures when left alone. Again, the entire basis of homoeopathic therapeutics rests not upon the study of the causes of diseases, but upon the symptoms which constantly present themselves. As a result of this, many minor symptoms are relieved and the patient's confidence is won, although nothing is done to control the pathological process itself. No detail of diagnosis or treatment should be too small to attract the attention of the regular physician.

The first duty of the physician when called to a case of illness is to reach a diagnosis as to the cause of the ailment, and not until he has formed a definite idea as to the condition which confronts him should he prescribe any medicinal agent. In certain cases where the symptoms are severe or indicative of immediate danger it may be necessary to give relief by the use of temporary remedies, not only to save life, but also to remove symptoms which, because of their severity, mask the condition so that a diagnosis is impossible. Thus a patient may be found in collapse or in a state of syncope. The cause of this state may be obscure, but the pulse, heart-sounds, and respiratory action may indicate the need of immediate stimulation. In another instance agonizing pain, as that due to a crisis in locomotor ataxia, or renal or hepatic colic, may require a hypodermic injection of morphine as soon as the physician assures himself that the pain complained of is genuine. In other instances the case may be so obscure that several days of careful study may be necessary to reach a correct diagnosis, and during this time palliative remedies may be required.

Before ordering a drug or method of treatment the physician should have a clear conception of what he is trying to accomplish. No remedy should be given unless there is a distinct indication for its use. The old-fashioned "shotgun" prescription, containing many ingredients, one or more of which might hit the mark, should be supplanted by the small-calibre rifle-ball sent with directness at the condition to be relieved. Having decided upon the remedy indicated, the physician must next determine the dose required. This latter decision is almost as important as the first, for very often an error in dosage will cause failure of the remedy. A large part of the therapeutic skill of the physician consists in fitting the dose to the needs of his patient.

In the treatment of all forms of disease the physician must never forget the following influential factors in the case, which are often of greater importance than the measures devoted to the treatment of the disease itself:

1. The maintenance of vital resistance by proper feeding.

2. The elimination of effete materials by the kidneys, bowels, and skin.

3. The relief of annoying symptoms which sap the patient's vitality and often obscure the true state of the system.

4. That sufficient physical and mental rest and sleep are obtained if possible.

1. That the proper use of food in both acute and chronic illness is of great importance is not only manifest, but it has been proved by scientific investigation that lack of food often prevents the system from successfully combating the entrance and growth of infecting micro-organisms. The patient who has a greatly lowered vital resistance not only suffers from the effects of the particular disease by which he has been attacked, but not rarely dies from the growth of other micro-organisms which find him a fair mark for their attacks, thereby producing what Flexner has well called "terminal infections," and causing Osler to say that "a man rarely dies of the disease from which he is suffering," meaning by this that though he may be ill of a specific infection, other germs really produce the fatal issue. Care in feeding is therefore never to be ignored, and the various ways of feeding and preparing foods must be carefully studied. (See Part III.)

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2. It would seem hardly necessary to insist on the importance maintaining the active elimination of impurities from the body were it not that so little attention is paid by some physicians to these functions. In all infectious diseases the kidneys are required not only to eliminate the ordinary waste products of the body, which usually escape in this way, but in addition the increased waste produced by the fever and the poisons produced directly and indirectly by the growth of the invading micro-organisms. It is essential therefore that the patient shall pass urine in sufficient amount to carry off these substances, and this result often may be obtained by giving plenty of water to drink and increasing diuresis by the use of sweet spirit of nitre and citrate or acetate