The Manuals, however convenient for reference in the hurry of practice, are not suitable for systematic study. In some of them, the phraseology of the prover has been altered. In others, the symptoms, as reported by the prover, have been arbitrarily sundered into fragments and these fragments are scattered throughout the record. Or symptoms ex usu in morbis have been introduced and the names of diseases supposed to have been cured by the drug are incorporated with the pure symptoms.
In all of them the arrangement is somewhat altered. In many, attempts at abbreviation have been made, and with no better success than if one should squeeze one's lemons to lessen the bulk of one's luggage and yet hope to have good lemonade at the end of one's journey; for it always happens, and must from the nature of the case, that the skins are the part retained while the juice is thrown away.
If a Manual must be employed, that of Noack and Trinks seems preferable; for it preserves the phraseology of the prover and does not to any great extent sunder groups of symptoms, while it places under distinct headings the pure symptoms, and the clinical effects of the drugs and the theoretical speculations of the compilers, so that the student is in no danger of mistaking the one for the other, a danger to which Jahr's Manual does certainly expose him, and for which reason Jahr's work is less desirable than that of Noack and Trinks.
We have dwelt at some length on the sources from which the student should seek his knowledge of Materia Medica, and with good reason! "For, can a bitter fountain send forth sweet waters?" "Do grapes grow on thorns, or figs on thistles?" If the student should fall among false or incompetent teachers, could the doctrine and practice he learns be true and successful?
Having selected a remedy on which to commence his studies, the student should gather together all the reports of provers, whether in the form of their daily records (in which form our dear and lamented colleague Dr. Joslin published his admirable proving of Rumex crispus, as did also the Austrian provers), or in the Hahnemannian anatomical scheme, and should carefully peruse them.
We will assume that he has selected Pulsatilla, and will use this remedy to illustrate what we have further to say. We have no other proving of this drug than the very perfect one of Hahnemann in Vol. 1. of Materia Medica Pura.
During the first perusal, and several may be necessary for the purpose, the student should endeavor to make a general analysis of the proving. This analysis would enable him to place the drug along with several others in one or other of certain groups into which he will find, as he advances in his studies, the Materia Medica arranges itself. Among the chief points of this general analysis will be the following:
I. Sphere of action in the drug.
It will be seen that every drug affects some organs or systems of organs or tissues more decidedly than others. Pulsatilla, for example, acts pre-eminently upon the vegetative system, upon the organs of reproduction and their appendages, and upon the composition of the blood, depressing the action of the former systems and producing in the latter a condition similar to that of one form of chlorosis.
We learn these facts by bringing a knowledge of Physiology to bear upon and interpret the symptoms of the intestinal tract and of the urino-genital organs, those of the vascular system and the symptoms of the head and disposition. For in these we have retarded digestion, vertigo, audible pulsation of the carotids, momentary loss of sight and hearing on sudden exertion, palpitation, paleness, retarded and scanty menstruation with syncope and exhaustion; depressed melancholic disposition.
On the other hand, the student will notice that Pulsatilla exerts but little action upon the bones, skin and glands, and this will be another important step toward grouping.
II. The extent to which the organic substance is affected.
From some provings it must be gathered, Spigelia, for example-that the organic substance is but slightly affected or only in isolated localities, while in other provings the effect is profound and general, Carbo vegetabilis and Lachesis.
In others, again the affection of the organic substance and the irritation of the nervous system are equal in degree and both are great, Arsenicum. Conclusions on this head are drawn from the following symptoms: those of the complexion and of the skin generally, as regards color and temperature, which enlighten us respecting congestions, if there be any, and the color and character of the congesting fluid; those of the evacuations from the bowels, bladder, uterus and all secreting glands and surfaces; those of the cutaneous eruptions and ulcers; finally, those which denote the existence of dyscrasias of whatever variety, e. g., dropsies, phthisis, cancer, gout, rheumatism, etc.
Under this head we find in the proving of Pulsatilla no evidence of any further action than that above mentioned, a hydremic dyscrasia and which is further corroborated by the abundant serous or thin mucous discharges from secreting glands and surfaces.
III. The action of the drug on the vital power,
...correlative of the above, and shown in the symptoms of the nervous system as they are given conjointly with the symptoms of the various organs to which the different parts of the nervous system are distributed. He may consider the nervous system under five heads:
- The sensorium, of which the symptoms are found chiefly under the rubrics Head and Disposition.
- The general sensibility
- The general mobility. Data respecting these heads are found in the symptoms of the tissues to which the nerves of sense and motion are distributed.
- The special sensibility, as exhibited in the symptoms of the organs of special sense-the eye, ear, nose and tongue.
- The sympathetic system-as exhibited in the symptoms or organs containing involuntary muscles, in the intestinal tract and in all the sphincters.
In forming conclusions on any one of these points, regard must be had to the entire remaining action of the drug. We should otherwise reach a very false judgment. Pulsatilla, for example, produces blindness and deafness.
We might regard these as very important affections of the special senses, did we not learn also that these phenomena occur simultaneously with scanty and difficult menstruation, and with palpitation and throbbing of the carotids, and conjointly with great pallor and frequent syncope. These concurrences compel us to regard the blindness and deafness as sympathetic symptoms occurring in a chlorotic patient, and connected perhaps with a hydremia produced by Pulsatilla.
These three sections of a general analysis having been elaborated during a first perusal, the student will already be in a position to arrange many drugs in groups by their similarities and differences in these respects. He will note, for example, that in their sphere of action Pulsatilla and Nux vomica are closely allied, while again they differ widely in their mode of action both on the organic substance and on the vital power, etc.
The practical use of such an analysis is this that when such fundamental facts are known of two or more drugs, it is enough to have clearly in mind, in any case of disease, what are the effects of the disease in these three fundamental respects. If, then, the action, for example, on the organic substance be similar to what we have seen to be the effect of Pulsatilla, there can be no possibility of Nux vomica being applicable in the case and no need, therefore, of studying that drug further for the case.
This process of elimination by means of a general analysis may be relied on wherever we have good and complete provings of drugs, and where the case of disease presents clear and definite symptoms. When we are dealing with fragmentary provings and obscure cases it is of course not practicable.