Carroll Dunham

Part 4

As further examples, we may adduce the following: Spigelia and Silicea both affect the special senses remarkably and similarly; yet they are extremely different in their action on the organic substance. Hyoscyamus and Carbo vegetabilis affect the sphincters similarly, though in other respects so unlike.

After thus generalizing in a comprehensive way, the student will observe certain phenomena of a more special character; for example, that among the variety of sensations recorded as having been produced by the drug, there is a certain uniformity in general character throughout most of the organs affected.

But here he meets difficulties arising from inaccuracy of provers, or rather from the fact that, all descriptions of sensations being clothed in figurative language, the imaginations of different provers suggest to them different modes of expression. The wealth of the German language in synonyms has not diminished this difficulty. An approximate analysis of sensations such as has been made by Dr. Dudgeon would be of service in this regard.

The individuality of some drugs is much more strongly marked than that of others by this feature of their effects, and pro tanto, it serves as their characteristic. Thus Bryonia and Squilla are distinguished by sticking, and Arsenicum by burning, pains.

Another point to be noted, and which may serve still further to individualize the drug, is periodicity, which in many drugs is well marked and of a definite type; e. g., arsenicum, Ipecacuanha, Natrum muriaticum, Nux vomica. In Pulsatilla it is very marked, but the type is not constant.

But, perhaps, the most important of all the considerations in which resides the individuality of a drug are the conditions and concomitants of the symptoms. The conditions are the phenomena of time, place, and circumstance on which the symptoms depend.

For example, Pulsatilla produces tearing pain in the hip. So do several drugs, but that of Pulsatilla occurs in the afternoon, condition of time; it occurs and is aggravated in a warm room, condition of place; occurs during and is aggravated by repose, condition of circumstance.

A concurrence of this phenomenon and these conditions is found only under Pulsatilla. Here these conditions are the characteristic. The concomitants are those phenomena, whether we call them sympathetic or secondary, which always accompany any symptom or group of symptoms. Absence of thirst is a concomitant of many groups of symptoms under Pulsatilla. So likewise are chilliness, cold feet, wakefulness in the evening and sleepiness in the morning, etc. Nux vomica has the reverse. So is cold sweat of the forehead under Veratrum.

Having thus made a general analysis of the proving, obtaining, first, a general view of the action of the drug on the great divisions of the organism and of the pathological conditions which it produces; and, second, a general view of the characteristics of its action, the student may proceed to a special analysis, which will involve a similar study of the action of the drug on each organ and anatomical region of the body. In this he cannot do better than follow the Hahnemannian scheme.

The points to be considered in each region and under each rubric are the following: The organic changes; the sensations, their nature, locality and direction; the conditions of time, place and circumstance, and the concomitants. Thus, for example, in studying the Head, he may consider:

  1. The SENSORIUM, under which the subdivisions may be:
    1. Vertigo, its nature, conditions of time, place and circumstance, and its concomitants.
    2. Thus, the vertigo of Pulsatilla is a staggering; it occurs after eating, in a warm room, and during repose (there is a rare alternate effect); the concomitants are heaviness in head on stooping, paleness and internal heat in the head.

    3. Intelligence, with conditions and concomitants as above.
    4. Memory, with conditions and concomitants as above.
    5. Illusions of the imagination, and concomitants as above.
  2. Headache, under which the points to be noted are:
    1. Character of the pain.
    2. Locality.
    3. Its course if it moves.
    4. Conditions and concomitants as above.
  3. THE ORGANIC CHANGES, which are to be studied in the same way. These comprise all objective and material phenomena.

In this manner, the student will examine the effect of the drug upon each organ and tissue of the body, as will be more clearly shown by a scheme for the study of the Materia Medica which will be appended to this essay.

The result will be an accurate knowledge of the action of the drug, in so far as the proving is complete, upon the whole organism in general and in detail. The special analysis will serve to correct certain errors into which the general analysis might lead the practitioner. Conditions are not always uniform for all the organs.

Thus, although the general conditions of Pulsatilla are occurrence and aggravation in the afternoon and evening, during repose and by heat, with relief by motion and cold, and must be so stated in a general analysis, yet there are a few special symptoms to which the opposite conditions attach, and this fact is brought out by the special analysis.

The study of a proving to be practically available must be comparative. After ascertaining the properties of each drug by positive investigation and analysis in the manner detailed, the next step is to ascertain what drugs resemble it, and in what features they are like and how they differ.

To make such a comparison as this in studying the Materia Medica, a repertory is indispensable, and this need alone, if a repertory were not equally indispensable in daily practice, would be a sufficient reply to those who idly talk about such a work being superfluous or mischievous.

Such is a method of studying the Materia Medica which, after much reflection and trial of various plans, I venture with unfeigned diffidence to unfold. It is elaborate and requires a wearying application which those alone can appreciate who have engaged in similar tasks. To complete such a systematic study, even in comparative leisure, might require seven years of unremitting labor, just the period for which a lad is apprenticed to learn his trade.

Should we shrink from devoting so long a time to the mastery of the most complex and difficult, and the noblest science and art which are possible to man on earth? I desire to add a few words of a practical nature. Prescribers are liable to two errors of an opposite kind; the possibility of which will be apparent from what has been written.

The one consists in prescribing from a general analysis of drugs without regard to the characteristics which individualize them. This is equivalent to prescribing any member indifferently of a whole group of drugs, and necessitates a corresponding generalizing view of disease. It is the method of the Old School which seeks to arrange drugs and diseases in groups and which ignores characteristics and individuals.

The other error consists in prescribing on the strength of one or two characteristics which may be detected, without however examining whether the general effects of the drug correspond to the general features of the disease. Now, characteristics, for the most part, as we have seen, derive their value from their association as concomitants or conditions with some symptom which is not in itself a characteristic. Disconnected from this, they are as void of significance as a man's nose would be if cut off from his face, though while on his face it might have been the chief feature by which his friends recognize him.

I will not deny that by this method, great successes, "lucky hits" I would call them, are sometimes made. But I do stoutly affirm that atrocious and inexcusable blunders are much more frequently the result.

I admit, too, that in certain cases of disease there is no possibility of making such an analysis as we have advised, and that certain drugs are so incompletely proved that we know of them only one or two characteristic symptoms and cannot study them as recommended. All that can be said of such cases is that they are incomplete and come under no rule.

We must do the best we can and adopt a defective method, which is nevertheless sometimes successful rather than make no attempt to cure. Better cure by a "lucky hit" than not at all. But let not this lead us astray where we might do better.

If one had to traverse a wilderness he would desire first of all a compass. If this were not to be had he might "steer by the stars." If these were obscured he might judge from the direction of vegetation and of hills and rivers. Failing these, he might even "guess" and his guess might lead him right. Nevertheless, few travelers of sound mind would be led by such a success to prefer a "guess" to a "compass."

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Excerpted from The Science of Therapeutics
by Carroll Dunham M.D.

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