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THERAPEUTICS OF THE DAY; In a Series of Letters. By Dr. WILHELM STENS, Sanitary Councillor of His Majesty the King of Prussia, and Physician in ordinary to H. R. H. Prince Albrecht of Prussia. Translated from the German, with the special permission of the Author, by HENRY ST. CLAIR MASSIAH. London, Printed by J Wertheimer and Co. 1863. 8vo., pp. 344. From Messrs. Turner and Co., London.
We all know that the auxiliary medical sciences have made wonderful progress within the last forty years. Physiology has been reconstructed on a firm basis. Pathology may almost be said to have come into existence as a science within this period. The same is true of Organic Chemistry.
With these great advances in the sciences which concern themselves with the healthy organism, the diseased organism and the tissues, functions, aliments and excrements of each, we should naturally look for a commensurate advance in the successful treatment of disease, in Therapeutics. To our great surprise, the men who have contributed most to the improvement and elaboration of the auxiliary medical sciences, are the first to tell us not merely that no advance has been made in the knowledge of curing diseases, but that such advance is, in the nature of things impossible — that science teaches us, it is true, how, in many cases, to prevent the occurrence of disease, how somewhat to alleviate its pangs and curtail its ravages — but as for a cure, that is impracticable and the physiologico-pathologists demonstrate this impossibility by the data and terms of their sciences. In opposition to all this, we do see indisputable cures effected under the hands of these same physicians through the use of the old specifics — Cinchona, Mercury, Opium, the mode of action of which is still a tantalizing mystery to those who employ them.
Seeing this contradiction between dominant opinions and patent facts, we must conclude that the scientific men of the reigning school of medicine have failed to make, in the region of Therapeutics, discoveries corresponding to those which they have made in Physiology, Pathology and Chemistry, simply because they have not set about the work in the right way. They have looked in vain because they have not looked in the right direction. Their reasoning has been profitless because their premises have been unsound. In a word, their philosophy of the nature of the science of Therapeutics has been absolutely wrong.
Now, to convince an intelligent non-professional person, who has a knowledge and a justly high appreciation of the recent discoveries in Physiology, Pathology and Chemistry, that while the views of the men who have made these brilliant discoveries are in the main correct on these subjects, yet on the subject of Therapeutics they are all wrong, hopelessly and completely astray — it is necessary to analyse their whole philosophy of the science of Therapeutics — to show its faulty basis and construction, its rottenness from bottom to top.
This is the labor to which Dr. Stens has brought so much learning, good tense, deep reflection and brilliant illustration, in this series of letters, addressed to the Archduke John of Austria, who has been an efficient protector and patron of Homoeopathy.
“Therapeutics is the rich ripe fruit of medical science. The separate branches of this noble science only grow and bud forth as tending to its final development and maturity. They exist not for themselves, but on its account; and concentrate in it as in their acknowledged and absolute centre. He and he alone, who can apply, scientifically and conscientiously, the various branches of the art, deserves to be called a Physician. He who does not, may be a clever and distinguished investigator of nature, but he has not the slightest claim to the title of Doctor.”
Reviewing the history and stating the present condition of Physiology, Pathology and Materia Medica, as taught by the dominant school, Dr. Stens shows their relation to each other and to the science of Therapeutics of which he gives an analysis of the various methods, showing their weakness and fallacies. This leads to a discussion of these sciences as they are regarded and studied and used by Homoeopathists and of the homoeopathic therapeutics, — “a fabric resting on the two solid columns of a Pathology and a Materia Medica, respectively, of subjective and objective observation”
Letters upon the dose, the history of Homoeopathy and of Hahnemann, the results of homoeopathic practice and the objections to Homoeopathy conclude this work, which is a rich treasury of fact and illustration, and should be in the hands of every practitioner and intelligent layman.
The translation is unquestionably faithful. One would surely not desire to sacrifice fidelity in rendering a foreign writer, to felicity in the style of the English version. The rendering may, however, obscure the Author's meaning by its very fidelity. Fidelity may go so far as to be faithfulness to the letter only, and the spirit of the writer may be entirely hidden by at echnical literalness. The really best translations are those in which the idiom of the foreign tongue is rendered by a corresponding idiom of the vernacular. Those who have tried to do this know its great difficulty, and will be far from passing a harsh judgment on laborers who through a conscientious faithfulness fail, as Dr. Stens' translator often has done, from a lack of confidence. A single quotation of a very unimportant sentence will illustrate our meaning. Page 290, we read:
“Jean Paul calls Hahnemann a singular double head of Philosophy and Learning, in his scattered leaves.” This translation is literal, and in that sense it is faithful. But we think many readers, not devoid of intelligence, would be puzzled to guess what is meant by those “scattered leaves,” in which it would appear that Hahnemann is somehow “a singular double head.” Would it not be more intelligible if rendered thus, 'Jean Paul, in his Zerstreute Blaetter, 'Scattered Leaves, calls Hahnemann, etc“? D.
Since the commencement of the present volume of the Review, the space which we had intended to devote to book notices has been taken up with other articles. Hence it is that this little monograph, among others, although having been before the profession for a year, has never received any previous notice in our pages.
In the history of the plant the Author gives its botanical and historical description, the various preparations used, the authorities of every school, its toxicological effects, antidotes, effects upon dogs, pathological appearances and therapeutical deductions.
For the general effects, and these are principally on the nervous and vascular systems, the Author quotes writers in the homoeopathic, allopathic, and eclectic schools. The pathogenesis of the drug is exceedingly meagre. One of the best provings that has been made, that reported by Dr. Wm. E. Payne, of Bath, Me., is omitted. The provings have all been made with the mother tincture, fluid extracts, concentrated tincture, the Gelsemine and some minor preparations. The quantities used varied from one-tenth to twenty-five drops of the mother tincture, one-tenth to five drops of fluid extract or concentrated tincture, and one-tenth to one grain of the Gelsemine. From these provings we should not expect to find characteristic symptoms. No provings with the dilutions are published, as the Doctor says: “In but one case can I find that the dilutions above the first, caused any pathogenetic symptoms; nor should I consider them of much practical importance if collected.”
Dr. Hale is an indefatigable worker and has probably gathered nearly all that has been written on this remedy. We hope he will continue his experiments and institute some provings with the more attenuated forms than the mother tincture or crude extract. We should of course not feel satisfied with provings made exclusively from the dilutions, neither should we rely on those effects produced by the strongest preparation.
In our limited experience in this disease, which we have never cared to extend, the treatment has not always proved satisfactory, and if Dr. Yeldham can lead us to better results his work will be a welcome addition to our list of monographs.
In 1860 Dr. Yeldham published in pamphlet form, an octavo of some twenty pages, a lecture on Syphilis and Gonorrhoea, one of a course on Surgery delivered in the London Homoeopathic Hospital. To this many additions have been made and we have in the present work the Author's personal experience in the homoeopathic treatment of the common venereal diseases.
He says in his preface that in his earlier practice of Homoeopathy he “followed the few scanty directions of Jahr, and found that the results were not so superior to those of Allopathy as he had expected, and, therefore, some modifications in the treatment were necessary, careful observation convinced him that change must be made in the doses used internally, and a freer employment of external remedies.” This has been his practice with satisfactory results.
In the treatment of Gonorrhoea Dr. Yeldham mentions as an interesting fact that the practitioners of the old school have arrived nearer the truth in the treatment of venereal than in any other class of disorders; that most of their remedies are specifics. Here, then, both schools occupy the same ground and the only difference is the dose. Both cure their patients, the old school no quicker with their disgusting doses than the Homoeopathists with a greater variety of remedies, including those of the old school and many of which it is ignorant. Under any system the disease will in many cases baffle the skill of the practitioner and severely tax the endurance of the patient, and here it makes considerable difference to the latter whether he is to swallow the enormous doses of Allopathy, or the powders which the Homoeopathist prescribes.
In the inflammatory stage of Gonorrhoea, the doctor gives Aconite, the second or third decimal dilution, and sometimes alternates it with Merc. corr. Canth., Cannabis, Copaiva, and Thuja are mentioned and their indications, familiar to all, are given. No very decided results have been experienced from Agnus cas., Arg. nit., Cub., Petros., Puls., Rhus, Mez., and Ferr. Our author says that injections are rejected by our school as causing strictures and being unhomoeopathic; both assertions he denies. The former he says is unsupported by facts. The great objection, we consider, is that they repress the disease and give rise to serious sequelae. Those most frequently employed by Dr. Yeldham are Hydrastis canadensis and Liquor Plumbi diacetatis. Of the former he uses an infusion in the proportion of an ounce of the drug to a pint of water, of the latter half a drachm to an ounce of distilled water.
In the treatment of Gleet, the symptoms, exclusive of the discharge, are of so negative a character that it is difficult to lay down indications for a particular remedy. The selection must be made from the constitutional as well as the local symptoms. It is most commonly found associated with a depressed state of the general health, and in this ease Nux and Sulph. are of the utmost service. Canth., Mercurius, Nux, Puls, and Sulph. will comprise the list of remedies most frequently called for. Change of air, temperate and nutritious diet, local or general bathing with tepid or cold water are advised.
The complications of Gonorrhoea, such as irritation of the bladder, phimosis, erysipelas of the penis, orchitis, inflammation of the prostate gland, etc., are spoken of and their general treatment given. This is no different from the usual course.
In treating primary syphilis his main dependance is on Mercurius sol.; second in importance to this is Nitric acid on the other remedies recommended for chancre he places but little reliance. As a local treatment he uses a lotion of Calendula.
In secondary syphilis he uses Mercurius and Kali hydriod, and for the tertiary form he gives the names of several remedies without any special indication, which the practitioner must ascertain for himself in each case.
Braithwaite concludes his six months labors in January and July, and to the American reprint, which reaches us about a month; later, we turn to see what, if any, advances have been made in the science of medicine. In the department of practical medicine we are not disappointed in finding nothing of very great practical importance. It is always interesting to know what is going on outside of oar school, in what direction “practical medicine,” is moving. We find among other items that subcutaneous injections of Quinine are recommended as preferable to larger doses administered by the mouth; Faradization and Galvanism are receiving some attention as therapeutic agents; considerable has been published in the medical journals in favor of Rennet wine in Dyspepsia, one teaspoonful in a wine glass of water immediately after 'meals. Sarracenia is still very highly spoken of as remedy in variola notwithstanding the many reported failures.
In apoplexy attention is called to the position of the patient as important for the apparent reason that when he is supine his tongue falls back, impeding respiration and causing congestion of all the vessels of the head and neck. If the patient be turned on the side, the tongue pulled, or allowed to fall, forward the stertor ceases, the mucus drains away, the congestion disappears and the patient will generally recover. In case of suspended animation Dr. Sylvester's plan is spoken of; all obstructions to the passage of air to and from the lungs, of course, must be removed and the mouth and nostrils cleaned from all foreign matters. The body is then laid on its back on a flat surface or a plane slightly inclined upward from the feet, and the tongue drawn for- ward to project a little from the side of the mouth. Then the arms should be grasped just above the elbows, drawn upwards until they meet nearly above the head, and then at once replaced at the side. This should be followed by modererate pressure with both hands upon the lower part of the sternum. This process is to be repeated twelve or fourteen times in a minute. If there are no natural respiratory efforts, a dash of hot water (120° Fahr.) or cold water may be employed for the purpose of exciting them. The temperature of the body should be maintained by friction, warm blankets, etc., etc.
There is nothing new in operative surgery, nor, in the medical treatment of surgical oases, do we find anything of importance. Nothing in the line of military surgery published in the medical journals is referred to. We should not recommend the publication of the military blunders in the medical department of our army.
In this connection we cannot forbear mentioning an article on non-interference in natural labor, communicated to the Boston Med. and Surg. Journal of January 15, 1863. The writer gives as the result of his experience in nearly three thousand cases, that women recover at least as well after long, lingering and laborious labor, the duration of which may have been extended to some days, as after the easiest, quickest, and most natural delivery. He charges a hurried labor upon the “grasping and selfish practitioner, whose object is to hasten his case, save time, and thus add to the number of his fees and patients.” In a practice of nearly thirty-five years he has found that the mortality of both parent and child has been greatly lessened by trusting more to nature and less to art. In a tabular statement which he publishes, he gives the number of arm, feet and other abnormal presentations, which have not been few, and of the three thousand cases no deaths of the mothers have occurred, except in seventeen, from independent causes, such as phthisis, dysentery, etc. He recommends the accoucheur to visit his patient frequently before and after her confinement, acquaint himself with her condition, former habits, character and peculiarities, and lay down a clear and distinct course of hygiene at every stage of pregnancy. When labor has come on he would have her in bed as seldom as possible, till the child's head is about to escape from the uterus. He insists on the mother throwing off the after birth herself, and seldom puts a finger on the placenta till it tumbles into his hands. The lochia, from this treatment, disappear in forty-eight hours, and no bad symptoms ever follow. Laceration of the perineum has not occurred in his practice for more than fifteen years. The author quotes the late Dr. Joseph Clark, who had, besides the charge of a large lying-in institution, 3,862 private cases of midwifery, out of which he never lost a mother, and he had only one forceps case, which be failed in completing. If space had permitted we would have published the article from which we have quoted, entire, but we have endeavored to give the gist of it, and return to Braithwaite.
To induce premature labor at a premeditated hour, a caoutchouc bag, made in the shape of a dumb-bell, is used. This, is introduced by means of a uterine sound, one end or ball into the cervix uteri, the other remaining in the vagina. The bag is provided with a tube, and being distended by water is prevented from either slipping into the uterus or vagina, and serves to dilate the os. Cases are given by the author, Dr. Barnes where the instrument has been used satisfactorily. It Is an improvement on that of Dr. Braun, which consisted of a single bag.
Among the many interesting articles in the miscellanies we find some notice of the hard rubber or vulcanite used by dentists for plates for artificial teeth. Several oases of poisoning attributed to it are reported.
|Source:||The American Homoeopathic Review Vol. 03 No. 10, 1863, pages 470-475|
|Description:||Book Notices 10; Therapeutics of The Day; in a Series of Letters, by Dr. Wilhelm Stens; a Monograph Upon Gelseminum: Its Therapeutic and Physiological Effects together with Its Uses in Disease, by Edwin M. Hale; Homoeopathy in Venereal Diseases, by Stephen Yeldham; Braithwaite's Retrospect of Practical Medicine and Surgery|
|Editing:||errors only; interlinks; formatting|