HOW SHALL WE TEACH MATERIA
MEDICA AND THERAPEUTICS
– Dr. E B Nash
In “ye olden times”, and not so very far back either, the
self-styled regular school of medicine pronounced surgery the “opprobrium
of medicine”. In these latter days the order seems to be reversed, and
medicine has become the opprobrium of surgery. In other words it used to be. If
you cannot cure, cut. Now it is if you cannot cut, cure (if you can). What is
the reason of this ? I do not believe it to be so much on account of the
improved method in surgery, as in the fact that as compared with ours, they have
a very meagre knowledge of the action of drugs, and no law to guide to the
application of them to the healing of the sick. This is admitted and confessed
in their claim to be simply the medical school of experience. They have rejected
the only ‘Nature’s Law of Cure’ ever discovered and given to the world by Samuel
Hahnemann ; a law which could alone lead to an experience, which was reliable
and should endure as long as the truth of Nature’s Law anywhere in science
should endure.
Under the power of this Nature’s Law, Aconite Napellus cures the same
yesterday, today and forever, all affections for which it is the true similimum.
Guided by this law, Hahnemann could, by provision, name Camphor, Copper and
Hellebore as the leading remedies for an epidemic of a very fatal disease before
he had ever seen a case of it, but simply from a history or record of the
symptoms characterising the genus epidemicus. If such a system does not deserve
the name of a science of medicine, where can we find one in this valley of the
shadow of the death ? Having then such a sure foundation, which is the mark of
distinctiveness as a school of medicine, let us not cast away our confidence,
but continue to build upon it so earnestly and so well, that future generations
shall bless us for having profited by the heritage left us in the law of the
cure by our glorious master.
In our list of remedies already deserving the name of polychrest, we have an
armamentarium for battling with the ills to which flesh is heir, such as the
world never, in its whole history, saw before, and yet with a generation of
years of honest experimentation, I am persuaded that a great ocean lies yet
before us for exploration.
Let us for a moment take a retrospective view. In the up-building of our
materia medica comes first : Hahnemann with his Aconite.,
Ars., Bell., Bry., Calc., Canth., Caust., Cham., Cina., China., Coloc., Ferr.,
Graph., Hep.,Hyos.,Ign.,Iod.,,Ipec., Kali-c., Lycop., Merc., Nat-mur., Nit-ac.,
Nux-v., Op., Phos., Phos-ac., Puls., Rhus-t., Sepia., Sil., Staph., Stram.,
Sulph., Thuja and Verat-alb., many more not so well-developed might be
added.
How any man in one lifetime could give even these thirty-six remedies to the
world, so well-developed for practical application in healing the sick, is
beyond my comprehension, and when it comes to doing and leaving a work that
should live to bless humanity for all time to come, I would rather bear the name
of Samuel Hahnemann than that of any king (King David perhaps excepted), that
ever sat upon a throne.
Then we have other very valuable remedies added by Staph, Hering, Franz,
Hartiuab, Helbig, Jeanes, Braums Burt, Rubini, Payne, Kitches, Drysdale,
Backman, Schreter, Joslyn and others.
Now we are asking ourselves how we shall teach materia medica ?
In order to answer that question another question should precede it, viz; How
shall we know materia medica for there is no system that can teach well that
which we do not know ?
As we go over the list of polychrest remedies at hand, who gave us most of
them ? and which have stood the test, “ab usu in morbis”,
Unquestionable Hahnemann.
Has any system for discovering the pathogenetic and curative powers of drugs,
better than his, yet been discovered ? How did he impart the knowledge of
his remedies to his followers ? He told his followers both to prove remedies and
how to apply them to the sick for their cure in the incomparable Organon.
Everyone that has read the Organon, knows that
Hahnemann taught to all the symptoms in the case and apply the remedy which in
its pathogenesis covered most of this case.
Or that in any case, the peculiar symptoms which appeared in a case should be
covered by the remedy that had these symptoms as their strongest
characteristics.
Here were two methods of prescribing. The success attending such prescribing
was to say the least, very gratifying and similibus curantur became our formula.
Can we better it ? I do not believe we can.
Dr.T C Duncan has written a very interesting article on “How to teach
Materia Medica” and in the first part, he asks the question, “Shall
Nash’s Leaders in Homeopathic Therapeutics be the
first book ?” If he had put that question to me, personally even at the
risk of being charged with egotism, I would have answered “Yes” or
Allen’ Keynotes or any other man’s books, that would get the student to
“salting down” (for future use) in his memory the peculiar and
characteristic symptoms of every medicine.
Dr.Duncan’s curriculum is summed up in this way :
Materia Medica, therapeutics, etiology, clinical medicine
– First year
Toxic drugs, histological cell changes (first
nationals) – Second year
Physiological drugs, antidotal, bacteriology, constitutional diseases – Third
year
Drug outlines, keynotes, constitutionals, diagnostics – Fourth year
Drug comparisions, similitudes, exciting causes, Applied medicine.
This is the arrangement he proposes and perhaps it is as good can be, but it
seems to me that these characteristic or keynote symptoms are the backbone for
prescribing purposes of our materia medica and that giving only one place in
eight to the branches comprehended under the head of materia medica and
therapeutics is far too little. To be sure, we must teach the toxic,
physiological and outline action of drugs, but when we come to actual
prescribing, every true homeopathician knows that the characteristic and
peculiar symptoms, as developed in our Hahnemannian provings must take the lead.
Why then give it so small a place in our teaching ? How would I change it ? I
would put our key notes, or leading verified symptoms, just as far as possible,
in close connection with every other teaching of materia medica and
therapeutics. For instance when I was teaching of the toxic effects of a drug
like Digitalis, I would teach that the slow pulse was not
only characteristic of the poisonous effect, but was also characteristic for its
use in the treatment of the sick. So also of the soporific effects of opium,
the violent catharsis of croton tig, etc. So also of the
physiological action of drugs.
I would while teaching under any of the above-named heads never cease to
endeavour to so impress upon the student’s mind the characteristic,
symptomatology of our medicines that he would never forget them.
In intimated in the beginning of that paper that I believed that the reasons
for the “craze” in surgery was forced in that direction because of the
inadequacy of their therapeutics.
The general toxic and physiological action of remedies is about all they
teach or know, and they placed in classes such as tonics, anti-phlogistics,
sudorifics, diuretics, cathartics, etc, but you ask them to give the diagnostic
shades of difference which enable us to choose between Podophyllum,
Aloes, Croton tig and Nat-sulph for a case of
diarrhoea and they know little or nothing about it.
Compared with our system, they have no knowledge that enables them to make
the close selection to the one remedy of a class adapted to a case of disease.
Now the difference between them and us is , that while they have not, we have a
materia medica and a scientific “Law” for applying it, but are not
applying ourselves as a school to so thorough an understanding of it as we
should. We are not making ourselves masters of our art, but we are in too many
instances chasing off after other things, specialities in medicine are getting
too large a place among us. Now, do not understand that I ignore specialities.
They have their place and we could not get along with them but I positively know
for instance, that much of the local treatment resorted to in affections having
a constitutional origin is entirely unnecessary and very often positively
injurious.
The reason of this, I repeat because we do not sufficiently understand our
art as homeopathic physicians. It should be our pride to boast, that with our
superior system of therapeutics we are able to cure without operation most of
the diseases which, under the old school are obliged to come to the knife.
The fact once impressed upon the people will be of an immense advantage to
our school. More cases have died from the operation for the appendicitis in the
last ten years than died in fifty for the need of it. In thirty-five years of
general practice I have had many cases of this disease to treat, some in which
operations was pronounced to be the only hope, and without operations have my
first death to record. What was my remedy ? I only used one remedy in all my
cases. The indicated one, always selected in accordance with the infalliable
rule laid down in paragraph 153 of the
Organon. (We all know what that is).
Now let me call attention to the importance of teaching our classes
comparative materia medica. More can be sometimes done by this system to
teaching to impress upon the student’s mind the important, leading symptoms of
materia medica and therapeutics than by any other.
Let me illustrate. Take the one very common symptoms so often present in
disease – great restlessness. In my “Leaders”
I have called Aconite, Arsenicum
and Rhus tox a trio of restless remedies. Now it
would be of no practical use to the prescriber to know this. Now differentiate
between them.
Aconite restlessness is accompanied with fear, synochal fever and pain to
which the patient is very sensitive. Fear, especially fear of death is its
leading characteristic, “O, I shall die!” or if he is ashamed or
unable to express it in words, he looks and acts it out. It is the fear as much
as the pain that makes the patient so full of agonised restlessness. Though
there may be no real danger in the case, the patient feels that there is.
Now, the Arsenic restlessness goes with extreme prostration, or reduced
vitality, hence is not generally found indicated in the beginning of acute
diseases, while Aconite of Rhus tox’s restlessness is on account of aching pains
which make him toss around or change position for the temporary relief he gets
from the MOVEMENT. Arsenic wants to move from place to place, but is not
relieved. Neither Aconite nor Arsenicum gets such relief from movement, nor does
Rhus tox or Arsenicum fear like Aconite, or atleast to any such degree.Aconite
tosses to and fro in agony and fear, while Arsenicum is too weak to toss as the
anguish and restlessness would incline him to do. And so we can follow up a
comparision of these remedies until they shall so have entered into the mind of
the student that he will not easily forget them. Dr.E A Farrington, gave some of
the finest comparative studies in materia medica that ever appeared in print.
But they were not appreciated by the profession and he wrote me in answer to my
inquiry, that they were stopped for that reason.
Since the appearance of “Leaders”, I have been asked to state
through journals how I obtained my knowledge of the materia medica. For the
benefit of students, I think I replied in short, through the
“Chironian” that I began by reading Hempel’s “Materia Medica and
Therapeutics, arranged upon a Physiologico-Pathological basis” (The title
of his first edition). It was delightful reading and gave a sort of general
knowledge of some of our remedies, and student as I was, I thought I had it
about all, and felt pretty disgusted when my classmate, Mr.M C Ernsberger told
me that I would after all have to refer to good old Jahr for practical guidance
in the selection of my remedy at the bedside. Much to my chagrin I found it
true.
When Hering’s characteristic cards appeared I bought and studies them
together with my good wife until I knew each one of them by heart. Then I
followed with Guernsey’s keynotes and Raue’s therapeutic hints, as they appeared
in their works on Obstetrics and Pathology. And I want to say that when these
three works appeared there was a forward movement along the line of succesful
homeopathic prescribing, which, if it had been kept up till now would have put
us as a school where no one would have thought of asking the question, “Is
the seperate existence of the homeopathic school still a necessity ?” Still
less bringing it up for discussion in a State homeopathy society.
Now I am aware that I have not yet answered the question. How shall we teach
materia medica and therapeutics ? for these two subjects should never be
separated so long as the physician’s highest and ONLY calling is to restore
health to the sick, which is called healing (Section
1, Organon) remain true. I will now state how I will teach.
1st – I would require the student who was a candidate for graduation
to pass a ninety percent examination on the key note or characteristic symptoms.
This would be my beginning, for we must begin somewhere. I would be careful to
let him understand that much remained to be learnt after this, that could not be
compassed in his college course, and that he had now entered into a life study
of a subject of the greatest possible importance.
2nd – I would drill the student on comparative materia medica from a
symptomatical standpoint, until be became an adept, if there was such a
possibility in his nature.
3rd – I would try to lead him to inquire the why or wherefore the
difference between different remedies having similar symptoms. For instance, why
the constipation of Bryonia and Nux vomica differed in this, that one was
attended with frequent, ineffectual desire for stools, and the other with
absence of it, being careful to guard him against hesitating to use the remedy
on the simple indication of its presence whether he could explain it from
physiological standpoint or not.
Finally – I would recommend him to a careful study of the
principles touching the subject as laid down in the “Organon”.
I have indicated more at length in my “Leaders”
(pardon the frequent allusion) at least the way I have learned and would teach
the subject and apply it.
In conclusion, I want to say that I hope never to see the time when we, as a
school of medicine, will ever depart from the strict inductive method of
Hahnemann.