5. Therapeutics

Therapeutics. The following are the four foundations of rational therapeutics. (1) Inasmuch as the organs act in obedience to natural forces in and around us; (2) since we possess the power of controlling these forces; (3) since disorder and disease are but the physiological phenomena, or the anatomical results of the disturbing action of ordinary or extraordinary influences; and (4) since the functions of the organs, and, it may be, even their anatomical state will return to the normal, if the influences become normal: it logically follows that therapeutics as a science consists in bending to our will the numerous natural forces which affect the human body, or in counteracting or neutralising their effects by other forces, until, in either case nature returns to the normal. To handle, as it were, the natural influences which surround us in such a manner as to effect this change on the functions of the body, is called treating the disorders or diseases of it. It is with this meaning that we shall speak of rational treatment.

Now it is evident that treatment may be of many kinds:

1. Preventive Treatment

Preventive Treatment. The science and art of preserving health is known as Hygiene, and it is manifestly founded on an accurate knowledge of physiology. If we thoroughly understood physiology, and had unlimited power over the forces of nature, we might so preserve health that disease would he unknown. Unfortunately, we have neither this knowledge nor this power except in a small measure, and hygiene is correspondingly imperfect; but as far as it goes, hygiene renders therapeutics unnecessary.

Another form of preventive treatment is prophylaxis. This is something more than simple hygiene or preservation of health; it recognises the causes of disease at work, and either avoids them or counteracts them by anticipation.

Prophylactic treatment may be either negative or positive: a man may guard against infection by avoiding certain things, such as water which is poisoned by cholera or typhoid fever; or he may have himself vaccinated to prevent small-pox, take quinia to prevent ague, or drink lemon-juice to prevent scurvy.

2. Immediate Treatment

Immediate Treatment. When hygiene and prophylaxis are powerless or cannot be employed, the case comes into the hands of the therapeutist. The organism is disturbed, deranged, or diseased, and now there is an occasion for therapeutics, for remedy, for relief, or for cure. All these terms manifestly imply a necessity for interference, that is, the actual presence of derangement from the normal state, and they introduce us to our own proper subject.

a. Removal of the cause.- Having met with a case of disease which we have failed to prevent, we first naturally try to remove or destroy the came, and thus restore the normal state We extract a foreign body from the finger, or a poison or indigestible meal from the stomach; we neutralise an acid by an alkali; we kill parasites. In doing so, we simply follow nature's second method of recovery. Now there are manifestly as many ways of effecting a cure as there are causes of disease. We may alter the food, and then we say the treatment is dietetic; we may alter the atmosphere, and then we say the treatment is climatic; or we may employ the chemical and other substances contained in the Pharmacopoeia, when our treatment will become medicinal.

b. Symptomatic treatment.-If we fail to remove the morbid influence, we may attempt to neutralise or counteract its morbid effects on the body. Knowing the physiological action of many different measures, we select such as act in an opposite direction to the morbid cause, and employ them to counteract it. As a method of treatment this is manifestly much inferior to the preceding; we are now striking not at the cause of disease, but only at its effects. Still even this limited power may be of the greatest value; sometimes it is all that is required-we may have to treat only the effect that persists after the cause has ceased or been removed, especially in sensitive and vital organs. This kind of treatment is called symptomatic, palliative, and under certain circumstances expectant (expectare, to wait); it is manifestly a copy of the third method of natural recovery.

It is evident that we have before us here an enormous field for research and application. If we can but find a means, whether medicinal or not, which shall counteract each abnormal condition to which the body may be subjected, we may defy disease. But here we are met by certain difficulties. Before we can hope to combat disease in this way, we must know (1) all about disease and its causes, that is, we must have a perfect pathology; and (2) all about the effects of therapeutical agents upon the body, that is, have a complete pharmacodynamics or pharmacology. It is unnecessary to say how far either the one or the other of these is from being a complete science. Another discouraging fact is that there is a limit to all hope of a cure, a limit to all treatment, because the morbid influence may have so far anticipated the remedial as to have altered the body structurally. If a limb is lost, we cannot restore it; if the mitral valve is covered with diseased growth, we cannot renovate it. But we are right when we maintain that these organic structural changes, grave or hopeless as they may be, are but the results of the action of some cause with simple beginnings, which we shall yet discover. As our knowledge of pathology advances we are steadily learning, e.g. more about the nature and origin of cancer, for which the limb had to be removed; more about the causes of rheumatism, which covered the cardiac valve with unnatural growth. If we ever cure cancer and rheumatism, we shall manifestly do so by influencing the causes or ,the beginnings of the two diseases: medicines may be expected to affect morbid processes rather than products, to alter morbid physiology rather than morbid anatomy. We do, however, possess certain means of treating even structural changes of organs, as we shall discover when we come to discuss metabolism.

The student is now in a position to consider the meaning of two terms constantly being employed in therapeutics-namely, rational treatment and empirical treatment. Treatment is said to be rational when it is suggested by all our chemical, physiological, and pathological knowledge. Such treatment must be successful if our observations are correct: it is founded on great natural laws which are known and understood. Empirical treatment is founded on experience only, and conforms to no yet known law. It may be, and frequently is, as successful as rational treatment, or sometimes even more so; but whether successful or unsuccessful, we can offer no scientific reason for it. All that we can say is, that experience has proved incon-testably that a particular kind of treatment was beneficial in a multitude of instances, and that it will probably be beneficial again. We hope soon to know more about the various remedies that have been successfully employed; and as we acquire this knowledge, and come to be able to give a reason for their effects, i.e. refer them to some great natural law, we shall transfer these remedies from the group headed "empirical," and add them to the group called "rational." Therapeutics will become a perfect science when empiricism has thus without exception given place to rationalism.

Plan of the following chapters.In approaching the study of the general therapeutics of the different systems of the body, we will adopt the following plan suggested by the preceding considerations: (1) We shall give a brief sketch of the physiological relations of the system. (2) We shall consider fully the pharmacodynamics of the same, dealing chiefly with the drugs examined in the previous parts of the work, but referring frequently to non-medicinal measures, such as food, air, exercise, and baths. (3) A rapid sketch will be given of some of the pathological relations of the system, those being selected which best serve to illustrate the action and uses of remedies, i.e. disorders or derangements rather than diseases of the parts. (4) A brief reference will be made to the evidence of natural recovery in the particular system, and to the failure of such attempts, i.e. the limits of treatment. (5) The rational therapeutics of the system, founded on the previous four divisions, will complete the account.