Therapeutics, Therapeia, Therapeutica, from I cure.
By this term is meant the application of remedies for the cure, alleviation, or prevention of disease. Taken alone, and in its widest sense, it includes not only medicinal agents, but many surgical operations, as lithotomy, amputations, &c. In connexion with Materia Medica, the meaning of this term is limited to the application of medicinal substances for the purposes above indicated. If taken in its fullest sense, it embraces so wide a range of subjects, that it would be impossible, in a small volume like the present, to bestow a due consideration on the whole; and it is very evident, that a treatise on the science in its more limited sense, namely, that of including the articles of the Materia Medica alone, would be very incomplete and defective. In the following pages, therefore, some of the most ordinary remedial agents, which properly belong to the surgical department, as blood-letting, issues, setons, and acupuncture, have received notice, as being inseparably connected with the former class of therapeutic agents. Electricity, electro-magnetism, and galvanism, which cannot properly be ranged in either of the above classes, have also been considered, with reference to their effects on morbid conditions of the body.
Therapeutics and pathology are so intimately connected with each other, that unless the latter be well understood, theoretically as well as practically, it is almost impossible to be a successful therapeutist. It is true, that occasionally empirical practice may succeed in effecting cures, but he alone who is well grounded in the science of Pathology can administer remedies with a hope of anything like uniform or permanent success. By the term Pathology is meant a thorough knowledge of disease, its causes, pathognomonic signs, and symptoms, the morbid changes which take place in the several organs of the body, and an intimate acquaintance with morbid anatomy. But this does not comprise all that is required to form a sound therapeutist. He should be thoroughly acquainted with the medicines which he employs, their natural history, their chemical composition, their physiological effects on the healthy frame, their modus operandi in morbid conditions, their effects in over-doses, and their manner of producing death. To this should be added a knowledge of their indications and contra-indications, as well as of those combinations which increase or diminish the medicinal activity of the various drugs. Such an amount of knowledge is only to be attained by many years of study, experience, and close observation; but every step which is made towards acquiring this information will render the practitioner so much the more efficient in the discharge of the duties of his profession.
Notwithstanding the rapid strides in the science of Pathology which have been made of late years, by the aid of chemistry and the microscope, there yet remain many points involved in deep obscurity. Of this, Tetanus, Hydrophobia, and diseases of an intermittent or periodic type, may be taken as prominent examples. When we have ascertained more precisely the seat and nature of now obscure diseases, which can only be done by more extended anatomical researches, and when the modus operandi of medicines on the human frame is more clearly understood, we shall, doubtless, be enabled, by attacking the cause of the disease with appropriate remedies, to eradicate it at once from the system; but, in the obscurity which at present hangs over our knowledge of the history of various diseases, we must, in many instances, content ourselves with playing, if I may so express it, a secondary part, by attacking the symptoms which present themselves in the course of a disease; and he will be the most successful in his practice who does not allow the smallest of these symptoms to pass unheeded, but directs his efforts to their removal or alleviation. It is not only on the bold, prominent symptoms which powerfully arrest our notice, that attention should be bestowed, but it is upon the small, and in the patient's estimation, perhaps, insignificant symptoms, that the experienced physician will seize, and from which he will draw deductions, to serve as a guide in regulating his subsequent treatment of the case. These symptoms must be sought for, or they will never be discovered; indeed, it should be laid down as a rule in practice, that there is no such thing as a trivial symptom; even the smallest, in the estimation of the patient, may be fraught with deep importance to the experienced eye of the intelligent practitioner. Paradoxical as it may sound, it is undoubtedly true, that in some diseases the very absence of an ordinary symptom is, of itself, sufficient to constitute one. These observations are not intended, in any degree, to detract from the vast importance of endeavouring to ascertain, by close and vigilant examination, the source and origin of a disease which we are called upon to treat. Without an accurate knowledge of these points, we shall fail to effect a radical cure, however successful our efforts may prove in alleviating, for a time, the severity of the symptoms.
A consideration of the diversified causes in which certain diseases have their origin, should teach us the necessity of minutely examining into each individual case, and of adapting our remedies to the cause, as far as that can be ascertained. It should, further, teach us to receive with great circumspection, remedies which, from time to time, are paraded in the periodicals of the day as specifics, or "almost specifics," for obscure and hitherto incurable diseases. Take Epilepsy, for example: we know that it may proceed from several causes; thus, it may arise - 1, from organic disease of the nervous centres; 2, from the pressure of a portion of bone upon the brain; 3, from a vitiated state of the digestive organs; 4, from derangement of the uterine system; 5, from aniemia; 6, from plethora; 7, from moral causes, as fright, &c.; and 8, from the presence of intestinal worms. The enumeration of these various origins of a single disease shows the folly of relying on any single remedy as a means of cure. No article of the Materia Medica that we are acquainted with at present could possibly fulfil all the indications here presented. The Salts of Iron have been found useful in those forms of Epilepsy connected with anaemia; but what possible benefit can we expect from them when the disease has its origin in organic lesion of the nervous centres; and what but mischief, when it proceeds from a plethoric condition of the brain, or of the system?