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recovery. And when well, they are not so often, in their own language—and still more rarely in that of the physiciancured, but have simply recovered. Modern progress seems to indicate that the farther both the public and the profession get away from the old meaning of this word, cure, the better; for when it is properly understood in the modern light of cause and effect, much complex, indiscriminate drugging will be saved, and the dealers in cures—from corn-cures to cancer-cures—will have their mercantile enterprises better understood. If modern therapeutics be coming to have less and less to do with cures, in the old acceptation of the word, then materia medica is surely equally progressive; for there are probably hardly any now who believe in the possibility that any drug should cure any disease, and therefore it is doubtful now whether there be much chance left, in the profession of medicine at least, for repetitions of the episodes of Cundurango, Missisquoi Water and mud, and Chian Turpentine. But, as the doctrine of cures disappears, the utility and certainty of remedial agents become better established, so that the modern progress is attained in both directions.
Another element in the progress of the recent past is a gradual and steady emancipation from the trammels of arbitrary doses of medicines. Physicians are no longer satisfied now with the doses given in the books. With increasing knowledge and broader views, they now look for effects; and the time is, perhaps, not far off when the only use of stated doses of medicines will be to know what quantity to begin with. It has come to be very commonly recognized that different persons, and even the same person in different conditions, are very differently susceptible to the action of medicines; and that, within certain limits, quantities must be adjusted to almost every individual case. In three successive cases of confirmed epilepsy in adults, the number of seizures was not sensibly reduced by less than 100 grains of bromide of potassium a day in one case, 160 grains in a second case, and 240 grains in the third case, and these quantities produced only moderate bromism. Had the doses of the standard books been adhered to, two out of the three cases would have been unimproved by the remedy.
There are cases in which ringing in the ears will be caused by 2 grains of sulphate of quinine; there are others which require 60 grains to give this sign of saturation; and there are persons in whom different quantities are required at different times. To treat a recurring malarial fever without recognizing these facts, is to fail of success and to discredit both the physician and the medicine, in a considerable number of the most difficult cases, where most credit is to be gained. Dr. William H. Van Buren, more than twenty-five years ago, emphasized this liability to be trammeled by arbitrary doses. In the treatment of consecutive syphilis, he found that a number of cases recovered under the use of 40 grains of iodide of potassium a day; but others were not impressed by less than 100 grains a day, while a few required 480 grains a day to give similar results. His teachings, and those of others who followed him, applying the same principle to other agents, have done much for the modern progress in this important matter of doses; for it is generally realized now among the best therapeutists that no remedy can be properly considered as having failed until it has been pushed to a physiological or a pathological effect.
There has also been very important progress made in the knowledge obtained and applied in scrutinizing the quality of medicines, which has resulted in the production of a better class of medicinal agents than was ever before attained; and it is of no small advantage to have learned that this close scrutiny and discrimination by individuals, throughout the length and breadth of the land, is far the most effective way of checking adulteration, and the mismanagement due to carelessness, ignorance, and cupidity in the vending of medical supplies. Year by year, more physicians realize the fact that the "drummer" is not their safest dependence, drum he never so wisely ; and they listen to his voice and take his samples more warily, trusting in their own ability to judge of the agents which are so important to them and their patients.
Every year more “Pharmacopæias are sold, more physicians confine themselves mainly within their scope, and more
tests and reagents are used; and now that the “ Pharmacopæia” has a full set of officinal test-solutions, it may be confidently expected that more physicians and pharmacists will learn to apply them in this important interest of effective medicinal agents. All physicians who want to know it know now that it is not the writing of papers on adulterations or the resolutions of societies, so much as the individual knowledge, care, and watchfulness of each physician for himself, that secures to him the character of his supplies. It has always been the case that good supplies could be easily obtained by proper care and scrutiny; but it has never been so easy as it is now, in consequence of the general improvement in the quality of supplies and the wider market for selection.
Moderately good and poor qualities are as plentiful and as cheap as ever; but the physician, having learned that cheap supplies are poor economy, is upon his guard if he desire to be. He has also learned that high-priced supplies are not always the best, and hence his safety lies only in his own testing processes and in avoiding complex remedies and forms of medicine which it is difficult or impossible to test.
Another element of progress, notable within the past few years, is that physicians use fewer and more active agents and use them more simply. The time for complex prescriptions and of using several agents at the same time seems to be passing away; and physicians do not go from one preparation to another so easily as heretofore. The using of a few definite agents and the knowing from personal observation just what they will do is of such manifest advantage that it would be strange indeed if there was no progress here. Physicians' orders, from being long and embracing many doubtful and indefinite articles and many duplicates or articles used for similar purposes, are, in the main, now short and compact. Ten or fifteen standard medicines at a time are about all that an ordinary physician wants; and this, about twice or thrice a year, keeps up a supply of not over double that number of agents in all, for common daily use. This enables him to watch the qualities better and to keep his stock fresh and in the most efficient condition.
Much progress has also been made in using more concentrated forms of medicines. Decoctions, infusions, vinegars, and wines, have almost gone out of use; while tinctures and syrups are steadily falling into disuse, though not so rapidly as they deserve. These are all replaced by the far more accurate and convenient fluid extracts, with their small and effective doses, which can be so easily administered in so many different ways. Thus the physician and pharmacist, instead of keeping two or three preparations of the same drug to get stale on his shelves, need keep only one, and this the best and most accurate one.
Much has also been gained in the precision with which medicines are measured for administration; and the measuring apparatus has been much extended and much improved in accuracy, so that it is not difficult now to get fairly accurate weights and measures at a reasonable cost.
The many and great advantages in the use of the salts of a few alkaloids have led to the extreme of seeking to extract and use the active principles of drugs, instead of the preparations of the drug, in all possible cases; and there are many excellent reasons for this if it were only practicable. Unfortunately, the 80-called active principles rarely represent the drug from which they are taken, either fully or fairly, and they are of such variable strength that they are less trustworthy than the drug itself. Beside this, many of the alkaloids and nearly all the glucosides are so loose in their molecular structure, that they split up and become partially or wholly inert without change in appearance and under circumstances that are not known. Physicians who examine most closely into the character and processes of extraction of many, if not most of these so-called active principles, will see that they are frequently the result of the chemistry applied for their extraction, and that they do not pre-exist in the drug and therefore can only partially represent it.
Finally, perhaps the greatest progress of all has been in the power and definiteness of the agents used and in judging of the manner and the effect of nsing them. Many years ago when, among the first of these very definite and powerful agents, the American hellebore came into use for controlling the action of
the heart, it was objected that its use was merely controlling a symptom of disease without going to the root of the matter at all. The pneumonia went on all the same, and perhaps the depressing action of the drug was simply added to the depressing action of the inflammation; and harm rather than good might be rationally expected to result. It took some time to show, by actual experience, that the drug could be given in controlling quantities without more depression than was needed in a sthenic disease, and that the lowering of the pulse rate by fifteen to twenty per cent meant the sending of fifteen to twenty per cent less of inflammatory blood through an inflamed, congested, and oppressed organ, whose obstructed functions were threatening life; and, therefore, that treating this pulse-symptom was really treating the whole of the disease by controlling its prominent element. It was thus clearly recognizable that, by subtracting one prominent element or symptom from the group which constitute a disease, the bond is broken, and it then tends to disintegration, just as, when an atom or a group of atoms is subtracted from a molecule, it splits up and loses its identity and its reactions.
Then, when bromide of potassium was successful in controlling the seizures of epilepsy, it was objected that it merely controlled the expression of the diseased condition, without affecting that condition, since, when the medicine was omitted or was used in too small quantity, the seizures would recur. But in the progress made in the recent past, it has been abundantly shown that, when the bromide is skillfully managed and continued with great perseverance and care for a sufficient length of time after the attacks had ceased, many patients were no longer in the condition which caused the attacks, and that thus, in treating the principal symptom, the condition causing it had also been treated successfully.
Again, in those agents which simply reduce temperature, as, for example, the use of salicylates in acute rheumatism, the effect is to control one symptom primarily; but it happens that, through the close relationship of symptoms, two others of equal importance are also controlled, namely, the pain and swelling.