THE STUDY AND VALUE OF THERAPEUTICS. 
A Paper read before Jhe Medical Association of South Carolina 
by Geo. E. Trescot, M. D., Professor Mat. Med. and Thera- 
peutics, in the Medical College of the State of South 
Carolina, at the Annual Meeting in Charleston, April, 1871. 
Prof. Huxley in one of the articles published in his “ Lay 
Sermons and Addresses,” writes as follows : “ Merchants occa- 
sionally go through a wholesome though troublesome and 
not always satisfactory process, which they term taking stock. 
After all the excitement of speculation, the pleasure of gain, 
and the pain of loss, the trader makes up his mind to face 
facts, and to learn the exact quantity and quality of his solid 
and reliable possessions. The man of science does well some- 
times to imitate this procedure; and, forgetting for the time 
the importance of his own small winnings, to re-examine the 
common stock in trade, so that he may be sure hcftv far the 
stock of bullion in the cellar, on the faith of whose existence 
so much paper has been circulating, is really the solid gold of 
truth.” 
I propose briefly to examine some of the most prominent 
grounds for our belief in the value of drugs, and some of the 
most current themes in regard to the manner in which they 
are supposed to act. I hope to prove that in any case, the two 
important factors of successful treatment are these: the general 
information derived from study, and the ability of the phy- 
sician to adapt that information to the case before him. 
The day has long passed when we look to “ an hexameter 
from the Iliad to allay the gout, or rheumatism to yield to a 
verse from Lamentationsbut it cannot be denied that we 
find physicians, even at the present time, who treat disease 
on grounds as irrational as our rude forefathers, and who, 
when pressed to the wall can give no reason for the faith that 
is in them. The successful treatment of disease should be the 
earnest desire of every conscientious physician, not only be- 
cause it is demanded by those who submit themselves to our 
care, but also that we may each contribute what we can to 
advance our profession. The study of medicine is a science, 
the practice of medicine is an art. When the physican stands 2 
by the bedside of the sick his knowledge of Anatomy, Physi- 
ology and Pathology can be used only for his own informa- 
tion, what the sufferer demands is relief, and this he must 
give out of the abundance of his Therapeutical resources. If, 
when disease is presented to our view, it invariably followed a 
definite known law in all of its manifestations, and, if', when a 
particular drug was given it was invariably followed by the 
same results, the practice of medicine would be as accurate as a 
proposition in geometry. But this is not the case, and one of 
the hardest facts for a young practitioner to realize, is one of 
every day occurrence, namely, that the first time he finds him- 
self face to face with any given disease, his case may differ 
materially from the typical description he has read and studied 
in his text book. A comprehensive knowledge of Thera- 
peutics embraces every possible means for the relief and cure 
of disease—hygenic, dietetic and medicinal. Now in regard to 
the value of drugs, the question at once arises is there any 
drug whose nature, action and dose is sufficiently well known 
to warrant the assertion that if given in a certain diseased con- 
dition, the administration of that drug will tend to the relief 
and cure of that condition, if an affirmative answer could not 
be given, there would at once cease all need of special medical 
education and training? From the time when John of Gaddys- 
den treated a Royal Prince of England, for small pox, by 
putting him on a red bed surrounded with red curtains, and 
giving him red medicine to drink, to the day when Professor 
Bennet, of Edinburgh, announced to the profession that there 
were but fifteen medicines which were good for anything, 
the revolutions in the teachings of Therapeutics has been 
many, and I can truly say, it is only of late that well directed 
efforts have been made to advance this most important study. 
It has been the habit with many of late years, even whilst using 
medicines, to sneer at their value. 
The brilliant advance of Physiology and Pathology teach- 
ing us with stronger emphasis day by day, that many morbid 
conditions will tend to recover without medication, has 
been used to deny utterly the power exercised by many 
of the most valuable articles of the Materia Medica. Medi- 
cal men have allowed themselves to be misled by dazzling 
theory, consequently ignoring well sustained facts, but the 
reaction has commenced, and in the words of another, “ this 
loss of faith in Therapeutics has been deplored by men, who, 
like Sir Thomas Watson and Dr. Copland, have made them- 
selves deservedly famous as skilful practitioners. Others who 3 
are still bearing the full burden of professional labor, like Dr. 
Wilks, Dr. Sieveking and Dr. Fuller, have given expressions to 
similar opinions, and I wish this enlarged edition to be taken 
as my solemn protest against the disparagement of a large 
amount of Therapeutical wisdom which has been handed down 
to us for our guidance in the treatment of disease, from one 
generation of medical observers to another.” 
The skilful operation of the surgeon, and the prompt relief 
given by the dexterous accoucheur, strike the beholders with 
wonder and inspire them with faith, while the silent reasoning 
of the physician savors of doubt and the necessarily uncertain 
answers which must often be given to useless questions are 
taken for so many indications of ignorance. But I am sure that 
the physician who calms an excited brain, quiets a throbbing 
heart, or relieves a congested lung, does as much to ward off 
the tendency to death as the surgeon who ligates a bleeding 
vessel, and raises a depressed bone, or he who by the timely 
application of the forceps saves the mother’s strength. Let 
me now ask this direct question : Why is it that we find phy- 
sicians of equal ability and experience widely in 
regard to the value of a particular medicine in some particu- 
lar ailment? I think a satisfactory answer can be found in 
this fact—that in most morbid states one of the following 
conditions exist: “A.” The disease remaining for sometime 
undetected, when first recognized has reached that stage 
where repair is impossible. “ B.” The disease has a natural 
tendency to terminate in health. “ C.” The drug used in 
treatment has so little influence on the system, as neither on 
the one hand to interfere with the tendency to health, or on 
the other to aggravate the tendency to death. In many cases 
of phthisis, Bright’s disease, diabetes, affections of the brain 
and spinal cord we have examples of the first; in pneumonia, 
typoid fever, many cases of the eruptive fever/and in a large 
number of functional derangements we have examples of 
the second. In the treatment of rheumatism by mint water, 
and typoid fever by small doses of chlorate potassoe or the 
we have examples of the second and third com- 
bined. M. Paget has remarked that the human body was 
made for the storms of life as well as for its calms; this great 
truth, I conceive, lies at the very foundation of all successful 
practice, and if neglected will make us either blind routinists 
or wondering vaccillating practitioners. 
The first point which we should attempt to determine is 
this: How far can we go in the investigation of disease, and 4 
to what extent can we lay down laws for the operations of 
those agents we use to control and overcome disease ? The 
antagonistic schools can be well seen by the following quota- 
tions. Dr. Anstie writes: “ So long as we persist in assuming 
that the effects of medication are mysterious to us, not be- 
cause we have not toiled long enough at physical science to 
understand them, but because they are produced through the 
agency of forces which are neither wholly physical nor wholly 
spiritual, so long shall we be incapable of real progress.” Dr. 
Inman on the contrary writes : “ The words vital force signify 
the living principle which exists in every organized being. It 
is the power which enables the eye to see, which a camera 
obscura cannot do; which converts inanimate matter into 
combinations that the chemist cannot imitate, which frames 
out of the same material various organs, each having a differ- 
ent function.* It is not simply the result of a fortuitous con- 
course of atoms, for they may be present and no life be there. 
It is not nerve force, for that is dependent upon life, and a 
dead nerve is as powerless as a stone. It is not organization 
alone, for organs may be present, as in a corpse, where there 
is no life or vital force. It is a force completely sui generis, 
but one which, being more or less allied to physical forces, 
has its phenomena more or less modified thereby.” Now 
this warfare between vital and physical, has ever been the 
great stumbling block in the way of medicine, I hold the 
doctrine that both views are, to a certain extent, true, and that 
we are absolutely forced to adopt the conclusion laid down 
by Herbert Spencer, in his “ First Principles” of a “New Sys- 
tem of Philosophy,” that we must rest upon “ this deepest, 
widest and most certain of all facts, that the power which the 
Universe manifests in us is utterly inscrutable” Dr. Gull, in 
his admirable address before the B. M. A., at the meeting held 
at Oxford, warned us in weighty words of the tendency to 
explain everything by physic and chemistry. “ How often 
has medicine been thus diverted from her difficult path. A 
discovery in physics has made us for the moment no more 
than galvanic batteries, or a discovery in chemistry at another 
mere oxydizing machine; to-day, however, we go to bed-side 
work untrammelled by any exclusive theories, we must, there- 
fore, refer our physiological difficulties to the physiologist, 
and our chemical theories to the chemist, and still admit that 
there remains an unlimited area of study for us in tracing the 
causes and relations, and in recognizing the presence of dis- 
ease.” The next important point to consider is the immense 5 
value of clinical medicine in giving clear indications as to 
the true part taken by drugs in the cure of disease. It has 
been said by a thoughtless writer, that the only men who fear 
clinical medicine are the teachers of Materia Medica. I deny 
the accusation, and state most distinctly, that no branch of 
Medicine has been more advanced by clinical study than 
Therapeutics; for it has taught us these three facts : that in 
some cases we can give medicine with almost a certainty of 
success; in other cases, where recovery followed the most 
alarming symptoms, medicine had not the slightest agency in 
the result, and that in other cases, where death occurred, 
medicine could not have been beneficial. 
Let me illustrate by some common examples: Take a per- 
son exposed to malarial influence and attacked with Remit- 
tent Fever, we give Quinine, and check those morbid condi- 
tions, which, if left to themselves, would destroy J(our patient. 
Now listen to the following (Rey. Sys. Med. Art. Soft. Brain): 
“ A young lady, aged 22, in her first attack of acute rheuma- 
tism, marked by considerable swelling and redness of knees, 
wrists and ankles, and a recently developed systolic murmur 
at the base of her heart, received a visit from some friends, 
was excited in conversation, and had palpitation of the heart. 
A few minutes after her friends had left her she grew faint, 
looked pale, became unconscious, and remained so for two or 
three hours. At the end of that time she was confused, un- 
able to utter any intelligible sentence, clipped her words, 
made some sounds which were quite inarticulate, and had 
marked right hemiplegia, the features being drawn to one 
side, the right arm completely, and the right leg incom- 
pletely paralysed. At the end of three days speech was per- 
fect ; at the end of a fortnight the hemiplegia had disappeared. 
The most rational interpretation of such a case is, that an 
embolus blocked up the left middle cerebral artery, and led to 
impaired nutrition of the brain, which equals the first stage 
of softening, but that owing to either the re-establishment of 
the circulation by the breaking up or removal of the embolus, 
or the establishment of the circulation in the collateral vessels 
the nutrition was restored.” 
Now, no one would say that in such a case, by the admin- 
istration of drugs we could have cured the patient; but sup- 
pose some drug had been given, it would have been very 
easy to attribute the cure to the drug given. Take another 
example—a case reported in the Med. Times and Gazette by 
Dr. Habershon: “A patient, some years ago, was admitted, 6 
under my care into for acute Pneumonia on 
the right side. The symptoms were well marked, and with 
the saline treatment he speedily convalesced, and was about 
to leave the Hospital; fatal symptoms, however, very unex- 
pectedly came on, for, after a good night, and partaking of 
his usual breakfast, even assisting to clear away the breakfast- 
things, he told the nurse that he was faint, he sat down upon 
the edge of the bed, and in half an hour died ; the lung was 
recovering, as we expected, and the pneumonic deposit in it 
had become nearly absorbed, but we found, what had not pre- 
viously been ascertained, that he had recently suffered from 
acute gonorrhea ; the veins at the base of the bladder were 
filled with adherent fibrin, and the illiac veins were in a simi- 
lar state; a clot separated from these veins had been carried 
to the right ventricle, and the action of the heart had become 
so embarrassed as to cause speedy death.” No one supposes 
that medicine could have relieved this condition. Now, I 
contend that every time a disease is proved to be what is 
called self-limiting, or that a condition exists over which 
medicine has no control, or again, that a given drug has no 
perceptible effect, either good or bad, in a given morbid con- 
dition, Therapeutics gains both positively and negatively. 
The important fact that clinical medicine is forcing upon us 
is this, “ that the strength of modern Therapeutics lies in the 
clearer perception than formerly of the great truth, that dis- 
eases are but perverted life processes, and have for their 
natural history not only a beginning, but equally a period of 
culmination and decline.” 
The next important point to be considered is this, to what 
extent does the physiological action of our medicinal agents 
enable us to judge of these therapeutical indications. If we 
turn to Dr. Harley’s recent work on ‘‘Old Vegetable Neurotis,” 
we read : “ The first effect of hemlock is a depression of the 
motor function, and its last is the complete obliteration of all 
muscular movement derived from the centro-spinal motor 
track.” From this statement, it is clear that we should use 
conium with great success in certain convulsive disorders, but 
many who have used it found it to fail. Take a subject 
which, at the present time is exciting much interest—elec- 
tricity. Dr. Reynolds writes as follows : “ I want you to 
bear in mind certain points respecting the effects of the con- 
tinuous current upon the limbs, according to the direction in 
which it is passed through the limbs, supposing I have the 
positive end of the battery connected with a person’s left 7 
hand, and the negative end connected with his right, the cur- 
rent passing from the positive to the negative pole goes up 
the person’s left arm to the trunk of the body, and down the 
right arm to the machine again. In the arm in which the 
current is passing upwards the irritability of the muscle 
and nerve is gradually increased ; in the other arm, in which 
the current is passing downwards, the irritability is gradually 
diminished. One arm will act more, the other less readily 
than in health. It may occur to you to ask, ‘ If that be the 
case, which current should I use to relieve pain and spasm ?’ 
All I have to say is, that so far as I have s«.6n, it does not 
make the smallest difference; theoretically it should make a 
very great difference, but practically it makes none. I have 
seen pain or spasm relieved as much by the current in one 
direction as in the other.” 
I will now take the treatment of a few diseases as taught by 
prominent physicians of different countries, and hope to show 
by an analysis of such treatment, that the propositions I shall 
lay down at the conclusion of this paper, will hold good. I 
select four marked conditions of common occurrence: Ty- 
phoid Fever, Rheumatism, Tetanus and Delirium Tremens. I 
cannot, of course, go into any discussion of the different 
pathological views entertained of these diseases, except so far 
as they are brought forward to prove or disprove the value 
of some drug which has been strongly recommended in 
their treatment. And first, in regard to typhoid fever, 
any one who undertakes to treat this disease according 
to rules laid down by any One writer, never mind how 
great may be his ability or experience, will soon find, 
that to do so, is impossible; there has been as much 
sound reasoning, as much speculative theory, and as large an 
amount of practical experience brought to bear on this dis- 
ease as any to which flesh is heir; again, I suppose there is 
amongst the intelligent, educated physicians of the present 
day, as much agreement as to the general principles upon 
which a case of typhoid fever should be treated, as upon any 
one point in medicine. But let the current medical literature 
of the day be examined, and we would suppose that the The- 
rapeutics of typhoid fever was amongst the most complicated 
problems in medicine. Take the views in regard to alcoholic 
stimulants in typhoid fever, and where can you find more oppo- 
site views, held and taught by more accomplished physicians. 
And first, let me ask, is there any physician who will give or 
withhold alcohol, because he has become convinced that its 8 
action in the human system is known and can be explained. 
Some few there may be, but the vast majority of practitioners 
come to the conclusion to use or not, alcohol, simply in con- 
sequence of the outward manifestations exhibited by their 
patient in regard to strength or debility, and trouble them- 
selves as little about the theory of its action, as Prof. Huxley 
does, when asked about the politics of the man in the moon ; 
now this may be wrong, it may be all the work of gross igno- 
rance or lamentable indifference, but it is true. Let any one 
spend an hour with Dr. Anstie, at Westminster Hospital, and 
then walk to 3* Guy’s Plospital, and listen to a clinical lec- 
ture by Dr. Wilks, and unless he holds pretty firmly to the 
doctrine that there is “a soul of truth in things erroneous,” 
he will certainly come to the conclusion that one of these two 
eminent physicians must be mistaken ; but if he has reasoned 
on this subject, as all men should do on subjects which are 
dependent on various contingencies, he will learn that the 
profession owes a debt of gratitude to Dr. Anstie and Dr. 
Wilks, for they have taught us not by theory, but by large 
clinical experience, that in many cases of typhoid fever, 
there is no necessity to stimulate, while in other cases stimu- 
lants, judiciously administered, become very important factors 
in the recovery of the patient. Now, it may be said that this 
is one of those general conclusions which amounts to nothing, 
granted, but is not the general conclusion, that in a given 
number of cases of typhoid fever, some will require stimu- 
lants and some will not, a much safer and more reasonable 
guide to treatment than either of the special conclusions, that 
alcoholic stimulation is, or is not, essential to the treatment 
of this disease. What shall we say in regard to the use of 
mercury in typhoid fever; suppose two physicians standing 
by the bedside of a patient in consultation, one educated 
according to the doctrine of Prof. Wood, of Philadelphia, 
and the other fresh from Edinburgh, where he had seen the 
experiments of Prof. Bennct, in regard to the action of Mer- 
cury. The question comes up for consideration, whether in the 
case before them, a dose of calomel shall be given ; the first 
point is this, is the mercury to be given for its specific action 
upon the liver or not. Dr. John Harley would say yes ; why, 
because he believes, “ if we carefully regard the insipient symp- 
toms of enteric fever, we shall find that they have reference to 
derangement of the hepatic function, and consequently “ with 
the view of arousing the liver to activity,” he gives small 
doses of mercury for three or four days. Again, Wunder- 9 
lich strongly recommends the use of calomel before the tenth 
day, why, according to Dr. Aitken, “ to influence the elimin- 
ation from the intestinal glands, by direct local action on the 
intestinal membrane.” This statement is not altogether cor- 
rect. Wunderlich, believes that calomel, in addition to what- 
ever effect it may have upon the secretions, also reduces 
temperature. Neimeyer agrees with Wunderlich and tells us, 
“that in the great majority of cases where this remedy is 
given during the first week, and before the occurence of much 
diarrhoea, the course of the disease is rendered milder and 
shorter.” Trousseau does not seem to plac£ much reliance 
in calomel, except as a purgative. We have then calomel 
given for very different reasons by different physicians in 
typhoid fever, and we all know that there are physicians who 
do not give calomel at all in this disease; we are again driven 
to the general conclusion that no one can lay down any defi- 
nite rule in regard to the use of mercury in this disease, and 
consequently the administration of mercury in typhoid fever, 
must be left to the individual tact and discrimination of each 
physician. 
Turn to the index of Prof. Stifle’s great work on Thera- 
peutics, or to Dr. Waring’s “ Practical Therapeutics,” and 
look at the articles enumerated as useful in typoid fever, the 
one gives us a list of twenty articles, the other of fifty. What 
greater proof can we have that a disease may present the 
most variable aspects in addition to its regular features, and 
that no one line of treatment can possibly be correct. 
If we turn from the Therapeutics of typhoid fever to that of 
rheumatism, we are met with a greater amount of contradic- 
tory statements. The treatment of rheumatism can be com- 
prised under four heads—the opium, alkaline, elimination by 
blisters, and the let alone treatment—each having strong advo- 
cates. The most generally received views in regard to the 
pathology of the disease is that it is caused by an accumula- 
tion in the body of an excessive amount of acid. Now Dr. 
Fuller neutralizes this by alkalies, Dr. Herbert Davies elimi- 
nates by blisters, while Drs. Sutton and Gull let the super- 
abundant acid find its way out by any road it pleases to take. 
The Medical Journals, for the last three years, have been full 
of the discussion in regard to the value of particular treat- 
ment in this disease. With very little trouble any one can, 
at|j|is very moment, read the views held by a large number 
of English, Irish, French and German physicians; all he will 
have to do is to look into Braithwaite’s Retrospect from 1867 10 
to 1870, and Dr. Rogers’ recent work. In regard then to 
this disease, as far as its pathology and treatment is con- 
cerned, most physicians will come to the same conclusion 
as those arrived at by Dr. Garrod and Prof. Bennet, that in 
the first place “ the pathology of articular rheumatism must 
be allowed to be in a very unsettled state, and further obser- 
vation and experiments are required before we can arrive at 
any satisfactory conclusion with regard to itand in the 
second place, that “ our treatment of this disease, therefore, is 
purely empirical; sometimes directed against the pain, at 
others, against the supposed inflammation; now attempting 
to combat the pathological condition of the blood, then striv- 
ing to remedy its effects by acting on the secretions, and not 
unfrequently giving specifics, in the hope that any change in 
the constitution, however produced, may be beneficial.” Now 
is there anything in all this of which we should be ashamed ? 
I unhesitatingly answer no; and we again arrive at a general 
conclusion, which is this : that the man most competent to 
treat rheumatism is he who believes that neither opium or 
alkalies, neither blister nor mint water can be relied upon to 
relieve and cure rheumatism, but that under certain circum- 
stances each of them can be used. Delirium tremens is of 
common occurrence. To it we will now turn our attention. 
In the consideration of this disease we find the most opposite 
views, both in regard to its causes and treatment. Is it, or is 
it not, caused by the withdrawal of alcoholic stimulants; or 
does the man about to have an attack stop drinking simply 
because he is going to have an attack ? Both sides of this 
question have been argued with much ability, and it has, after 
all, simply been decided that some cases come on when in 
the middle of a debauch, and that the sudden withdrawal of 
the alcohol has, in so many cases, been followed by no attack 
of delirium tremens, that we cannot look upon this with- 
drawal as a certain cause. The treatment of this disease at 
the present time may be considered as consisting in either the 
use of opium, digitalis, capsicum, choral, the joint exhibition 
of alcohol and opium, or the do nothing plan. Mr. Headland 
writes of opium: “In delirium tremens, and in all cases of 
delirium unattended with high fever, it may be said to be our 
sole reliance.” 
Dr. Waring says: “ In delirium tremens opium is the sheet 
anchor, but discrimination is necessary in adjusting 
combination, etc.” Dr. Aitken tells us that “ the two most 
fatal errors that can be committed in the treatment of delirium 11 
tremens, are either to bleed the patient or to give him opiate.” 
Dr. Anstie writes that in former times “ the production of 
continuous sleep for several hours was the sole and all-im- 
portant means of cure; it was, therefore, the custom to ply 
the patients with larger and larger successive doses of opium, 
with the view of drowning the delirium in narcotic stupor. 
Great mischief arose from this wide-spread belief and prac- 
tice.” Again, Mr. Jones, of Jersey, strongly recommends 
digitalis. Dr. Fraser states that all the cases he saw, in which 
digitalis was used, were unsuccessful. Dr. McCrea believes in 
leeches. Dr. Salter put his faith in sedatives, aided by stim- 
ulants, but above everything else food. Dr. Maclean “ does 
not allow the blood of a patient, already poisoned by alcohol, 
to be still further charged by the use of stimulants;” and so 
we might go on in regard to choral capsicum, and, in fact, 
every drug used in the disease ; but what does it all amount 
to? Another general conclusion that delirium tremens can- 
not be treated by one definite rule. “ Dr. Murchison advo- 
cates no special rule, his mode of treatment depending upon 
the individual character of the case ;” and what better advice 
can be given than in the words of Dr. Handheld Jones : “ From 
the above exposition, it must appear how necessary it is to 
exercise a sound discrimination in treating a case of delirium 
tremens, and how injurious any mere routine proceeding is 
likely to be.” We come, finally, to the Therapeutics of te- 
tanus. Most physicians when called to see a case, either of 
typhoid fever, delirium tremens, or rheumatism in a person of 
previous good health, feel that in regard to the prognosis, 
they have everything to hope for a favorable termination; it is 
very different with tetanus, the mere mention of this terrible 
disease fills us with alarm, and until the case we have on hand 
is thoroughly convalescent, we have not a moment’s ease.” 
In regard to the mortality of tetanus, we have the awful re- 
cord of Dr. O’Beirne, who saw two hundred cases without 
one recovery. We have Mr. Poland’s statement: “ Taking 
all forms together, in a fair average number of cases, the pro- 
portion seems to be seven deaths to one recovery.” On 
the other hand, we have Mr. Curling, who says : “ In those 
cases in which the access is slow, the spasms by no means 
violent, and where the patient can obtain sleep, whether 
traumatic or not, we may, generally, anticipate a favorable 
result.” Dr. Eben Watson, gives us thirty-three cases treated 
by Busch and Demme, with fourteen recoveries and nineteen 
deaths; and ten of his own cases, four recoveries and six 12 
deaths. Again, in regard to the pathology of this disease, 
we have those who believe it to be an essential reflex irrita- 
tion of the spinal cord, while others hold it to be primarily a 
blood poisoning. Again, in regard to the cause, what a di- 
versity of opinion ; one thing, however, is very certain, it 
does not often follow a clean cut wound, and what a blessed 
comfort this must be to the surgeon. Mr. Poland’s record in 
regard to this fact is very striking. Only one case out of one 
thousand three hundred and sixty-four followed the use of the 
sharp knife, while one out of fifty-five followed injury of the 
nerves from accident. We are compelled to agree with Sir 
Thos. Watson, when he tells us that whatever may be the 
different causes, “ that a certain predisposition is, for the most 
part, necessary to render the body susceptible of the disease 
under the operation of the exciting cause.” 
What drug should we give in Tetanus? Turn to Stille 
and Waring, and we find nearly every letter in the alphabet, 
from Aconitum Napellus to Zinci Oxidum ; turn to Sydney 
Ringer, and we find two drugs only. If we were now, instead 
of considering the treatment of individual disease, to consider 
the claim of individual remedies, I do not know what we 
could better do than subscribe to a dozen copies of Tilden’s 
Journal. Let us suppose that in any given case a correct 
diagnosis has been made, and we had determined to give a 
medicine which in similar cases has apparently been of much 
benefit, can we explain how this beneficial action is brought 
about. Quinine, in Intermittent Fever, comes as near a 
specific as any article in the Materia Medica. Now, how 
does it act ? Some tell us through the blood, others say that 
it is by its influence on the nervous system. If there are any 
two recognized authorities on Therapeutics in America, Profs. 
Wood and Stille certainly must be named. Prof. Wood tells 
us : “ The inferences deducible from these facts are, in the first 
place, that Peruvian bark acts on the system through the me- 
dium of the circulation; and, secondly, that its action is 
dynamic, that is, upon the vital properties of the parts af- 
fected, and not through any chemical combination with the 
tissues, which would otherwise retain the alkaloid.” Prof. 
Stille, with more reason gives us no explanation. Read the 
section on “ Mode of action of Cenibona and its Salts, 
that is certainly no explanation of its action. It may be said 
that it is not fair, simply to take one portion of the chapter 
on Cinchona, and that if we carefully read all that he has said 
about its Therapeutical application, we will see in what man- 13 
ncr he supposes it to act. This is true to a certain extent; 
but surely, if there was any one way in which the action of 
Cinchona could have been explained, Prof. Stille would have 
said something definite about it when he came to explain the 
“ Mode of Action of Cinchona and its Salts.” Mr. Headland 
makes Quinine a “ Restorative Hcematic.” Why, because 
Dr. Bence Jones says, “ No imagination could have anticipated 
that a certain line of research would lead to the supposition 
that man and all animals possess, in every part of the body, 
the most characteristic peculiarity of the bark of the Cin- 
chona trees of Peru.” Dr. Handfield Jones, on the contrary, 
tells us that the power of Quinine over malarial diseases de- 
pends upon its influence on the cerebro-spinal and sympathetic 
systems, and that it is certain that it does not act as a 
chemical antidote to the malarial poison. Again, Prof. Wood 
and Dr. Billing contend that Digitalis is a sedative. It is 
needless to say that a large number of writers at the present 
day hold it to be a stimulant. From these opposite views 
comes an endless discussion as to when it must be .given in 
Heart Disease, and when it must not be given. But it is 
needless to go on. Every physician who honestly endeavors 
to find out what has been written to explain the action of 
Medicine, knows what difficulties he has to contend against. 
And here let me say that the great value of Prof. Stifle’s 
work on Therapeutics consists in the fact that it is so free 
from dogmatic assertion. 
It may be asked if all is so confused and contradictory in 
Therapeutics, what good can there be in any one taking the 
trouble to study the subject? When Dr. Rogers asks: 
“ What is the cause of this absence of fixed principles in 
therapeutics,” and when Dr. Ross says “ it is a standing re- 
proach to the therapeutics of the present day that it has no 
fixed principles,” I conceive they both have erroneous ideas 
in regard to the manner in which the question of Therapeutics 
can be settled. They are both looking to the day when our 
medical knowledge will become so accurate that we will be 
able to account for all the phenomena of disease. Now I do 
not believe that day is ever coming, unless it be in the morn- 
ing when Prof. Huxley has succeeded in artificially creating 
life. What I have said contains, I well know, nothing origi- 
nal. I have quoted largely from others, and in doing so 
have purposely confined myself to those whose writings are 
of easy access to all physicians. I submit, in conclusion, the 
following propositions. I repeat they contain nothing new 14 
or original, and that most of them will be granted. What I 
wish my medical brethren of South Carolina to do is not 
simply to grant them, but to act upon them in their daily 
practice. I feel satisfied that if these views are faithfully 
carried out they would do much to banish the baneful in- 
fluence of quackery, and the disgraceful effects of the “ I31ack 
Art ” amongst regular practitioners. They would also accom- 
plish one great result for the junior members of our noble pro- 
fession. It would teach them not to be dogmatic in respect 
to treatment when a patient recovers, and not to be unduly 
depressed when a patient dies. 
1st. That in many diseases there is a natural tendency to 
recover, notwithstanding the most diverse modes of treat- 
ment, and even without any treatment at all. 
2d. That in many diseases the organic changes, incom- 
patable with life, begin so insiduously, and work so steadily 
and rapidly, that when detected we can do little or nothing 
for our patients. 
3d. That in some few diseases we have found certain reme- 
dies which, in the vast majority of cases, act so beneficially 
that we are almost justified in using the expression—cured. 
4th. That in some diseases the manifestation of functional 
derangements so far precede any radical organic change, that 
by controlling the functional derangements we can relieve the 
organ which is endangered. 
5th. That in some organic diseases, whilst we know of no 
medicine by which we can restore the organ to its normal 
condition, we do know of medicines which can so far relieve 
the distressing effects of that organic disease as to warrant 
the assertion that the patient is entitled to our therapeutical 
art, for many years of life and many hours of ease and comfort. 
6th. That in some few diseases we have, as yet, found no 
remedy which appears to offer any hope. 
7th. That no physiological or chemical theory has yet been 
advanced, in regard to the remedial powers of any one drug, 
what has received the verdict of the profession—proved. 
8th. That no one physician, however eminent his ability, 
or however large his experience, can lay down absolute rules 
for the treatment of any disease. 
A distinguished author of the present day, writing on a 
subject entirely different from the one I have chosen for this 
paper, says : “ No class of men is ever very far removed from 
the level of its own age.” I would earnestly ask, are we, as 
practising physicians, on a level of our day in regard to the which may modify the individual case before us, or do we 
simply get ourselves into the habit of looking upon certain 
symptoms, as invariably meaning a certain disease, and a cer- 
tain disease invariably calling for certain remedies ? It is 
much easier to do the one than the other ; and, thanks to a 
merciful Providence, the ignorance or dogmatism of the phy- 
sician is often undetected because the patient recovers. Nei- 
meyer, in the preface to his great work, writes as follows : 
“ This progress I attribute mainly to the fact that, of late 
years, medical explorers have recognized the only path by 
which therapeutical science can be advanced, and have fol- 
lowed it with brilliant results. My outspoken assertions of 
ten years ago have come true; I then denounced the error 
of postponing all medical treatment of disease, until our 
knowledge ot the action of medicines, and our insight into 
processes, should be so far advanced, that means of cure 
would be very evident. I pronounced this ideal goad to be 
unattainable, and declared it idle to hope for a time when a 
medical prescription would be the simple resultant of a com- 
putation of known quantities. I lamented that physicians in- 
stead of striving to promote the healing art by their own 
efforts, should seek aid from the institutes of physiology and 
pathology, or from the laboratory of the chemist, obtaining 
now and then an injurious suggestion, but never gaining an 
idea serviceable in the relief of an afflicted fellow creature.” 
I hold that Neimeyer has erred as much in one extreme as 
men like Dr. Bence Jones and Mr. Headland have erred in the 
other, and that the true and only reasonable hope for success- 
ful practice must be based on the clear recognition and frank 
acknowledgment that Physiology and Pathology, the labora- 
tory, and the carefully conducted experiment with drugs, are 
all but so many means for arriving at just conclusions in re- 
gard to the treatment of disease, and that he who ignores the 
one, or unduly exalts the other, will most assuredly misguide 
those who look to him for guidance. The man who, at the 
bed-side of the sick, puts on a grave face, and says, “ you 
are very ill, but I will cure you,” and the men who say, “ in 
this disease so many will die, and so many recover, so I will physician has to find out for himself, and in this consists the 
ability of the individual; the originality and tact of the 
physician lies in bis power to adapt his general information 
to the Special cast* before him. Let us then, each in his own 
immediate sphert work for the common good of our pro- 
fession ; and let us all remember that any case we are called 
upon to treat must stand on its own merits. We live in an 
age of progress and ceaseless intellectual excitement; no men 
need more than we physicians, that calm, sound exercise of 
reason, making us hear patiently, think deeply, and act cau- 
tiously. As there are none so low as not to claim our 
sympathy, and none so high as not to need our help, so there 
is no disease so trilling that it may not end in death, and 
none so severe that we cannot do something to relieve. 
The greatest of English poets, he whose sweet song has 
cheered so many drooping hearts, and whose noble philos- 
ophy has sustained so many faltering intellects, tells us— 
“Some turn this sickness yet might take 
Even yet. But he—what drug can make 
A withered palsy cease to shake.”