554 



MEDICAL SCIENCE AND PRACTICE. 



the treatment of symptoms that is, of the 

 cough ; the latter is the treatment of the essen- 

 tial disease, by improving the constitutional 

 powers. There can be no doubt of the value 

 of the one-drug treatment of disease, nor that 

 it is strictly scientific and has largely contrib- 

 uted to the advance of therapeutics. It is es- 

 sentially the definite basis of therapeutics, and, 

 in appropriate cases, gives the chief successes 

 of medicine. But where disease is a complex 

 condition, the treatment must also be complex ; 

 and, even where a single cause can be defined, 

 its effects and results give to the affection a 

 complex character. 



Improvement in the methods of treatment 

 of the insane has been manifested in the dis- 

 carding of the system of mechanical restraint, 

 and the substitution of judicious mental con- 

 trol ; in the tendency to prefer for all classes 

 of patients public to private institutions, which 

 is illustrated by a bill that was introduced into 

 the British Parliament in 1881, to facilitate 

 the extension of the privileges of the public 

 institutions to private patients ; and in the in- 

 creasing esteem with which the treatment of 

 lunatics in private families is regarded. 



The essential aim of therapeutics may be 

 stated as being the induction of a physiolog- 

 ical process for the remedy of disease. The 

 more nearly this induced process assumes a 

 definite chemical or dynamic form, the more 

 positive and direct is its action; and recent 

 advance has greatly tended toward the state- 

 ment of many therapeutical problems in chem- 

 ical or mechanical terms. At the same time, 

 the influence of the nervous system is so con- 

 stant and direct in every process of the body, 

 that these problems must always be distinctly 

 physiological, and can not be stated as purely 

 chemical or mechanical. The nervous element 

 is, however, neutralized as an interrupting ele- 

 ment, in many cases, by its very constancy, 

 by reason of which it is present alike on either 

 side of the equation, both in cause and effect. 

 But if therapeutics has been thus simplified 

 in one direction, it has made use of more com- 

 plicated physiological processes in another di- 

 rection. Some of its most certain and remark- 

 able effects are obtained by acting upon the 

 nerve-centers in the brain and spinal cord, 

 by which these effects are normally induced. 

 Nervous influence is thus subordinated to, in 

 place of disturbing, the therapeutic plans. 

 Very striking in this connection are the re- 

 sults obtained by the precisely localized and 

 measured action of heat and cold upon the 

 central nervous system. 



The growing identification of therapeutics 

 with physiology is also seen in the hygienic 

 treatment of disease. Not only are hygienic 

 measures used for general purposes of advan- 

 tage, but distinct applications of hygiene are 

 employed for a distinct physiological effect. 

 Schemes of dietetics, for instance, are not only 

 nsed with negative precautionary aims, but 

 with positive remedial intentions. By the 



prevalence of certain climatic conditions, nat- 

 ural or artificial, physiological states of the 

 body are induced, and may be calculated upon 

 as distinctly curative. Exercise may be so or- 

 dered that particular secretions and" processes 

 shall be stimulated, while others are unaffected. 

 This mode of treatment has largely displaced 

 the use of drugs, and has greatly diminished 

 the expectation of specifics, if not the desire 

 for them. 



The advance of chemistry has produced 

 some new remedies of importance, which have 

 not, however, been derived from the organic 

 side of the science. No connection has been 

 traced between the chemical composition of 

 the essential principle of a secretion and a 

 chemical remedy ; and while chemical stimu- 

 lants and depressants have been demonstrated 

 for every organ, their action has not been 

 explained by any law of chemical or physical 

 constitution. The rule established by Rabu- 

 teau, that the therapeutic energy of soluble 

 metallic salts is in direct ratio with the atomic 

 weight of the metal contained in the salt, sug- 

 gests probabilities of the enunciation of such 

 laws in the future. 



The relation of electricity and disease has 

 been well investigated ; a precise code of elec- 

 tro-therapeutics has been established, and clear 

 results of considerable value have been ob- 

 tained ; but it can not be said that electricity 

 has been as successfully applied in the reme- 

 dial as in the diagnostic section, and a feeling 

 of disappointment in regard to its influence 

 on disease has been produced. 



Important advance has been made in the 

 principles of the administration of drugs, es- 

 pecially in the matter of their application to 

 the part they are designed to affect as directly 

 as possible. By the subcutaneous injection of 

 the active principle of drugs, the effect is more 

 localized and less constitutional disturbance is 

 produced than when the administration is by 

 the mouth. Moreover, the remedy acts more 

 quickly, and enters sooner into the general 

 circulation ; and the risk of decomposition be- 

 fore absorption, which is incurred by admixt- 

 ure with the digestive fluids, is avoided. The 

 method of direct application is also exempli- 

 fied in the inhalation of suitable substances by 

 smoking in a pipe or cigar. So much doubt 

 has been cast by physiology upon the absorb- 

 ing power of the skin, that external treatment 

 by lotions and ointments has been greatly re- 

 stricted. 



Special study has been given to the employ- 

 ment of anaesthetics. A considerable number 

 of substances have been used more or less ex- 

 tensively, and their physiological effects have 

 been closely compared. A smaller quantity of 

 the inhalent has been found to be sufficient, 

 and happier results in view of the slight dan- 

 ger to life incurred in ordinary inhalations 

 have been obtained by the method of "mixed 

 narcosis," or the subcutaneous injection of 

 narcotics before the administration of the in- 



