During the past summer, in response to a request made in the April and May numbers of this journal, I have been receiving from our subscribers, lists of thirty remedies each thought to be the most important. This correspondence has brought out some very interesting facts, some of which I will present in this article.
I did not intend that it be understood, that I thought any one could practice medicine at the present time, as our improved knowledge demands that we should practice it, with but thirty remedies. My desire was to know which of our remedies was considered most perfectly the representative of its group, or as adapted to a specific line of pathological indications.
From the lists returned to me, every one—100%—contained gelsemium as a nerve sedative. Ninety percent of the lists contained aconite, belladonna, and macrotys. These four remedies occurred first on seventy-five percent of the lists. Eighty-eight percent contained nux vomica, or strychnine, ipecac, and echinacea. Seventy-five percent contained bryonia, veratrum, lobelia and cactus. Sixty-five percent contained phytolacca, hyoscyamus, apocynum, and chionanthus. Fifty percent only contained pulsatilla, hydrastis, Podophyllum, digitalis, chloroform and apomorphine.
Forty percent contained crataegus, capsicum, rhus, asclepias, hydrochloric acid, boric acid, cocaine and cascara.
So truly is every physician a law to himself in this that probably not one would be perfectly satisfied with the above list. Almost every one will notice the omission of quinin and morphin. A large number would demand a more general, simple, active cathartic such as epsom salts. Many would prefer some other antiseptic to boric acid. Carbolic acid would cover a little more ground perhaps. While hydrochloric acid represents an essential acid, an alkaline remedy is just as essential, and such a remedy is omitted.
One doctor begins the list with calomel, epsom salts, Podophyllum and castor oil. He certainly entertains the idea that the intestinal tract must be kept clean.
Another physician gives us an excellent list of the alkaloids, which I consider well selected, as they represent the remedies which stand the highest on the above list. The following are the prominent ones on his list:
Aconitine, atropine, gelsemine, veratrin, bryonine, emetine, morphine, cactin, aloin, capsicin, hyoscyamine, digitalin, cocaine, quinine, strychnine, copper arsenate, ergot, codine, caffeine, podophyllum and helenin.
This list proves the statement that I made three months ago, and last month also, that the alkaloidal method is leading the regular physician into a very close relationship with our teaching and our methods.
Taking the list above as a basis, I will take the liberty to add to it thirty more remedies, classifying them all in accord with the essential conditions which the busy doctor must meet and presenting them as probably sufficient when properly learned to meet the demands of the physician in at least eighty percent of the cases he would be called upon to treat. As special fever remedies I would of course include aconite, bryonia, gelsemium, veratrum and belladonna. The latter remedy being essential, when the fever is caused by acute local congestion, not for the fever directly but for the underlying pathology, at which time it is combined with the indicated sedative. For pain, opium and its salts, dioscorea, and colocynth. For general sedatives, additional to gelsemium, macrotys, hyoscyamus, passiflora, the bromides and pulsatilla. For anesthesia general and local, chloroform and cocaine. For the heart cactus, digitalis and apocynum, the latter representing also a remedy for dropsy. For glandular and blood remedies phytolacca, Podophyllum, iris, chionanthus, echinacea and thuja.
For their action upon the mucous membranes, notably those of the bronchial tubes, and upon the skin, ipecac, turpentine, sanguinaria, lobelia, jaborandi and apomorphine. This latter is an important stomach evacuant. Then among the tonics and stimulating remedies, nux or strychnia, hydrastis, quinine and some form of iron and capsicum, phosphorus, avena, calabar bean, nitroglycerine.
There is a necessity for both acids and alkaline remedies. For the former hydrochloric acid and sulphurous acid. For the latter calcined magnesia, or sodium bicarbonate.
As an intestinal antiseptic in addition to this use made of some of the remedies named, we would suggest sodium sulphite. For bowel remedies epsom salts, and cascara. For remedies acting on the reproductive organs ergot, virburnum, mitchella.
For astringents, geranium and gallic acid.
For specific diarrheas, copper arsenates.
For general antiseptics, carbolic acid and boric acid and formalin.
As a stomach sedative, bismuth, either alone or combined with equal parts of ingluvin. As digestives, pepsin and some preparation of papaw.
For genitourinary and bladder remedies staphisagria, saw palmetto, hydrangea.
It is understood that these remedies are interchangeable in the classes in which I have placed them, several of them being well adapted to two or more of the classes. Their action may also extend beyond these classes.
I ask of every reader that he criticise this list in the severest manner, as representative of the remedies for each condition; and write me his criticisms, making suggestions for remedies to replace any one of those which I have named, and giving his reasons for so doing, also, making additions to the list as may seem to him to be demanded. This will enable us to complete a list which may be given to students or those desiring to learn our methods as the first essential remedies for study. From these remedies given, valuable compounds can be made which would add materially to our resources, if we were obliged to depend upon this list alone.
So interesting were some of the remarks that were made in the letters I have received, that I take pleasure in reproducing some of them.
Wesley Van Nette, Clyde, Ohio, says:
There is an old saying that an ingenious man can make anything with a jack-knife, but I do not like this plan. Give him a dozen good tools and how much more can he do.
It's the same with the treatment of disease. I have known doctors who prided themselves on the few remedies that they could get along with. One old M. D. said to me I can do anything with a dozen remedies. My experience teaches me that a larger variety of good remedies to select from is always of advantage if the physician thoroughly understands his remedies. I carry the largest stock I have ever seen in any physician's office, and I have no cause to regret doing so. The longer I practice medicine the more faith I have in drugs.
The objections are that so many drugs require so much more study and expense. This, of course, is true. Our business is to relieve human suffering, and the better equipped, the better prepared we are, and the more thoroughly we understand our remedies, the better is the result. It certainly takes study, and persistent, continuous, hard study if we succeed in practice. We must study every case; I don't believe that any lazy man, ever became eminent as a medical practitioner. The question should not be how few remedies can I use, but how best to fit each important condition with the exact remedy. If there is a calling under the sun, in which a man should be master of his art, it is certainly that which ministers to the ills of suffering humanity.
Dr. George H. Candlin, of Eaton, Colorado, says: Your journal is among the first I read each month and the short concise articles containing single truths as recorded by many doctors are very helpful indeed. I think THE THERAPEUTIST the greatest exponent of specific medication that we have, and it is certainly the champion enemy and eradicator of drug nihilism.
Dr. Thomas W. Musgrove, of Sultan, Wash., makes some very trite remarks, especially in favor of putting calomel first on the list. There are many of our readers who will believe that the doctor's grounds are well taken considered from his view point. In looking over his entire list of sixty remedies, he certainly has a choice list, one exceedingly well selected and one which I think would answer the purpose of many physicians who would not acknowledge themselves bound to follow Eclectic methods. Considering that word in its full meaning, it is certainly an Eclectic list.
"I have made a list of remedies as you request in the April THERAPEUTIST. I first wrote a list of sixty remedies off hand and then revised it to place the ones I use most frequently in the 30 list. You, as an orthodox Eclectic will smile at my putting calomel as No. 1. But after forty years of study and practice I am sure calomel is the first drug in the materia medica if one knows how to use it. I have learned to use it so that I have never had a case of salivation or anything approaching it in all my experience. But as you remark somewhere I have seen some horrible examples of the same. I have given calomel to patients from two days old to eighty years of age. I always adjust the size of the dose to the patient and always give bicarbonate of soda with each dose, followed by epsom salts if needed. I get delightful results from calomel since I found out how to give it. I have no prejudice against your favorite physic, podophyllum, when it is indicated. That is when the stools are dry, hard and dark. Then it is splendid. But when the stools are light, frothy or stinking, calomel and soda is the specific. Give it in broken doses, according to the size and temperament of the patient; 1/10 gr. to all ordinary children and adults every hour till 2 to 20 doses are taken—generally 10 is the maximum dose. I think you will find quite a number of regular Eclectic remedies in my list and I use many others occasionally as you would see if you read my list of 60 remedies.
I will be glad to see the list you will compile from those sent you.
Dr. Margaretha Wilkenlow, in naming her remedies for each class, says that she used carbonate of magnesia in a form of a powder for varicose veins for old stubborn tibial ulcers. She uses geranium during the course of pulmonary tuberculosis when there is hemorrhage. She uses trifolium with good results for cough and night sweats in these cases and staphysagria for excessive expectoration, and in tuberculosis of the kidney. These are certainly good suggestions.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.