New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

Page 177 text:

THE POSITION OF THE SIMILE IN THE MEDICINE OF TO-DAY BIOLOGIC BACKGROUND 'THE simile rule rests upon experiments with test animals and healthy human beings. It is most logically explained by the work of a number of German, and several English, authors, who have called attention to the widespread incidence of alternating oppositely directed phases in biologic activity. I refer to the early work of Schulz, and the more recent work of Boyd, Kotschau, Rentz, and a host of others. Early in his work-about 1882- Schulz demonstrated that it was possible to obtain diametrically opposite biologic effects from small and large doses of either organic or inorganic stimuli. From this, he reasoned that it might be possible to apply a biologically active substance to a diseased organism in such a manner as to produce a return to normal, by the use of a substance in moderate amounts, which in its intoxications would still further alter the biologic status for the worse. Schulz suggested that the effects of a substance administered in large amounts to healthy subjects, afford us a record of the particular tissues and functions upon which such a substance is capable of acting. It was a logical sequence of his experiments that small amounts would alter these same functions and tissues in an opposite direction. This alteration in effect of large and small doses is known as the Arndt-Schulz Rule, and was the first basically scientific formulation offered to explain the long known usefulness of homeopathy in the clinical field of medicine. Schulz was the first individual to observe that various phases or stages of effect could be obtained from biologic stimuli, but in producing these changes, he recognized only the influence of dosage. More recently Boyd, Kotschau, and Rentz have shown the importance of time, and many other con- ditions influencing the reactions described by Schulz. For example, Ptentz has shown that a single dose of novocaine at first narrows, and later dilates, small blood vessels. The clinician is constantly observing similar phases in disease: for example, the change from leukopenia to leukocytosis in the early stages of peritonitis, from chill to fever in pneumonia: from shock to turgor in sunstroke, and so forth. The physiologist sees a succession of rhythmically alternating events and not an isolated reaction, hyperglycemia-hypoglycemia, leukocy- tosis-leukopenia, hypertension-hypotension, vasoconstriction-vasodilatation, tachycardia-bradycardia, are simple illustrations. Again, biologic response is conditioned by the status of the tissue acted upon. Adrenalin constricts at first only the normal vessel, while in the same dose it initially dilates the traumatized. Many other elements, such as time of day, season of the year, tissue concentration, and so forth, play a positive part in responses to stimuli. One hundred seventy-eight

Page 176 text:

IT HAPPENED IN ANATOMY- . Dr. Gerlach-Describe to me the mesentery of the duodenum. Bohmer-I cant describe it but l'll draw it. Dr. Gerlach-Dat iss a goot drawink but I giff you feefty. Vat structures pierce the diaphragm? Rohmer-CI-Ie fooled me once but not againl NOTHINGI Dr. G-erlach-Excellent, I giff you zero. BACTERIOLOGY- Schwab-Give me the lid of that Petri dish, Hank. I'm ready to plant the culture. Sherwood-You don't put it on the lid, you put it on the media. Schwab-You're crazy, it belongs on the lid. Sherwood-O. K. Schwab-fAfter 15 minutesl Dr. Hotchkiss, how long does it take for the bacteria to fall from the lid on to the media? GYNECOLOGY- Dr. Silverblatt-What are the three stigmata of gonorrhea in women? Tramont-Well, I really don't think you can always blame the woman. Dr. Silverblatt-CAS the class laughsl Doctor, stigmata means signs. CHEMISTRY- Quiz Master-What are the advantages of mother's milk over cow's milk? L. Rubin-It doesn't have to be kept on ice. Sherwood-It doesn't have to be pasteurized. Reinstein-lt comes in more attractive containers. PHARMACOLOGY- Dr. Boyd-What is another name for Chorea? Kay-St. Vitus dance. Dr. Boyd-Who was St. Vitus? Kay to Sherwood-Who the hell was he? Sherwood-Buzzzzzzzzz Dr. Boyd-Well? Kay-Oh yes, he was the man who chased all the rats out of Ireland. PATHOLOGY- Miss Fisher-Dr. Speer, I've come to return my box of slides. Dr. Speer-Carl, will you please take care of Miss Fischer's box. OBSTETRICS- Dr. Yerbury-What is the first thing you ask your patient when she tells you she thinks she is pregnant? Gartner-Ask her if she had any intercourse. PHYSICAL DIAGNOSIS- Dr. Zimmerman-What are to two types of breathing? Tedesco-What? Dr. Zimmerman-What? Tedesco-What? Dr. Zimmerman to class-What did he say? Class-He says he can't hear you. Dr. Zimmerman-Oh-What are the two types of breathing? Tedesco-Oh-NORMAL AND ABNORMAL. MINOR SURGERY- Dr. I-Ierrlin-What is the first thing you do when you find a patient in shock? Burrett-You give him a whiff of chloroform. ORAL SURGERY- Dr. Mayer-What is Tic Doloreux? De Philips-Why Doctor--er it's-that is-it's a form of Neurology. H R One hundred seventy-seven

Page 178 text:

TI-IOMAS H. MCGAVACK, M. D. Associate Professor of Medicine In recognizing the various factors concerned in the production of phasic effects, homeopathy focuses upon the clinical field in medicine, and attempts so to utilize drugs and other medicinal agents that organismal activities can be depressed or furthered as the indications may suggest. Perhaps the matter becomes clearer when we say that adrenalin in usaul dosage at first con- stricts, and, shortly thereafter, dilates the bronchioles of the lung. Therefore, we use it in asthma to relieve bronchial spasm. However, if we give repeated doses in short succession, its action is manifested predominantly in the first, rather than in the second phase, and so we not only do not relieve our attack, but actually make the status of the patient worse. By way of further illustration, it is recalled that insulin in reasonable amounts increases the utilization of sugar by the tissues, but if the dosage is pushed too far, decreased metabolism supervenes. As Rentz has said, There is scarcely any biologic stimulus of any sort that has not at some time, under some conditions, produced phasic effects, which is another way of saying that under certain definite conditions almost any known biologic stimulus can be applied according to the simile rule. LIMITATIONS OF HOMEOPATI-IY Of course, the above statement does not infer that homeopathy is applic- able in every case of disease, nor in any particular case of a disease under all circumstances, or in all of its manifestations. lt does imply the possibility of utilizing any and every phase of the action of a biologic stimulus in some medical condition, according to a very definite rule-the simile. This general- ization springs logically from any deep or detailed discussion of phase action. This does not mean that it is universally applicable, that is, does not imply that homeopathy rests upon, or presupposes, an infallible basic law. It merely implies that the homeopathic rule is useful in medicine in finding a curative agent in some cases of disease. THE SIMILE AS A FINDING PRINCIPLE Perhaps a simple illustration will make clear the finding value of this rule. The characteristic features of acute amoebic dysentery are at first, loose, watery bowel movements, later containing, in addition to fecal matter, con- siderable blood and mucous. If the condition continues, nausea and vomiting of a persistent type supervene, the patient becomes dehydrated, heart and kidney damage may occur, and, very late, neuritic manifestations may ap- pear. Such a sequence of events has been produced by ipecac and also by arsenic-assuming of course, that each is administered by the proper route with due attention to size of dose, interval of administration, and total amount of drug used. In other words, arsenic and ipecac, under proper conditions, may reproduce the picture of amoebic dysentery. By simile thinking, there- fore, they should be useful in the disease. We can find them by comparing their effects with those of the disease: when similarity exists, the conditions of the simile rule are fulfilled. It is interesting to note that these two drugs form the basis of the more successful prescriptions for amoebic dysentery today. While the modus of their action remains obscure, their effects lead us to a correct therapeutic ap- plication, via simile thinking. Many further examples of drug action can be invoked, from which we can generalize that the simile is in its essence, a finding principle. The value of the rule rests entirely upon its ability to aid One hundred seventy nine