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

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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

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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

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us in arriving at useful therapeutic procedures: and not at all upon its phil- osophical attractiveness. Such value is fully attested in the common practices of medicine today, 'for instance, the administration, under proper conditions, of iodine in exophthalmic goitre: the same drug in certain forms of syphilis: phosphorus in human rickets: mercury and other heavy metals in lues Cparen- thetically, it may be said that bismuth has been employed more than one hundred years in this disease by those familiar with simile thinkinql: the snake venoms in the purpuras associated with thrombocytopenia: latrodectus mac- tans in angina pectoris: quinine in malaria: sulphur in arthritis: the same remedy in furunculosis: and so forth. THE INDICATION S F OR PRESCRIPTIONS ACCORDING TO THE SIMILE lt is a common misconception that subjective symptoms are used entirely for the selection of remedial agents according to the simile rule. That con- ception has undoubtedly arisen from the necessity of stressing subjective phenomena, in the early days of homeopathic practice. At that time there was an almost total absence of any knowledge of the basic sciences of the medical art. In the medicine of today, however, we may find our remedy by atten- tion to etiologic factors, anatomicopathologic Cstructurall variations, physiolog- ico-pathologic Cfunctionall alterations, prognostic indications, and so forth. Etiologic considerations bring us homeopathically to the use of vaccines, to the application of allergens, to the employment of more or less specific anti- gens, and so forth. Indeed, one might at least theoretically suggest that Ien- ner's small pox vaccine could have come about entirely by simple thinking In actuality, Ienner observed that dairy maids rarely developed small pox. By simile thinking, we may observe the great similarity existing between intox- ications of cow pox virus in human beings lvaccinial, and the manifestations of the disease, small pox, against which it protects. The etiologic applica- tions of the simile will perhaps remain its most accurate and effective usages, but they do not detract from the value of prescriptions made on other indi- cations. Anatomico-pathologic Cstructurall changes in disease are often helpful guides in applying the simile. For example, some centuries ago, it was learned empirically that mercury was useful in treating the dreaded scourge, syphilis. More recently, experiments have actually shown that mercury produces all the structural changes of syphilis. Moreover, the chronic inttx- ications from it show a predilection for all structures of the body in somewhat the same frequency as is to be observed from the ravages of the spirocheta pallida. W Again, the structural changes taking place in the kidney in uranium nitrate poisoning prove conclusively that the drug can never be useful in glycosuria due to pancreatic disease: but only in that of kidney dysfunction. Pathologico-physiologic manifestations may also offer indications for simile thinking. The influence of iodine upon the thyroid gland are well known and, without some degree of disturbance in that organ, rarely will iodine be useful in disturbances of sugar metabolism. lt is quite true that many thera- peutic procedures which coulcl have been reached by simile thinking have actually been determined in other ways: as, for example, by antipathic, allo- pathic, or heteropathic reasoning. Let us approach the therapeutic problem of One hundred eighty