Accuracy and efficiency in homoeopathic therapeutics is only possible to those who have a clearly defined idea of the field in which the principle of *Similia is operative.
The scope of homoeopathy is a subject which has received too little consideration by teachers and practitioners alike. Hazy and confused ideas prevail. As a result we find on the one hand a few sincere but misguided enthusiasts attempting the impossible and bringing ridicule upon themselves, and on the other hand, the great majority, ignorant of the higher possibilities, missing their opportunities and bringing discredit upon themselves and their art by resorting to unhomoeopathic measures in cases which could readily be cured by homoeopathic remedies. One believes too much, the other too little. Neither one knows why he succeeds in one case and fails in another.
Haphazard cures do not justify boasting. The art of pharmaco- therapeutics in general, and of homoeopathy in particular, is not advanced by such work. What we need is clean-cut, scientific work; work capable of being rationally explained and verified; results attained by the intelligent application of a definite principle and a perfected technic in a sharply delimited field.
The therapeutic principle is known; the technique of prescribing has been developed; a large number of remedies have been prepared; but the field of action has not been clearly defined.
In this respect we are like an army which is wasting much good ammunition trying to search out a hidden enemy of whose exact location it is ignorant.
A philosophical aeroplane, sent into the upper regions of the air, may be able to locate the enemy exactly and enable us to train our guns directly upon him.
Homoeopathy as a therapeutic method is concerned primarily only with the *morbid vital processes in the living organism, which are perceptibly represented by the symptoms, irrespective of what caused them.
In defining the scope of homoeopathy it is necessary first to discriminate between disease *per se, as a morbid vital process and the material results or products in which the morbid process ultimates. With the latter, homoeopathy primarily has nothing to do. It is concerned only with disease *per se, in its primary, functional or dynamical aspect.
Disease *per se, Hahnemann says, is “nothing more than an alternation in the state of health of a healthy individual” caused by the dynamic action of external, inimical forces *upon the life principle of the living organism, making itself known only by perceptible signs and symptoms, the totality of which *represents and for all practical purposes constitutes the disease.
It becomes necessary, therefore, in homoeopathic prescribing to carefully separate the primary, functional symptoms which represent the morbid process itself, from the secondary symptoms which represent the pathological end-products of the disease.
The gross, tangible lesions and products in which disease ultimates are not the primary object of the homoeopathic prescription. We do not prescribe for the tumor which affects the patient, nor are we guided by the secondary symptoms which arise from the mere physical presence of the tumor: We prescribe for *the patient selecting and being guided by the symptoms which represent the morbid, vital process which preceded, accompanied and ultimated in the development of the tumor.
If there is doubts as to which symptoms are primary and which are secondary the history will decide. In the evolution of disease in the living organism, functional changes precede organic or structural changes. *”Function creates the organ”, is a maxim in biological and morphological science, from which it follows that *function reveals the condition of the organ.
The order in which the symptoms of a case appear, therefore, enables us to determine which are primary and which secondary, as well as to ascribe reflex symptoms to their source and correctly localize the disease.
For the homoeopathic prescriber the totality of the functional symptoms of the patient is the disease, in the sense that such symptoms constitute the only perceptible form of the disease and are the only rational basis of curative treatment. Symptoms are the outwardly perceptible signs or phenomena of internal morbid changes in the state of the previously healthy organism, and are our only means of knowing what disease is. They represent a change from a state of order to a state of disorder. When the symptoms are removed the disease ceases to exist.
These phenomena result from and represent the action upon the living organism of some external agent or influence inimical to life. With the morbific agents themselves homoeopathy primarily has no more to do than it has with the tangible products or ultimates of disease. It is taken for granted that the physician, acting in another capacity than that of a prescriber of homoeopathic medicine, will remove the causes of the disease and the obstacles to cure as far as possible before he addresses himself to the task of selecting and administering the remedy which is homoeopathic to the symptoms of the case by which the cure is to be performed.
In thus focusing attention upon the individual and purely functional side of disease upon disease *per se, the sphere of homoeopathy may be clearly perceived.
From this point of view, the most significant and general feature to be observed about the phenomena or disease is the fact of motion, action, change; change of states, forms and positions; change resulting from the application of morbific force in the living organism; change from a state of health to a state of disease; and the reverse; change of symptoms and their groupings; change of order to disorder; change of form of diseased structures; change of function; change of molecular combination and arrangement; everywhere motion, change and transformation so long as life lasts. In one word, we find ourselves in the realm of *pure dynamics. This is the true and only sphere of homoeopathy, *the sphere of vital dynamics. In fact homoeopathy might well be defined as the Science of Vital Dynamics. Its field is the field of disordered vital phenomena and functional changes in the individual patient, irrespective of the name of the disease, or of its cause. Its object is the restoration of order and harmony in vital functioning in the individual patient. Its laws are the laws of motion operating in the vital realm, which govern all vital action. Its fundamental principle is the universal principle of Mutual Action. “Action and Reaction are Equal and Opposite”.
“The unprejudiced observer”, says Hahnemann, “well aware of the futility of transcendental speculation which can receive no confirmation from experience be his power of penetration ever so great takes note of nothing in every individual disease, except the *changes in the health of the body and the mind(morbid phenomena, accidents, symptoms) which can be perceived externally by means of the senses; that is to say, he notices only the deviations from a former healthy state of the diseased individual, which are felt by the patient himself, remarked by those around him and observed by the physician. All these perceptible signs represent the disease in its whole extent, that is together they form the true and only conceivable portrait of the disease.” (Organon, par.6)
The tangible things which the examining physician finds in the body are not the disease, but merely its effects. It is as impossible, and therefore as futile, to try to find a disease in the hidden interior of the organism as it would be to try to find a thought by an exploration of the interior of the brain, the electricity in the interior of a dynamo, or the song in the throat of a bird. Such things are known only by their phenomena. Metaphysically considered, they may be said to subsist in the dynamic realm as substantial entities, or forces, but as such they are perceptible only to the “inner vision”, through the eyes of the mind. They are “spiritually (that is, mentally) discerned” The metaphysical conception serves as an aid in the interpretation of the phenomena.
Practically, however, we do not deal with abstractions. We deal with facts and phenomena, with symptoms.
“The totality of these, its symptoms, *of this outwardly reflected picture of the internal essence of disease, that is of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known (its nature and) what remedy is required.” (Organon, par. 7.)
The removal of all the perceptible symptoms or phenomena of disease removes disease itself and restores health. Hahnemann thus philosophically distinguishes between disease itself and its causes, occasions, conditions, products and phenomena, and in so doing shows clearly that the sphere of homoeopathy is limited primarily to the functional changes from which the phenomena of disease arise. In other words, homoeopathy is confined to and operative only in the sphere of vital dynamics.
Primarily homoeopathy has nothing to do with any *tangible or *physical cause, effect or product of disease although secondarily it is related to all of them. Effects of disease in morbid function and sensation may remain after the causes have been removed. Removal of the tangible products of disease, if it be too far advanced may have to be relegated to surgery. Homoeopathy deals directly only with disease itself, *the morbid vital processes manifested by perceptible symptoms, which may remain and continue after the causes have been removed and conditions changed.
It stands to reason, as Hahnemann says, that every intelligent physician, having a knowledge of rational etiology, will first remove by appropriate means, as far as possible, every exciting and maintaining cause of disease and obstacle to cure, and endeavor to establish a correct and orderly course of living for his patient, with due regard to mental and physical hygiene. Failing to do this, but little impression can be made by homoeopathic remedies, and what slight impression is made will be of short duration.
Having done this he addresses himself to the problem of finding that remedy, the symptoms of which in their nature, origin and order of development are most similar to the symptoms of the patient, and to the proper management of it, when found, as to size and frequency of doses.
While gross pathological tissue changes, organic lesions, morphological disproportions, neoplasms and the physical effects of mechanical causes are not primarily within the domain of *Similia, and therefore are not the object of homoeopathic treatment, the morbid processes from which they arise, or to which they lead, are amenable to homoeopathic medication. Homoeopathic remedies, by virtue of their power to control vital functions and increase resistance, often exercise a favorable influence upon physical developments well as upon the tangible products of disease or accident. Thus, the growth of tumors may be retarded or arrested; absorption and repair promoted, even to a total removal of the morbid product or growth; secretions and excretions may be increased or decreased; eruptions, sores and ulcers healed. But all these happy tangible results are only incidental and secondary to the real cure which takes place solely in the functional or dynamical sphere, quelling disturbance, controlling metabolism, antidoting poisons, raising resistance and bringing about cure by the dynamical influence of the symptomatically similar remedy.
Following the exclusion method adopted by Dake, in his “Therapeutic Methods,” and using a modification of his phrasing, the sphere of *Similia may be defined as follows:
1. Homoeopathy relates primarily to no affection of health where the exciting cause of disease is constantly present and operative.
2. It relates primarily to no affections of health which will, of themselves, cease after the removal of the exciting cause by physical, chemical or hygienic measures.
3. It relates primarily to no affections of health occasioned by the injury or destruction of tissues which are incapable of restoration.
4. It relates primarily to no affections of health where the vital reactive power of the organism to medicines is exhausted, obstructed or prevented.
5. It relates to no affection of health, the symptomatic likeness of which may not be perceptibly produced in the healthy organism by medical means, nor to affections in which such symptoms are not perceptible.
The class not excluded, the one in which homoeopathy is universal and paramount to all other methods, must be made up of *affections of the living organism in which perceptible symptoms exist, similar to those producible by pathogenic means, in organisms having the integrity of tissue and reactive power necessary to recovery, the exciting causes of the affections and obstacles to cure having been removed, or having ceased to be operative.
The sphere of Similia in medicine is thus limited to those morbid functional conditions and processes which result primarily from the dynamic action upon the living organism of morbific agents inimical to life.
The living organism may be acted upon or affected primarily in three ways; (1)Mechanically. (2) Chemically. (3) Dynamically. The causes of disease fall naturally under these three heads.
Under the head of mechanical causes of disease come all traumatic agencies, such a lesion, injuries and destruction of tissues resulting from physical force; morbid growths, formations and foreign substances; congenitally defective or absent organs or parts, prolapsed or displaced organs, etc. These conditions are related primarily to surgery, physical therapeutics and hygiene.
The destructive action of certain chemical poisons such as the acids and alkalies is a sufficient illustration of the chemical causes of disease, although all such agents have also secondary dynamical effects, which come within the sphere of homoeopathy. Diseases arising from these causes require the use of chemical or physiological antidotes, combined in some cases with measures for the physical expulsion of the offending substances, and followed by homoeopathic treatment for the functional derangements which remain or follow.
Entozoa or organized living animal parasites, when their presence in the body gives rise to disease, must be expelled by mechanical measures or by the administration of medicines capable of weakening or destroying them without endangering the person suffering from their presence. Dynamical treatment on homoeopathic principles may be required to remove the functional derangements and restore the patient to health.
The effects of dynamical causes of disease, by which is meant all those intangible and medicinal or toxic agents and influences which primarily disturb the vital functions of mind and body., come legitimately within the sphere of *Similia. These are very numerous, but they may be roughly classified as (1) mental or psychical, atmospheric, thermic, electric telluric and climatic, (2) dietetic, hygienic, contagious, infectious and specific the last three including all disorders arising from the use or abuse of drugs, and from all bacterial agents or pathogenic microorganisms which produce their effects through their specific toxins or alkaloids. Homoeopathy successfully treats bacterial or zymotic disease, such as cholera, yellow fever, typhus and typhoid fever, malarial fever, diphtheria, tuberculosis and pneumonia, by internal homoeopathic medicines, without resorting to bactericides, germicides or anti-septics. Such agents have their use only in the field of sanitation, which is environmental, not personal. We disinfect the typhoid patient’s excretions but not the patient himself.
Again quoting Dake’s admirable exposition, but qualifying his third proposition, and adding a fifth paragraph:
“The domain of *Similia may be reached by another route, Looking at the various drugs and other agencies capable of influencing health, and advancing, as before, by the method of exclusion, it may be said:
1. The homoeopathic law relates to no agents intended to affect the organism chemically.
2. It relates to none applied for mechanical effect simply.
3. It relates to none required in the development or support of the organism when in health.
4. It relates to none employed directly to remove or destroy the parasites which infest or prey upon the human body.
“Looking over the armamentarium of the therapeutist for agents not excluded, one class is found, namely; *those agents which affect the organism as to health in ways not governed by chemistry, mechanics, or hygiene, but those capable of producing ailments similar to those found in the sick”.
In regard to Dake’s third proposition it can and will be shown that, inasmuch as the development and support of the organism when in health depends upon the principle of *assimilation as demonstrated by Fincke, the principle of *Similia does relate to these processed; for assimilation depends upon mutual action, upon action and reaction, and this is the fundamental principle of homoeopathy.
To the foregoing proposition as formulated by Dake one more should be added.
5. The homeopathic law relates to no agents or drugs administered for their direct or so-called physiological effects.
Circumstances arise occasionally which make it necessary, temporarily, for the homoeopathic physician to use drugs in “physiological” (really, pathogenic) doses for their palliative effect. Although the ruling principle of his medical life is *cure by symptom-similarity, and that end is always held in view as an ideal, he is not thereby forbidden the use of palliative measures in cases where they are appropriate and necessary.
Hahnemann, after showing the futility of antipathic medication as a curative method, and pointing out the dangers incidental to its use, admits the utility and necessity of resorting to palliation in certain emergencies. In a note to Paragraph 67, he says:
“Only in the most urgent cases, where danger to life and imminent death allow no time for the action of a homoeopathic remedy-not hours, sometimes not even quarter hours and scarcely minutes in sudden accidents occurring to previously healthy individuals-for example, in asphyxia and suspended animation from lightning, from suffocation, freezing, drowning, etc.- It is admissible and judicious at all events as a preliminary measure, to stimulate the irritability and sensibility (the physical life) with a palliative, as for instance, with gentle electric shocks, with clysters of strong coffee, with a stimulating odor, gradual application of heat, etc. When this stimulation is effected, the play of vital organs goes on again in its former healthy manner, for there is here no disease to be removed, but merely an obstruction and suppression of the healthy vital force. To this category belong various antidotes to sudden poisonings; alkalies for mineral acids, hepar sulphuris for metallic poisons, coffee and camphor (and ipecacuanha) for poisoning by opium, etc.”
The principle of palliation is here recognized and a few illustrations given of its legitimate application in one class of cases. If it is noted that all these illustrative case are characterized by *shock or collapse, it will be seen that the principle has a somewhat wider application than appears on first consideration of the cases enumerated by Hahnemann. It may fairly be extended, for example, to cover, certain cases where sudden and unendurable pain occurs and collapse is threatened by such semi-mechanical conditions as the presence or passage of renal calculi and gravel, or biliary concretions. In exceptional cases of these and similar conditions, analgesics may be used temporarily as anaesthetics are used in surgical and dental operations, and for the same purpose, that is to prevent or relieve shock.
When all has been said and the scope of homoeopathy has been defined as clearly as possible it is evident that there is a border-land between homoeopathy and its related sciences around which it is impossible to draw sharp lines of demarcation. In this region each physician must be governed by his own individual judgment and the circumstances of the case. It follows that there will always be differences of opinion between individual physicians under such circumstances. The physician who is imbued with the spirit of homoeopathy endeavors always to keep his mind open and free from prejudice. While striving always to perfect his knowledge of homoeopathic technic in order that he may meet any emergency and extend the borders of his art to the farthest limits, he never forgets that the necessities and the welfare of his patient are first. He will not allow either pride or prejudice to obscure his sense of his own limitations, nor those of his art. Circumstances sometimes arise when the strongest man and ablest prescriber, by reason of the great moral pressure brought to bear upon him by the peculiarities of his patient of the environment, or from lack of time, will be compelled to tide over a period of unendurable suffering by the use of analgesics, or of some other measure to meet extraordinary emergencies. He does this as a charitable concession to the weakness of human nature, his own perhaps as well as others, without in the least degree lowering his standards, or bringing discredit upon himself or his art. He does this knowing, perhaps, that if he had time and the circumstances permitted, he could do better. But time and circumstances are sometimes, at least temporarily, beyond his control. It is possible to violate the *spirit by adhering too closely to the *letter of the law. Victory is sometimes gained by appearing to yield, which is quite in accord with the principle of *Similia, a sort of moral homoeopathy. A strategic retreat to another line of defense in war often gives a stronger base from which to lunch a successful attack.
In cases of renal or hepatic colic, for example; If the physician is firm and calm as well as skilful, and possesses the entire confidence of the patient and his family and friends, he may be able to alleviate the agonizing pain and carry such cases through to a happy termination by the use of homoeopathic remedies alone. It has often been done and when possible is the ideal way.
But the physician may have been newly called to the case or family and not have had time to gain their complete confidence by the results of his work and teaching.Patients have to be educated in the principles and methods of homoeopathy by discussion, instruction and demonstration, and this requires time. When they have felt or witnessed the results of competent homoeopathic prescribing they acquire confidence. Some become enthusiastic advocates and propagandists of homoeopathy, and are always ready to uphold and cooperate with their physician in demonstrating its methods even in the gravest emergencies. Others are interested only in quick results, caring little or nothing about how they are obtained. the latter are very difficult to hold in such cases and some of them will not continue with the conscientious homoeopathician, no matter what he does. Between these two classes exists a third, the members of which can be interested in homoeopathy to a degree that will enable the practitioner to hold them as patients and retain their confidence and cooperation in homoeopathic treatment in all but extreme cases. It is in such cases that the pressure referred to will be brought to bear upon him, and he may be compelled to resort temporarily to palliation to gain time and strengthen his position. Unless he can do this there is but one honorable course left for him to pursue-resign the case and withdraw. In pursuing either of those courses the conscientious practitioner is beyond the criticism of all fair- minded persons. But he is always open and frequently subjected to the attacks of prejudice, bigotry and jealousy, and to these the best defense is silence and a clear conscience.