IN the April number, 1884, of the Homoeopathic World, there appeared the following communication to the Editor :.
DR. SKINNER ON M. PASTEURS HOMOEOPATHY.
Dear Sir,-If the italicized is not Homoeopathy, what is it ?.
Thos. Skinner, M.D.
M. PASTEURS EXPERIMENTS.
M. Pasteur made an interesting communication to the Paris Academy of science on Monday in relation to canine madness. His experiments had shown him that an injection in the region of the skull of the virus of rabies always produced the malady in an acute form, but that an injection in the veins only occasionally had acute results, being often followed by chronic infection only, without barking or ferocity.
If a dog were inoculated with fragments of marrow or of nerve taken from a mad dog, the disease would be communicated. M. Pasteur further stated that he had rendered twenty dogs proof against the disease by inoculating them with other virus than the virus of rabies. Fowls and pigeons injected with the latter became affected, but recovered spontaneously.
“If the italicized is not Homoeopathy, what is it ?” Just so, what is it?.
I think a little reflection will show that it belongs in the sphere of preventive medicine, and is not Homoeopathy, i.e. it is an extension of the principle of similars to the prevention of disease.
Many other ardent homoeopaths besides Dr. Skinner have claimed that vaccination is a proof of the truth of homoeopathy; that it is, in fact, part and parcel of it. Evidently this is from the want of a little thought on the subject, since it must be manifest that such is quite impossible, for the simple reason that homoeopathy is a system of curing-similia similibus curantur-whereas vaccination is not a curative measure at all, but a preventive one.
And since prevention is, admittedly, better than cure, it must follow that it cannot be the same; therefore vaccination is not homoeopathy, though I shall suggest that it might fitly be termed Homoeoprophylaxis, inasmuch as vaccinia and variola are similar pustular diseases, and the former being preventive of the latter, it may be in obedience to the principle-LIKE PREVENTS LIKE. Being a question of prophylaxis it cannot be classed in any system of cure.
And that likes are prevented by likes, I could adduce very many examples to show, did the narrow limits of this little treatise admit of it. Here it must suffice to differentiate between homoeopathy and homoeoprophylaxis, and to endeavour in a very general way to study a little the true nature of the latter as exemplified in vaccination and analogous facts such as Pasteurs inoculations.
Giving a variolous patient vaccine pus, or lymph (vaccininum) wherewith to cure his small-pox, that is Homoeopathy, and we have ample testimony that it will thus act if given in refracted dose, and thus acting, it can hardly be other than homoeopathic in such action. The law of similars is the groundwork of both; in the one case to prevent, and in the other to cure.
M. Pasteur and others, by their inoculations, are empirically labouring to extend homoeoprophylaxis in the line indicated by Jennerian vaccination, or rather it is a revival of the old inoculation for small-pox, and on a line with syphilization.
We are here met by the dose question, just the same as we are in homoeopathy, or the treatment of disease by the light of the law of like. By the clear light of this same law will preventive medicine also have to march.
But the dose ?.
Jennerian vaccination is in accordance with the principle of homoeoprophylaxis, though only enunciated as an empyric fact by Jenner, and ever since practised as such. Pasteur gets, perhaps, a little farther by advancing along the line of “cultivating”; One cannot help wondering, however, how much pasteur knows of isopathy and of homoeopathy. We will return to M. Pasteurs experiments presently.
THE prevention of disease according to the law of similars – homoeoprophylaxis – is still struggling with its swaddling clothes, but we may reflect on the following:-.
Two similar diseases will affect the organism similarly; they will affect the same parts,organs, or tissues, and in a like manner.
If we call the two diseases a and b, and the organism O, then if a fall upon O, and affect it positively (positive effect = c), this effect of a upon O, c, will be like the effect of b (=d), for a and b are alike.
Now if we admit that the similarity between a and b is enough to render them effectively equal, potentially congruent, then we should say a=b, and therefore c=d. Consequently O+a = O+b, and O+c = O+d.
That is the question for the solution of which we must appeal to scientific experiment, both at the bedside and in the laboratory, as well as to abstract reasoning.
It has frequently appeared to the writer that time and quantity (dose), are not duly reckoned with in the question of the efficacy or inefficacy of Jennerian vaccination; and Pasteur seems also to lose sight of both factors in his own experiments. The great mass of medical men firmly believe that vaccination protects against variola; and, that vaccinia and variola are ALIKE is quite certain; it is only the degree of the likeness that can be subject of dispute, for both are pyrexial pustular diseases.
Statistics of a number of years, nevertheless, show that variola is, in the aggregate, about as deadly as ever, allowing for a natural decrease in its vis by age; this cannot be controverted, so much must be conceded to the anti-vaccinators.
And yet, given groups of individuals are evidently protected for the time from variola by vaccination, and the more recent the vaccinia the greater the temporary protection, provided the effect of the vaccination be not too great, in which case there will be a homoeoprophylactic aggravation, and then there will not only be no protective power, but on the contrary the vaccination will be predisposed to it, i.e. instead of a positive and a negative eliminating one another we shall have two positives to be added together.
Let us express the difference between a vaccinated and an unvaccinated individual by the algebraic quantity x. Now, what is the nature of x? Is it positive or negative? Quoad perfect health is negative, but quoad the organismic individual it is positive, if a diseased condition can be said to be a positive one.
To begin with, it is inconceivable that x should be a CONSTANT FACTOR, which is evidently the general assumption; it must be always a lessening quantity, and x might thus be initially congruent with variola, while it may be at any subsequent point be incongruous.
This really expresses the sum of human experience on the question of the efficacy or inefficacy of jennerian vaccination, though it is it not apprehended; whence the cry for re-vaccination coup sur coup on the one hand, and the want of faith in vaccination on the other, both positive being readily comprehensible if the effect of vaccination be recognized as an inconstant factor.
And from these considerations it must be manifested that the protection afforded by vaccination will be different in different individuals, and diminishingly different in the same individual, and always growing less and less until it is nil. Thus x might today be preventively equal to variola in an endemic form, but not equal to it in epidemic form, but not equal to it in epidemic form. In other words the protection afforded by x is relative and contingent. Moreover, if the vaccinosis be too great i.e., too powerfully diseasing, it not only cannot protect, but must actually add fuel to the flames.
We thus appear to arrive at the conclusion that vaccination does relatively and contingently protect from small pox as a disease, but nevertheless, mortality from small-pox remains in the aggregate the same, but in a greater percentage. That is to say, fewer people probably get small-pox but the absolute number of deaths is not affected, or is greater.
In pro-vaccinational and anti-vaccinational literature, morbility and mortality are commonly confounded together. We have no means of knowing how many people get small-pox, either absolutely or proportionately, we only know how many die of it. Therefore all the vaccination statistics are wide of the mark except perhaps those in certain hospitals.
The pro-vaccinators maintain that vaccination protects from variola, because they see that, as a general rule, the vaccinated do not get small-pox. The anti-vaccinationists say, “Oh! but a good many of your vaccinated persons do get small-pox nevertheless, and the mortality from small-pox is as greater as ever, or greater than ever!” Both sides are honest; both are apparently dealing with facts; both are striving after truth, and collectively they spend enough human energy to enrich a nation or colonize a continue. Where then is the missing link?.
While writing this, an ardent bacterist, Dr. H. Thomas of Llandudno, very kindly sends me a clipping from the Athenaeum of March 15th, 1884. It runs thus:.
M. Pasteur and his fellow labourers communicated to the Academic des Sciences on the 9th of February the important fact that by inoculation with the virus taken from mad dogs they can render all dogs absolutely safe from the effects of rabies, in whatever way and in whatever quantity the virus may be administered.
This is the same fact referred to by Dr. Skinner farther back. .
But we find no principle enunciated ++here by the Athenaeum; nevertheless, the results must be in obedience to the law of similars in prophylactics – homoeoprophylaxis.
Here M. Pasteur and his fellow-workers, just the same as the Jennerian vaccinators, and the anti-vaccinators-here, I say, they practically ignore the element time, and the altering nature of the protection. When people speak of “the necessity of re- vaccination, because vaccination loses its effect”, time is roughly reckoned with, but an arbitrary limit is set entirely devoid of any scientific basis.
On the other hand it has been often noticed that a healthy person gets variola soon after vaccination, which to my mind militates in no wise against a belief in the protective power of vaccination, but is to be interpreted as meaning that the vaccinial infection was more than enough; just the same as a little Aconite will lessen feverishness, while much Aconite will make the feverishness worse.
Continuing now to let x stand for the difference between a vaccinated and a non-vaccinate, we must keep well before our minds that x represents the remaining effects of a disease – vaccinosis and this is not a constant quantity; in an otherwise healthy person it must be continually growing less and less, and finally become extinct.
Therefore to determine whether vaccination protects against variola or not, we must first have the date of the vaccination in each case of varioloid or small- pox in the vaccinate. Were a considerable number of such cases tabulated, we might arrive at some idea as to how long a given vaccination continues to affect the individual sufficiently for the vaccinosis to leave no room for variola, provided always that the vaccinations were unipotential.
IS IT POSSIBLE FOR VACCINATION TO BE CONTINGENTLY EFFECTIVE, AND YET FOR THE MORTALITY FROM SMALL-POX TO BE GREATER?.
This question crops up and presents itself to ones mind thus: Vaccination protects from variola say the vaccinators.
Quoth the anti-vaccinators – That is impossible, because some of those who have been vaccinated do get variola, and the mortality from variola has actually increased, so where is the prevention?.
How can these things be?.
Let us ponder these points. And first of all let us not confound morbility with mortality. We really want three words to express our meaning well. Firstly, mortality , or the number of deaths; secondly morbidity, or the quantity of ill-health of the living; and thirdly morbility, or the number of those who actually take a given disease. I ask forgiveness for this word- coining; no one need use the words if they are useless or objectionable, but it seems to me that these three ideas must be accurately expressed if we are to adequately discuss the question.
In judging of the ill-effects of vaccination, only the mortality is considered as a general rule by the pro-vaccinists. By giving attention to the vaccinational morbidity (the vaccinosis of this little treatise), I have been enabled to do some notably good clinical work, and I put the facts observed before the world as a duty, and really unwillingly, as I am sure to be much misunderstood, but that cannot be helped, and besides I am now wandering away from my text.
Before we can scientifically reckon with vaccination we must take accurate account of the morbility, as well as of the mortality and morbidity. The practical physician alone has the necessary scope for making observation in respect of the morbidity arising from vaccination, i.e., vaccinosis. Unfortunately it is completely ignored as a general rule.
Any statistician can observe and arrange the facts relating to its morbidity, and the Registrar General might be got to deal with them as he does with those relating to mortality. But, I must submit that mortality statistics alone without morbility statistics cannot possibly lead to any real settlement of the vaccination question, for we want to know not only how many die of small-pox, but also how many get it and get over it.
Herein, it seems to me. lies the kernel of the nut.
And not only do we want to know how many get small-pox and recover, and how many get it and die of it, but also what is the morbidity of those protected by the vaccination.
What is the ordinary liability of the perfectly healthy to catch small-pox, i.e., what is their prospective morbility, morbidity, and mortality?.
Assuming that vaccination does protect, relatively and contingently, what do we pay for the protection, not in money, but in vaccinial morbidity, or vaccinosis?.
It seems to me probable that ordinary Jennerian vaccination is not efficiently protective in those whose proneness to catch small-pox is very great, while it is efficiently protective where the proneness to catch small-pox is less.
If we reflect upon this for a while we shall see that there is nothing unreasonable in this proposition.
The unvaccinated are not equally prone to catch small-pox; we vaccinate them all alike.
Now is it even conceivable that the vaccination has rendered them equally immune, when some of the unvaccinated were already immune?.
My line of argument here stands thus :- Vaccination is preventive of small-pox, when the proneness to catch it is small; and when the proneness to catch it is small, those who do get small-pox do not die of it, therefore vaccination affects the morbility rather than the mortality of small-pox. I refer to the ordinary Jennerian vaccination, and not to microscopic homoeoprophylaxis.
If I am right then we can affirm on aphoristic grounds that ordinary microscopic vaccination will diminish the morbility but increase the mortality, i.e., fewer will get it, but more will die: the mortality will be greater.
Vaccination is a homoeopathic diseasing measure; one disease is given to prevent a like one-vaccinia to prevent variola. If the diseasing process of vaccination fail to protect, then the vaccinated person will be more likely to die because there is the homoeoprophylactic aggravation: the two diseases combine to kill the patient just the same as too much of the homoeopathic remedy will aggravate the disease to which it is highly homoeopathic: with, perhaps, the like result.
This is manifest, for in vaccinating a person we are diseasing him; we communicate vaccinosis to him: if he, in addition to the vaccinosis, now get small-pox he is more likely to die the worse he has the vaccinosis.
If y represent the prospective mortality of the unvaccinated and x the difference between the vaccinated and the unvaccinated, i.e., vaccinosis, then the chances of dying of the vaccinated person who gets small-pox are y + x.
DYNAMIC OR MICROSCOPIC HOMOEOPROPHYLAXIS.
WHEN In began with this little essay I meant it to be on the one hand a contribution to the clinical history on Thuja occidentalis, and on the other hand a plea for the recognition of the clinical importance of vaccinosis, particularly in chronic neurotic headaches. But as I went on I felt impelled to say a few words on the subject of what I have called homoeoprophylaxis, and now I cannot bring myself to concluded without dipping a little into the dynamics of preventive medicine according to the law of likes.
Strewn about in literature there are examples of small dose homoeoprophylaxis; see Hahnemannian homoeopathy.
Then vaccine “lymph”-pus-has been dynamized more homoeopathic and given as a prophylactic against small-pox in epidemic times, and apparently with effect. Thuja occidentalis has been used in like manner by more than one homoeopathic practitioner, and they claim that it is effective. The eminent Dr. David Wilson of London, has, I hear, long used Thuja, in dynamic dose, as a sure preventive of variola.
Speaking for myself, I have for the last nine years been in the habit of using vaccine matter, in the thirtieth homoeopathic centesimal potency, whenever small-pox was about, and I have thus far not seen anyone so treated get variola.
Dr. Masoto inoculated the diphtheritic exudation in an epidemic of diphtheria, and that with success.
It seems to me that the requirement of the age is to systematize the prevention of disease according to the law of similar, AND IN DYNAMIC DOSE. Clearly the dynamic dose is essential, or at any rate the very small dose, for otherwise the homoeoprophylactic aggravation would be a serious detriment in every way. It is easy to see that M. Pasteur and his fellow workers are sailing down straight on this rock, whereon they are sure to suffer shipwreck. .
M. Pasteurs latest communications to the Academie des Sciences are as follows:.
“If the virus of rabies be transmitted from the dog to the monkey, and then from monkey to monkey, it will be found that after each transmission the virulence of the virus had become enfeebled. If the virus thus enfeebled be transmitted to a dog, or an animal of that species, it will remain still attenuated. By a few transmission of the virus from monkey o monkey, there can easily be obtained a virus so attenuated as shall never communicated by obtained a virus so attenuated as shall never communicated by hypodermic inoculations, the disease to a dog.
Inoculations by trepanning of such virus will likewise produce no result; but an animal will, notwithstanding, be rendered perfectly proof against the disease. The virulence of the virus becomes, on the contrary, augmented in its passage from rabbit to rabbit. If a dog be inoculated with virus thus augmented in power, a far more intense form of the disease will be manifested than that apparent in ordinary canine madness, and will invariably prove fatal”.
By applying these and other observations, M. Pasture obtained virus of different degrees of virulence, and succeeded, by inoculations of the milder qualities, in preserving animals from the effects of more active and mortal kinds. For example, after several days longer than the shortest incubation term, M. Pasteur extracted virus from the head of a rabbit which had died of the diseases, and inoculated successively two other rabbits.
Each time a dog was inoculated with the virus, which, as had been seen, would increase each time in virulence. The result was that the dog was ultimately rendered capable of bearing a virus of mortal strength, and became absolutely proof against canine virus. M. Pasteur anticipates that the time is still distant when canine madness will be extinguished by vaccination, but pending that consummation,he feels pretty certain that he will be able to avert the consequences of a bite from a mad dog. He says:.
“Thanks to the duration of incubation after a bite, I have every reason to believe that patients can be rendered insusceptible before the mortal malady had had time to declare itself.” M. Pasteur states, in conclusion, that he had solicited the Minister of Education to appoint a Commission to test his experiments. He added:.
“The principal experiment that I shall attempt will consist in taking from my kennels twenty dogs insusceptible to the disease, and placing the same in comparison with twenty ordinary dogs. I shall then have all these forty dogs bitten by a number of dogs in rabid state. If the facts that I have enunciated are exact, the twenty dogs that I believe to be proof against the disease will remain healthy, while the other twenty will become affected.
For a second experiment no less decisive, I propose to place before the Commission twenty vaccinate and twenty vaccinated dogs. All the forty I shall then inoculate in the most sensitive parts with virus taken from a rabid dog. The twenty vaccinated dogs will resist, and the other twenty will all die of madness, either paralytic or furious”.
That is as far as M. Pasteur has got a present, and his labours clearly tend in the direction of homoeoprophylaxis and homoeopathy; but time and dose are not duly reckoned with. The fatal fallacy underlying the whole thing is regarding the immunity produced by Jennerian or Pasteurian vaccination as a constant factor whereas it is a constantly diminishing one, and must, in thee nature of things, be so.
As a last word I would put on a plea for homoeoprophylactic vaccination, or what might be termed homoeopathic vaccination, That is to say, the vaccine matter is to be prepared as a homoeopathic remedy, and to be given but he poisoning a series of animals is ridiculous; an ordinary vial will do just as well. It is with virus thus attenuated that I used to treat myself when I was attending small-pox instead of being revaccinated. I used to treat my family and others with whom I was compelled to associate in the same way. None of us ever took small-pox.