It is an objection often urged against Homoeopathy, that, as a system of therapeutics, it dispenses with the necessity for diagnosis. The objection is unfounded. For all purposes of prognosis and hygienic management, we have as great need of diagnosis as our brethren of the old practice. And so we have in prescribing. We profess to prescribe according to the “totality of the symptoms.” But by this we are far from meaning to imply that each symptom is considered and prescribed for, independently of all the other symptoms. On the contrary, while on the one hand, every symptom must be taken into consideration as indispensable to a true “picture of the disease,” and hence, in this view, no one symptom can be said to be less important than another; yet, on the other hand, the symptoms vary among themselves in rank. Some are primary or idiopathic, others are reflex or sympathetic. The latter are as important to a “picture of the disease” as the former, but they are important not simply as symptoms, but as sympathetic symptoms. Now, to form a diagnosis is to distinguish from among the whole number of symptoms, the idiopathic and sympathetic symptoms, to attribute each symptom, whether idiopathic or sympathetic, to the organ or tissue which is in reality its seat, and to form a just notion of the pathological condition of that organ or tissue. That it is necessary for us to make such a diagnosis before prescribing, follows at once from the rationale of a homoeopathic prescription.
The homoeopathic practitioner having got “a picture of the disease he is about to treat”, i.e., having got the “totality of the symptoms,” proceeds to compare this picture with the pathogenesis of various drugs. Now, these pathogeneses are themselves “pictures of disease;” they are symptoms of drug-disease. As such, they are divisible into idiopathic and sympathetic symptoms; the organs, or tissues, in which they have their seat, and the pathological conditions of these organs, may be various. In seeking a drug whose symptoms shall correspond most nearly to those of the disease to be treated, it is evidently necessary to seek a drug, the idiopathic symptoms of which shall correspond to the idiopathic symptoms of the disease and the sympathetic to the sympathetic; a drug, too, whose symptoms of either variety shall have the same seat as the analogous symptoms of the disease, and shall result from a similar pathological condition. But we cannot select this drug without having previously formed a diagnosis, not merely of the disease to be treated, but also of the various drug-diseases or pathogeneses that constitute our Materia Medica.
This necessity may be illustrated by a reference to errors into which a neglect of it leads us. Spontaneous vomiting of bile by a child may be an idiopathic symptoms indicating abdominal derangement; or, it may be merely sympathetic of cerebral disturbance. Several drugs produce vomiting of bile; some directly or idiopathically, by affecting the digestive organs; others, by a reflex or sympathetic action, their primary action being on the nervous centers. According to our diagnosis of the disease in the child, and of the drug-disease, we should give under the one view, Nux vomica, Ipecacuanha, or their analogues; or, under the other, Belladonna.
Again, depraved appetite, convulsive movements, distorted vision, a peculiar aspect of distress, may be the idiopathic expression of disorder in the nervous centers, or may be sympathetic with irritation produced by entozoa. In the one case we should select a remedy which affects the nervous centers idiopathically, as Belladonna or its analogues; and in the other a remedy which acts idiopathically on the vegetative sphere, and affects the nervous centers sympathetically, as Cina. Neglect to distinguish between these varieties of symptoms has led compliers of manuals to recommend Cina in hydrocephalus.
Moreover, it is requisite to determine the seat of the symptoms, both in the disease and in the pathogenesis. Pain and tenderness in the right iliac region, with local heat and fever, may have their seat in the cellular tissue, in the muscular or peritoneal layers, in the caecum, or even, at certain times, in the ovary. So might similar symptoms in a pathogenesis arise from a pathological condition of these various tissues. Evidently we cannot select our remedy with certainty of its adaptedness, unless we make a diagnosis both of the disease and of the pathogeneses of the drugs.
Again, tenderness in the coxofemoral region, pain on moving the limb, and on pressing the great trochanter in toward the acetabulum, may have its seat in the tissues of the joint, or in the nerves that supply that region. And we have drugs that affect the tissues of the joint, and others that affect the nerves in question. We must select the former if the joint, and the latter if the nerves be affected; and in order to make the selection we must previously make the twofold diagnosis so often urged. Neglect of this has led to the erroneous recommendation of Colocynth in hip-joint disease. A two-fold diagnosis, then, is a necessary preliminary to a properly conducted homoeopathic prescription.
The diagnosis of the disease to be treated is to be made, of course, where the disease is encountered, at the bedside. But the diagnosis of the drug-diseases constitutes the systematic study of the Materia Medica.
Our provings are a mass of symptoms, for the systematic study of which some feasible method has been long a desideratum. Their study and arrangement under the form of a diagnosis furnish a method well calculated to fix the characteristics of the drug in the memory, and at the same time, as we have shown, practically useful to the prescriber.
Dr. Watzke and Dr. Kaspar, resident physicians in Wurmb’s Homoeopathic Hospital, in Vienna, have arranged a number of remedies in the form of a diagnosis, the exposition of which constituted the matter of lectures on Materia Medica, delivered by Dr. Kaspar at the Hospital, in the summer of 1851. (1 1These lectures the author attended.-ED.). The substance of sixteen lectures by Dr. Kaspar follows, from which the scope and aim of the analysis will be evident; and it may not be amiss to suggest that these analysis are designed rather as aids in the study of Materia Medica than as direct guides for practice, and that, being greatly condensed, they require diligent study and constant comparison with the Hahnemannian pathogeneses.