Having been honored by the President of the Society’ with an appointment to report on the use of High Potencies in Chronic Diseases, I trust it may not be considered an unwarrantable presumption if, for the following reasons, I venture to modify, to a slight extent, the theme assigned to me.
First. The subject contemplates a report of a practical nature. But from the stand-point of practice, I think that a clear and well-defined distinction between acute and chronic diseases is not possible. If we attempt to base such a distinction upon the element of time alone, paying regard only to the duration of the disease, it cannot be made at the beginning of the treatment, and cannot therefore be of any practical value in determining the potency to be used.
If we base the distinction upon a pathological conception- that is, upon the presumed existence in the patient of some dyscrasia, diathesis or miasm- it is equally impossible, at least in very many instances, to make it at the commencement of an illness.
It is a matter of common remark that cases which begin without any sign of miasmatic or dyscratic complication often develop in their course unequivocal evidence of such complication, so that a case which would, in the outset, have been regarded as, in this sense, unquestionably acute, proves in its course to be unmistakably chronic.
Second. Furthermore, the subject as stated, involved a kind of petitio principii. To require a report on the “Use of the High Potencies in Chronic Diseases” is in some sort to imply that these potencies are especially useful and appropriate, if at all, in the treatment of chronic diseases as distinguished from acute diseases-an implication which it is true corresponds to a very widely received opinion among those physicians who have but little practical acquaintance with the action of the high potencies, but which, as we shall see, is not supported by the results of experiment.
By the kind indulgence of the Society, then, I shall beg leave to report on the “Use of High Potencies in the Treatment of the Sick.”
No question connected with Homoeopathy has given rise to more vigorous controversy or to more earnest partisan feeling than that concerning the infinitesimal dose. The most bitter opposition of the Old School to Hahnemann was based on this question. It has been also the chief ground of division and contention among homoeopathists themselves.
After an animated disputation covering a period of more than fifty years, there seems now, however, to be a cessation of hostilities between the advocates and opponents of the higher potencies. There seems to be a mutual disposition to suspend the discussion hitherto maintained chiefly on hypothetical grounds, and to appeal in good faith to the “ultima ratio-experiment. The times are favorable, therefore, for a quite survey of the field and for a dispassionate estimate of the experimental knowledge of which the practical labors of our colleagues have put us in possession.
It is probable that Hahnemann was never what could be called an “heroic prescriber.” In his work on The Venereal Disease, published 1789, before he had discovered the homoeopathic law of cure, he portrays the evil effects of excessive doses of mercurial preparations, and speaks of radically curing some cases of syphilis by the use of a single grain of Mercurius solubilis in divided doses; and says that eight grains thus administered will often be sufficient to cure “very severe cases of syphilis.” Compared with the practice of his contemporaries, these are almost infinitesimal prescriptions.
In his first essays upon the homoeopathic law, Hahnemann advises the administration of doses but little, if any, smaller than those he had previously used. We first meet with the recommendation to use infinitesimal doses in the essays on “scarlet Fever,” published in 1801, but referring to cases treated in 1799. He here advises Belladonna and Chamomilla to be given in preparations which correspond pretty nearly to the third centesimal dilution.
It pleases Dr. Dudgeon to suppose that “this sudden change,” as he calls it, from material to infinitesimal doses, was a matter of expediency and policy rather than of conviction on the part of Hahnemann, inasmuch as it coincided in point of time with the prosecutions of Hahnemann by the apothecaries.
But there is no evidence that the change was so very sudden as to require such an explanation. Even so short a period as one year spent in constant practice might be sufficient to satisfy so acute an observer as Hahnemann, that remedies given according to the homoeopathic law must be given in very small doses.
The whole career of Hahnemann is a consistent protest against the adoption or renunciation of any procedure connected with the practice of medicine, on grounds of mere policy or expediency. Hahnemann’s long life was a continual sacrifice of ease and prosperity and highly prized friendships to his convictions of truth. While therefore, during a period of twenty years he submitted to be driven from city to city rather than renounce the right of dispensing his own medicines, is it at all probable that he devised the method of diluting or potentizing remedies and insisted on the superiority of potentized remedies, simply, or in any degree from motives of expediency?
In subsequent essays Hahnemann advises still more distinctly the administration of potentized remedies, and in the first edition of the Organon, published in 1810, he says: “Scarcely any dose of the homoeopathically selected remedy can be so small as not to be stronger than the natural disease and not capable of overcoming it.” About the same period he advise the use of the ninth dilution of Nux vomica and the eighteenth of Arsenic.
In the earlier volumes and editions of the Materia Medica Pura, Hahnemann recommends a particular dose for each remedy. Some remedies are to be given in the first dilution, some in the third, some in the ninth, some in he fifteenth, some in he twenty-fourth, some in the thirtieth.
In subsequent editions of the Materia Medica and in the work on Chronic Diseases, Hahnemann, as is well known, advises that all remedies be given in a uniform dose-the thirtieth dilution.
In the latter years of his life he speaks of using with great success the sixtieth, one hundred and fiftieth and three hundredth dilutions, and it is well known that during these years he did not confine himself to a uniform dose, but used in some case the lower potencies, and in some the very highest.
It is not unworthy of remarks that as Hahnemann’s practical experience in the treatment of disease increased, so did his estimate of the advantage and necessity of using higher dilutions, in a least many cases, likewise increase.
The promulgation of the dynamization theory by Hahnemann, and his adoption of the practice of giving infinitesimal doses, were the occasion of the most violent denunciation of Homoeopathy by his professional opponents. Indeed, to this day, this really subordinate department of the method is regarded by allopaths as the essential feature of the method is regarded by allopaths as the essential feature of Homoeopathy; and to a superficial observer it would seem as if the infinitesimal dose were almost the only obstacle to a blending of Homoeopathy and the so-called Physiological School of Medicine.
The progressive advocacy by Hahnemann of the higher dilutions, and especially the introduction by Korsakoff of what are technically known as the “high potencies” (the one hundred to fifteen hundredth) gave rise, as has been said, to a lively and bitter and decidedly personal controversy among homoeopathists.
In every party or school which is still a minority, there are always Conservatives, who regret the necessity which compelled a separation from the party or school of the majority; who strive to make that separation as little decisive and marked as may be; who stoutly oppose any measure which would tend to increase the division or to make it irremediable; and who hail with delight almost any project of compromise or reunion. There are also Radicals, whose turbulent nature revels in the sensation of opposition; whose tendency it is lay more stress on points of difference than on points of coincidence; who, having once separated from the majority, will not only entertain no thought of a reunion with them, but consider that fidelity to the principle on which their separation was based, requires that the separating chasm should be made continually wider. they seem to glory, not so much in the truth for the sake of which they separated, as in the mere fact of separation.
These two classes are necessary in every progressive school. The Radicals furnish the propelling force- the steam. The Conservatives supply the restraining and moderating influence -the fly-wheel.
Among the followers of Hahnemann, the Radicals and the Conservatives were the respective parties to the contest about the potentization theory; and in weighting the arguments which each side brought forward, we must not lose sight of the respective tendencies of these two parties.
The law, Similia similibus curantur, which is the essence of Homoeopathy, was not an absolute novelty in medicine. Indeed, Hahnemann’s first arguments in favor of it was drawn from the records of medicine. He showed that, in all ages, many cures had been made in accordance with it. He proved that his contemporaries, often unwittingly and sometimes consciously, applied it in treating the sick. To urge its admission as the universal law of cure was, therefore, simply to advocate the recognition, as a universal truth, of that which was already received by medical men as, at least, a truth of partial and limited application.
Accordingly, the opposition to Hahnemann was, at the very first, moderate. It was somewhat of the nature of a demand for more conclusive testimony.
Men of conservative tendencies might very consistently, at this time, have become homoeopathists; for it was not unreasonable to anticipate, at some period in the not distant future, a universal recognition of the homoeopathic law of cure and a consequent reunion with the dominant power.
But the dynamization theory was in irreconcilable opposition to all the notions of Hahnemann’s opponents. It taught that doses inconceivably small were sufficient to effect radical cures in acute and dangerous diseases-that such doses were even more efficacious than larger ones. It taught that instead of the curative power of the drug being directly in proportion to its material quantity, there was reason for believing that, to some extent, at least, the converse was true.
There could be no such things as a compromise on this question. Truth lay either with Hahnemann or with his opponents. It could not lie between them. To maintain this dynamization theory would be to make the separation between homoeopathists and the dominant school of medicine perpetual and irremediable.
It is easy to perceive what sort of a reception was likely to be accorded to the dynamization theory by the Conservative homoeopathists. They could not regard it without unfavourable prepossessions. If compelled at last to admit its soundness, this would not be until irresistible testimony in its favor had been amassed-nor even then without regret for the fact and deprecation of the obstacles which it created in the way of a reunion with the Old School. All their a priori assumptions would be unfavorable to its validity.
The Radicals, on the other hand, would receive with joy this additional element of difference from the Old School of medicine. They would advocate it with enthusiasm. Their a priori arguments would lend it a vigorous support.
Thus in relation to a question that can be settled by experiment alone, and by a course of experiment requiring careful unprejudiced observation through many successive years, we have all the conditions requisite for an ardent controversy at the very outset, before any valid evidence could possibly have been gathered by either party.
We shall be less surprised at the vigorous opposition to the dynamization theory, if we recollect the condition of medicine and pharmacy at the beginning of the present century. The posology of that period was decidedly heroic. Drugs were given in the crudest forms. Pharmaceutical chemistry had not yet discovered the essential principles of drugs, the use of which at the present day has made doses of the one-fourth, one-eight, or one-twentieth of a grain familiar even to practitioners of the Old school. The microscope was still a rude and primitive instrument; quantitative chemical analysis had not attained any great development; much less was there any thought of applying, as is now done, the reactive susceptibility of the living organism to detect, through its specific affinities, particles of matter so small as to elude the microscopist and the chemist. In fact the doctrine of the extreme divisibility of the metaphysician than on the demonstration of the naturalist.
For this very reason, on the other hand, the speculations of the metaphysician had at that period the wider scope and the greater authority. And thus it was very easy for some of Hahnemann’s more radical followers to erect on a figurative illustration used by him in the Organon a “cloudcapped” theory of the transplantation of the medicinal force from the substance of the drug to the substance of the vehicle used for dilution, and upon the basis of this airy hypothesis to explain all manner of supposed action and reaction of drug-spirit upon diseased force, etc., etc.
These consideration will, I think, justly us in passing over with scarcely on the word of comment all that was so copiously written on the subject of the dose, from the date of Korsakoff’s first publication to the date of Dr. Trinks’ public letter to Dr. Stens in 1859.
The principles involved in the question of the efficacy and advantage of high potencies are these:
1. The curative power of a properly selected drug is not in the direct ratio of the quantity of the drug.
2. The process of potentization which Hahnemann invented, develops a curative power in substances, which in the crude form, manifest no such power; and it increases the curative power of drugs which in the crude form do manifest a curative power.
Now, although these principles had been satisfactorily established, one would think, by the successful use of the third or sixth potencies, long before the controversy about the “high potencies” began, yet it will be perceived that almost all the objectors who began to write after Korsakoff’s publication and Hahnemann’s cautious and conditional approval of it, derive their arguments from considerations of the probable quantity of the drugs which these high potencies might contain. Thus we are cautioned, even by those who admit that higher potencies have curative powers, that they are not to be trusted in acute diseases which have a rapid course, because, as Dr. Scott expresses, it, “in these diseases the vital forces act with exaggerated energy and to act upon them, we require a greater anoint of medicinal power, that is, a lower dilution.” This statement, it will be perceived, regards the curative power as directly proportioned to the quantity of the drug, and begs the whole questions at issue.
But when Hahnemann had shown that a more efficient curative power was exerted by the first dilution or trituration, or even by drop doses of the mother tincture of drugs than by massive doses, as he had done to the satisfaction of all homoeopathists, long before the higher dilutions were ever made, he had demonstrated that the curative power of drugs is not in the proportion of their material quantity, and had thus established the principle of the dynamization theory.
When, furthermore, he showed to the satisfaction of all homoeopathists, that substances which in their crude state exert no medicinal power, such as gold, charcoal, tin, common salt, etc., etc., do, after dilution, trituration or potentization, come to possess a medicinal power, he demonstrated, in part, the second principle of the dynamization theory.
These demonstrations removing the questions of dose entirely from the domain of mechanics, in which power is directly proportioned to quantity, left the whole question open for experiment.
The points to be determined were these:
1. The curative power of a drug not being directly proportioned to the quantity of the drug, what relation does exist between this power and quantity? What effect does a continued diminution of quantity exert upon the curative power of the drug?
2. It being admitted that the potentization process does develop the curative power, what are the limits of this development? What varieties in the nature and extent of this developed power are produced by various degrees of potentization?
Obviously these questions were to be solved only by a long course of methodical experiment.
While the controversy on hypothetical grounds was being carried on by the Conservative and Radical homoeopathists, reports of cases were accumulating in the homoeopathic journals, which furnished indisputable testimony to the action of the higher potencies. Among those who published these records, the names of Gross, Stapf, Hering, von Boenninghausen, Aegidi and Nunez are conspicuous.
Their testimony was disputed on various grounds. Against some cases it was urged that they were inconclusive, since it was not clearly shown that the cure resulted from the remedy given and not rather from some hygienic prescription or restriction resorted to at the same time. Such criticism is legitimate, and cases to which it is fairly applicable must be excluded.
Against other cases it was was urged that the data were not so fully recorded as to enable the reader to make sure of the diagnosis. I do not think such criticism as this is admissible, unless in a very few cases.
The value and authority of clinical records always depend on the reputation of the reporter for knowledge, accuracy and integrity. Now, whether, in reporting a case of alleged pneumonia, the reporter simply state that it was a case of pneumonia, presenting such or such characteristic symptoms, or whether he present a minute and elaborate detail of all the rational and physical signs of the patient, obtaining by the aid of auscultation, percussion, mensuration and chemical and microscopical analysis-in either case, we have nothing to depend upon but the scientific capacity and the integrity of the observer.
If he have these qualities in a sufficient degree to obtain with certainty the requisite physical and rational signs on which to base a trustworthy diagnosis of pneumonia, his statement of this diagnosis will be sufficient without the details. If he have them not, no details which he might pretend to give would be deserving of the slightest confidence. These considerations annihilate the objection made by Dr. Watzke to cases published by Gross and boenninghausen in the Archiv.
In general, however, it were well to exclude, provisionally at least, all cases of doubtful diagnosis.
While cases demonstrating the value and efficacy of the high potencies were accumulating, a few cases were also published in which, the higher potencies having been used without effect, a lower potency or a crude dose of the same drug effected a cure. Dr. Black relates that in a case of headache Lachesis (30) only produced symptoms of nervous disturbance, while Lachesis (6) effected a cure. Dr. Trinks records a case which had been treated by Hahnemann for nearly two years with Rhus in a higher dilution without effect, and which he himself cured within a few months by repeated doses of the mother tincture of Rhus.
The angry controversy was brought to a temporary close by Dr. Trinks’ public letter to Dr. Stens, in which he states: “I was born a skeptic. As to the wonder cures (cures by the high potencies) published in the journals, I can only say, I do not believe a word of them” “Non credo quia impossible est,” seems to be the creed of Dr. Trinks-the impossibility consisting in a mere assumption, on his part, that such preparations cannot possess any power. This same argument- “non credo” may, with equal force, be urged by the allopathists against the first or third dilutions, which Dr. Trinks is in the habit of using.
The argument proves too much. If Dr. Trinks may dismiss with “I don’t believe it,” the testimony of those who advocate the high potencies, on the same grounds may these reject his accounts above referred to, of the cases in which he alleges that the lower potencies were efficacious where the higher had failed.
But the opponents of the high potencies were not content with seeking to invalidate the testimony of the advocates of these preparations. Some of them presented records of case in which they had made unsuccessful trails of the high potencies. Of these, many were no doubt made in good faith, and must be accepted as evidence that there are cases in which the high potencies fail of cure. But the majority of these records are like those of Dr. Watzke, referred to by him, in the Oesterreichische Zeitschrift, vol.ii., where he says, the patients on whom he tried the high potencies suffered for most part from diseases in which there was little reason to expect a favorable result from any remedy, in whatever dose, for, he says, they were cases of “dissolving pulmonary tubercle, of fungoid tumor of the brain, of cerebral and pulmonary apoplexy, of spinal paralysis, of chronic hydrocephalus, valvular insufficient of the heart, of fibrous tumor of the uterus, etc., etc.
Yet, no doubt, Dr. Watzke is one of those who would exclaim against the unfairness of Andral in pretending to test Homoeopathy in the Paris hospital, by giving a single dose of a homoeopathic remedy to a patient laboring under incurable disease!