Paragraph 6. The unprejudiced observer-well aware of the futility of transcendental speculations which can receive no confirmation from experience-be his powers of penetration ever so great, takes note of nothing in every individual disease, except the changes in the health of the body and of the mind which can be perceived externally by means of the senses; that is to say, he notices only the deviations from the former healthy state of the now 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.
The teaching of this paragraph is that the symptoms represent to the intelligent physician all there is to be known of the nature of a sickness, that these symptoms represent the state of disorder, that sickness is only a change of state and that all the physician has to do is correct the disordered state. Hahnemann, it seems, would say that it is great folly for a man to look into the organs themselves for the purpose of establishing a theory to find out whether the stomach makes the man sick, or whether the stomach makes the liver sick and such like. We can only end in theory as long as we think that way. So long as we get the mind to thinking about a man’s organs and how these things are brought about we are in confusion, but not so when we meditate upon the symptoms of the sick man as fully representing the nature of the disease after these have been carefully written out.
Hahnemann starts out in this paragraph by speaking of “the unprejudiced observer.” It would almost seem impossible to find at the present time one who could be thus described. All men are prejudiced. Man is fixed in his politics, fixed in his religion, fixed in his ideas of medicine, and because of his prejudice he cannot reason. You need only to talk to him a moment on these subjects and he will begin to tell you what he thinks; he will give his opinion, as if that had anything to do with it. Men of the present day cannot recognize law, and hence they are prejudiced; but when men have authority on which they can rest, then they can get rid of their prejudices.
Suppose we have a large dictionary that we say is an authority on the spelling of words. If a club of one hundred and fifty men who bought that dictionary, and put it into a closet and say, “That is how we agree to spell,” that is a recognition by these men that the book is authority. There would be henceforth no argument on the question of spelling. But if there were no authority one man would spell one way and another man in another way; there would be no standard of spelling. Such is the state of medicine at the present day, there is no standard authority. One book is authority in one school, and in another school they have another book, and so there is confusion.
Men cannot get rid of their prejudices until they settle upon and recognize authority. In Homoeopathy the law and its principles must be accepted as authority. When we know these, it is easy to accept them as authority, but seeing they are not known there is no authority and everybody is prejudiced., Men often ask, Doctor, what are your theories as to Homoeopathy? What are your theories of medicine?” I have no theories. It is a thing that is settled from doctrine and principle, and I know nothing of theory. A woman came into my office this morning and said, “Doctor, I have always been treated by the old school, but the doctors were unable to decide whether the liver made my stomach sick or the stomach made the liver sick.” This is only confusion.
No organ can make the body sick; man is prior to his organ; parts of the body can be removed and yet man will exist. There is no such thing as one organ making another sick. When we realize that them course of things is from centre to circumference we must admit that the stomach was caused to be in disorder from the centre, and that the liver was caused to be in disorder from the centre, but not that they made each other sick. One who was has been taught such ideas cannot rid himself of them for a long time. It is matter of years to get out of these whims and notions which we have imbibed from our inheritance. We cannot rid ourselves of confusion until we learn what confusion is.
In this paragraph Hahnemann does not speak of changes of tissue or changes in the organs, but changes of state. Man could see and feel tissue changes, but these do not represent to the intelligent physician the nature of disease or disease cause, they only indicate that because of the disorder within certain results have followed. The unprejudiced observer can see that pathology does not represent the nature of the disease, because numerous so-called diseases can present the same pathology and the same phenomena.
The trouble is that there are so few unprejudiced observers. To get rid of our prejudices is one of the first things we must do in the study of Homoeopathy. Therefore let me beg of you, while sitting in this room, to lay aside all that you have heretofore imagined or presumed, the whims and notions, and “what I thought about it.” the things that you have learned from men and books, and only follow after law and principle, things that cannot deceive, cannot vary.
Even law will deceive if man is of prejudiced mind, because then he misreads the law and doctrine, and when things are called back they look to him white; every image is inverted in his prejudiced mind, because he realizes only with his senses, and sees with his eyes and feels with his fingers only the appearance of things, just as we say that the sun rises, judging from our eyes, although we know from our intelligence that it does not rise.
If we believe our senses only we will accept all the notions of men. If the senses were invariable men would agree, but they are variable and no two men will agree in everything, for just as men’s observations differ so different notions and theories will be established. We must try to get rid of the prejudices that we have been born with and educated into, so that we can examine the principles and doctrines of Homoeopathy and seek to verify them. If you cannot put aside your prejudices the principles will be folly to you. The unprejudiced observer is the only true scientist.
“He perceives in each individual affection nothing but changes of state.” The changes of state are such as are observed by the patient when he says he is forgetful, that his mind does not operate as it did, that he is often in a state of confusion, that when he attempts to deliver a sentence a part of it goes away from him, the idea passes away, or that he is becoming irritable, whereas he was pleasant, that he is becoming sad, whereas he was cheerful before, that there are changes in his affections, in his desires and aversions. These things relate to states: not to diseased tissues, but to a state of disorder or want of harmony. Dr. Fincke expresses it as ” a distunement.”
After the patient has related everything he can about his change of state, the physician may be aided by information from outsiders, from relatives who look upon the patient with goodwill, who wish him well. If the husband be sick it is well to get the wife’s testimony. After the physician has written down all the information in accordance with the directions of 85 for the taking of the case he then commences to observe as much as he can concerning the disorder, but more particularly those things which the patient would conceal, or cancel relate, or does not know. Many patients do not know that they are awkward, that they do peculiar and strange thing in the doctor’s office-things that they would not do in health, and these are evidences of change of state.
The physician also notes what he sees, notes odors, the sounds of organs, chest sounds, intensity of fever, by his hand or by a thermometer, etc., and when he has gone over this entire image, including everything that can represent the disease, he has secured all that is of real value to him.
What if there are changes in tissue present? There is nothing in the nature of diseased tissue to point to a remedy; it is only a result of disease. Suppose there is an abdominal tumor, or a tumor of the mammary gland, there is nothing in the fact that it is a tumor or in the aspect of the tumor that would lead you to the nature of the change of state. The things that you can see, i.e. the changes in the tissues, are of the least importance, but what you perceive in the patient himself, how he moves and acts, his functions and sensations, are manifestations of what is going on in the internal economy. A state of disorder represents its nature to man by signs and symptoms, and these are things to be prescribed upon.
Take a case which as yet has no pathological changes, no morbid anatomy, one that has only functional changes; the collection of signs and symptoms presents to the intelligent physician the nature of the state and he is clear as to the remedy. But if the patient does not receive that remedy, what will happen? The case will go on for a while, perhaps for two or three years, and when he returns to you on examination you will find that he has cavities in his lungs or an abscess in his liver, or albumin in the urine, etc.
If it were the last, according to the old- fashioned notions and theories, you must now prescribe for Bright’s disease; you would not think that remedy which you figured out two years before fitted his case perfectly then and is what he must have now. But he needed that remedy from his childhood, and you were able to figure it out from the symptoms of his change of state pure and simple, without tissue changes. Do you suppose because the disease has now progressed into tissue change, the organs are breaking down and the man is going to die, that this has changed that primitive state?
The man needs the same course of treatment that he has needed from his babyhood. The same idea of his disease must prevail now that prevailed before he had the tissue changes. Bright’s disease is not a disease, it is simply the ultimate or organic condition which has followed the progress of the original change of state. Under other circumstances that change of state might have affected his liver or his lungs.
Tissue changes do no indicate the remedy, and so as physicians we must learn to examine symptoms which are prior to morbid anatomy, to go back to the very beginning. Such a patient as I have described must be looked upon as when he was in the simple change of state before matters were complicated. Besides this there is no manner of treatment for Bright’s disease or any other organic change. Our remedies appeal to man before his state has changed into disease ultimates, and these remedies do not change because morbid anatomy has come on, they appeal as much after tissue changes as before it. If we do not know what the beginnings are we cannot in an intelligent way treat the endings.
In a footnote Hahnemann says, “I know not therefore how it was possible for physician at the sick-bed to allow themselves to suppose that, without most carefully attending to the symptoms and being guided by them in the treatment, they ought to seek and could discover only the hidden and unknown interior what there was to be cured in the disease, etc.” The learned man in the old school today would say, “Oh, I do not care anything about your symptoms. I do not care if you are forgetful or irritable. If you do not sleep I will give you something to make you sleep. But I must sound your liver, for that is the cause of all your trouble, and I will prescribe for that.”
He supposes the liver is the cause of all the trouble, and believes that when that is corrected he has cured his patient. What a false idea! His mind is upon mere theory. It is common, when they do not know what has Killed a man, to make a post-mortem in order to discover the cause, and by this they find out certain pathological conditions; but the aim of the physician is to discover in his patient that just these conditions are present.
It is true, on the other hand, that the post-mortem affords the physician the means for a general study of the results of disease, which I would not, under any circumstances, prevent. Indeed, there are times when I would strongly encourage the study of morbid anatomy. The physician cannot know too much about the endings of disease; he should become thoroughly acquainted with the tissues in all conditions; but to study these with the idea that he is going thereby to cure sick folks, or that the things he picks up at such times are going to be applied in making prescriptions, is a great folly. It is astonishing that physicians should expect to find out by post-mortem and examinations of organs what to do for sick folks.
Physical diagnosis is very important in its own place. By means of physical diagnosis the physician may find out the changes in organs, how far the disease has progressed, and determine if the patient is incurable. It is necessary also in supplying information to Boards of Health. It may also decide whether you should give curative or palliative treatments. But the study of pathology is a separate and distinct thing from the study of Materia Medica.
In many instances foolish examinations are made. In the colleges women are examined with the speculum before a symptom is given, and if the mucous membrane is red the patient gets Hamamelis, and so on in a routine way through five or six remedies which cover all the complaints of women. Half a dozen remedies constitute the armamentarium of many of the eminent gynaecologists. Such a practice as that does not cure, does not even benefit temporarily, it is simply an outrage. But bad thought it is, perhaps it is not so great an outrage as is perpetrated when the physician imagines the disease is local, and that when he has cauterized it the woman is well, not realizing for one moment that these things come from a cause and that curing that cause should be his aim. Yet such is the teaching of the old school.
Now while the signs and symptoms are the only things that can tell the physician what the patient needs, and while those signs and symptoms relate to change of state and not to change of tissue, still there are signs that relate to tissue changes, and one who is acquainted with symptoms may consider these as indicating a change of state. For example, there are signs that indicate that pus is forming, there are appearances that will lead the experienced physician to know that the results of disease are coming; these are not valuable things in hunting for the remedy, but simply indicate certain conditions. The physician must learn to distinguish these from the symptoms that portray the state of the patient.
We are now prepared to see that if the patient is cured from cause to effect he must remain cured; that is, if the true inner disorder is turned into order he will remain cured, because this order, which is of the innermost, will cause to flow into order that which is of the outermost and finally the function of the body to become orderly. The vital order will cause tissue order, because the vital order extends into the very outermost of the tissues, and tissue government an order is a vital order; so if the cure is from cause to effect, or from within out, the patient will remain cured. In incurable cases the effects may be removed temporarily or palliated, but the patient himself has not been cured as to the cause. and owing to the fact that the patient cannot be cured the old changes will return and grow stronger because it is in the nature of chronic cases to increase or progress.
Certain results of disease which remain after the patient is cured can be removed if necessary, but it is not well to remove them before the patient is cured. If a patient has a disease of the foot bones after a bad injury and the foot cannot be cured, first cure the patient, and then if the foot is so clumsy and useless that he would rather have a wooden one remove the foot.
If you have to deal with a worthless honey-combed knee joint, first cure, the patient and then if the knee can never be useful and the limb is cold and the muscles are flabby consider the question of replacing it with an artificial one. If the economy after being turned into health cannot cure the knee nothing that can be done to the knee can cure it, Do not say that the patient is sick because he has a white swelling, but that the white swelling is there because the patient is sick.