The selection of the remedy theoretically simple, practically difficult-Necessity for defining what is similar-The sum total of the symptoms present not the sole indications, even according to Hahnemann-His merit in rejecting pathological speculation as our guide in selecting the remedy- The selection of the remedy a purely empirical, almost mechanical act-The characteristic symptoms to be our guide-The general and undefined symptoms to be neglected-Modern mode of compiling a book of characteristic symptoms-Hahnemann is very vague on the subject of characteristic symptoms-Characteristic features of epidemic diseases- Characteristic symptoms of intermittent fevers- Hahnemann’s denunciation of the usus in morbis-But many of his indications for medicines are derived from that source-Instances of these-Hahnemann’s system was not, after all, a mere mechanical comparison of drug and disease-It was more scientific than he allows it to be-Rau’s vindicating of the scientific character of homoeopathic prescription-he defends Hahnemann’s minuteness-But condemns a mere mechanical comparison of symptoms- Necessity for a profounder knowledge of the action of medicines on particular spheres of the organism than we can obtain in the Materia Medica-Cases in point-Hartmann shows that the homoeopathist attends to the exciting causes of disease-M. Muller defends homoeopathy from the charge of being mere symptomatic treatment-Schron shows that the collective symptoms cannot be the sole indication-We must distinguish between idiopathic and sympathetic-Kurtz-Wolf-Roth-Schmid tries to define similar-Watzke says the characteristic symptoms must guide us-Mosthaff says similarity is not the sole point to attend to-Peterson refers to the great number of unimportant symptoms in the Materia Medica, and proposes a plan for increasing them-Hirschel’s eight sources for obtaining indications-Hering says the characteristic symptoms must be our guide-Boenninghausen considers the character of the symptoms more important than its seat, and the condition of the symptom’s occurrence more important than either-This condition some times his sole guide-Wonderful influence of shaving-Medicine Doctores, D.G., Fid. Def.-Mure talks about characteristics, but practices mechanical reckoning-Griesselich says we must attend to aetiology, semiology, and diagnosis-Trinks enjoins attention to characteristics-What is similar?-Some diseases have no similars in the Materia Medica- What constitutes symptom?-Characteristic symptoms of some medicines act-Treatment of diseases with few symptoms-Medicines to rouse the system when torpid-Medicines to soothe the system when too irritable-Impotence of records of clinical experience-Works to aid us in the selection of the remedy.
THE subject of the present lecture is beset with numerous difficulties, and it is not without many misgivings as to my powers to do it justice that I approach it. The formula for the selection of the appropriate remedy similia similibus curentur, or let likes be treated by likes, is as vague and indefinite as could be wished for any such laconically expressed general rule, nor does it convey any idea whatever to out mind, unless accompanied by its more extended explanation as we find it in the Organon.
To effect a mild, certain, and permanent cure, choose, in every case of disease, a medicine which can itself produce an affection similar to that sought to be cured. Now this, though a little more definite and giving us, as it were, a glimpse, a hint as to what we should do, is very far from instructing us adequately as to how we are to select our remedy for a given case of disease. We have before seen how we are to a certain the affections medicines are capable of producing, viz., by testing them on the healthy individual. Do we then find that the affections produced by medicines on healthy individuals resemble those diseases occurring naturally? for if so, if in the pathogenesy of a medicine we can find, so to say, the reflection of a natural disease, then our object is attained, nothing remains for us to do but to give this medicine in this disease, and a cure is certain to result, if our law be founded in nature and truth.
But alas! the pathogenesy of a medicine does not present us with that perfect reflection of the natural disease, that were so much to be desiderated in order to carry out this law perfectly in practice; at least the reflection is not very apparent at first sight, and the image of the disease is so inextricably mixed up with different features of heterogeneous diseases, that it often puzzles us not a little to find the counterpart of our disease amid the labyrinth of symptoms each pathogenesy presents. Thus, while the selection of the remedy is theoretically simple and practicable, practically it is a most difficult and arduous job, and in many cases it demands a most careful and assiduous study in order to arrive at anything like a certainty that the medicine we select is the suitable one–the best.
Had the condition of cure depended upon the discovery of an affection, as the action of a medicine, identical with that to be cured, there would have been much less difficulty in making our selection, provided always these identically acting drugs could have been procured, for identity is something absolute and admits of no degrees of comparison. But such is not the case; the law of cure is a law of similar only, and similar is but a relative term and admits of degrees of comparison, as more similar and most similar. Of course I need hardly remark that it is a necessary consequences of the difference in the nature of medicinal and morbific agents that renders it indispensable that the term of analogy betwixt medicinal and natural disease should be similar and not identical.
In considering therefore the question of the selection of the remedy, seeing that the epithet similar is not a definite expression, it will be requisite to ascertain, if possible, its limits, to answer the question–What is similar? for unless that be done, it were vain to think of curing according to the therapeutic law of similars.
Our allopathic opponents often throw in our teeth that we are unable to give a precise definition of what we mean by similar; and when we attempt to explain the term, allowing it to possess a certain latitude, as the very nature of the word implies, they become angry, accuse us of prevarication, and would have us tied up to their own definition of the word, which, when examined, we find to be not similar but identical. But of this hereafter. Let us hear what Hahnemann’s instructions are respecting the selection of the remedy. After remarking, (Organon, Aphorism vi., vii.) almost in the very words of the empirical school of Philinus and Serapion, that the totality of the morbid symptoms alone constitutes the true portrait of the disease, he goes on to observe, (Ibid., Aphorism xviii.) “that the sum of all symptoms in each individual case of disease must be the sole indication, the sole guide to direct us in the choice of a curative agent.” However, as some slight offset to this statement, we observe that he allows other circumstances to have their weight in guiding our choice of the remedy, notwithstanding his very absolute assertion as to the actual symptoms being the sole indication for the remedy. Thus he writes (Ibid., Aphorism v.) :- “Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which generally depends on a chronic miasm. In these investigations the apparent physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupations, mode of living and habits, his social and domestic relations, his age, sexual power, etc., are to be taken into consideration.”
Why, we might naturally ask, if the sum-total of the symptoms actually present is to constitute our sole guide, are we to attend to all these other circumstances? In this paragraph we have an acknowledgment of the importance of all those circumstances that are insisted upon by the most notable practitioners of the old school, and which are rigorously excluded by the assertion that the totality of the symptoms present constitutes the sole indication. Here we have Hahnemann acknowledging the importance of the exciting cause, and of the proximate cause almost, though in the page immediately preceding he ridicules all attention to these subjects. This is another proof, in addition to those I have already brought under your notice, of Hahnemann’s unwillingness to cancel any idea formerly expressed, and thus we have here, as in many other parts of the Organon, side by side, the different, nay, opposite notions of different periods of his life. The contradiction would have been avoided had Hahnemann qualified his absolute language regarding the totality of the symptoms being the sole indication. Had he said the chief indication, we could have had nothing to say against it; but sole indication was his original expression, and sole it must remain, even though he admits other indications.
With the exception that Hahnemann transgressed his own rule in professing to have discovered the essential nature of certain diseases, viz., the chronic diseases, of which mention has been made in the last two lectures, and that he founded thereon a peculiar mode of treatment by antipsorics, and antisyphilitics, and antisycotics–with this exception I say, we must admit that Hahnemann rendered an important service to practical medicine when he pointed out the in utility for therapeutic purposes of all investigations regarding the proximate cause of diseases, and when he asserted the vanity of all transcendental speculations, and declared as false and untrustworthy every indication based upon the undiscoverable essential nature of the disease. He regarded the morbid phenomena cognizable by the senses as completed facts, the cause of which it was not incumbent on the practitioner to know or to search for.
Hahnemann, with that clear and critical spirit for which he was pre-eminently remarkable, could not fail to perceive that it was this metaphysical or speculative method of viewing diseases, of regarding them as something separate and distinct from the living whole, of conjecturing their peculiar nature, that had in all ages led physicians astray, and given rise to all those contradictory methods of treatment that have prevailed in medicine since it was cultivated as a science, and his object in limiting practitioners to take cognizance only of what was manifest and unmistakable in diseases, viz., their ostensible symptoms, was to remove the indication for treatment out of the region of hypothesis and place it once more within the domain of fact and of nature. His effort was to bring back medicine from the meta physical to the purely physical
This would of course place him at once in direct antagonism with the whole body of the so-called philosophical medical men, whose delight was to infer from the phenomena present the proximate cause and the essential nature of the disease; and the partisans of the various theoretical sects could not brook to be told that their ingenious theories as to whether the disease depended on spasm, inflammation, congestion, infarctus, and the like, or whether it was primarily a disease of the liver, the stomach, the brain, or the kidneys, did not help them a bit in their treatment of the commonest maladies. Accordingly we find even the sharpest intellects among them disputing with the greatest zeal these plain and common-sense views of Hahnemann’s, and even a Hufeland, (Die homoeopathie.) gravely alleging that Hahnemann’s system would only remove the symptoms but leave the disease, and that homoeopathy, if it ever came to be generally adopted, would prove “the grave of science,” a sentiment which has been re-echoed of late years by the Hufeland of England, Sir John Forbes. (Brit. and For. Medorrhinum Rev., vol. xxi., art. Hahnemann and Henderson, or Homoeopathy, Allopathy, and Young Physic.)
But if Hahnemann ran counter to the philosophical sect of physicians, he offended also in equal if not greater degree the pathological school, who, by their investigations and post-mortem examinations, thought they had discovered in the structural changes they observed on the dissecting-table, assisted by microscopical observations and the aids of improved chemical analysis, the real nature of many diseases. That their painful and minute investigations should be held utterly valueless, as far as treatment was concerned, was more than they could patiently bear to hear, and accordingly the congenial schools of pathological anatomy and organic chemistry, represented by Andral, Rokitansky, and Liebig, at once set their faces against a system that disparaged their discoveries, and trusted solely to the mere alternations in the patient’s feelings, which were scarcely deemed by them worthy of a thought.
And yet, in order to convince ourselves that all the speculations of the philosophical sects and the investigations of the iatro-chemical and pathological anatomical schools have not advanced the art of therapeutics by a hair’s breadth, we need only glance at the miserable success that has attended all the methods of treatment founded on the learned theories of the medical school.
Hahnemann’s system professes to aid therapeutics by a process the very reverse of all those founded on theoretical fancies, pathological or chemical. It leaves no margin for anything like theory. The effects of a number of medicines on the healthy human body having been duly registered, and the symptoms of the disease we have to treat being carefully noted, the practical rule was, as Hahnemann expresses it in the 147th paragraph of the Organon,- “Whichever of these medicines we find to contain, in the symptoms observed from its use, the greatest similarity to the collective symptoms of the natural disease, this medicine will and must be its most suitable, its most certain homoeopathic remedy.”
The sum therefore of the practitioner’s duties, in regard to the selection of the remedy, according to Hahnemann, resolves itself into a purely empirical act, an almost mechanical comparison of the drug-symptoms with the disease-symptoms, and the medicine found to present the greatest similarity in respect of its symptoms with those of the disease is the most appropriate, the most homoeopathic remedy. But it is not all symptoms that, according to Hahnemann, are of equal importance in guiding our selection, for he tells us, in Aphorism 153, that it is the more striking, singular, uncommon, peculiar, or characteristic symptoms of the disease that are to be kept chiefly or almost solely in view; it is for analogues to these that we must search through the lists of medicinal symptoms. “The more general and undefined symptoms,” says Hahnemann, “such as loss of appetite, headache, debility, restless sleep, discomfort, and so-forth, demand but little attention, as symptoms of such a general nature are observed in almost every disease and from almost every drug.”
Now this appears a sufficiently plain and common-sense rule, but unfortunately Hahnemann seems to take for granted that we can tell intuitively what are these characteristic symptoms of diseases and of medicines, and many homoeopathists seem also to take it for granted that they can. This pretension on their part has given rise to some most extravagant and ridiculous propositions on the part of some of Hahnemann’s followers, who have set themselves up as competent guides. A favourite achievement of these learned gentlemen on both sides of the Atlantic is to cull from Jahr’s Manual all the symptoms that diligent compiler has distinguished by italics, and in this way make books, the size to whose pages makes them serviceable for shaving-paper, but for no other purpose that I wont of.
When I say that Hahnemann has not told us how to distinguish the characteristic symptoms of diseases, I do not mean to say that he has entirely omitted to mention this subject in his minute directions to us as to how we are to take down and study our cases, which will be found in the Organon, Aphorism 84 to 99 inclusive, but what he does say there upon the subject does not go a great way to illume our previous darkness. In Aphorism 95, for instance, he says, talking of the mode we should pursue in investigating chronic diseases, “the most minute peculiarities must be attended to, because in these diseases they are the most characteristic, and least resemble those of acute diseases, and if a cure is to be effected they cannot be too accurately noted.”
Again, as regards epidemic diseases, he tell us what we are to consider their characteristic symptoms. One case of epidemic disease, he says, will not enable us to learn them; it is only from the careful observation of several that we can do this. “In writing down the symptoms of several cases,” he says, (Organon, Aphorism 102.) “the sketch of the morbid picture becomes ever more and more complete, not more extended and spun out, but more significant, more characteristic, and more comprehensive, as regards the peculiarities of this collective disease. On the one hand, the general symptoms (e.g. loss of appetite, sleeplessness, etc.) become particularly and exactly defined, and on the other, the more marked and special symptoms, which are peculiar to but few diseases and of rarer occurrence, at least in the same combination, become prominent and constitute what is characteristic of this malady.”
Now, as far as we can gather from this rather obscure passage, it would appear that, contrary to what we would anticipate, all the characteristic symptoms of the epidemic disease are not met with in one case, but that it requires the observation of several to enable us to fill up the characteristic portrait. In other words, the minute shades of symptoms observed in several cases go to constitute the characteristic features of the disease. We should rather have thought that the characteristic symptoms of an epidemic disease should be met with in every individual case of the disease. Again, you will remember that, in his Organon (Aphorism 235, etc.), Hahnemann enters at great length into the treatment of intermittent fevers, and he tells us that the chief characteristic indications for the remedy are to be learned from “the symptoms of the patient’s health during the intervals when he is free from fever.” (I take this opportunity to correct a typographical error in my published translation of the Organon, p.281, line x., where “free from fever” has been printed by mistake “free from pain”).
In many places of his writings Hahnemann denounces trusting to the usus in morbis, in other words, the experience of the good effects of a medicine in one disease as a guide for the employment of the same drug in what we may suppose to be a similar case–a curious paradox indeed, that the system he introduced to the medical world as the “Medicine of Experience” should dispense altogether with experience! for to that it amounts. We observe, however, that in the prefaces to the provings of many of his medicines, especially his later ones, he gives long lists of the morbid states for which the medicine has proved useful; but fearful apparently that this proceeding might be taken to indicate a connivance at that pernicious custom of the old school of being guided to the employment of a medicine by the usus in morbus, he adds a note to the first list of this kind in the Chronic Diseases, which is too characteristic to be passed over.
He there regrets that these enumerations of the symptoms that have disappeared under the use of the medicine have been misunderstood, and stated to be conditions that might determine us in the selection of medicines in our treatment–indications– which they are not in the very least; “such illusions,” he adds, “we leave now as heretofore to our allopathic step-brethren.” And precisely the same idea occurs in the first part of the Chronic Diseases, at page 150. (Curiously enough it happens that the name Hahnemann adopted for his system, homoeopathy, is derived from the motto of the empirical school, ouolov=aoos, ouolov Oapuakov, which means that similar diseases should be treated similarly, in other words, experience of past diseases should be our guide in the treatment of present ones. This motto has frequently been used as the formula of the homoeopathic system, improperly as I cannot help thinking. It appears to me far from improbable that, in the early part of his career, Hahnemann had the idea of reviving the empirical system of treating diseases, if I may judge from his writings previous to 1805, and this seems also to be the impression of the author of an essay, published at Berlin in 1834, entitled Franc. Frid. Brisken, diss. Philinus et Hahnemannus, seu veteris sectae empiricae cum hodierna secta homoeopathica comparatio. It is singular therefore to find Hahnemann in his later days denouncing experience as a guide for treatment.
It is difficult to see what other use these lists could possibly be put to than to aid us in the selection of the remedy. They constitute Hahnemann’s experience of its curative action, and are of the same kind of value as the histories of cases successfully treated, and the fact that Hahnemann gives us such lists is a proof to my mind that he latterly altered his notions respecting the utility of records of cases, though he could not bring himself so far to eat his own words as to give regular details of cases treated by him; but in these lists he gives us the next best substitute for such histories, in the morbid states he succeeded in curing with the various medicines; while at the same time, to preserve his own character for consistency, which I very much fear was impossible, as I think I have in former lectures shown he had lost it long ago, he gives a fling at the vile allopathic custom of seeking for an indication ab usu in morbis.