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.