But Hahnemann has himself furnished us with other guides to the selection of some remedies which could never have been obtained from a mere mechanical or arithmetical comparison of symptoms, and the value of these hints or indications is so great that we only regret the number of the remedies is so few for the employment of which he has furnished us with such admirable guides. Thus of nux vomica he says, the experience of a long practice has taught him that this medicine is particularly adapted for persons who are of a very anxious, zealous, fiery, or violent character, or where the disposition is malicious, wicked, or disposed to anger. It is suitable for the morbid symptoms remaining after the catamenia, when that function comes on some days too soon and the discharge is somewhat too copious.
It is also useful for those affections caused by drinking too much coffee or wine, and especially such as arise from a prolonged sedentary life in close apartments; likewise for those that arise from too prolonged mental exertion. As regards pulsatilla, he gives some indications for its use that could only have been obtained from clinical experience, as we would scarcely have discovered them from ever so careful a study of its pathogenesy. Thus, he says, it is especially adapted to women whose catamenia are retarded by a few days, and for the effects of eating pork, when it disagrees, neither of which symptoms do we meet with in its pathogenesy. Again, he says it is peculiarly adapted to persons of bashful disposition, disposed to tearfulness, and subjects of secret sorrow and vexation, or, at all events, to persons of a mild and yielding disposition, if in their days of health they were good-humoured and gentle (or frivolous and good-natured). It is also adapted to those of a slow phlegmatic temperament, but not at all to persons of rapid resolve and lively movements, but who are at the same time not good- tempered.
I believe it will be generally conceded that Hahnemann’s recommendation of arnica as specific for the effects of falls, blows, knocks, bruises, sprains, or lacerations of the solid parts was owing more to its ancient repute as a vulnerary among the common people than to the pathogenetic effects he observed from its administration.
It was, as he himself tells us, experience that convinced him of the efficacy of rhus in the effects of sprains, inordinate muscular exertion, and bruises.
In like manner, the utility of opium in removing the torpor of the sensitive nerves, which in many cases renders it impossible for the patient to perceive and to detail accurately his morbid symptoms, is a gain of experience.
In the Chronic Diseases (vol.i. p. 163) he gives a list of a number of indications for remedies which we should scarcely have discovered in a search through their pathogeneses. “Overloading of the stomach,” he observes, ” is best removed by hunger (i.e. some weak broth in place of the usual dinner) and a small quantity of coffee; derangement of the stomach by means of fatty substances, especially pork, by pulsatilla and hunger; derangement of the stomach, which causes eructations with taste of the food, by highly potentized antimon. crudum; a chill of the stomach from eating fruit, by smelling at arsenic; derangement of the stomach with spirituous liquors, by nux vomica; derangement of the stomach, with gastric fever, chills and rigor, by bryonia; a fright, when it can be given immediately, and especially if it have produced fear, by opium; but where we are only called in after the lapse of a considerable time, or where vexation is also combined with the fright, by aconite; but if grief is the effect of the fright, by ignatia; annoyance that has produced anger, violence, heat, and vexation, by chamomilla, but if besides the vexation there is chilliness and coldness of the body, by bryonia; annoyance, with indignation, profound inward vexation, and throwing things away that he may have in his hand, by staphysagria; indignation, with silent inward vexation, by colocynth; unfortunate love, with silent melancholy, by ignatia; unfortunate love, with jealousy, by hyoscyamus; a severe chill, besides confinement to the house, the room, or the bed, by nux vomica; if diarrhoea have resulted from it, by dulcamara; or if pains are its effect, by raw coffee; if, however, fever and heat are the consequences, by aconite; a chill, followed by attacks of suffocation, by ipecacuanha; a chill, followed by pains, with lachrymose disposition, by crude coffee; a chill, followed by coryza, with loss of smell and taste by pulsatilla; a sprain or dislocation, in some cases by arnica, but most certainly by rhus; contusions and wounds by blunt instruments, by arnica; burns of the skin, by compresses of water mixed with highly potentized arsenic, or the continual application for hours of alcohol, heated by immersion in very hot water; weakness from loss of humours or blood, by china; homesickness, with redness of the cheeks, by capsicum.
Many other passages might be brought forward from Hahnemann’s writing where he gives indications for the use of remedies that could not have been suggested to him by their pathogenetic effects solely, but those I have already adduced will suffice for the present.
Whilst, then, Hahnemann professedly pointed to the comparison of the symptoms of disease and drug as the sole indication for the choice of the remedy, he in fact, gave homoeopathy a much wider basis. In the first place he tacitly admitted that we must exercise some discrimination and reasoning power, when he stated that it was the characteristic symptoms of disease and drug that should guide us, for we must exercise our judgment and selection in determining what symptoms are characteristic, and this, again, cannot be done without a thorough acquaintance with pathology. Again, when he introduced into his system his theory of chronic diseases, and insisted on its value to therapeutics, he therein encouraged a search for the (proximate) cause of the malady, a search that in its issue should influence us in the selection of some medicines in preference to others, the preference not depending on the similarity to symptoms present, but on the supposed or ascertained antecedents of the disease. This was a concession in favour of aetiology, as determining the choice of the remedy, which his disciples are justified in improving upon.
I have given examples from Hahnemann’s writings where the choice was to be determined by the occasional cause of the disease, and others where the temperament, disposition, etc., of the patient were to help us in our selection, and not a few instances in which clinical experience was the only or the chief source of the indications of medicines.
Thus, then, I think I have made it clear that the homoeopathy of Hahnemann was not that blind counting of the symptoms of medicine and drug which some isolated passages of his writings would make us suppose it to be, and which some of his disciples assert it is; but from what I have said it will be evident that aetiology, semiology, and nosology all play in determining the practitioner as to the remedy he should select; and the charge brought against homoeopathy by its adversaries, that it is merely what is called an empirical system of symptom-treating, falls to the ground, even as regards the homoeopathy of Hahnemann.
Of those of Hahnemann’s disciples who have most successfully endeavoured to interpret the therapeutic maxims of the Master in accordance with the present state of real science, none has brought an acuter genius or a better-stored mind to bear upon this subject than the late Dr. Rau of Giessen. A scholar, an author of considerable repute, it was not till a very ripe maturity of years that he becomes a convert to homoeopathy, and that not without considerable resistance on his own part, as before he perceived the truths in Hahnemann’s doctrines, his penetrating glance had taken cognizance of many of the faults Hahnemann had committed against science and he had publicly exposed the weakness of the homoeopathic doctrine. Such a man, committed by his published work against the new system, who had everything to lose and nothing to gain by its adoption, it is no small triumph to homoeopathy to have gained over; but such a man was not one to sit down quietly and swallow uninquiringly whatever Hahnemann chose to enunciate in the oracular style of discovers. Of equal scientific standing with Hahnemann, and with no great disparity of years between them, he could presume without impertinence to discuss and criticise Hahnemann’s doctrines during Hahnemann’s life time with the same freedom that we can, now that the great Master is no more. The traits I have given you of Hahnemann’s character and disposition will prepare you for the information that Hahnemann disliked him as a free-spoken critic of his writings even more than he valued him as a great conquest from the ranks of the enemy. However, I should say that it is not with reference to the work to which I am about to refer that Hahnemann took offence at him, on the contrary, he was rather pleased with this one, and occasionally quotes approvingly from it in the Organon, a compliment he pays Dr. Rau alone of all of his followers.
Dr. Rau (Werth der Hom. Heilverf., p. 40) says that Hahnemann’s maxim, ” in order to cure the patient we must remove the symptoms,” was the gage of defiance thrown down to the enemy, by many of whom it was taken up, in order to defend the glory of rational medicine. He ridicules the idea of the removal of all the symptoms not being equivalent to the removal of the entire disease, and quickly observes that he would consent to be ill all his life, provided the disease did not manifest itself by any symptoms. He says, that in that method of treatment denominated rational, par excellence, there is great room for being deceived. Its chief basis is diagnosis, which, however, according to the confession of some of its most able advocates, rests on very weak foundations, as some very important material alterations in the interior remain frequently undiscovered during life. Dr. Rau then relates several remarkable instances of the sort. Among the rest he refers to the infinite variety of opinions respecting the proximate cause of the single disease cholera. The empirical practitioner is he who, without seeking to know the proximate cause of the disease, merely endeavours to remove the most prominent and troublesome symptoms. But the elucidation of the proximate cause being in many cases impossible, the rational practitioner is often forced to act quite like the empirical practitioner, and prescribe for the prominent symptoms. Again, it is well known that as the opinions of the so-called rational practitioner vary greatly respecting the proximate cause of any particular disease, for instance, the cholera, so does also their mode of treatment of this disease vary in an equal degree. In the totality of every disease we recognise-
1. The proximate cause.
2. The sum of the symptoms cognizable by the senses. Both these united constitute an inseparable whole, and they cannot be conceived as existing the one without the other.
Hence, with the removal of the proximate cause, the external phenomena or symptoms must likewise be destroyed, and, in like manner, the proximate cause must be destroyed as soon as the totality of the external symptoms are made to disappear. Therefore the maxim cessante causa cessat effectus may be read in inverted fashion, effects remoto evanuit causa. How, says Dr. Rau, can a method of treatment founded upon these irrefragable logical deductions be less rational that that method that is founded upon deductions relative to the obscure and hidden proximate cause? Is it not unpardonable presumption to call this uncertain groping in the dark the only rational medicine? The whole difference between the two methods consists in this, that one party pretends to treat only the proximate cause of the disease, while the other seeks only to remove the totality of the symptoms. Both are causal treatment; the former particularly founded on fancy, the latter on fact.
Slovenly empirical practitioners seek only to remove certain symptoms that appear to them to be grave, which is a procedure fraught with danger. The system of Hahnemann, however, pays attention to all the symptoms presented by the patient, even the most minute, for in it the choice of the remedy is determined by the sum total of all the symptoms. Dr. Rau. them enters on a defence of this minuteness, and justly remarks that it is impossible to suppose any symptoms, however minute, that do not depend upon an alteration in the organism. He then examines the questions as to whether the consideration of all the symptoms in all cases of disease can give a sufficient indication for the most successful treatment.
He sets his face, however, against a mere mechanical comparison of the sum-total of the symptoms of the disease with the medicinal symptoms, without attempting to determine the relative importance of either; for, he says it is often impossible to find a medicine that corresponds completely with all the symptoms present, in which case it is requisite to regard chiefly the more important and essential symptoms, and to distinguish them accurately from the less important, secondary, and sympathetic ones. The most experienced practitioner, he remarks, will acknowledge the difficulty of this problem in many cases, especially as the symptoms of the sympathetic affection are often more prominent than those of the idiopathic disease; hence it is necessary to pay attention not only to the actual symptoms, but also to predisposing circumstances, epidemic, but also to predisposing circumstances, epidemic constitutions, the course of other diseases prevailing at the same period, and so forth; in a word, to make use of all aids that can put us in a position to look with the inward eye of reason into the interior of the organism, in order that we may obtain a right idea of the dynamic character of every disease we have to treat.
In order to do this we require more accurate knowledge of the remedial agents than we can obtain from Hahnemann’s Materia Medica, viz., a knowledge of the particular spheres of the organism in which the medicines exert their effects in a certain specific manner. Thus, he has, in some cases of dysentery, seen no benefit from the administration of medicines exactly corresponding to the collective symptoms of the disease, and it was only after discovering their obscure inflammatory character that he at length succeeded in curing them. This he did by means of aconite, the great homoeopathic antiphlogistic, though one of the importance symptoms of the disease, the bloody stools, was not to be found in the pathogenesis of that drug.
Hahnemann’s psora- theory, he alleges, is an acknowledgment of the necessity of paying attention to the causal nexus. To show the importance of searching for the possible cause of the disease, independent of the symptoms of deranged sensation actually present, he mentions that he has known cases of severe headaches, which bad lasted for years, yielding to none of the remedies chosen in strict accordance with the symptoms present, which only went off after the extraction of a carious tooth that had never occasioned the slightest uneasiness. In cases of doubt, he acknowledges it to be the safer method to trust to the collective symptoms present for the indication, rather than to rely upon conjectures as to the nature of the disease; but he is far from denying the possibility, in many instances, of discovering the proximate cause of the disease by our reasoning powers.
If the practitioner’s attainments in physiological, pathogenetic, and pathological knowledge are considerable, he will often be enabled, from a study of the symptoms actually present and a research into all the circumstances connected with the disease, to distinguish the idiopathic from the sympathetic symptoms, and to devote his attention particularly to the former. Thus he will pay less attention to the dull aching headache that so often accompanies gastric affections than to the gastric affection itself, and thereby he will be enabled to select the remedy much more speedily and accurately than if he sought for the parallel for each particular morbid phenomenon among the confused array of symptoms in the Materia Medica. He would, without a painful and anxious research, treat an indigestion arising from eating fat pork differently from one caused by sour fruit, and in cases where a poisonous substance had been swallowed he would certainly commence the treatment with an emetic. A bilious diarrhoea, brought on by vexation, he would treat at once with chamomilla, whilst a diarrhoea brought on by a chill he would cure with dulcamara. He would unhesitatingly select staphysagria for an affection of the mind brought on by annoyance, accompanied with indignation; and aconite for the bad effects of a fright, etc. But still the true homoeopathist would never select a medicine whose pathogenetic effects did not correspond to the symptoms of the disease.
The same point is dwelt upon by Dr. Hartmann, in his Therapia of Acute Disease. “It has been supposed,” he writes, ” that Hahnemann neglected to take cognizance of the exciting cause of the disease. The opponents of homoeopathy have frequently charged us with this neglect; but unjustly so, for every homoeopathic practitioner knows that in many cases, the proper selection of the remedial agent depends exclusively upon a knowledge of that cause.”
He then proceeds to enumerate the medicine mentioned by Hahnemann as specifics for certain accidental effects, to which list he adds the following:-Rhus toxicodendron for the injurious effects of a drenching; cocculus (query capsicum) for the effects of home-sickness; china for the physical and mental weakness produced by blood letting, haemorrhage, wakefulness, night sweats, onanism, venereal excesses, etc.; nux vomica for diseases occasioned by want of exercise and those produced by over- indulgence in alcoholic drinks; and he adds: “A homoeopathic physician who is acquainted with the pure effects of chamomilla, mercury, sulphur, china, valeriana, iodine, etc., will never prescribe these remedies without inquiring, in the first place, whether the symptoms have not been occasioned by the excessive use of these substances, in which case, he would administer suitable antidotes.” (Hartmann, Hempel’s translation, Introduction, vol.i. p. 29.)
Dr. Moritz Muller, a sincere admirer of Hahnemann, and a willing testifier to the great value of his discoveries to practical medicine, was one who, like Rau, brought a great sore of physiological and other scientific attainments to bear upon the therapeutical system he adopted. Unfortunately, like Rau, and for the same reason, viz., his independence of judgment and his refusal to take every word of Hahnemann’s for gospel until he had carefully subjected it to the searching criticism of his well stored and truly logical mind, he soon incurred the personal dislike of Hahnemann, who went so far as to denounce him publicly as being no true homoeopath, and never rested until he had enforced his retirement from the medical superintendence of the Homoeopathic Hospital in Leipzic, where he had exerted himself in the most devoted and unselfish manner without nay remuneration. After his retirement, the direction of the hospital fell into the hands of others, who flattered Hahnemann by avowing the most implicit faith in his every maxim, but who were incapable of comprehending the system they professed to practise; the consequence of which was that the hospital, which had furnished brilliant results during the period of Dr. Muller’s service, gradually fell off, and at length, chiefly owing to the incompetence or roguery of one of its physicians, the notorious Fickel, came to an untimely end. Notwithstanding the ungenerous treatment he had received from Hahnemann, at the instigation doubtless, of some personal enemies who possessed the ear of our illustrious but easily prejudiced Master, Dr. Muller never ceased to regard him with veneration and esteem; and on all occasions undertook the defence of his defensible doctrines against the assaults of his enemies. In a paper published in the second volume of the Allg. Hom. Zeit., he endeavours to remove from homoeopathy the reproach of being a rude empiricism, and represents the selection of the remedy as a work of the highest order of inductive reasoning, where all flashy attempts to ascertain the essential nature of the disease are relinquished, and the practitioner aims at forming a just conception and appreciation of all that is capable of being observed in the disease. He insists that the homoeopathist must endeavour to oppose the character of the homoeopathic remedy to the character of the disease, and not merely search for the whole array of the perceptible symptoms of the disease in the recorded effects of the medicines. He shows the groundless nature of the reproach that homoeopathy is identical with the ordinary symptomatic treatment. Homoeopathy, he says has to do with the totality of the symptoms, whilst the ordinary symptomatic treatment concerns itself only with those symptoms that are most prominent.
Dr. Schron (Hauptsatze d. Hahn. Lehre, p. 5; Naturheilprocesse und Heilmethode, 2, Aphorism 192; Hg., ii, 35.) undertakes the defence of physiology and pathology against the attacks of Hahnemann, and shows that the collective symptoms cannot be the sole indication for the selection of the remedy. In the first place, he proves that Hahnemann contradicts himself when he says that the totality of the symptoms must be the sole indication, for he admits other things as capable of determining our selection, such as the exciting cause, the individuality of the patient, prevailing diseases, psora etc. Schron admits the symptoms to be the most important indication, but the practitioner must avail himself of everything that can throw light upon the case of disease and can guide him on the right way to the selection of the remedy. Hence he insists on the importance of obtaining a better knowledge of the characteristics of the medicines, which he says is the kernel, whilst the bare unthinking symptomatology of diseases and medicines is but the shell.