In our investigation of diseases, as well as in our consideration of the pathogenetic action of drugs, we must, says Schron, endeavour to ascertain which symptoms are essential and idiopathic, and which are non-essential and secondary or sympathetic. The right remedy must correspond to the disease in the idiopathic symptoms; and if several remedies exhibit such correspondence, the sympathetic symptoms will enable us to select the most appropriate from among them. The main difficulty, however, it will be seen, is to determine which are the idiopathic and which the sympathetic symptoms of diseases, whether natural or artificial.
Dr. Kurtz c Hyg., iv. also lays great stress on the necessity for ascertaining the character of the drugs, and makes the selection of the remedy an affair of the reason and judgment, and not a mere enumeration of symptoms.
Dr. Wolf (Achtzen Thesen, 4ter Satz.) understands by the totality of the symptoms the collection of all the pathological points from the commencement of the disease until the moment when the physician is called in; he says that it is requisite to investigate the symptoms through their whole development and history.
Dr. Roth (Hyg., vii. 497.) of Munich holds the controversy upon the totality of symptoms as the indication to be a mere hair splitting logomachy; for says he, without symptoms objective and subjective it were impossible to make a diagnosis.
Dr. George Schmid, (Ibid., ix.1.) convinced that the similarity of symptoms is the only thing to guide us in the selection of the remedy, endeavours to ascertain what we are to understand by this similarity. The determination of this, he says, is the most difficult part of practice, for the problem is to distinguish what is apparent from what is real, and it is requisite to pay attention to every circumstance capable of affording us an explanation of what is similarity betwixt disease and medicine. Great value is attached to the elucidation of what is characteristic in the symptoms of disease and medicine.
In like manner Watzke (Bekehrungsepist., 81.) observes: in treatment all depends on finding a remedy which, by numerous experiments on the healthy, has shown that it can constantly, certainly, and powerfully produce on the affected organ or system and its sympathies and antagonisms an action corresponding in characteristic similarity to the collective symptoms in the case before us, and the efficacy of which, as a curative agent of this sort, has been proved at the sick bed.
Dr. Mosthaff (Die Hom. in ihrer Bedeutung.) says that it is not a mere superficial similarity betwixt the symptoms of the disease and of the drug that we are to be guided by; he acknowledges the similarity as an important but by no means the sole point to be attended to in the selection of the remedy.
Dr.Peterson of Pensa, whose name I have already had occasion to mention more than once in the course of these lectures, as he has written largely, if not lucidly, on many points in connection with homoeopathy, has given us his ideas on the subject of the choice of the remedy. (Arch., xiv) He calls attention to the great difference in the intensity of the symptoms observed from the proving of drugs and those that occur in natural diseases, and admits that the contents of the Materia Medica of Hahnemann offer a vast array of unimportant and paltry- looking symptoms; but he reminds us that we are not to search in the Materia Medica for exact correspondence, as far as the intensity of symptoms is concerned, to the phenomena of natural diseases. In our mind we must always represent to ourselves the symptoms in the Materia Medica as much greater than they really are, and the symptoms of the natural disease as much less intense then they occur. In this way we shall be able to find more exact correspondences than otherwise offer themselves. He proposes to supply the deficiencies of the Materia Medica, by adding those symptoms we observe to occur in the course of an acute disease when the medicine has not been perfectly homoeopathically chosen. Such symptoms, not being the same as those the disease presented before the employment of the medicine, are to be attributed to the action of the drug, even although they are not to be found in its provings, and are capable of being developed in the healthy subject. These symptoms he advises to be added unhesitatingly to the pathogenesis of the medicine, and he also, contrary to the advice of Hahnemann, advises to add also to the pathogenesis those symptoms that have disappeared under the use of the medicine. By these two very impure sources we might doubtless soon extend the pathogenesy of a medicine to the dimensions of a thick volume, but I doubt very much if the difficulties attending the selection of the drug would be at all diminished; on the contrary, with such a mass of doubtful symptoms they would necessarily be very much increased. I sincerely trust that no ignes fatui, delusively promising us greater facilities in the choice of the drug, like these of Dr. Peterson, will ever tempt us to deprive our Materia Medica of its title of pure, and lead us astray into the quagmires of uncertainty and impurity. Dr. Peterson does not allude to the necessity acknowledged by the other writers on this subject, of endeavouring to ascertain the characteristic points in the symptoms of drug and disease.
Hirschel (Die homoeopathie, p. 145.) says the indications for the selection of a remedy are derived-1, from the complex of the symptoms of the disease, particular attention being paid to the primary, idiopathic, pathognomonic, and diagnostic signs (diagnosis and semiology); 2, from the affected systems or organs (anatomico-physiological foundation); 3, from the morbid process, its character, history, and stage (physiological foundation); 4, from the internal aetiological circumstances on which the disease depends (proximate cause), as far as this can be ascertained (aetiology); 5, from the external exciting causes, even when these are very remote (e.g., in chronic disease, dyscrasic maladies) (aetiology); 6, from the peculiarities of the individual diseased in reference to constitution, moral condition, temperament, mode of life, etc; 7, from the peculiarities of the atmospheric and telluric influences in respect to weather, temperature, time of the year and day, prevailing endemic and epidemic diseases; 8, from the particular modifications produced in the morbid symptoms by external and internal influences, such as motion, position, open air, mental exertion, certain functional acts, as eating, drinking, etc. Hirschel remarks that homoeopathy has this advantage in simplicity over the old system, that there are no contraindications for the employment of medicine to be considered in it. It only knows indications. Every medicine that does not possess the quality of similarity as regards the disease is simply not indicated, and should not be administered. There can be no contraindications for the employment of a medicine which presents the necessary similarity in respect of its pathogenetic effects to the symptoms of the disease.
Dr. Hering of Philadelphia, the most prolific of homoeopathic authors, one who has written, we may fairly say, de omnibus rebus et quibusdam aliis, for he has in his voluminous writings treated as well of things that are not as of things that are, among the oceans of whose exuberant rhapsodies we often perceive an under- current of plain common sense, a vein of the pure gold of truth in the otherwise unprofitable quartz-mountain of hypothesis, which will often amply, repay the labour of digging it out- Dr. Hering, I say, has touched upon the subject of the choice of the remedy, without, however, throwing much light upon it. He tells us (Arch., xv. 1). that it is the concordance in the characteristic symptoms that must guide us in the selection of the remedy. Pathology, he says must teach us the peculiarities or characteristics of disease and cases of disease; iamatology must teach us those of the medicine. We should complimenting Dr. Hering at the expense of truth were we to say that we had gained a great accession of wisdom from this advice. Hering has, however, written an excellent essay on the study of the Materia Medica, the most important of studies in enabling us to select the proper remedy, which I can heartily recommend to your careful consideration. It is translated in the second volume of the British Journal of Homoeopathy.
That eminent repertory-manufacturer, Herr von. Boenninghausen (N. Archiv, i. 1, 84 et seq.) of Munster gives us his view on this subject. He observes, that most likely all homoeopathists, on first commencing the study of the system, felt as he did, that the pathogenesis of almost every medicine contained the elements of almost every disease under the sun. It is only by a comparison of the different pathogeneses among each other, and particularly by comparing them with actual cases of disease, that we see how erroneous was our first idea. He says that by a comparison of the remedies one with another we soon begin to perceive remedies one with another we soon begin to perceive their differences or their peculiarities, and from their peculiarities we gain the only just idea of their therapeutic employment. The very prover of a remedy may not at first observe or be able to distinguish what are the peculiar and characteristic symptoms of the medicine he had carefully proved. Thus Dr. Franz, he says in the preface to his proving of asafoetida makes no mention of what are the peculiar and characteristic symptoms of this medicine, which Boenninghausen declares to be-pains shooting from within outwards, generally of a burning character, obtuse, and intermitting. This character of the pains is, says he, a better indication for the use of this drug than the particular seat of such pains. Thus asafoetida does not show such pains in the nose ears, lips chin, teeth, etc; but Boenninghausen would not feel the slightest hesitation in giving this medicine for that sort of pain occurring in any part not noticed in the proving, the character of the pain being in his opinion of more importance than its seat. Another important point to be attended to in the choice of the remedy is, that the conditions under which the disease-symptoms occur should correspond with those under which the medicinal symptoms are observed. The conditions he here alludes to are the period of the day, the position of the body and other circumstances. These conditions he attaches great weight to, and makes them often constitute the characteristics of the medicine. These views of Boenninghausen’s we observe to give a colouring to all the works, such as repertories, manuals, and other aids to practice which have issued from his prolific pen, and we notice that his example has influenced not only his copier Jahr, but also Ruckert and Cl. Muller in their Repertoriums. In all these works the character of the pain or symptom is put forward more prominently than its exact seat, and in many of them the condition under which the symptoms occur likewise occupy a more important place. This I believe to be a mistake, which, though pardonable in unprofessional individuals like Boenninghausen and Jahr, whose whole medical education was obtained from the writings of Hahnemann, ought not to have occurred in the works of well- educated medical men like Ruckert and Muller. As regards the selection of the remedy on account of the accordance of the condition under which the medicinal and disease symptoms occur, Boenninghausen carries this to a most extravagant length, so far, indeed, that he occasionally loses sight altogether of the symptoms, and looks for a resemblance in the condition solely. To show you how he does this, I shall give you a specimen from one of his last works.
In his preface to his Manual of Homoeopathic Therapeutics (I quote from Laurie’s edition). after observing that the choice of the medicament frequently depends on the condition of the aggravation or amelioration, he gives us the following illustrative case:-“My friend Dr. Lutherbeck (to whom I always intrust my practice in my absence) gave to one of my patients for some sequelae of a case of deeply-rooted tubercular phthisis of which I had cured him (amongst which a disagreeable smoothness, with a thick coating of mucus on the teeth, formed the predominant symptom, and invariably became aggravated for two consecutive days every time he shaved), carb. anim. 30, with the most successful results, although the only symptom on the skin of the face (152) noticed by Dr. Adams was not present.” On turning to the symptom in question in Hahnemann’s Chronic Diseases, we find it be as follows:-“The skin of the face smarts, especially on the cheeks, about the mouth, and the chin (after shaving).” Now, I believe this symptom to be altogether unimportant in itself, and probably attributable to anything but the medicine swallowed. Dr. Adams resided in Russia, and probably the day on which he observed this wonderful symptoms was rather cold, which would cause his face to smart after shaving; or it might be he had used some coarser soap than usual; or possibly his razor was not quite in order or was not “a well-tempered blade;” for does not the poet (I mean Mr. Mechi’s of Leadenhall-street) not only notice this fact but propose the remedy, in the following lines?-
“Most people complain that shaving’s a bore.
Each day’s painful scrape only chafes an old sore;
Choose the cutler who stands at the head of the trade-
Half the better depends on a well-tempered blade-
In the front of these lines his name is displayed.”
Dr. Adams, however, leaves us in blissful ignorance of all these matters, and our self-constituted doctor Boenninghausen accepts his symptom as a genuine medicinal action, the only important point of which to him is the parenthetical observation “(after shaving).” For, be it observed, the state of the teeth has nothing whatever to do with this operation as far as carbo animals is concerned; indeed, carb- anim. nowhere offers a state of the teeth at all resembling that of Dr.Lutherbeck’s patient, either after or before, or independent of shaving; and Dr. Lutherbeck’s patient had no smarting of the face whatsoever. All the resemblance between the patient and the prover is that something was observed by each after shaving; but though there is an obvious connection of the prover’s symptoms with the operation of shaving, there is none as regards the patient’s symptom, unless it be that the patient probably made faces in the glass as many do after shaving, and then first observed the mucus on his teeth. The circumstance of the symptom occurring invariably for two successive days is no doubt very remarkable, and has its due weight with us; but what most interests us is the new light thrown by Boenninghausen on homoeopathy, whence it would seem that in the selection of our remedy it is quite immaterial whether or no the symptom be among its pathogenesy, provided only any symptom is noted as occurring under a condition analogous to that under which any symptom of the disease occurs. Thus it would have answered Boenninghausen’s purpose equally well, if the symptom recorded by Dr. Adams had been, in place of what it is, “inclination to wipe the face after shaving,” a circumstance almost as likely to occur as the smarting of the face after that operation, the “after shaving” being, test Boenninghausen, the sole thing of importance in the matter.
I would not have deemed it necessary to occupy your time with the exposure of such extravagant absurdities, were it not that of late we have seen Boenninghausen held up to our admiration as the greatest living authority on homoeopathy, whereas he is nothing but a useful repertory-maker and enthusiastic dilettante practitioner, who, not having had any medical education and having taken to homoeopathy late in life, is not at all qualified to give an opinion on points which require a thorough acquaintance with many of the auxiliary branches of medicine, and, above all, the mental discipline and qualifications for forming a correct judgment on medical subjects, only attainable by a thorough medical education. (Here von Boenninghausen has evidently no mean estimate of himself as an exponent of the homoeopathic system, and often censures very severely some whom we are inclined to consider as the most learned and scientific of our body. This is by no means an uncommon habit with dilettanti homoeopathists, homoeopathists, even in our own country. These doctors Dei gratia, seem disposed to put in a claim for the exclusive title of Fidei Defensores, to judge by the rating they occasionally administer to us for our deviations from what they are pleased to set forth as the true homoeopathic doctrines.)
Dr. Mure, in his book upon the Homoeopathic School of Rio, talks indeed about characteristic symptoms as determining the choice of the remedy; but the specimens he gives of his practice exhibit nothing of the sort, nothing but a mechanical reckoning of the symptoms of the disease and of those of the drugs corresponding best with it, drug that presents the greatest number of the symptoms of the disease without any regard to their quality or character, being that he fixes on. No doubt, by this mechanical reckoning up of the symptoms of drug and disease, a lucky hit is often made, just as the most irrational empirics often make lucky hits, and the most ignorant peasant sometimes succeeds in curing a disease that has baffled the skill of the most learned professors; but the perfection of medicine does not consist in making lucky hits, but in being able to select our remedy with the greatest possible amount of certainty; for this, some other method than the arithmetical process is required.
In the selection of the remedy, says, Dr. Griesselich, Handbuch, 164 we must keep in view-
1. The individuality of the patient in its whole extent. as regards predisposition, etc.
2. The symptoms, from their commencement until their present state, as regards duration, connection, intensity, etc.
3. The ascertainable cause that acted on the patient, as a consequence of which the predisposition to the disease burst forth in flames; the external noxious influences.
Consequently we must pay attention to the aetiology, semiology, and diagnosis of the disease. But, continues he, as our object is to oppose to the disease a medicine resembling it, and that in its characteristic symptoms, we require to attend to the same points as for the investigation of the disease, we require to diagnose the medicinal just as we do the natural disease. Hence it is requisite to estimate the value of the symptoms. It is only by the exercise of our reasoning faculties that we are able to raise phenomenology and symptomatology to a higher rank.
The certainty and rapidity, continues Griesselich, with which we are able to recognise a disease from its symptoms, and to employ for it the appropriately similar medicine, depends upon the actual state of our objective and subjective pathological and pharmaco-dynamical knowledge. This explains why there are so many cases of disease that we cannot do any good to, partly because the medical art is not omnipotent and never will be so, partly, because every physician is not able to make himself master of all the resources the art affords, or to have them always in readiness to apply at the proper moment. It must therefore happen that a false selection of remedies is occasionally made, and the most skilful is not he who never makes a false selection, but he who does this least frequently. After showing that other circumstances formerly detailed guide us in the selection of the remedy, he observes that homoeopathy is a causal and rational mode of treatment in the best sense of those terms, although among homoeopathists there are certainly some more coverers of symptoms.
Dr. Trinks (Handbuch, Introd., p. xxx.) says truly that the most appropriate and specific remedy for every case of disease is that one whose positive peculiar effects on the healthy human organism present the greatest similarity to the peculiar and essential phenomena of the disease to be cured. By this similarity the medicine betrays its direct action on and relation to the disease to be cured, and the organs and systems of the organism where it has its seat. It may happen that several medicines offer this similarity to a case we have to treat, whereby there will be some difficulty in selecting the best remedy; but this may generally be done by ascertaining which of the remedies resembles the disease, not only in its most essential but also in its less essential symptoms. If, notwithstanding what may appear to be a proper selection of the medicine, the practitioner should not see the expected full and perfect cure, he must endeavour to ascertain-1st, if his choice of the medicine was appropriate; 2nd, if the disease has not undergone some essential change in its phenomena, character and course, by the action of the medicine was given in the proper dose. In the first case, he will have to make another and more careful selection. In the second case, the remedy will not do to be repeated; it will be requisite to have recourse to another, which shall resemble the disease in its now modified and altered form. If, after the administration of the well-selected remedy, the disease undergoes a change in the quantity but not in the quality of its essential symptoms, we may infer that the dose administered has not been sufficient, though the choice was correct. It will never be requisite to give two remedies at the same time in a disease. Even when two acute disease occur in the same individual at one and the same time, it will not be necessary to give two remedies at once; we must direct our attention to the cure of the most dangerous disease first, and when that is past we can then set about curing the other. In like manner, where an acute disease occurs in the course of a chronic one, we must neglect the latter until we have subdued the former. In other respects, Dr. Trinks’s advice does not differ from Hahnemann’s and he does not inform us how we are to distinguish the characteristic essential symptoms of drug and natural disease.