Having thus laid before you as briefly as I could the principal views that have been advanced by both Hahnemann and his disciples relative to the selection of the remedy, it remains for me, before concluding this lecture, to give you by way of summary, my own reflection on the subject.
As the selection of the remedy must be founded on the similarity of the symptoms of the disease with the pathogenetic effects of the medicine, we must in the first instance determine what we are to understand by such similarity, The word similar has given rise among the opponents of homoeopathy to a number of objections and reproaches, which it is impossible to contend are wholly destitute of foundation. What do you mean by similar? they exclaim, and, without for an answer, each interprets it as seem good to himself. And to say the truth, it is impossible to give a precise definition of it. We feel the awkwardness of the expression, and are aware of the latitude of meaning it is susceptible of. Beyond actual identity, one thing may be said to be similar to another, from an almost exact correspondence to a very faint resemblance. Hahnemann says, the homoeopathic remedy is that which presents the greatest possible similarity in its pure effects to the symptoms of the disease. But the greatest possible may be very far removed from a great actual similarity. For instance, the disease is a fungus haematodes, with all its concomitant phenomena; what is our greatest possible similar to this among the pathogenetic effects of medicines? Evidently the chief phenomenon of the disease, the fungus itself, is not represented at all in our Materia Medica. We may find some of the concomitant symptoms pretty well repeated in several of our medicines. The accompanying gastric and intestinal conditions, the state of the skin, the loss of rest at night, the condition of the spirits and mental faculties, may be all tolerably well represented in the effects of several medicines; but what will this avail us? These accessory symptoms are common to a vast number of diseased states. One practitioner tells us he has discovered the homoeopathic analogue to the disease in phosphorus, and states that he was guided to its selection by one symptom in particular, viz., “small wounds bleed much,” that from this hint he administered the medicine, and the successful results justified his selection. This is evidently a similarity of the loosest sort, the faintest of resemblances; and yet, though this is an extreme case, it must often happen, from the very wide difference there exists betwixt the intensity of natural diseases and the very trivial effects produced by the cautions provings of medicines, that the resemblance that is to guide us must be equally faint. The main feature of very few of the severest diseases is represented in the pure effects of medicinal substances, and the practitioner has consequently to seek for resemblances among the accessory symptoms of the malady. Hahnemann says the disease and medicine must resemble each other in their characteristic symptoms; but what he understands by characteristic symptoms is evidently something very different from what is so understood by nosologists. The Materia Medica is chiefly made up of what are called subjective symptoms, i.e., sensations experienced by the prover; but the characteristic symptoms of diseases, in the idea of nosologists, are almost principally the objective or physical symptoms. Now, as these latter are but rarely met with in the Materia Medica, it is obvious that the homoeopathist can only, in the vast majority of cases, compare subjective with subjective symptoms, and his endeavour must be to ascertain the characteristics of these subjective symptoms. Where objective can be compared with objective, as can be done with respect to a few diseases and medicines, there is no difficulty; but in the comparison of subjective with subjective, the case is altered, and hence the necessity of the most minute and careful investigation. There are three points to be chiefly attended to in this investigation:-
1. The seat of the pain or sensation, and that not so much the typographical seat, as the structure, organ, or tissue of the body, where it occurs.
2. The exact character of the sensation, whether it is burning, shooting, tearing, pressive, tensive, etc.
3. The condition of its occurrence, aggravation, amelioration, or cessation.
All these circumstances together make out the characteristic of the sensation, and the pure effects of the remedy must be correspond in all these features to the symptoms of the disease to entitle it to be considered as a homoeopathic, a similarly acting substance. In the prefaces to his medicines, Hahnemann has furnished us with some of the characteristics of the symptoms of several medicines. Thus of bryonia, he says, that the tearing pains it produces are aggravated by motion, and relieved by rest, whilst the reverse is the case as regards the tearing pain of rhus; and these characteristics are of great use in guiding us to the selection of one or the other medicine in a case of actual disease. He has done the same by several other medicines, and some of his disciples have attempted, with more or less success, to point out some of the characteristic of other medicines. Unfortunately the number of medicines is not great where the characteristics can be indicated with equal precision.
Another help to the practitioner in his selection of the remedy has been furnished by the effort of some of the best pathologists among the homoeopathists to determine the particular organs, tissues, and systems of the organism chiefly acted on by various medicines: thus the affinity of aconite for the vascular system, of belladonna for the mucous membranes, of bryonia and rhus for the serous and tendinous structures, of mercury for the bones and skin, etc., etc., have been pointed out; and all these efforts tend to lessen the uncertainty of the practitioner, and to render his practice more successful, though, It must be confessed, they have a tendency to lead him into a slipshod method of treatment, if such indications be not looked upon merely as hints, and in no case to be relied upon to the exclusion of a careful study of the Materia Medica.
Those diseases are easiest to treat which have a goodly number of well-marked symptoms, and Hahnemann has well observed, that among the most difficult cases we meet with are those where there is a great poverty of symptoms, where there are only one or two symptoms. In the former case, there being many points of comparison, it will rarely happen that the choice lies betwixt more than two or three medicines; but in the latter, for example, neuralgic affections, chronic headaches, cardialgia, diarrhoea, skin diseases, etc., it often happens that ten or twelve medicines seem equally indicated for such affections., Hahnemann advises us to give a medicine which we think is indicated, and if it be the right one it will cure the disease, but if not, it will stir up some other symptoms, which will then enable us to prescribe with more precision.
I have already alluded to the cases where, notwithstanding the administration of an apparently rightly chosen remedy, no result ensues; there is no reactive power, the system is as it were in a state of torpor. In such cases I have stated Hahnemann advises the administration of a dose of opium, whereby the reactive power of the organism will be roused from its semi-paralysed state. Dr. Wolf has found moschus of use in similar cases, and Griesselich has found advantage from the administration of wine. Acidum nitricum, sulphur, and mercury have been employed by others for similar purposes, with good results. Hahnemann has directed us to employ mesmerism in certain analogous cases, and Aegidi has found good effects from electricity.
Equally or even more troublesome are those cases where there is an excess of irritability, where every medicine seems to produce too violent action. In such cases it is often advisable to abstain altogether, for a time, from medicine, and to trust to dietetic means, mesmerism, out-of-door exercise, and the regulated use of cold water externally. Nux vomica, ignatia, and pulsatilla, in small doses, are often of service in reducing the oversensibility to medicinal impressions.
Notwithstanding Hahnemann’s denunciation of indications from clinical experience, I confess I consider this a very valuable aid to our selection of a remedy, and in common, I believe, with all Hahnemann’s disciples, I look upon fully and carefully detailed cases as second in value only to the accurate records of pathogenetic provings. I wish I saw in the English language a careful digest of the numerous interesting and instructive cases that are to be found scattered throughout the homoeopathic literature of Germany, France, and England.
Various works designed to assist us in the choice of the remedy have, as you are aware, been published. Among these I may allude to a few of the most important. Boenninghausen’s Repertory is very good in its way (though now rather antiquated), and it has this defect, that it is difficult to find in it precise seat of the symptoms, their character and the conditions of their occurrence being most prominently set forth. His Manual is a laborious work, but I confess I have not found it of much practical use; the indications are of much too general a nature to be serviceable to the practitioner; they can, at the most, only serve to guide him to a limited list of medicines from which to select the appropriate one. Jahr’s Repertory is founded on Boenninghausen’s and is certainly in some respects an improvement on it, but very many of the symptoms are not reliable, more especially those professedly derived from clinical experience. Weber’s and Ruckert’s arrangements of the Materia Medica are certainly good, but they sadly need an index to each of the sections into which the symptoms are divided. In their present form, they often give us a great deal of trouble to ascertain if the symptoms we seek be in the Materia Medica or not. They contain only the pure pathogenetic effects of the drugs Muller’s Repertory is very useful in some respects, but it has the same fault as the others in not affording facilities to our search for the particular seat of a pain or symptom. Hempel’s Repertory is better in some respects than any of those mentioned, but it is very imperfect, and follows Weber’s vicious plan of not arranging the medicines in alphabetical order, whereby much time is sacrificed in our search for the required symptoms. I may direct attention to a little American work entitled Bryant’s Pocket Manual, which possessing no claims to originality, is a compilation that will often give the practitioner a useful hint as to which medicine in the Materia Medica he is most likely to find adapted for his case. But none of the works I have alluded to are perfect, or even as good as they might be. I hope, however, we shall not have long to wait before we have a really good Repertory of the Materia Medica, where with a minimum expenditure of time and trouble, we shall be able to put our finger at once upon the medicines which shall be most homoeopathic to the diseases we are treating; for, as our thesaurus medicaminum increases, we become more and more conscious of the difficulty of finding the appropriate remedy amidst the chaos of pathogenetic effects that make up the Materia Medica.