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.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.