THE PRINCIPLES AND PRACTICE OF HOMOEOPATHY by RICHARD HUGHES.
L.R.C.P., Ed., M.R.C.S., Eng., M.D. (Hon.), N.Y., Phila., St. Louis, U.S.A.
I am to endeavour, in the ensuing course of Lectures, to tell you what Homoeopathy can do in the various recognised forms of diseases, and with what instruments it effects the doing. But before I come to such exposition, it is necessary that you and I should arrive at a mutual understanding as to what Homoeopathy is, and as to some at least of the questions that arise out of its theoretic conceptions and practical applications.
Briefly, then, let me define what is contained in the word we are using. Homoeopathy, I would say, is a therapeutic method, formulated the rule SIMILIA SIMILIBUS CURENTUR let likes be treated by likes. The two elements of the comparison herein implied are the effects of drugs on the healthy body and the clinical features of diseases; in either case all being taken into account, which is appreciable by the patient or cognizable by the physician, but hypothesis being excluded. Medicines selected upon this plan are administered single (i.e., without admixture), and in doses too small to excite aggravation or collateral disturbance.
I believe that nine-tenths at least of the adherents of Homoeopathy would accept this as a true account of all that is essential to it. If it be so, it is obvious that the thing with which we shall have to do is a METHOD not a doctrine or a system. It belongs to the art of medicine rather than to its science. Of course, the rules of art need not be, should not be, merely empirical: they should be in harmony with philosophy and science, and framed with correct conception and from sound induction.
I shall try to show you that Hahnemann’s method fulfills these requirements; that his way of regarding disease and drug action is eminently philosophical, that his direction to treat likes with likes results logically from a true induction from the facts of the matter and his reduction of dose follows as a necessary corollary thereto. But it remains a method still, and nothing more.
It takes a particular aspect of disease and of drug-action not denying that there are others as the opposing surfaces; and of the possible modes of applying the one to the other which we shall see to be three in number, it selects that which is expressed by SIMILIA SIMILIBUS. Observe also that this expression in its completeness as constituting the Homoeopathic formula is (in our definition) worded as a rule of art rather than a law of science. It does not say, SIMILIA SIMILIBUS CURENTUR likes are cured by likes, which (to say nothing of its dubious Latinity) would be inadequate, if meaning merely that such cure may be, unwarrantable if implying that all cure is, so wrought. It says, SIMILIA SIMILIBUS CURENTUR let likes be treated by likes, (In the discussion as to the true reading of the Homoeopathic formula, it has sometimes been overlooked that the subjunctive mood is used here, not in its potential (likes MAY BE treated by likes) but in its imperative force. It is like the well-known CEDANT ARMA TOGOE where the same grammatical form is employed.) which is good Latin and tenable direction.
I am well aware that the affirmative form of the phrase has long been current among Homoeopathists; (See Note 1 to this Lecture (p.9).) and that, so rendered, it has been taken as equivalent to a law of Nature, or even of morals.( See Note 2 (p.11). It is however, quite unwarranted by history, and must no longer be suffered to mislead. I know also how tempting it is to give to a method a philosophic body, to connect what is in itself purely practical with theoretic conceptions in the present case of life, disease, and of the MODUS OPERANDI of drugs.
This has been attempted by many adherents of Homoeopathy, from its founder onwards: and with theories of dynamism and such like, they have built up a system as ambitious as those which reigned in the seventeenth and eighteenth centuries. It is natural that the enquiring mind of man, “looking before and after,” should seek so to round his conceptions. But these thinkers have too often become so enamoured of their speculations that they have required or seemed to require that the profession should accept all, if they are to take any, should adopt the philosophy as well as the creed.
In so doing, they have seriously prejudiced the cause they have sought to advance. The notions of Physiology and Pathology current eighty years ago, and with which therefore the earlier Homoeopathists were imbued, are now greatly changed, and are not acceptable to the present generation. That Homoeopathy has been linked with these, has needlessly multiplied its vulnerable points; and it is at these that the attack of its hostile critics is generally made their success at such outworks favoring in themselves and others the belief that they have made the citadel untenable. ( See for instance the “Examen du systeme de S. Hahnemann: le spiritualisme et le mader alisme en Medicine” Par Dr. Stapparts, Brussels, 1881; the article on Homoeopathy by Dr. Glover in the Last Edition of the ENCYCLOPAEDIA BRITANNICA; and that of Professor Palmer in the NORTH AMERICAN REVIEW of March, 1882).
Our wisdom would rather have been to have kept on the ground chosen with such general acclamation by Dr. Geddes Scott, in his Prize Essay of 1848, which you will find in the Sixth Volume of the BRITISH JOURNAL OF HOMOEOPATHY. He there showed the great value of Homoeopathy to be that it was a theory of CURE rather than of DISEASE, and led direct to practice without the intervention of any further theory; in short, that it was a therapeia, complete in itself, and independent of allied sciences of Physiology and Pathology, so far as these consist of doctrines and conceptions, and are more than CATALOGUES RAISONNES of facts.
It appears, therefore, from what has been said, that Homoeopathy is essentially a practical method. It is, as its originator called it, an organon an instrument for effecting in the best manner a certain end, viz.: The cure of disease. It answers to machines like the steam-engine and the spinning-jenny; and like these must have had an inventor. That inventor was SAMUEL HAHNEMANN.
That the idea of fitting likes to likes in the treatment of disease had occurred to men’s minds prior to Hahnemann may be freely acknowledged. It may be found here and there in medical literature from Hippocrates downwards. But when examination is made into the nature of these similarities, they will be found in most instances something very different from those which Homoeopathy uses as its fulcra. That vomiting should be checked by an emetic, in an emetic dose (VOMITUS VOMITU), was treatment by similars in the eyes of the father of Medicine; and his successors wandered still further from the mark.
Their notions on the subject have been fully exhibited by Dr. Dudgeon, in his “Lectures on Homoeopathy,” and by Dr. Burnett, in his “Ecce Medicus!” Signatures the resemblance in form or colour of parts of plants to parts of the body; analogies yet more imaginary between the constituents of the macrocosm of the world and the microcosm of the organism; the use of preparations of the organs of animals for disorders of the same organs in man a practice at present undergoing a curious revival; the application of certain theoretical qualities of bodies dryness, coldness, and so forth to corresponding rather than opposite characters of disease these were the similars of the mediaeval physicians.
A few late writers Stahl the Dane, Stoerck, de Haen noticed the occasional or possible curative operation of measures (I say “measures,” and not drugs, for Stahl’s instances of cure by similars are all of external applications, like heat to burns, save one the use of Sulphuric acid for Acidity of stomach; and this, as the acid is not shown to be capable of causing VITAL Acidity, such as that which it cures, is no better Homoeopathy than that of the mediaevalists.) which caused disorder similar to that of the patient; but there they left the matter. Hahnemann’s distinction is that he grasped this similarity as the only real and fruitful one; and, seeing reason for suspecting it to be a general and not an exceptional basis of cure, tested and worked out his thought until he formulated it as a standing rule for the best medical practice.
This Hahnemann, of whom I am now speaking, was a German physician whose long life extended from 1755 to 1843. The story of it I need not tell you here, you can read it, if you know it not already, in the pages of the two books I have mentioned, or yet more fully in the Memoir by our able Russian colleague, Dr. Brasol, which was contributed to the International Homoeopathic Congress of 1896, and may be found in its Transactions. I will only say that the man who lived this life was no common character Jean Paul Richter’s phrase for him, “a double-headed prodigy of genius and erudition,” being amply borne out by his doings.
Perhaps the best way to get an unprejudiced idea of the manner of man he was, is to read, in Dr. Dudgeon’s collection of his “Lesser Writings,” his earlier works on medical and allied topics. Of these I cannot now dwell, my present business is with the genesis in his mind of the thought which led him to Homoeopathy. It arose when, in 1790, he was rendering Cullen’s “Materia Medica” into German. He felt dissatisfied with the Scotch professor’s explanation of the febrifuge properties of Cinchona, and his consideration of the subject led him to the results which as was his wont in translating he expressed in a footnote. (See vol. II., p. 108.) “It will not” he writes, “be such an easy matter to discover the still lacking principle according to which its action may be explained. Nevertheless, let us reflect on the following.
Substances such as very strong Coffee, Pepper, Arnica, Ignatia and Arsenic, that are capable of exciting a kind of fever, will extinguish types of Ague. For the sake of experiment, I took for several days four QUENTSCHEN of good Cinchona twice a day. My feet, the tips of my fingers, etc. first became cold, and I felt tired and sleepy; then my heart began to beat, my pulse became hard and quick. I got an insufferable feeling of uneasiness, a trembling (but without rigor), a weariness in all my limbs, then a beating in my head, redness of the cheeks, thirst; in short, all the old symptoms with which I was familiar in Ague appeared one after the other. Also, those particularly characteristic symptoms which I was wont to observe in Agues obtuseness of the senses, a kind of stiffness in all the limbs, but especially that dull disagreeable feeling which seems to have its seat in the periosteum of all the bones of the body these all put in an appearance. This paroxysm lasted each time for two or three hours, and came again afresh whenever I repeated the dose, not otherwise. I left off, and became well.”
I have said in another place, when speaking of this experiment, that Hahnemann “proved Cinchona to discover on what principle it acted” in Intermittents. (Manual of Pharmacodynamics, p. 395. The references to this work are made to the Fourth and later Editions, the pagination of which is uniform). It would be better perhaps, to say “whether it, like the other febrifuges, excited a kind of fever.” But I must maintain that this is the true account of it, and not that which is put forward by the representatives of a certain school amongst us, who rather read into his doings their own later ideas.
Thus Dr. Adolf Lippe writes: “Hahnemann was sitting at leipzic, with his midnight lamp before him, translating Cullen’s `Materia Medica,’ which was then a standard work. He came to Cinchona officinalis, and found Cullen say that this bark possessed specific febrifugal actions, because it was both the most aromatic and bitter substance known. Hahnemann laid down his quill and exclaimed, `Preposterous!’There are more substances, more barks, possessing more, both bitter and aromatic properties, and Cinchona is not a specific for Ague. He argued, while it does cure some cases, it does not cure other cases. There must be a way to find out under what conditions the bark cured and did not cure.
It was at that moment that this good and benevolent man had an `Inspiration.” He concluded to take the drug himself, and whether light could not be brought into the prevailing darkness. Bright and early in the morning, Hahnemann went to the `Apotheke zum Goldenen Loewen’ on the market-place of leipzic, and there and then selected some fresh Cinchona bark, and obtained some vials and Alcohol. He prepared a tincture, took it, and behold, the symptoms he observed on himself showed a marked similarity to cases of Ague cured by him by the same drug, and it was then that a new light broke upon him! That light was this: A drug will cure such ailments as its sick-making power will produce similarity to.”
To do him full justice, I have given Dr. Lippe’s IPSISSIMA VERBA; and, as he expressly writes to correct the account I have presented of the matter, I must hold him to them. Contrast now his narrative with Hahnemann’s own; and it will be seen at a glance that the two are incompatible. The school Dr. Lippe represented are careless about similarity between disease itself and drug-action, so long as the “conditions” of the two correspond. To favour their view, therefore, Hahnemann must have proved Cinchona bark to ascertain under what conditions it cured Ague; whereas he himself tells us that he did so to find out whether, like other febrifuges, it was febrigenic at all, and that his result was to find it productive of all the symptoms, general and characteristic, of the Intermittent paroxysm.
This is a digression, to clear Hahnemann’s proceeding from misrepresentation on the part of his own followers. It is still more important to vindicate it from the objection made by opponents, that it is a wholly insufficient nay, a false basis of a curative method. This challenge is supported by the allegation, first, that bark has no real power of causing in the healthy such a fever as that imagined by Hahnemann: and, secondly, that it cures Ague by an action, not on the body of the patient, but on the minute organisms of which MALARIA consists, so that its therapeutic power is independent of any it may exert on the healthy frame.
In reply to these statements, I would ask you to suspend your judgment till we come to the treatment of the Malarious Fevers, when it will be fully discussed. In the meantime, however, I may be permitted to refer you to the article on Cinchona in my “Manual of Pharmacodynamics,” where you will find numerous instances of the febrigenic power of the drug and its alkaloid, ending with a description of the Cinchona-fever by Bretonneau, warranted by Trousseau and Pidoux, which quite corresponds to that of Hahnemann; you will also see it demonstrated that Ague may be cured by Quinine in doses far too small to affect the vitality of microzymes. But even were no such evidence forthcoming, no amount of doubt cast upon Hahnemann’s Cinchona-experiment and his inference therefrom would impeach SIMILIA SIMILIBUS CURENTUR; for this was suggested by it, not built upon it.
It might have been found that Newton’s apple (to which it has been happily compared), fell to the ground for other reasons than because of gravitation, but that would not alter the fact, subsequently ascertained by him, that matter as such attracts matter in proportion to its mass. Following up the hint afforded him by his apple, Hahnemann (like Newton with moon’s motions) tested his hypothesis by application to all other congruous instances by seeing how far it would explain the recorded successes of the past and lead to fresh ones in the future. It is on a body of evidence of this kind that his method ultimately rests, and not on the single experiment which originally led him to it; and deductive verification is as good evidence of truth as the graduated induction urged by Bacon. Buckle has well-argued this in one of his essays; and has shown that, INTER ALIA, it was the way in which Kepler arrived at his great discoveries.
Hahnemann’s further procedure may best be related in his own words. “I now commenced to make a collection of the morbid phenomena which different observers had from time to time noticed as produced by medicines introduced into the stomachs of healthy individuals, and which they had casually recorded in their works. But as the number of these was not great, I set myself diligently to work to test several medicinal substance of the healthy body, and see! the carefully observed symptom they produced corresponded wonderfully with the symptoms of the morbid states they would easily and permanently cure.” (Lesser Writings (tr. Dudgeon), p. 586).
The first fruit of this task was the “Fragmenta de Viribus Medicamentorum Positivis,” published in 1805, and containing pathogeneses more or less complete of twenty seven medicines. This was, as its name implies, in Latin; but in 1811, Hahnemann began to issue in successive volumes his German “Reine Arzneimittellehre,” containing (in its First Edition) fifty-eight drugs, proved on a much larger scale. (The six volumes of the First Edition appeared at intervals from 1811 to 1821; those of the Second Edition from 1822 to 1827; and a Third Edition of the first two volumes saw the light in 1830 and 1833.) He continued to add to his old and take part in new provings for some time yet, and altogether furnished materials for the knowledge of at least ninety medicines; besides giving an impetous to the work of experimenting on the healthy body which has never lost its force, and has been and is most fruitful in results.
The provision for working the new method supplied in the “Fragmenta de Viribus” was followed up by an exposition of its theory and rules for its practical working. These first took the form of an essay in HUFELAND’S JOURNAL for 1806, entitled “The Medicine of Experience,” and finally, in 1810, of a separate treatise. the “Organon of Rational Medicine.” Of the latter work I hope to give some account in my next lecture. Suffice it now to say that in it Hahnemann leaves no point untouched which conduces to the working of the machine he has invented.
Besides a full discussion of the theory of his method, and demonstration of its philosophical and scientific soundness, he gives minute rules for the examination of patients, for the proving of drugs, and for the selection of remedies upon the Homoeopathic principle. He enquires what should be done when only imperfect similarity can be obtained, when more than one medicine seems indicated, and when the symptoms are too few to guide to a satisfactory choice. He considers the treatment in the new method of local diseases (so-called), of mental disorders, and of the great class of intermittent affections.
There are yet two features of the method of Hahnemann which have not come before us the single remedy and the reduced dose. The first is obviously a necessary corollary of the rule; as the drug is proved, so it must be administered, if it is a true SIMILE. Hahnemann saw this at once, and in the trials which substantiated the soundness of his therapeutic rule used none but single remedies. “Dare I confess,” he wrote in 1797, (Lesser writings, p.373) “that for years I have never prescribed anything but a single medicine at once, and have never repeated the dose until the action of the former one had ceased a venesection alone, a purgative alone, and always a simple, never a compound remedy, and never a second until I had got a clear notion of the operation of the first? Dare I confess, that in this manner I have been very successful, and given satisfaction to my patients, and seen things which otherwise I never would have seen?” The necessity for reduction of dose was not so self-apparent.
In 1796 we find Hahnemann thus expressing himself(Ibid., p. 312):- “The cautious physician, who will go gradually to work, gives this remedy (the Homoeopathic one) only in such a dose as will scarcely perceptibly develop the artificial disease to be looked for (for it acts by virtue of its power to produce such an artificial disease), and gradually increases the dose, so that he may be sure that the intended internal changes in the organism are produced with sufficient force, although with phenomena vastly inferior in intensity to the symptoms of the natural disease; thus a mild and certain cure will be effected.” In the “Medicine of Experience” and the “Organon,” however, the logical consequences of the new method in the direction of posology are perceived and started.
The dose of a Homoeopathically-selected remedy he there argues, must obviously be smaller than one intended to act in an opposite direction to the disease. It should be so far reduced that its primary aggravation (which he supposed a necessary occurrence) should be barely perceptible and very short. This last direction involves a theory as to the action of similar remedies, which may well admit of question; but that comparatively small dosage is essential to them is a fact beyond dispute. It characterizes not only the practice of the avowed disciples of Hahnemann, but also that modified Homoeopathy which (after the distinguished Professor at University College) may be called Ringerism. Drop doses of Ipecacuanha wine were unheard of till it began to be given to check vomiting instead of to excite it; and while the twelfth of a grain of Corrosive sublimate was deemed sufficiently fractional for all previous purposes, the reduction went to hundredths when the drug was administered in Dysentery.