Hitherto, in dealing with three elements of the method of Hahnemann the aspect it takes of disease, the mode in which it ascertains drug-action, and the principles on which it fits the one to the other I have confined myself to exposition and vindication of Hahnemann’s own deliverances on the subject, and these mainly as contained in his `Organon’. There is still, however, a criticism to be made on his positions from the standpoint of the medicine of to-day; and to this, I must now address myself.
In the opening words of the definition of Homoeopathy which formed the starting-point of my First Lecture, I said Homoeopathy is “a therapeutic method.” It is, I might have added, so described by its author. We find the name, the formula and the full statement of it in the First Edition of the `Organon.’ “Hitherto,” he writes in the Introduction, “the diseases of human being have been treated not rationally, not on fixed principles, but according to various curative intentions, among others by the palliative rule CONTRARIA CONTRARIIS CURENTUR.
Directly opposite to this lies the truth, the real road to cure, to which I give the guide in this work: To cure mildly, rapidly, and permanently, choose in every case of disease a medicine which can of itself produce an affection similar to that it is wished to cure (SIMILIA SIMILIBUS CURENTUR).” Homoeopathy is a therapeutic method; and it belongs, avowedly at least, exclusively to that part of the therapeutic sphere in which drugs are our instruments. “To cure” “choose in every case of disease a medicine.”
It gives no instruction as to the other resources of the physician’s art diet, regimen, temperature, climate, the use of water and electricity and so forth. Some analogies among these and even among psychical affections, to the operation of similars have been pointed out by various writers from Hahnemann downwards; but, whatever be their value, (Hahnemann’s suggestion of the kind have been criticised by Dr. Dudgeon in his Lectures (p. 71-4), and by Dr. Sharp in his “Essays on Medicine” (1874), Essay VI. On the other side see Dr. Percy Wilde in the M.H.R., for 1896, pp. 116, 149.) that at any rate find no place here.
For our present purpose. Homoeopathy is a method of drug- therapeutics; and while it has the advantages, must also share the limitations, of its materials. These limitations are of several kinds, but are mainly imposed by the superior claims of other remedial measures. SIMILIA SIMILIBUS may be the best mode of choosing medicines, but medicines are not always the chief or the most appropriate means of treating the sick. Such a thought was hardly so familiar to the age of Hahnemann as it is in our own.
The ordinary medical attendant was then in fact as in name an apothecary one who served out drugs from a store; his only variation upon this theme occurring when he bled or blistered. Of the natural history of disease nothing was known, and the idea of trusting to it was before Skoda and Dietl unheard-of, Hygiene played as little part in the doctor’s prescription as it did in the patients’ lives; and the TOLLE CAUSAM on which we now lay so much stress was then directed only to those hypothetical morbid states obstructions, spasms, altered humours, and so forth which were assumed as the foundations of disease. With the advance of knowledge on these subjects a corresponding encroachment has been made on the sphere of drug-therapeutics; and Homoeopathy occupies a less prominent part in the practice of Homoeopathists, not because they trust to it less as a guide to drug selection, but because they have less need of drug-action itself.
In a lecture “On the Place of Drugs in Therapeutics,” delivered at the London Homoeopathic Hospital in 1895, which is readily accessible, (See M.H.K. xl.14.) I traced the progressive adoption of this position from Hahnemann himself through Caroll Dunham, Dudgeon and Dake. In assuming it on my own part, I reminded my hearers of the potency of diet in Scurvy and of regimen in Lithaemia; and of the benefit of the exposure to Nature’s influences as seen in Pfarrer Kneipp’s system (to which might now be added the fresh air treatment of Phthisis).
I showed the wide range of the maxim TOLLE CAUSAM (“that royal road,” as Hahnemann calls it), applying it to the abuse of the tea, coffee, tobacco and Alcohol which to say nothing of coca, kola and absinthe play so large apart in present-day life; and also to the place occupied by the reflex action in the etiology of disease. I recognised the aid brought to the healing art by Surgery, by Hydrotherapy, by Electricity, by gymnastics and massage (I might have added, by heat and cold). I need not further enlarge on this subject. I only mention it here to show that I am not unmindful of the wide field of therapeutic work which lies outside the special plot of ground we cultivate; and of our right and duty, as physicians and not merely Homoeopathists, to labour in it.
Proceed, therefore, with my comments on our original definition, Homoeopathy is a therapeutic method, formulated in the rule SIMILIA SIMILIBUS CURENTUR let likes be treated by likes. The two elements of the comparison here implied are the effects of drugs on the healthy body and the clinical features of disease, in either case “all being taken into account which is appreciable by the patient or cognizable by the physician but hypothesis being excluded.” We shall have more yet to say upon SIMILIA SIMILIBUS; but must first dwell further on what I have called the elements of comparison, and will begin with the aspect of disease which is selected for it.
I suppose that all lectures on the Practice of Physic commence the account of particular diseases by describing their clinical features. “Every now and then,” as my former teacher at King’s College Dr. George Budd used to say, “we meet with” cases presenting such and such groups of phenomena and sensations. He would then give the name by which the malady thus constituted is styled, and would proceed to relate how it came about, and wherein essentially consisted so far as these points were known. But observe the differences involved in this “so far.”
The etiology and Pathology of the disease were more or less uncertain, and our conceptions of them was liable to vary as new facts came into view. But its clinical features remained. They were those which perchance Sydenham, or even Hippocrates, had described as graphically as any modern physician: they, amid all shiftings of conceptions about them, were permanent and sure.
Hahnemann, as we have seen, took these features as the disease- basis of method. Simplicity and certainty were his aims in practical medicine. He could not conceive that the obstacles to them were insurmountable, and we have heard him (See p. 15.) expressing out of his profound Theism his faith that as the Creator has permitted disease in its numerous forms (See p. 15.) He must also have to reveal to us a distinct mode whereby it may be known and combated. This “distinct mode” was, he considered, the clinical. He was indeed far from refusing the aid of etiology to such extent as it was available.
The `Organon’ has shown him pointing out that it is obviously part of the physician’s duty to ascertain the presence or incidence of any exciting causes of disease, that he may remove them now and ensure their avoidance in future. It is also desirable, according to his teaching, to discover the past causes both predisposing and exciting of the patient’s morbid condition, as certain medicines are found specially suitable when disease has originated in certain ways Arnica when from injuries Rhus and Dulcamara when from cold damp and so on. Pathology, however, Hahnemann absolutely rejected for therapeutic purposes.
It was in his day far more a matter of guess-work than it is now, and was too much of a quicksand for a sure foundation to be laid in it. But he went further, and maintained that a knowledge of the essential nature of disease was both unattainable and useless. His views on this subject are best expressed in aphorism 5 and 6 of the Fourth Edition of the `Organon’ (they were omitted, I know not why, in the Fifth):- “It may be conceded that every disease is dependent on an alteration in the interior of the organism. But the alteration is only guessed at by the understanding in a dim and illusory manner from what the morbid symptoms reveal concerning it (and there are no other data for it in non-surgical disease); and the exact nature of this inner-invisible alteration cannot be ascertained in any reliable manner.
The invisible morbid alteration in the interior and the alteration in the health perceptible to our senses together constitute to the eye of creative Omnipotence what we term disease: But the totality of the symptoms is the only side of the disease turned towards the practitioner this alone is, that is perceptible to him, that is the main thing he can know respecting the disease, and that he needs to know to help him to cure it.” The side of disease which Pathology explores was thus to Hahnemann its NOUMENON in the strict sense of the word recognised metaphysically as existent, but taken no practical account of for all purposes, but those of thought represented by the phenomena “The totality of the symptoms” is to the therapeutist, the disease.