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.
Is this position tenable? Most persons would at once answer in the negative; they would do so, I think without regard to the end set before us, in thus limiting our apprehension of disease. If we were dealing with it as an object of science, a branch of natural history, it is certain that symptomatology would be an insufficient basis for our knowledge. No one has better shown this than Liebermeister, in his Introduction to the section on `Infectious Diseases’ in Zeimssen’s “Cyclopaedia.22 The basing unities of disease on symptoms gave us such Pathological entitles as Hydrops, Icterus, Apoplexy, and the like; and “from this symptomatic stand-point Quotidian Fever was a different malady from the Tertian or the Quartan form, while on the other hand Ascites and Tympanites were only different forms of the same disease.”
He goes on to argue that the most scientific because the most real rule of classification must refer to CAUSES, must be etiological. The Quotidian and Quartan types of fever are one, because they both originate from Malaria; they are to be differentiated from pyaemic febrile attacks, though these may have a similar rhythm and similar symptoms, but are to have grouped with the other Malarial affections which differ greatly in symptoms, such as Malarial Neuralgia, Malarial Diarrhoea, Malarial Cachexia. “The lightest form of Varioloid is regarded as essentially identical with the most severe form of Variola; on the other hand, Vaccinia and Varicella are separated from it. The simplest Diarrhoea arising from the poison of Asiatic Cholera is to be ascribed to this disease: On the other hand, a very severe and deadly Cholera Morbus is to be marked as another malady.”
Nor is it for classification only that such scientific knowledge of morbid states can be turned to account. It avails for prognosis. That we are able to distinguish true Typhus from other forms of Continued Fever, and that we know its natural history enables us to affirm, that if the patient survives the nadir of his prostration between the fourteenth and seventeenth day, and then displays an upward tendency, he will pretty certainly recover. It avails for the general management of the patient.
To recognise Relapsing Fever as present leads to a care being taken after the first apparent recovery which would otherwise be needless, but which here materially influences the course of the second paroxysm: It also suggests the use of antiseptics, during the interval for the possible prevention of the recurrences, as carried out so successfully by Dr. Dyce Brown in Aberdeen. (See B.J.H. xxxi, 355.) It avails, again, for estimating the influence of treatment. Of old, every Chancre which disappeared without secondaries supervening went to the credit of the Mercury given, or to the demonstration of its needlessness if it had been omitted. We now know that the Soft Chancre which occurs by far the more frequently of the two has no such significance, and is naturally without SEQUELAE.
Now if medicine were an applied science only, it would be with such knowledge and its utilisation entirely that we should be concerned. But it is (as we have seen) the merit of Homoeopathy that in it medicine assumes its true place in being an art the art of healing. It should have, as I have said, a life of its own, independent of the nourishment its associated sciences bring. The method of Hahnemann gives it this, by taking the clinical aspect of disease as it working basis. Pathological knowledge has little to do with drug-selection so determined. It has taught us for instance to recognise Enteric Fever as specifically distinct from Typhus, and for many purposes this differentiation is highly important. But the indications for its Homoeopathic remedies were just as plain when it was classed merely as “Typhus Abdominalis,” and were as well given of old by Wolf and Trinks, as they are new by Jousset and Panelli.
Again, if our aim be the ascertainment of the particular organ affected in a given case, symptomatology is certainly insufficient. Not, indeed, because it is to be distinguished from physical diagnosis, and has to do with “rational” signs merely. The phenomena requiring a `scope or speculum’ for their perception, the sounds elicited only by percussion and auscultation, are as truly symptoms, as is a dilated pupil or a wheezing respiration. Not thus, but because to ascertain the seat of disease we have to bring in the aid of morbid Anatomy.
This is the science of LESIONS; while clinical medicine takes account of MALADIES which, in the words of Tessier, are “constituted by an assemblage of symptoms and lesions undergoing a definite evolution.” The one speaks of Hepatisation of the Lung, the other of Pneumonia; the one of Herpes, the other of Shingles. Now the lesion save where, as in the last instance, it is on the surface is a thing inferred only, not perceived or experienced; and hence is not strictly included within the range of the knowledge of disease required by the Homoeopathic method which again to quote Tessier is one of “positive indications.”
To many minds, accustomed to make physical diagnosis their chief aim as physicians, this is a very unacceptable feature of our practice. But let us look at the matter dispassionately. What do you gain by inferring, from certain signs, that a given group of symptoms means the presence of inflammation of the air-cells proper, as distinguished from the bronchial mucous membrane or the pleura? Something, it may be, for prognosis: You know better what the patient has to expect and both he and you feel more security from being able to follow the morbid process as it were with your mind’s eye through all its stages.
In other cases, as where the digestive organs are at fault, a knowledge of the precise seat of the malady aids you in general management: You can order such food only to be taken as will give the affected portion rest farinaceous where the stomach, animal where the duodenum, is involved. In neither instance, however, have you gained anything as regards drug-treatment, especially if you are going to conduct this on the principle of SIMILIA SIMILIBUS. Your medicine must indeed act on the same parts as those affected by the disease, and in the same manner. But, if it produce a like group of symptoms, the inference is that it does so. As Hahnemann wrote in the `Organon’ (aphorism 148) “A medicine which has the power and tendency to produce symptoms the most similar possible to the disease to be cured, affects those very parts and points in the organism now suffering from the natural disease.”
It is from the phenomena that in diagnosis, you infer the noumena: Quite as surely, in treatment, if drug and disease have the same phenomena, it may be concluded that their noumena are also identical. You are indeed in this way more certain of your aim; for your diagnosis may be wrong, as the autopsy not uncommonly proves, but your comparison of symptoms if intelligent and painstaking cannot err of the mark. And further, it must be remembered that our object, is to select not a SIMILE only, but the SIMILIMUM the medicine whose action on the healthy correspond to the particular case in its individuality, in the finer features and more minute ramifications of the malady here presented.
Identity of lesion is insufficient for this: “We want” as Dr. Drysdale has said, “a Pathological simile far more exact and quantitatively like than that afforded by mere coarse morbid Anatomy, which is common to all cases alike.” We get this by fitting together, the variety of phenomena manifested in disease and in drug-action by “covering” the one with the other. We may not be able to explain why certain symptoms are present in certain cases; but we must believe that each has its proximate cause, and that the combination of such causes constitute the individual malady from which the patient is suffering, and to which our drug must be fitted.
For drug-therapeutics on the Homoeopathic principle, therefore, symptomatology may justly supersede diagnosis, as being in many cases surer and in all more thorough. It gives us a further advantage (which I have already touched upon), in that it often enables us to attack maladies in their forming stage, before they have developed such lesions as physical signs can manifest. The totality of symptoms is intended to be a curative indication; and if disease is to be cured it should be taken as early as possible, before such results have occurred as become the subjects of morbid Anatomy POST MORTEM, or even of Pathology during life.
In such early stages maladies are often recognisable by rational signs alone, and mainly by symptoms of a subjective nature. This point has been forcibly made by Carroll Dunham, in his Essay entitled. “The Relation of Pathology to Therapeutics”. and I would take the opportunity of commending the writings of this “beloved physician” (by no name less tender can those who knew him speak of him) to your most earnest attention. His lucid style is but an index to the clearness of his thought; and in him Hahnemann finds an expositor who knows how to reconcile him to science and expound him in reason without sacrificing an iota of his essential principles.
In the Essay I have mentioned he shows, that as Physiology takes cognisance, not of life, but of the results of life, so that with which Pathology is concerned is the result of the abnormal and perverted life which we call disease. The products of disease Pathology sees, hears, or infers: It knows nothing of disease itself. Hence, to base Therapeutics upon Pathology alone is to make the former merely palliative a pumping out a leaking ship instead of stopping the leak. It may be said that we do not know where the leak the primary disturbance is, and that if we knew we could not reach it to stop it.
But by the proving of medicines we obtain agents which their powers to cause similar inundations, and therefore presumably, similar breaches, which upon the principle SIMILIA SIMILIBUS it is the hypothesis that they can repair. If then, the comparison between the results of disease and of drug-influence be thoroughly and accurately made, the parallelism of action must reach also to that which originates either. “And here,” Dr. Dunham writes, “I cannot refrain from tendering homage to the wonderful provision of genius by which, in an age when Pathology, as we understand it, was unknown. Samuel Hahnemann anticipated all that we have said, and all that the most advanced thinkers of our day have taught, respecting the scope and influence of Pathology in relation to Therapeutics.
The symptoms of the urinary organs in connection with the discharge of morbid urine would at one time have been regarded as the proper subject of treatment. But Pathology has now taught us to trace these symptoms back to the kidneys and beyond the kidneys to the blood, and beyond the blood to the nutrition and the destruction of all the organised tissues. As Dr. Carpenter remarks, `When, for example, the urine presents a particular sediment, our enquiries are directed not so much to the sediment itself, as to the constitutional state which causes an undue amount of the substance in question to be carried off by the urinary excretion, or which prevents it from being (as usual) dissolved in the fluid.’ To confine the attention, therefore, in prescribing for a given cause, to the immediate organ the perversion of whose functions is most obviously pointed out by the prominent symptoms, is to disregard the clearest indications of Pathology.
We must analyse these prominent symptoms, and must include their remotest elements in our indications. Nay, these remotest elements the constitutional disturbances of which Carpenter speaks are even more important indications for treatment than the more obvious and objective symptoms. But how can we analyse these more obvious symptoms, and ascertain those `constitutional disturbances’ in which they have their origin? In no other way than by a study of the functions of the entire organism in what way and to what extent they are performed in an abnormal manner.