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.
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.