And this brings us at once to that rule on which Hahnemann so strongly insisted, that the entire organism of the patient should be examined in every possible way, and that the `totality of symptoms’ should be made the basis of the prescription; nay, that the constitutional, general symptoms are often more conclusive as to the proper treatment than the more obvious local symptoms. The grand old master reached at a single bound the same conclusions to which the labours of a half century of able Pathologists have at last, with infinite research, brought the medical profession.”
All this time we have been dealing with general principles: but let us look at special forms of disease, and see whether or not the Hahnemannian mode of regarding them is sufficient for their treatment.
1. The FEVERS constitute a group which plays a large part in daily practice. They are maladies in which morbid increase of temperature exists prior or out of proportion to any local inflammation which may be present. The theory of this state is still a moot one. According to some Pathologists it depends upon excessive heat-production; according to others upon deficient heat-radiation; while yet another class (with whom I venture to think the truth resides) believe that both factors operate at one time or another in the process. (See my “Knowledge of the Physician,” Lecture V.) But whatever be the genesis of fever, it remains a positive fact a clinical entity, with which we have to deal.
Upon the Homoeopathic principle, we have to treat it with drugs capable of producing fever. How they do so, we may not know; but our ignorance of the process matters little if we are sure about the result, “An infinitesimal quantity of Atropia a mere atom,” writes Dr. John Harely “as soon as it enters the blood, originates an action which is closely allied to, if it be not identical with, that which induces the circulatory and nervous phenomena accompanying Enteric or Typhus Fever.” This is sufficient; and as soon as we learn it to be a fact from Hahnemann’s proving of Belladonna (made, I may add, before Dr. Harely was born), yet minuter quantities of Atropia (in the form of the juice of its mother plant) became in our hands trusted remedies for these very fevers.
Again, the classification of fevers of which we have already spoken, so necessary for science and so valuable for general purposes, has but the smallest influence upon drug-selection. The old divisions of Synocha, Synochus, and Typhus (the last with its “nervous” and “putridus”), worthless as they are from a scientific point of view, are much more useful for our practice than those of Typhus, Typhoid, Relapsing, and Ephemeral. They denote the KIND of fever with which we have to do, its quality and mode of life; and to us it is all important that our drugs, next to being really febrigenic, should correspond in their action to the kind of fever present. They can hardly set up a whole Typhoid, in its complete evolution; but the febrile state they develop is certainly either a Synocha, a Synochus, a Typhus nervosus versatilis or stupidus, or a Typhus putridus; and if we find these states existing, in the essential fevers, the exanthemata, or elsewhere, in them we shall have our remedial means.
2. After FEVERS, the most important group of disease consists of the INFLAMMATIONS. To the Pathology of this morbid process many pages are devoted at the commencement of every treatise on Medicine or Surgery. Whether, after all that has been written, we know much about it in its essence, may well be doubted; but even if we do, of what avail is our knowledge for treatment at any rate for medicinal treatment? The old phenomenal signs, DOLOR, PALOR, RUBOR, TURGOR, still for all practical purposes constitute INFLAMMATION, when externally manifested and when it is internal, and so invisible, the facts which lead us to infer its presence and seat are no less of the symptomatic order, as I have already argued. To treat Inflammation Homoeopathically, it is only necessary to find a drug capable of setting it up, at the same spot and in the same manner, as evidenced by the symptoms.
3. The NEUROSES, of which I would in the third place speak, are still as Libermeister says symptomatic groups. Their unity is one neither of cause nor of lesion; it is clinical only. It is of much interest to know what is the seat and process of the Epileptic paroxysm; but our choice of Anti-epileptic remedies must be determined mainly by the power they have of inducing similar paroxysm in the healthy subject, explain it or not as we can. In like manner is it with Cholera and Tetanus and Hysteria; no conceivable knowledge we can gain as to their intimate nature would make us better able to fit Homoeopathic remedies to them than we should be, if we possessed their symptomatic analogues in drugs.
It thus appears that of the three elements which exist in all knowledge phenomena, laws, and causes, it is the first which for positive therapeutic action, chiefly concerns us in disease. Not that the other two are worthless to us, even for this end. Our laws here are classification the recognition in morbid states of genera, species and varieties analogous to those of animated nature. These enable us to form groups of remedies associated with them, instead of having to wander through the whole Materia Medica for each prescription: They also give a continuity to medicinal treatment, without which the USUS IN MORBIS were of no avail.
Hahnemann led the way here, by constantly insisting on the existence of fixed and definite types of disease, to which standing remedies should be applied; and by giving us group of “Antipsorics.” I fear, however, that he must be considered as having rejected all enquiry into causes I mean proximate causes, the noumena of the phenomena in this sphere. In so doing we need not follow him. His ground for taking symptoms as the element of parallelism between disease and drug-action was that they only were surely known in his day this was true, and his selection of them was most prudent.
But to maintain that they alone were knowable was unwarrantably to bar the progress of science. His stricter followers have acted on the DICTUM, and have looked askance on the positive Pathology of the present day, with its physical diagnosis and post-mortem confirmations. They have always been a decade or more behind hand in their recognition of such distinction as those between Typhus and Typhoid, between Chancre and Chancroid, and in their use of such means as auscultation and thermometry. Now this is altogether wrong. An inference from symptoms, if sure, is as good a basis for treatment as symptoms themselves. This sureness is assumed in the prognosis given and the general management instituted: Why should it not be also for purposes of drug-selection? By proceeding upon it we secure another route to the SIMILE we desiderate.
We use symptoms to reach it, because they are its most certain expression; but if it can be otherwise attained, the alternative access may often be useful. Morbid lesions sometimes occur almost, if not quite, without symptoms, as for instance Caries of the Vertebrae and Senile Pneumonia. To attempt to “cover” these from the results of the proving of drugs would be futile. But Toxicology and experiments on animals here come to our aid and give us in Phosphorus a substance capable of inflaming alike the cancellous structure of bone and the pulmonary air-cells; so that with it we can combat these diseases, however latent and expressionless they may be.
There is indeed something fascinating about similarities of this kind; and our late colleague Dr. Sharp proposed (following in the footsteps of Paracelsus and Rademacher) to make seat of action instead of symptoms the basis of our method, which accordingly he would call “Organopathy.” That remedies so led to may prove effectual is undoubted; We have a good example of them in the Ceanothus Americanus which, though never proved on the healthy, and only known to “act upon” the spleen, has been found strikingly effective in pains, enlargements, and other disorders of this organ. But we should never, if possible, rest content with identity of seat between disease and drug: We should aim also at making their kind of action the same, and this can only be done by securing similarity in their symptoms. In this way we elevate the SIMILE to a SIMILIMUM, and proportionately enhance its energy in cure.
We thus come back to the phenomena as our mainstay in practice; for therapeutic purposes, the totality of symptoms, constitutes the disease. As a result of this view, the examination of patients by the Homoeopathic prescriber is far more minute than that ordinary practised. He can hardly, indeed, inspect and explore for himself more thoroughly than does the well-trained practitioner of to-day; but he listens to and questions the sick person with greater patience and more painstaking completeness. He pays more regard to subjective symptoms. I have already more than once indicated the large part played by sensations in Homoeopathic proving and prescribing of medicines: I am glad now to support our appreciation of these from an Address delivered by the late Dr. Russel Reynolds in 1874.
“Is it not coming to this,” he protested, “that but little attention is often paid to the accounts which patients give of themselves, their ideas, emotions, feelings and physical sensations? These are things which we cannot weigh in our most guarded balances measure by our finest scales split up by our crucibles or describe in any terms save those which are peculiar to themselves and which we cannot decompose. These symptoms are often disregarded and set aside: And the patient, whose story of disease is made of them, is thought fanciful, hypochondriacal, hysterical, nervous, or unreal; because, forsooth, we have physically examined thorax, abdomen, limbs and excretions, and have found in them nothing wrong; because we have looked at the retinae, examined the limbs electrically, traced on paper the beatings of the pulse, weighed the patient and not found him wanting.
Still he is miserable, in spite of placebo and assurance that there is nothing organically wrong! There may be in him a consciousness of a deep unrest; or of a failing power which he feels, but which we cannot see; or of a something worse than pain, a sense of impending evil that he is conscious of in brain or heart; a want of the feeling of intellectual grasp, which he may call failure of memory, but which memory when we test it seems free from fault; a want of the sense of capacity, for physical exertion, which seems, when we see him walk or run, to be a mere delusive notion, for he can do either well or easily to our eyes and those of others; and so he is called nervous, and told to do this or that, and disregard those warnings which come to him from the very centre of his life.
And let me ask whether or no it has not again and again happened in the course of such a history as that which I have only faintly sketched, that some terrible catastrophe has occurred: Do we not see minds gradually breaking down while we say there is no organic change in the brain? Hearts suddenly ceasing to do their work, when after careful auscultation we have said there was nothing to fear? Suicide or sudden death sometimes disturbs the calm surface of our scientific prognosis of no evil. We may be startled, and may then see all that we ought to have before. But when the ripples that such unforeseen events have occasioned on that smooth surface have subsided, we go on as we have already done, and still pay but little attention to what the patient feels, and delight ourselves in the position of our knowledge with regard to physical conditions of which he may know nothing and may care still less. No one can appreciate more highly than I do the value of precise observation, but I do not believe that minute, delicate, and precise observation is limited to a class of facts which can be counted, measured or weighed.
No one can see more distinctly than I do, the wrong conclusions at which a physician may arrive at by accepting as true the interpretations which fanciful patients may offer of their symptoms; but I am sure that if we pay no heed to these mistaken notions of a suffering man, we loose our clue to the comprehension of the real nature of his malady. Morbid sensations and wrong notions are integral parts of the disease we have to study as a whole, and we are bound to interpret their value for ourselves; but we can ill afford to set them aside, when we are as yet but in the dawn of scientific Pathology, and are endeavouring to clear away the obstacles that hide the truths we hope hereafter to see more clearly about the mystery of disordered life. The value of such symptoms may be slight in some kinds of diseases, when compared with that of those phenomena which may be directly observed; but we are bound to remember that there are many affections in which they furnish the earliest indication, and there are not a few of which they are throughout the only signs.”
In the light of this, which is but one among the many advantages of Hahnemann’s mode of observing disease, I think we may make claim for it as being, not only the one safe thing for his own time, but also a mode of procedure most important in itself, and never to be left behind. It needs especially to be emphasised at the present day. It is with us as before the Reformation, when the Bible was used by the Church as a rule of faith only a source whence were to be inferred the doctrines and practices obligatory on her children.
What Luther and his followers did was as Dr. Robertson Smith has well shown to recover the Book itself in the totality of its thoughts and words, as a means of grace to each individual soul. The fruitful results thus achieved in the spiritual sphere will be paralleled in the medical as the clinical study of disease is allowed its due preponderance, and is made the direct road to Therapeutics. Of this reformation Hahnemann was the preacher in his day: And his voice must ever be echoed by his disciples when they see the profession straying into the alluring, but less practical, paths of Pathological speculation.
In support of thus acting, they could cite the words of another acknowledged leader in English medicine, also now deceased Sir Andrew Clark. In his Presidential Address at the Clinical Society of London in 1883, this distinguished physician said:- [LANCET, Feb. 3, 1883.)
“Another great work of our Society has been and continues to be, the unfolding of the exact relations which morbid Anatomy and incidentally. Experimental Pathology should hold to clinical medicine. These two chief servants of our art, excited and carried away by their marvellous successes, and assuming a joint sovereignty over our art, look down with condescending superiority upon clinical medicine, ridicule her claims to supremacy, scoff at her empirical distinctions, reproach her with being unscientific, and strive to torture her into a slavish subjection to their theories. But the true relation is not this: It is, indeed, the converse of it.
For the structural change is not disease, it is not co-extensive with disease; and even in those cases where the alliance appears the closest, the Statical or Anatomical alteration is but one of other effects of Physiological forces, which, acting under unphysiological conditions, constitute by this new departure the essential and true disease. For disease in its primary condition and intimate nature is in the strict language dynamic; it precedes, underlies, evolves, determines, embraces transcends, and rules the Anatomical state. It may consist of mere changes in the relations of parts, of re-arrangements of atomic groupings, of recurring cycles of vicious chemical substitutions and exchanges, of new conditions in the evolution and distribution of nerve force; and any or all of them may be invisible to the eye, inseparable from life, and undiscernible in death.
Undoubtedly the appearance of a structural alteration in the course of disease introduces a new order of events, sets in action new combinations of forces, and creates disturbances which must be reckoned with, even as mechanical accidents of the Pathological processes. But always behind the Statical lies the Dynamic condition; underneath the structural forms are the active changes which give them birth, and stretching far beyond the limits of Pathological Anatomy, and pervaded by the actions and interactions of multitudinous forces, there is a region teeming with manifold forms of disease unconnected with structural change and demanding the investigation which it would abundantly reward. It is in this mysterious and fertile region of dynamic pathogenesis that we come face to face with the primitive manifestations of disease, and learn how much knowledge from all sources is needed to understand it aright; it is here that we see how, without the help from Physics, Chemistry, and Biology, collecting, converging, and meeting in a common light, no single problem in disease can be completely solved; it is here that we are made to comprehend how the nature of a Pathological product cannot be determined by its structural character, but by the life-history of the processes of which it is only a partial expression; it is here that we observe how, in therapeutic experiments, the laws of the race are conditioned and even traversed by the laws of the individual; and it is here that we discover how clinical medicine is to become a science, and how she is already, beyond all question, at once the mother and the mistress of all the medical arts.”
(It is pleasant to find Dr. Clifford Allbut following in this direction his eminent predecessor. “Mere observation of disease,” he said in his inaugural lecture at the Middlesex Hospital School in 1900, “and morbid Anatomy have taken us almost as far these means can do. We must track our morbid processes in their earliest dynamic irritation, so as to arrest them at these stages.” (BRIT. MED. JOURN., Oct. 6, 1900)).