In my last Lecture I sketched the ground-plan of Hahnemann’s “Organon.” Let us now consider the three positions he takes up his attitude (1) towards disease, (2) towards drug-action, and (3) towards the selection and administration of remedies.
1. In the RESUME of his conclusions which I have quoted (aphorism 70), Hahnemann speaks of the sum total of the symptoms of a patient as the only curative indication which the physician can discover. In this he hardly does himself justice; for in aphorism 5 he has pointed to the knowledge of the CAUSES of the malady as important, and aphorism 7 and its note has assumed as obvious that any exciting or maintaining cause which is discoverable and accessible shall be removed. He has further reminded us, in aphorism 3 and 4 that both to prevent disease, and to make his curative treatment unobstructed and permanent, the physician must also be a hygienist. It would hardly be necessary to mention such points, but that Dr. Bristwoe has said that “for him, preventive medicine which deals specially with the causes of disease, and has been successful only in proportion to its knowledge of them, would have been a mockery and a snare.”
With these qualifications, however, Hahnemann’s doctrine is that the totality of the symptoms the sum of the sufferings the patient feels and the phenomena he exhibits constitutes, FOR ALL PRACTICAL PURPOSES, the disease. He does not say that they alone are the disease. On the contrary, he constantly speaks of them as the “outwardly reflected picture,” the “sensible and manifest representation,” of what the essential alteration is. His point is that at this last you cannot get, and, to cure your patient, need not get. If you can find means for removing the sum total of his symptoms, he will be well, though you may know as little as he wherein, essentially, he was ill (aphorism 6-18).
Now what objection can be taken to this thesis? No one can seriously maintain that symptoms and morbid changes are not correlative; that there is any way of inferring the latter except from the former, or any way of removing the former, as a whole, except by righting the latter their proximate cause. The critic we have now in view is too acute to say much of this kind. His main charges against Hahnemann’s view of disease is that it ignores Pathology and more especially morbid Anatomy, so that the “laborious investigations conducted in our dead-houses, which we fondly imagine to add to our knowledge of diseases,” would be “looked upon by him with contempt.” But in so speaking he forgets Hahnemann’s aim.
He is laying down what are the curative indications in disease, what the physician can and should know of it in order to remove it. Do the investigations of the dead-house help us here? The changes they discover are the results generally the ultimate results of morbid action; but in this stage of the process such action is no longer amenable to remedies. If it is to be cured, it must be taken at an earlier period, before there has occurred that “serious disorganization of important viscera” which Hahnemann speaks of as an “insuperable obstacle to recovery.” [Lesser Writings, p. 261.) And how shall it then be recognised, except by its symptoms?
No microscope can see the beginning of CIRRHOSIS of the Liver or of SCLEROSIS in the Brain and Cord; but the patient may feel them, and may even exhibit them. Some slight hepatic uneasiness, some dart of pain or altered temper or gait, may and often do supervene long before the pathognomonic physical signs of such maladies appear. It is impossible to say how much suitable remedies applied at this time may not do may not have done to arrest the morbid process then and there.
The Hahnemannic Pathology is a living one, because it seeks to be a helpful one. It was wisely pointed out by Clotar Muller that the contemplation of disease, mainly in the light of its final organic results had a discouraging effect; whereas, if we would just apply our method fully to each “TOUT ENSEMBLE” of disorder as it came before us, our possibilities were boundless. (Carroll Dunham’s Essay on the “Relation of Pathology to Therapeutics” (HOMOEOPATHY, THE SCIENCE OF THERAPEUTICS, p. 99) makes the same point).
But Hahnemann has been accused of ignoring Pathology in another way, viz., by “objecting to all attempts on the part of systematic writers and practical physicians to distinguish and classify diseases.” He is supposed to have been and the utterances of some of his own disciples lend colour to the charge a mere individualiser, regarding the maladies which affect mankind as “with a few exceptions, simply groups of symptoms, mosaics of which the component pieces admitted of endless re- arrangement.”
But this, again, is a great mistake, as I endeavoured to prove in a paper on “Generalisation and Individualisation” which I submitted to our International Congress of 1881, and which you may see in its Transactions. I there showed, by numerous quotations, that Hahnemann recognised as freely as any other physician the existence of definite types of disease, of fixed character because resulting from unvarying cause, to which distinctive appellations might be given and specific remedies (or group of remedies) allotted. He varied from time to time, as Pathology itself varied, in the list of those to which he would assign such place; but at the lowest estimate they cannot fairly be described as “a few exceptions.”
They embrace the whole field of “specific” disease acute and chronic. Take the instance of Intermittent Fever, which has been cited. Hahnemann is supposed to have declared these fevers innumerable, and each instance of them that came before him, an independent disease. But read the Section of the `Organon’ expressly devoted to the subject (aphorism 235-244). You will see there, that it is only sporadic Intermittents occurring in non-Malarious districts that he thus describes. The true endemic Marsh-ague he recognises as a disorder of fixed type, always curable by bark if the patient is not otherwise unhealthy: while the epidemic Intermittents, though distinct among themselves, have each a specific character so as to be amenable to one common remedy. It is in these (and the sporadic cases) only that he reprobates the blind Cinchona-giving practised in his day.
Here also, then, Hahnemann must be vindicated from the charge of ignoring any real Pathology, however little he valued the speculations of his own time which laid claim to that title. It is in the First Part of the Second Division of the `Organon’ that his views on the subject are expressed; and, allowing for the fact that they are nearly a century old, and therefore, possibly to some degree antiquated, there is nothing in them unworthy of a learned and sagacious physician. I reserve his theory about “Psora” intercalated in the French and Fifth Editions, which must subsequently receive a few words on its own account.
Hahnemann concludes this portion of his subject with some suggestions as to the examination of patients (aphorism 83-104), of which all that need be said is they are, as becomes their object, thorough. The Homoeopathic physician does not listen and enquire merely to find out to what class of maladies his patients are to be relegated. For this end but few symptoms are necessary, and the rest can be left. He has to get at their totality, that he may cover them with a medicine capable of producing them on the healthy subject; and in pursuit of this aim he must not account any detail superfluous.
It has been objected that we should come off badly upon such a method with Mrs. Nickleby for a patient. But happily all patients are not Mrs. Nicklebys: and when we do meet them, common-sense must deal with them accordingly. Of course, proportion must be observed; and anything we KNOW to be merely incidental must be omitted. Our colours must be mixed, like Opie’s, “with brains, sir.” But if we only THINK a detail unimportant, our wisdom will be to give the patient the benefit of the doubt, and insert it in our picture.
2. Such is Hahnemann’s attitude towards disease; and I think it comes out from examination proof against every objection, and fitted at all points for its object. Still more incontrovertibly can this be said of the position he takes up with reference to drug-action (aphorism 19-22). His one insistence is that this can only be ascertained, by experiment on the healthy human body. Few now-a-days question the value of this proceeding; but Hahnemann has hardly yet been awarded the merit which belongs to him, as its pioneer. Haller had indeed preceded him in affirming its necessity, and Alexander and a few others had essayed tentatively very tentatively to carry it out; but Hahnemann developed Haller’s thought into a doctrine, and multiplied a hundred-fold Alexander’s attempts at proving. When the profession comes to know him at his worth, he will be recognised by all as the father of Experimental Pharmacology.
The great value of choosing the human subject for our provings is, that thereby their subjective symptoms the sufferings as well as the phenomena they cause can be ascertained. There is of course the inevitable shadow here the counter-peril that a number of sensations of no moment shall be reported by the experimenters and cumber our our pathogeneses. This is inevitable; but Hahnemann at least saw the inconvenience, and did his best to avoid it. Let his rules for proving in the `Organon’ (aphorism 105-145) be read, and the information we have elsewhere as to his manner of proceeding be considered, and it will be seen that he did all that his lights suggested to make experimentation of this kind pure and trustworthy.
3. We pass now to the third division of the “vocation of the true physician,” as conceived by Hahnemann. How is he to use his knowledge of drug-action in the treatment of disease? How is he to wield the potencies the former gives him for the favourable modification of the latter?.
To the answer to these questions are devoted forty-eight aphorisms (aphorism 22-69) of the first and a hundred-and-forty-seven (aphorism 146-292) of the second division of the `Organon.’ Hahnemann argues that there are only three conceivable relations between the Physiological effects of a drug and the symptoms of disease, and therefore only three possible ways of applying the one to the other.
The two may be altogether diverse and heterogeneous, as the action of a purgative and a congestive headache; and if you use the former to relieve the latter, you are employing a foreign remedy you are practising Allopathy. Or the may be directly opposite, as the influence of a Bromide and the sleeplessness of mental excitement; then to give Bromide of Potassium to induce slumber is to act upon the enantiopathic or anti-pathic principle. Or thirdly, they may be similar, as Strychnine- poisoning to TETANUS or that of Corrosive sublimate to DYSENTERY.
If such drugs are used for their corresponding disorders, you are evidently Homoeopathizing. Now of these, Allopathic medication must be condemned, both on the ground of its uncertainty, and on that of the positive injury it does by disordering healthy parts and by flooding the system with the large doses of drugs necessary to produce the desired effects. Antipathic treatment is certainly and rapidly palliative; but the inevitable reaction which follows, lead to a return of the evil, often in greater force. It can rarely moreover, deal with more than a single symptom at a time; and even then its capabilities are limited by the very few really opposite states which exist between natural disease and drug-action.
Antipathy may do tolerably well for immediate needs and temporary troubles; but it is not competent to deal with complex, persistent or recurrent maladies. For these we are shut up to the Homoeopathic method, if we are to make any rational use of drugs in disease at all. This operates “without injury to another part and without weakening the patient.” It is of inexhaustible fertility, for the analogies between natural and medicinal disorders are endless. It is complete, for the one order of things may cover the other in its totality.
It is gentle, for no large and perturbing dosage is required for its carrying out. It is, lastly, permanent; for the law of action and reaction, which makes the secondary effects of antipathic palliatives injurious, here operates beneficially. The primary influence of the drug being in the same direction as the morbid process, the secondary and more lasting recoil will after (it may be) a slight aggravation directly oppose and extinguish it. It is thus that Hahnemann explains the benefit wrought by Homoeopathic remedies thus, and also by the theory (aphorism 28-52) of the substitution of the medicinal for the actual disease, of which he cites parallels in nature.
Here again we pause to ask what objections have been taken to Hahnemann’s position. His doctrine of the three relations between drug-action and disease seems too simple for certain minds. One (Anstie) calls it Metaphysical; another (Ross) Geometrical; a third exclaims “how curious, how ingenious, how interesting!” and seems to think that in so designating it he excludes the possibility of its conformity to Nature. But why should it not have these features and yet be true? What other alternative is possible? What fourth term of comparison can be found between (be it remembered) the effects of drugs on the healthy and the symptoms of disease? If you use the one for the other, you must do so Allopathically, antipathically, or Homoeopathically.
Medical men seem very fond now-a-days for disclaiming any system in their practice, and announcing themselves as altogether lawless and empirical. But they can no more help practising upon one or other of these principles than M. Jourdain could help speaking prose unless he launched into verse. If they would only analyse their own thoughts, they would see that as soon as they learn the Physiological action of a drug, they consider what morbid states it can indirectly modify or directly oppose.
These are two of the members of Hahnemann’s triad; and the difference between us and them is that our first thought seeks out what disorders the drug phenomena most resemble. We would not neglect the other two directions in which the medicine might be utilised, if we had reason to think it advantageous to follow them; and our complaint is that the profession at large do neglect and ignore the third, to the great loss of their patients.
Why should they do so? Some have answered that the method is really practicable, that real parallels between disease and drug- action are rare. To speak thus, however, implies a very deficient knowledge of Pharmacodynamics. Others have expressed a more general and natural objection when they have argued that medicines which are truly similar must aggravates rather than benefit, if they act at all. It would seem so; and it is not surprising that in the older works on Materia Medica morbid states analogous to the action of drugs are set down as contra- indicating their employment.
But this difficulty SOLVITUR AMBULANDO. Let any one take an obvious instance of such a contra- indication condition a sick stomach for Ipecacuanha, a congested brain for Opium, a dry febrile tongue for Belladonna. If he gives a quantity capable of exciting such states in the healthy, he may undoubtedly aggravate. But let him reduce his dose somewhat below this point, and he will get nothing but benefit. This has been tested again and again and no one has reported adversely to it: on the contrary, uses of medicines derived from the method are now becoming as popular in general practice as they have long been in ours.
Why should this benefit result? We have heard Hahnemann’s explanation, that such remedies work by substitution and by exciting reaction. It is one in which it is not difficult to pick holes, and he himself says, in propounding it, that he does not attach much importance to it (aphorism 28). Any discredit, however, resulting from its disapproval must attach equally, as regards substitution, to Bretonneau and Trousseau; as regards reaction, to more than one ingenious thinker of our own country, as Fletchers, Ross, Rabagliati. (See MONTHLY HOM. REVIEW, xxiii, 600-2.)
More recently, the hypothesis has been advanced, that medicines have, even in health, an opposite action in large and small quantities, so that the reduction of dose necessary to avoid aggravation gives you a remedy acting in a direction contrary, to that of the disorder, while its choice by similarity secures practicability and complete embracement. I myself feel great difficulty in acceding to this theory as a general account of Homoeopathic cure; but there is no justification for representing its adoption as an abandonment of the Homoeopathic position. It is an attempt at explanation, that is all: the fact that likes are cured by likes is the all important thing, account for it how we may. So Hahnemann said, and so all we Homoeopathists believe.
The side of Hahnemann’s position on which he is most vulnerable is his exclusiveness; in which he maintains his method to be applicable to all non-surgical diseases, and to render all other ways of employing medicines superfluous and hurtful. This led him, as has been fairly urged, to regard intestinal worms as product of the organism, and to ignore the acarus as the exciting cause of Scabies; it has resulted among his followers in a denial of palliatives to their patients by which much suffering might have been spared.
In the first matter, however, he erred in common with most of his contemporaries; and in the second he is not responsible for the excess of disciples who are often more Wilkesite than himself. The rational Homoeopathist recognises, indeed, the inferior value and limited scope of antipathic palliation. He knows that it is only properly applicable to temporary troubles; but in these he makes full use of it. He does not allow his patients to endure the agonies of Angina pectoris, when he knows, that Amyl nitrite will relieve them: he does not refuse them Chloroform during the passage of a calculus any more than during that of a foetus. Hahnemann’s exclusiveness is not to be justified; but it may fairly claim excuse as the enthusiasm of a discoverer, full of the sense of the power of his new method, and naturally led to apply it everywhere and to esteem it without rival.
The treatment of his subject in the second part of the `Organon’ is purely practical. It gives instructions for the selection of remedies upon the Homoeopathic principle, and for their judicious employment when selected. It 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. It considers the treatment on the new method of local diseases (so called), of mental disorders, and for the great class of Intermittent affections. It gives directions for diet and regimen; for the preparation of medicines; for the repetition of doses, and for their size.
It is on the last of these points only that I can touch here; for the rest I must refer to the work itself. Hahnemann’s treatment of the subject of dose had not had justice done to it, in consequence of our knowing only the Fifth Edition of the `Organon’. In the year 1829, after the publication of the Fourth Edition, he unfortunately determined to secure uniformity in Homoeopathic usage by having one dilution for all medicines, and this the decillionth the 30th of the centesimal scale.
Our present `Organon’ represents this view; but the first four edition make no such determination, and are entirely moderate and reasonable in the principle of posology they lay down. The dose of a Homoeopathically selected remedy, they say, must obviously be smaller than one intended to act antipathically or Allopathically. If too large, it will excite needless aggravation and collateral suffering. It should be so reduced, that its primary aggravation (which Hahnemann supposed a necessary result) should be hardly perceptible, and very short-lasting.
How far this must be, varies with the medicine used; and for suggestion on this point he refers to his MATERIA MEDICA PURA, where the dosage recommended ranges from the mother-tincture upwards, the 30th being a dilution of exceptional height. He alleges experience alone as having led him to attenuate as far as he has; but argues the reasonableness of so doing from the increased sensitiveness of the diseased body, pointing out that dilution does not diminish the power of a substance in proportion to the reduction of its bulk. Excluding the specific doses mentioned in the other work referred to, which are simply matters of fact and experience, there is nothing in this part of the `Organon’ in its essential structure to which fair exception could be taken.
I wish I could have stopped here; that there had been in the volume I am now expounding nothing more difficult to defend than what has gone before. In its first three editions i.e., up to 1824 there is not. Almost everything in Hahnemann’s work during the first quarter of this century is of enduring worth; it is positive, experimental, sound. But from this time onwards we see a change. The active and public life he had led at leipzic, with the free breath of the world blowing through his thoughts, had been exchanged, since his exile to Coethen in 1821, for solitude, isolation, narrowness.