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.