The reign of hypothesis began in his mind hypothesis Physiological, Pathological, Pharmacological. The theories he was led to form in all these branches of thought found their way into the later editions of the `Organon’, and so demand some consideration from us here. But let it be remembered throughout that they are not of the essence of its argument; that its structure and substance were complete before they appeared, and in the judgment of many of us are rather injured by their interpolation. Without them, all is inductive reasoning or avowedly tentative explanation; they, dogmatically asserted but all unproven, introduce a new and questionable element, they constitute what Drs. Jousset and Gailliard have well called the “romance of Homoeopathy.”
The first of these hypotheses is that of a VITAL FORCE, as being the source of all the phenomena of life, and the sphere in which disease begins and medicines act. Hahnemann would probably at all times have called himself a vitalist, in distinction alike from the animism of Stahl (which made the immortal soul the principle of life), and from the views of those who would bring all vital phenomena under the laws of Physics and Chemistry. He early, moreover, employed the term “dynamic” to denote the sphere in which true diseases took its origin and those effects of drugs which require vitality for their production.
Disease has its “materies morbi” and organic changes; but all these may be Hahnemann would have it always were secondary products and effects, the primary derangement being invisible and intangible, manifest only in altered sensations and functions. Drugs, again, produce many of them chemical and mechanical effects; but these might occur in the dead as in the living body. The exclusively vital reactions they set up in the crucible of the organism belong to another sphere; they correspond with the beginnings of disease, like them are revealed by altered sensations and functions, like them are to be characterized as “dynamic.”
Had he gone no further all would have been well. It is easy to read into his language the present protoplasmic doctrine of life; while the frequent commencement of disease in molecular rather than molar changes, (Hahnemann himself would have allowed this “frequent” to be more correct than “invariable”; for he considered Cholera due to the invasion of a cloud of minute organisms, and on this ground advised Camphor to be used so freely for it (see Lesser Writings, p. 851, 854). He is thus granting, IN PRINCIPLE, the germ-theory of infectious disease, and the propriety of parasiticide treatment in them.) and the dynamic as distinct from the mechanical and the chemical action of drugs, are recognised by all. But in his later years Hahnemann advanced from this thoroughly tenable position into one far less easy to maintain.
He adopted the view that vitality was a “force,” analogous to the physical agencies so called, without which the material organism would lack sensation and functional activity, which animates and energies it during life and leaves it at death. It is this “vital force” (LEBENSKRAFT) which is primarily deranged in illness, and on which morbific potencies both natural and medicinal act through the sensory nerves. Its behaviour under medicinal influence is ingeniously imagined and elaborately described (aphorism 127); and in the Fifth Edition of `Organon’ it is frequently mentioned as the actor or sufferer where previously the author had been content to speak of the organism (as in aphorism 148).
Now Hahnemann can hardly be thought the worse of for entertaining this view, since, in some form or other, it was almost universally prevalent in his day. If the advice of the present Pope has been taken, it is still the teaching of all Roman Catholic colleges; for it is simply the Thomist doctrine itself derived from Aristotle under another name. But the tendency of recent science is to regard the organism as no monarchy, wherein some “archaeus” lives and rules, but as a republic in which every part is equally alive and independently active, the unity of the whole being secured only by the common circulation and the universal telegraphic system of nerves. It is unfortunate, therefore, that Hahnemann should have committed himself and his work to another conception. Either or neither may be wholly true; but one would have been glad if the `Organon’ had kept itself clear of such questions, and had occupied only the solid ground of observation and experiment.
And now of the PSORA-THEORY. This is far too large a subject for justice to be done it here. It has been fully handled elsewhere; (See Dudgeon’s LECTURES ON HOMOEOPATHY, IX and X and my own PHARMACO-DYNAMICS, pp. 87, 90 and 839. A thoughtful paper on the subject was presented to our International Congress of 1896 by Dr. Goldsborough; and, with the discussions following, may be read in its Transactions. Dr.Goldsborough differs from me as to the range of cutaneous disease covered by the name “Psora” in Hahnemann’s writings, and indeed so extends it as to include itching eruptions of all kinds.
He makes him explicity contained for a doctrine of “herpetism” which I have viewed as only implicitly contained in his thought. He is thus unable to agree with me that Hahnemann “based the logical superstructure of his Psora-theory upon the distinct entity Scabies,” I have carefully weighed what my able colleague has written, but am unable to modify the judgment expressed in the text, and in the references given in this note.) and any one who would desire to deal fairly with Hahnemann on the point has abundant material for so doing. I can only say a few words as to what it purports to be and what it really is.
It is sometimes averred by Hahnemann’s critics that he made all Chronic Disease or at least seven-eighths of it originate in from the category of true chronic maladies those which arise from unhealthy surroundings, noxious habits, and depressing influences (aphorism 77) for these, he says, disappear spontaneously when the LOEDENTIA are removed. Neither will he allow the name to the medicinal affections which the heroic treatment of his day made so common (aphorism 74-6), and which he regards as incurable by art. True Chronic Disease consists of such profound disorders as Asthma, Phthisis, Diabetes, Hypochondriasis, and the like disorders insusceptible of cure by Hygiene, and tending to permanent stay and even increase.
A certain proportion of the affections so characterized were traceable to venereal infection Syphilitic or “Sycotic” (i.e., Gonorrhoeal); and it seemed to him that the remaining seven-eighths (it is here that these figures come in) must have some analogous “miasmatic” origin. In the medical literature of his day he found numerous observations (he cites ninety-seven of them) of the supervention of such diseases upon the suppressing of cutaneous eruptions among which Scabies then very prevalent held a prominent place. In this last he had found the “Miasm” he wanted. It resembled Syphilis in its communication by contact, its stage of incubation, and its local development, while it was far more general. He thereupon propounded it as together with the other contagious skin affections, the Tineae, etc., which he regarded as varieties of it the source of the non-specific Chronic Diseases, understood as defined.
Now it is easy for us, knowing what we know (or suppose we know) about Itch, to make merry over this theory of Hahnemann’s. But to condemn or ridicule him for it, is a gross anachronism. We forget that the modern doctrine of Scabies dates only from Hebra’s writings on the subject in 1844. Before that time men like Rayer and Biett could deny the existence of the across, and it was quite reasonable to regard it as only the product of the disease. Hahnemann, who was one of the most learned physicians of his time, knew all about it, and had, in 1792, written up on it. (See B.J, H., xxi, 670) He nevertheless, in 1816, described Scabies as a specific, miasmatic disorder, forming itself in the organism after contagion (as Syphilis does), and announcing by the Itch-vesicle its complete development within. It was thus regarded that he propounded it as the origin of so much Chronic Diseases. We, understanding it better, must refuse it such a place. But when we look beneath the surface of his doctrine, we find it far from being bound up with his view of Scabies.
It rests upon the broader ground of morbid diathesis, and especially upon that form of it associated with cutaneous disorder which has led the French Pathologists to speak of a DIATHESIS HERPETIQUE OR DARTREUSE. Translate Hahnemann’s “Psoric,” now into these terms, now into “scrofulous,” and you have the substance of his thought, which is absolutely true and of the utmost importance. It was for therapeutic purposes that he arrived at it, and these it has subserved in no common degree, giving us a wealth of new remedies, of long and deep action, which are our most valued means in chronic disorders. Compare, for instance, our use of Sulphur with that which generally obtains with that even which obtained in our own school before the Psora-doctrine was enunciated, and you will see what we have gained by it.
Here again, then, we cannot allow Hahnemann to be deprecated on account of his hypothesis, strange as it may seem to us. But we must regret that he incorporated it in his `Organon.’ Neither it nor its practical consequences form any part of his method, as such; and Pathological theory is out of place in the exposition of a mode of proceeding which is wholly independent thereof. In reading the `Organon’, let us determine to ignore it, or to translate its language in the way I have suggested: We shall then do greater justice to the main argument of the Treatise.
And now a few words upon the theory of DYNAMIZATION, which is a subject quite distinct from that of infinitesimal dosage. We have seen that Hahnemann was led to adopt and defend the latter on grounds whose legitimacy all must admit, whatever they may think of their validity. For the first quarter of a century of his practice in this way (he began it in 1799) he thus regarded and justified it. He maintained, as I have said, that by the multiplication of points of contact obtained, dilution does not weaken in proportion to the reduction of bulk; but, in so speaking, he admitted that it did weaken.
He even attempted to fix the ratio of the two processes, estimating that each quadratic diminution of quantity involved loss of strength by only one-half and this calculation remains unaltered in all editions of the Organon (note to aphorism 284). In the Third Edition, however (i.e., in 1824), there appears for the first time the note we now read as appended to aphorism 287. He here speaks of the unfolding of the spirit of a medicine as effected by the pharmaceutic processes of trituration and succussion, and in proportion to the duration of the one and the repetition of the other. By regulating these, accordingly, we can secure either moderation of excessive crude power on development of finer or more penetrating medicinal energy. In publications of 1825 and 1827, he carries yet further this new thought.
At first he had ascribed the increase of power to the more intimate mixture effected by his processes; but now he declares it to be something over and above this a change, a liberation of the dynamic, a development of the spiritual powers of the drugs, analogous to the production of heat by friction. Treated in this way, he affirms, “medicines do not become by their greater and greater attenuation weaker in power, but always more potent and penetrating”; there is “an actual exaltation of the medicinal power, a real spiritualisation of the dynamic property, a true, astonishing, unveiling and vivifying of the medicinal spirit.”
These views were so little in accordance with those expressed in the `Organon,’ that we find scant further trace of them in the Edition of 1829. In the note before-mentioned “refined” (VERFEINERT) becomes “potentised,” as we have it now; and in the directions for proving medicines a note is added to aphorism 129, saying that recent observation pointed to greater attenuation and potentisation rather than larger quantity as best giving the strength required for the purpose. This is all. In 1833, however, the pharmaceutical portion of the treatise has two new aphorisms (269, 270) embodying them.
Its posological section remains unchanged, save in aphorism 276. Here Hahnemann had said, in former editions, “a medicine, even though it may be Homoeopathically suited to the cure of disease, does harm in every dose that is too large, the more harm the larger the dose, and by the magnitude of the dose it does more harm the greater its Homoeopathicity.” In the Fifth Edition he adds, ” and the higher the potency selected,” which obviously changes the meaning of what has gone before, and makes dose a mere question of number of drops or globules. I mention all this to show how entirely the doctrine of dynamization was an after-thought, and how little the `Organon’ proper (with which we are immediately concerned) has to do with it.
But what shall we say of the theory itself, in its bearing on Hahnemann’s worth as a thinker? This must depend very much upon the stand-point from which we regard it. Was it a gratuitous hypothesis, at best a mere logical consequence of the other views of the originator? Or, was it an attempt to account for facts these being in themselves genuine? Hostile critics assume the former position, and judge accordingly. We, however, cannot do this. Whatever our own preferences in the matter of dosage, it is impossible to read the history of Homoeopathy, still more to be acquainted with its periodical literature, without recognising that highly attenuated medicines have an activity SUI GENERIS.
They show this in provings on the healthy as well as in the treatment of the sick; and not here and there only, but in such multitudinous instances as to make coincidence and imagination utterly inadequate as accounts of the phenomena. The Hahnemannic processes certainly do develop virtues in drugs which in their crude state are altogether latent. Brimstone, oyster-shell, flint, charcoal, table-salt these substances in mass have a very limited range of medicinal usefulness; but what cannot Homoeopathy do, what has it not done, with Sulphur, Calcarea, Silicea, Carbo vegetabilis and Natrum muriaticum, in the dilutions from the 6th to 30th? In this form they are in our hands as well-tried agents as any on which ordinary medicine depends. Their potency is a fact to us; how are we to account for it?
Hahnemann’s dynamization, in the light of later science, must be held untenable; but to this day we have nothing to put in its place. And even if we had, we should not the less honour the philosopher who perceived the necessity of the explanation, who brought to light the hitherto unknown phenomena, and set us to work at giving a scientific account of them.(Dr. Gatchell, in a very interesting essay, brought before the Paris congress of 1900 the views now entertained about the effects of solution, as substantiating Hahnemann’s dynamization. In a complete solution of a complex body, he writes, there are no molecules, but only “ions” into which the molecules have dissociated.
These ions are electrically active while molecules are passive, and so a fresh force may be said to have been imparted to the original substance. These views may be helpful to our conceptions, so far as compound salts and solvent processes are concerned, but they hardly aid us for other substances and modes of preparation; and as a solution of one part in the thousand is considered a “perfect” one, we do not even for the salts get far on in Hahnemann’s scale. Dr. Gatchell’s paper may be read in English in the MEDICAL ERA for April, 1901).
I have now completed my exposition of Hahnemann’s Medical Philosophy as contained in his `Organon.’ But we are accustomed now-a-days to demand more of Philosophy than that it shall be sound in method. It must also show its power in bearing fruit. Hahnemannians need not fear the challenge. There is a fine passage in Macaulay’s Essay on Bacon, in which he recounts the numerous gains to mankind which the science of the last two hundred years has contributed. If the writer of the `Novum Organum’ could have looked forward, he says, he might well have rejoiced at the rich harvest which was to spring up from the seed he had sown.
In like manner has even the immediate future responded to the impulse given by our Organist. Could he have foreseen the medicine of to-day, how much there would have been to gladden his heart. He lived in a time when heroic antiphlogisticism was in full force; when physicians “slew,” as in Addison’s day, “some in chariots and some on foot”; when every sufferer from acute diseases was drained of his life-blood, poisoned with Mercurials, lowered with Antimonials. and raked by PURGATIVES. He denounced all this as irrational, needles, injurious, and it has fallen never, we trust, to resume its sway.
The change thus wrought even in the practice of the old school would be a matter for thankfulness on his part; but how his spirit would have bounded when he looked upon the band of his own followers! The few disciples made during his life-time have swelled into a company of over twelve thousand practitioners, who daily, among the millions of their CLIENTELE, in their hundreds of hospitals and dispensaries and charitable homes, carry out his beneficent reform, making the treatment of disease the simple administration of a few (mostly) tasteless and inodorous doses, and yet therewith so reducing its mortality that their patients lives can be assured at lower rates.
He would see the Aconite and Belladonna, the Bryonia and Rhus, the Nux vomica and Pulsatilla, the Calcarea, Silicea, Sulphur, which he created as medicines, playing their glorious part on an extensive scale, robbing acute diseases of their terrors and chronic maladies of their hopelessness. He would see his method ever developing new remedies and winning new victories evoking Lachesis, Apis, Kali bichromicum, Gelsemium, and earning laurels in Yellow Fever as green as those which crowned it in the visitations of CHOLERA.
He would see his principles gaining access one by one to the minds of physicians at large the proving of medicines, the singled remedy, the fractional dose already accepted, and selection by similarity half-adopted under other explanations and names. He might well feel, like Bacon, about the “Philosophia Secunda” which should end his Instauratio Magna. He had given its “Prodromisive Anticipationes”: “The destinies of the human race must complete it in such a manner, perhaps, as men looking only at the present would not readily conceive.” The destinies of the human race, in respect of disease and its cure, are completing it; and will be yet more profoundly modified for the better as that completion goes on.