In the undertaking of a constitutional therapy there is already the implication that the constitution is not an unalterable state. As discussed above, this conception does not involve the restriction of constitution to inherited properties but the dynamic definition presumes a psycho-somatic constitution in which the flowing connection of inherited disposition up to the present disposition is regarded. With a constitutional therapy perhaps the highest aim of medicine is reached.
The doctrine of chronic diseases and their healing is a break from the pure method of Hahnemann, which selected the drug for each patient on the symptom similarity. For the chronic evils, syphilis and sycosis, this is very distinct. Because for these Hahnemann has prescribed one or two healing remedies without regard for the individual symptoms. Here he falls into the error which he had cast at the medicine then existing namely, to base the drug indication on the name of a disease, even if here etiologically definite connections of disease are present. For psora, the central problem of older hahnemann, the break with the simile principle is however, only a seeming one. Because for this hydra-headed monster he stresses a great number of drugs and for the selection among them, the simile rule is the supreme guide. The emphasis on this group of antipsoric remedies to day we call them merely constitutional drugs is simply one limitation which the master has shown. Because the selection among them requires a more extensive perfected use of the simile rule than is necessary for acute and localized diseases. For Hahnemann the endeavor towards better accomplishment, namely, the removal of predisposition to disease in addition, has been the occasion for an improvement in method. The theoretic substructure which he erected shows many defects which are not merely temporal but also dependent upon his capricious disposition. But for constitutional investigation the drug types derived by him from a systematic elaboration can furnish a valuable contribution and medical art is shown the way out from the fatalism of apparently unalterable predisposition. The increasing insight into the constraint under which the disease predispositions arise need in no way retard the freedom of a transforming fact.
RADEMACHER’S THREE UNIVERSAL REMEDIES
Hahnemann’s triple etiologic division of chronic disease relations was the one source out of which V. Grauvogl created. From it he made without hesitation three biologic forms of illness, also predispositions. His second source was the three states of Rademacher, who determined them simply through the drugs to whose healing powers they are subject; sodium nitrate, iron and copper. For Rademacher these three agents are the universal remedies in the sense of the old alchemists or iatrochemists, particularly in that they are remedies for the basics disease of the total organism (not them alone, but as representatives of three groups; for example, sodium nitrate as chief of the earthy and alkali salts). Universal remedies are not panaceas in any sense of the word, but they are used in contradistinction to organ remedies, that is, from agents which are suitable for disease of a single organ.
First, one should note that the three states of Rademacher through their relation to healing remedies are characterized in the meaning of Paracelsus and homoeopathy. Second, the affections designated through these drugs involve the entire organism so that one should ascribe to them general universal effectiveness. Rademacher emphasizes that these materials are friendly to the body, that is, they are not poisonous foreign materials (although this naturally cannot hold for man in respect to copper). But in any case it signifies that he also perceived the physiologic substances as especially suitable for such general actions. It is also worthy of note that it is furthermore exclusively concerned with inorganic materials (also in regard to the related members of the groups).
A special choice of the agent in maladies of the total organism in contrast to these characteristics seems to be secondary with Rademacher. The selection itself seems to have arisen from his personal purely empiric search. Only in sodium nitrate does he seem to have depended upon the Elixir salis of Paracelsus, for in its method of preparation he would recognize sodium nitrate.
Now it is very plausible that in this search Rademacher has presented a new interpretation of the three basic substances of his predecessor Paracelsus: sulphur, mercury and sal. According to Paracelsus these three basic substances form the physical body. They are not to be placed in any comparison with the conceptions of modern chemistry but with three types or forms into which the composite body is converted by chemical distillation: sulphur is that which, when completely burned, forms a gas, mercury is the mist and smoke which is precipitated unchanged (sublimes) perhaps as water and soot (carbon) and finally sal is that which remains in the retort, non-volatile and incombustible. One need not wonder that in primitive analytic chemistry these three generally recurring results of analysis in three forms were conceived and symbolized as the three substances of the body; the medicinal powers rested on them. Translated into our speech they take on perhaps the following implication: The basic material which is yielded in the elementary analysis of the living organism will also be of especially general medicinal effectiveness; because their concordance conditions (materially) health, and indeed it depends not merely on quantitative relations but also on local and temporal working together, on structure and the form of the substance.
We need to join ourselves with the sulphur, mercury and sal of Paracelsus just as little as to the iron, copper and saltpeter of Rademacher when we search for the essential of the constitutional problem. These drugs were nothing more to Rademacher than especially proven test agents, reagents for unknown (and, as he believed, unrecognizable) states of disease and especially those which involve the total organism. In actuality, Rademacher presents the recognition of a disease as a chemical analysis. Also in qualitative chemical analysis we do not recognize the nature of the substance, but we identify it only by means of known reagents. So he identifies the disease through the curative agent and beyond this the nature of the disease remains unrecognizable to him.
An important and (except in the homoeopathic school) completely neglected principle of recognition is driven to a point by him, even if onesidedly. Any other analysis of disease than that through the test drug is disdained by Rademacher, obviously from the apprehension that further analysis always admixes theories which press the medical treatment in the wrong direction. For this official medicine, the so-called physiologic school gave him ample illustration. But that he undertook the differentiation of the processes of disease through exact detailed observations which were in a position to ensure the union of disease with the medicinal agent without theoretic accessories, signifies a superlative absence of presumptions. Methodically considered, his purely empirical groping procedure is the exaggerated scientific method; but it can avoid complete sterility only in that Rademacher as well as many of his pupils through instinctive comprehension perceived that what was to them orderly observation of details could furnish them with drug indications. Since the path from disease signs to drugs had been broken at that time by homoeopathy, Rademacher is comprehensible only as follows; this self-willed, highly endowed physician in his rural seclusion built a method entirely onesidedly from the findings which he had made among the old alchemists and particularly Paracelsus and which stood in crass contrast to the therapeutics of his time. A theory based on the experiences of a single physician in search of cure and indeed so unsystematically, can also not develop a personal school. But all preconditions for amalgamating with homoeopathy are clear at present. We shall later mention this connection with respect to the constitution theory.
GENIUS EPIDEMICUS AND MODALITIES
Before doing so it is necessary to take into consideration another important fragment of the Rademachian method: the so- called epidemic status, the genius epidemicus. Today one tends to associate the epidemic appearance of diseases onesidedly with the extension of a living excitant. Before the time of bacteriology another one-sidedness was pardonable, and the current atmospheric-telluric influences were made responsible for the frequency of forms of disease. The general importance of this external condition can in no case be denied. The growth and extension of the excitant as well as man depend upon this atmospheric-telluric constellation. It is apparent that also here Rademacher goes back to the alchemists. In Paracelsus the so-called astronomy signifies not only an analogy of the microcosm (man) and the macrocosm (world), that is, all that occurs in the cosmos has it miniature in man but also the constant transference of powers from the cosmos to man; man is constantly subjected to atmospheric-telluric influences, there exists a concordance between materials and powers in man and those in the cosmos. Alteration in the substantially conceived powers of the cosmos was the equivalent and cause of alteration of substances in man, which signified disease.
Rademacher was moreover correct when he found the constitutio epidemica Sydenhams in the astronomy of Paracelsus. The epidemic influences without further analysis were made responsible for the appearance of epidemic forms of disease at certain times or much more (according to his Paracelsian manner, to recognize the disease from the drug) that diseases frequent in a given region at definite times were subject to the same drugs. With constitution this doctrine of constitutio epidemica seems to have nothing to do and Rademacher did not unite genius epidemicus with constitution. This would also not correspond with his intellectual medicine of experience. But for him constitution must be as unrecognizable and conceptual as disease. But indirectly the dependence of disease on the epidemic status was an important proof of the constitutional factor. Frequency of forms of disease as frequency of drug indications referred on the one side to the prevalence of equal external causes, but on the other side also to similar typical predisposition. This also held for the living excitant as for the atmospheric telluric influences as causes of disease. Because the susceptibility or nonsusceptibility (immunity), for example, against scarlet fever, also contributes to the recognition of the constitution, naturally in much smaller extent than perhaps the relation of an organism to moisture and cold. Grauvogl has correctly seen that what rademacher represented very generally by genius epidemicus, a purely empirical temporary union between form of disease and curative drug, is an important complex, and what is called in homoeopathy the accompanying circumstances. But while Rademacher accepts the totality of external conditions as an indefinite circumstance, homoeopathy attempts to observe the contemporary external conditions and so far as it is possible to split them into single measurable fragments; this is the dependence of man (in his transition from health to disease) on external conditions, the so-called modalities. There can be no doubt: the solution of genius epidemicus into detailed observations of external dependencies is not only scientific but also significantly improves the prospects for the discovering of healing agents. Rademacher goes far too wide in his skepticism when he concludes: because the dependence of diseases upon external conditions is never to be recognized in all details, so in general one can neglect the partially recognizable details obtained through observation. There is the same disregard for detail observations as for disease symptoms: and according to him they are also unsuitable for the determination of the healing remedy because they cannot offer a complete recognition of the disease. This is a prescientific viewpoint which till considers the question according to the nature of the totality. On the other hand, homoeopathy, in agreement with science of the modern age, questions according to the how: with what signs in detail does a man react to external conditions which also can be determined in particulars? It is better to have partial measuring sticks in hand than to have none at all.
The genius epidemicus and its precision through modalities signifies nothing else than susceptibility, sensitivity of definite individuals to generally prevailing atmospheric- telluric conditions. It also makes the constitution conspicuous in the same sense as an intentional drug proving will determine the sensitivity to a medicinal substance. Only in the genius epidemicus, the telluric-atmospheric influences from a natural mass experiment which shows average tendencies, typical dispositions to disease. In so far as constitutional types are sought, this general, naturally given criterium is entirely suitable. The difficulty exists only in gaining typical groups from the diversity of external conditions which correspond to human reaction types.
Rademacher circumvents this difficulty by accepting a division from another side; by proceeding from empirically found curative agents or groups of agents which are suitable for affections of the total organism in various epidemic situations. The weakness of this division lies in that in actuality, leaning on a bygone primitive epoch of chemistry, it is supported only by the experiences of this single observer and a few of his students. Seen from modern chemistry and pharmacology, it is not clear in any way why sodium nitrate, iron and copper should be prototypes of such general dug action. But mentally, Rademacher’s theory of three epidemic universal remedies, that is, three agents for the entire organism, which fit the genius epidemicus, contain all the presumptions for the consideration of constitution as they exist and are essential in homoeopathy, namely:
(1) The union of the manner of reaction of the organism with the drug and the differentiation accordingly.
(2) The union with the general influences of the environment (genius epidemicus which are determinable in details as modalities).
(3) The general constancy of the manner of reaction recognizable by the type (that is, their value for the total organism).
It is striking that this analysis of constitution is a purely dynamic, functional one. The usual description of types in sound and sick days according to form, tonus, color, preponderance of organ systems, etc., is not even considered. Moreover, in homoeopathy they are used as a rough basis so far as they can be obtained, but they are still insufficiently available. The functional and therapeutic viewpoints likewise have predominant significance for the constitutional consideration.
Rademacher, just as little as Hahnemann, intended a representation of constitutional types with his three types. Vll. Grauvogl first undertook the transformation and simultaneously an amalgamation of both theories. With his conception of constitution. One need not go into details on the compulsion and arbitrariness which accompanied him in it.
GRAUVOGL’S CONSTITUTIONAL TYPES
Grauvogl comes to a special doctrine of constitution in that he goes back to the chemical elements of the organism, hydrogen, oxygen, carbon and nitrogen. In principle he does the same as Paracelsus had done primitive chemistry. Indeed, it seems very logical to bring the constitution of the organism into dependence with the constituents, the chemical constituents. In this chemical foundation of constitution Grauvogl is in no way original but he proceeds in close conjunction with many predecessors and from the existing status of physiologic chemistry. Gerlach has shown this. Also the construction of three constitutional types on the basis of the relations of structural materials, H, O, C, and N, the representation of the hydrogenoid, oxygenoid and carbonitrogenous constitutions is no discovery of Grauvogl’s, nor is it the essential in his representation. Much more essential is his attempt, in conjunction with that of Hahnemann an Rademacher on the one side, to unite his three constitutions to drugs and on the other side to external circumstances, modalities, telluric -atmospheric influences and to empirically fix them.
The hydrogenoid constitution is characterized by predominance of reduction processes, through greater water content of the organism, particularly in the blood. This type is aggravated by cold and damp weather, by water in any form. One sees that a correspondence exists between the excess of water (or hydrogen) in the organism and in the external world in a Paracelsian sense. A further sign of disease on the basis of the hydrogenoid constitution should be the periodic course; and by Grauvogl this is brought into connection with nerve maladies and electric disturbances in particular. Still, this characteristic stands far behind the first. As agents for diseases which arise from the hydrogenoid constitution, according to the theories of Grauvogl, such materials serve which lessen the influence of hydrogen or water on the blood, which increase the oxidation of hydrocarbons. In the classification of these as well as in both other constitutions, Grauvogl proceeds mentally in a completely nonhomoeopathic sense according to the scheme of chemical contrasts. He perceives the cause of chronic diseases in an excess or deficiency of substances from which the organism is composed. In the case of the predominance of hydrogen and the deficiency of oxygen he would introduce drugs which will increase oxidation, leading to a sort of chemical balance. Such a chemical substitution therapy leaves the reactivity of the organism entirely out of consideration and yet Grauvogl is otherwise thoroughly familiar with the dynamic principle of drug action. Even in 1876 E. Schlegel offered to this internal contradiction of Grauvogl. But in regard to the classification of remedies to constitution he has not erred as in his theory: for the hydrogenoid constitution he advises primarily the alkali salts. The opinion that they essentially promote the influence of oxygen cannot be proven; one can say much better that the alkalis (apart from the picture of their drug effect) theoretically seem suitable for the hydrogenoid constitution because they withdraw water and indeed especially from those places in which it collects. The comparison of the Rademachian sodium nitrate state with the remaining alkalis as accessory agents to the hydrogenoid constitution is reasonable. More remarkable is the comparison to the sycosis of Hahnemann; the maintenance of this union can only lead to error. The designation hydrogenoid constitution, however, can still serve as a frame which embraces lymphatism and the tetanoid types from the side of modalities and the related medicinal substances. Precision may come, so far as is possible at present, from this conception.
The opposite to the hydrogenoid constitution is the oxygenoid. It is characterized by increased oxidation processes, by a lessened resistance of the organic compounds to the influence of oxygen. It was not unknown to Grauvogl that organic materials are first prepared through fermentative splitting. He also desired to designate the increased fermentative-oxidative splitting as oxygenoid. Consumption and hypersthesia, defects in albuminates and fat, energetic utilization of oxidizable materials, lessened storage imply this constitution. Since it was not conceivable that the increased destruction was traceable to an excess of oxygen, Grauvogl considered the defect in the organism to be in dysoxidizable materials, particularly carbon and nitrogen. In this obviously false deficiency theory stands a contradiction since according to Grauvogl the oxygenoid constitution has an aversion to meats, which they need most but cannot utilize. Then again the character of the modalities and the nature of the adapted drugs was led into bypaths by this theory. Because this type should feel better air-rich in carbon and nitrogen. Obviously better supported by observation is the report that these irritable, hypertonic, thin men feel especially bad in great tensions of the atmosphere, before a storm, tempest, and rain, that they have the so-called almanac pains, while they feel better after the rain and also during fog. To see therein an influence or air electricity, the charges in clouds and fogs has, at any rate, something in it. One only wonders why dry heat is not included as an aggravating factor for this constitution.
The classification of remedies in the oxygenoid constitution again is untenable, so far as it follows the theory of an equalization of a deficit. The carbonaceous materials, according to their effect picture, are certainly not oxidizing agents as Grauvogl would imply. That Rademacher’s universal iron belongs here is in correspondence with homoeopathic thoughts. The most perfect example of an oxygenoid manner of action, iodine, is not cited by Grauvogl in this series, although potassium iodide is (with a mistaken basis).
One can place the oxygenoid constitution in contrast to the hydrogenoid or torpid lymphatic, tetanoid and call it erethistic- arterial, basedowoid.
The third constitutional type of Grauvogl, the carbonitrogenous is characterized through accumulation and retention of carbohydrates and nitrogen in the organism and indeed insufficient oxidation.
The first signs of such a condition are increased respiratory frequency which not rarely is associated with a lessened pulmonary capacity and slight expansion of the thorax. Corresponding to the respiratory rate is increased pulse frequency. The patients feel best in open air (cold and damp do not aggravate in this state). A definite sign of the retention process is the pale urine which tends to be poor in chlorides and phosphates. In the blood picture one notes early unusual turbidity, the so-called melanotic blood cells. The blood is richer in them because of the suppressed progressive metamorphosis which is possible only as the result of an insufficient influence of oxygen and in the organic fluids and tissues. Thereby Grauvogl gives the physiologic-chemical and symptomatologic characteristics of a disposition which we designate today as arthritism or as bradytrophism. He has also correctly seen or foreseen that in this state fermentative destruction, fermentation prevails in contrast to oxidative processes, as we know today in carcinoma.
As curative remedies of the carbo-nitrogenous constitution Grauvogl gives a variegated series, beginning with copper in agreement with the third state of Rademacher, but actually incorrectly if one reflects on the copper effect picture. Of the remaining metals cited which he counts a oxygen carriers according to his equalization theory, the same holds. Likewise phosphorus in any case does not stand in the correct position since its entire picture of effect is oxygenoid. Sulphur alone which Grauvogl took over as the great psora-remedy of Hahnemann shows the essential depression of the metabolism for the carbo- nitrogenous constitution, particularly of the skin and intestinal functions, the tendency to fermentative processes and to venous stasis. Carbon itself shows these actions much more strikingly but Grauvogl does not place it in the series. According to homoeopathic thinking and according to the effect pictures as they are furnished by the provings, graphites and the other carbon compounds must actually stand in first place.