Grauvogl’s doctrine of constitution suffers in that it is overconstructed. And yet it is not to be denied that in his three great types he has created a classification whose differentiations have a vast justification in actuality. If one actually subjects many ideas of Grauvogl to a revision, then the basic trends of his constitutional doctrine remain useful: particularly the recognition through suitable agents, that is, groups of drugs, further through the dependence on general external conditions (modalities) and finally as far as possible the tracing back of the constitutional differences to varying conditions of the organism itself which is finally pursued down to the structural elements themselves. The description of the type differences is the constantly assumed but still inaccessible intermediation between the analytic, physiologic-chemical and psychic investigation on the one side and the determination of tendencies (sensitivities for drugs and external conditions) on the other side.
NEW CONCEPTION OF CONSTITUTION
Our present attitude toward the question of constitution should approximate reality as far as possible. But actually there are no types but persons. Therefore, we should give to each person his own constitution. We need speak of constitutions only in order to comprehend peculiarities of individuals in certain respects and to describe them with type conceptions. To determine this property as a deviation from an imaginary norm is as foreign to reality as it is useless. It is only by the special relations of a living organism to its environment that we can determine its properties. But it is not the characterization of a man in all respects that interests us, when as physicians we speak of constitution, but chiefly in his tendency to become sick. It is necessary to appreciate this intimate actual state before one can begin a study of its basis. A division according to inherited and acquired properties does not help us here. For the recognition and utilization the tendencies can be observed in their transient connections; likewise a rigid separation of constitutional anomalies and transitions to disease is not justified in actuality. Our most important task must be the recognition of susceptibility. The more the disposition reveals itself in the total person and not merely in the single organ, the sooner the conception of constitution can be applied. Eventually, we can depart from the conception. It would be better to speak of the anlage, the disposition of the total person. On the one side one can seek to recognize the present individual-historic developmental relations from the inherited and acquired, on the other side the organic configuration of the total disposition from the disposition of the parts. But a worthwhile synthesis is obtained first through the recognition of direction. As through the function of the organic structure the arrangement and meaning of a part becomes comprehensible to practical understanding so also the recognition of for what purpose in the anlage first yields a worthwhile unit.
Now there would be nothing more simple than to perceive the anlage from the disease itself. So far as this is possible, it is done. But from the designation as arthritism, lymphatism, neuropathy, one can only conclude that extremely general groups with uncertain limits are indicated more than they are precisely fixed by details. This is dependent upon the fact that out of a great series of diseases which are manifest in the history of a person or his family, it is difficult to ascertain the red line which establishes the endogenous factor. Because the common factor therein cannot be determined without a comparative series. If now it is difficult- through comparative experience on the course alone to group types of diseases themselves, then it is even more difficult when one attempts to determine the morbid relationships in a mutual anlage. But in spite of its indefiniteness the sketched conception derived from clinical experience remains an approximation to actuality. Furthermore, one will be justified in repeatedly undertaking a circumscription and compression of the actual connections, if they are sufficiently general, from their own viewpoint and position. The point of departure for such divisions will be the various morphologic or chemico-functional bases which concern the entire organism. So from the fixed mesenchyme there will be a division into tense and relaxed fibres. From the vascular system will be cut off subdivisions of lymphatic, venous, arterial types, partly into lymphatism, arthritism, and neuropathy, into hydrogenoid, carbonitrogenous, and oxygenoid constitutions. By another the point of departure for the subdivision will be placed in another direction. From the blood cells one can likewise proceed into subdivisions where the accent is placed more perhaps upon the eosinophile cells than has occurred up to the present. The progress in the study of blood groups is promising in this respect. Likewise serologic subdivisions seem very plausible. Of greater comprehensiveness are the types determined by incretions which are traceable to disturbances in equilibrium in the interaction of the endocrine glands. Through this subdivision the old conception of dyscrasia becomes superfluous. The division into hypo-and hyperthyroid of B (basedowoid) and T (tetanoid) types (according to Jaentsch) is only a beginning. Standing in close physiologic relation is the subdivision which divides the autonomic nervous system into vagotonic and sympathcotonic types. Here certainly much onesidedness is experienced. Like all onesidedness this can only lead to bringing classifications into discredit.
But if one remains conscious that thereby only a seeming preference for the physiologic and pathologic function of one significant process is recognized for the total organism, then the conception retains its justified place.
All these attempts to fix these indefinitely determined clinically derived dispositions into universal tissue systems, systems of chemical or nervous regulation, must be further supplemented. The division of Grauvogl is nothing more than a further attempt at division which goes back to three types of metabolic utilization; and indeed it is the most radical because it even goes back to the chemical elements of metabolic utilization. If now in a subdivision according to the preponderance of reduction, oxidation, carbon and nitrogen retention, one daringly leaps over the great gaps in our knowledge of the intermediary processes, then these types adapt themselves by virtue of the total recognition as well as the clinically derived aspect, so that the physiologic-chemical triple division can be used with reservations for approximating actuality.
But the Grauvogl hypothesis signifies more than an elaboration from the analytic side based on human systems of varying power. In this respect it would have only a very hypothetical value because of the errors in so many intermediate steps in its foundation. But since the types through their dependence on external influences (atmosphere and environment) and particularly through (experimentally ascertained) connections are determined according to tendencies, it achieves new significance. The systematic use of exogenous determining factors for type division, the recognition of tendencies and incidence through single facts which arise either from involuntarily given or arbitrarily introduced observations, which fill out the otherwise empty space between the innate (the conditions constituting endogenous factors) and the for what purpose of the anlage which otherwise are indicated only by a very generally sketched outline of disease, this is the fundamental new part and the important supplement which is characteristic of the homoeopathic doctrine of constitution.
We need not discuss the methodic advantages but that which seems preliminary and conjectural in Grauvogl’s representation can be altered and circumscribed by a better adaptation to the facts.
Therefore we shall purposefully select the way from the particular to the general and proceed from the diversity of the person. Yet how can we conceive the universal properties of a person, how can we gain the synthesis, the formula for the characteristics which are so diversified? Where is the super- conception for the morphologic, physiologic-chemical, vegetative and psychologic characteristics? The characterization of a person in all its details seems extended between a hypothetical unitary basis and a hypothetical unitary tendency. Neither is comprehensible as a unit. There only the comparison helps, a second comparison, an analogy, a further as if. Such a purely practical analogy is obtained through a comparison with a drug effect picture. Here we have a connection to a uniform test; a unit as-if of the basis and the tendency at the same time.
Let us take as an example perhaps a calcarea carbonica person; this is one whose entire manner of reaction seems altered in the sense of a constant calcium carbonate influence. This signifies first that all his properties are such as if they were brought about by the introduction of calcium carbonate and calcarea carbonica is the unitary basis for it. Actually the knowledge of this alteration is obtained by the observation of calcarea carbonica influence on man. At the same time the calcarea carbonica person signifies a susceptibility, a partiality, a tendency, a trend to calcarea carbonica. All true indications of the calcarea carbonica effect picture are characterized in so many fragments of a man who is sensitive to this substance, who reacts easily to it. What is here stretched between the known unitary basis and uniform tendency in signs, that we can attempt to sketch with conceptions as lymphatic, torpid, vagotonic, cold, hypotonic, hypothyroid, tetanoid, phlegmatic, hydrogenoid but the single trend remains fixed. The advantage which we have gained thereby does not only consist in that we have determined a personal type through an as -if known but we have also the advantage of possessing an image of a person represented by it, and which is reproducible through the same technique and (because of its great constancy) easily registered and can be used again as a test object. Calcarea carbonicum sensitivity can be repeatedly determined and fixed through studies on man and these observations registered and again made recognizable in other people. The characterization of a person by a medicinal substance seems at first heterogeneous but it is at least a very practical tool. It is likewise a rope thrown out which can draw itself from the water by its own fibres.
CONSTITUTIONAL SUBSTANCES OF VARIOUS RANKS
The likeness between the way of reaction of men and the drug actions leads so much better to the recognition of the endogenous constitutional factors: (1) the more general the way of reaction of the entire person is influenced and at the same time, (2) the nearer the normal, that is, without severe disease making assault, the characteristics of reaction can be determined. We seek to embrace the typical in the actions in men to all drugs. But only single organs or organ systems are altered by a number of medicinal substances. Such organ affinities at best can lead only to a determination of organ disposition. The smaller the drug stimulus is which provokes symptoms, the greater is the endogenous constitutional organ factor, the organ disposition. So moderate doses of cactus can make obvious a cardiac and aortic disposition, small doses of cantharis, a weakness of the urinary passages. But one will then speak of a cactus or cantharis case because such an organ weakness is not typical for the person as an entirety and because with somewhat greater doses of the drug, morbid reactions in these same organs can be evoked in all men.
Other substances act on an organ system, as vascular and lymphatic apparatus together with the mucous membranes and finally on all organs and all cells as perhaps mercury and lead. But the general effect is of such a nature that the disposition plays a subordinate role; in certain amounts and with certain repetitions of doses they are merely poisons. They give typical general morbid reactions but none typical for the person of typical disposition. They involve, in deed, the general basis of the living system but are too violent, too little reversible in their actions, in comparison with those which can respond with functional characteristics and reaction tendencies.
That substance will fulfill the two requirements mentioned for the recognition of constitution to the highest degree which has a vital physiologic function in the organism. Its influence on the general foundation in structure and function is established without further discussion. And the symptomatic expressions obtainable through it will always proceed out of the physiologic norm. The drug pictures of substances normal to the body will be perceived typically in constant deviations but still those standing nearest to the normal. Because for their appearance the endogenous factors play by far the most important role. If the introduction of the material occurs in not too unnatural a manner (for example, not through the injection of a non- physiologic form and amount into the blood stream), for the appearance of effect there must be presumed a special sensitivity to this substance, a special orientation. But should one simply designate such a special sensitivity to a substance as if a disturbance in the equilibrium in the economy even of this natural substance must exist? If this is obtained typically in the beginning with the assistance of chronic proving, then we secure a point with this substance where the likeness between constitution and drug picture of effectiveness is very close. Here the experimentally obtained unitary basis of a general alteration of reaction of the organism is identical with a basic substance of the organism. In other words; the line of activity of actual observations leads to a point which can be mentally fixed as a postulate, especially that the peculiar way of reaction of an organism, its special constitution must be found in the relations of its structural constituents. Constitution considered as dependent upon tension differences of the constituents will be in this way comprehended in actuality in single directions, the experiences and description made available as the function of a constituent. It is therefore not amazing that the drug picture of the substance natural to the body has furnished constitutional types and that these seem as constitutional agents of the first rank. Without the deeper basis being perceived, practical experience in homoeopathy has led distinctly to this result. One need only think of the role of sulphur, phosphorus, calcium and potassium, of sodium chloride as homoeopathic constitution agents of the first rank after which silicea, the carbon substances, then iron and iodine stand in a close position (with some slighter extent of general effect).
Between these constitutional agents of the first rank and the characteristic organ agents in the narrow sense stand a series of medicinal substances which by their effect picture stress so distinctly the endogenous factors as sensitivities in particular directions that they tend to become arranged as constitutional types. But their less fundamental secondary rank as constitutional agents (not as medicinal substances in general) can be recognized in that either the extent of their endogenous conditions is essentially narrower and perhaps only involves one organ system or that the effect picture is derived from a progressive clinical picture of disease. There are drug pictures such as those of sepia and pulsatilla which correspond more to the sensitivities of certain developmental phases, the female involution and evolution periods. Their constitutional aspect can be conceived as though it occurred through one incretory organ (here the ovary). So far as the incretory organ shapes the constitution such a drug may have an indirect influence. They are derived constitutional agents. If aurum influences the arterial system in the sense of red high blood pressure, then it enters into the apoplectic habitus only in a sense derived from the clinical picture of disease. If lycopodium and berberis are especially suitable for the lithemic-arthritic alterations so are their constitutional associations likewise derived from clinical sources. The constitutional fragment of these drug pictures is more or less extensive but never so fundamental and essential as in agents natural to the body and the constitutional aspect is always derived. Extent and intensity of the constitutional aspect in single drug types can also be graded.
If we admit thereby the physiologically necessary structural substances to a special position, then we also associate them in the sense of the old theory of elements; only science has shown us still other elementary constituents of the organism than those the Greeks or Paracelsus accepted in their time. Likewise we do not proceed hypothetically from the elementary constituents of the organism but in this theoretic method approach by the empiric method through the drug types.
SCHUSSLER’S BIOCHEMIC THERAPY
This is the place to glance at the so-called bio-chemistry (commonly called biochemic therapy) of Schussler. For the originally homoeopathic physician, W. Schussler, the decisive impression was that the mineral substances natural to the body must have an especially substances natural to the body must have an especially unique position. With grotesque onesidedness he limited his entire therapy to twelve so-called cell or tissue salts: ferr. phosphor., magnes. phosphor., calc. phosphor., kali phosphor., kal. chlorat., kal. sulfur., natrum muriat., natr. phosphor., natr. sulfur., calc fluorat., silica, calc. sulfur. The last was later struck out and it should be noted that silica, the anhydride of silicic acid, is not a salt. The election of tissue remedies or physiologically functioning agents as Schussler originally and suitably called them was based to some extent arbitrarily on the basis of the ash analysis of the organism available at that time (1873) in Moleschott’s book, The Circulation of Life, which was the totality of physicochemical knowledge for Schussler. Likewise, the followers of Schussler, there being only a few physicians among them, have not altered Schussler’s system, except that here and there recently iodine is mentioned as a physiologic agent but without the indications being given. It is remarkable at least that sulphur appears only in the form physiologically inactive (so far as known) the sulphate; likewise of the physiologic role of iron in the phosphate form, nothing is known. With these temporarily conditioned errors of refinement one might be satisfied. If Schussler, opposite to the homoeopathic method, had brought actual improvement or progress on a scientific basis, then one could follow him in his small partial field. But unfortunately, this is not the case. Moreover, in any case retrogression predominates when he took over the indications of the remedies previously employed homoeopathically, although he emphasized the value in a few positive reports of previously not or only rarely used drugs. In place of the effect picture of homoeopathy in all its extensive details as obtained by studies on the healthy, Schussler prescribes according to a deficient compend, to a certain extent only by inscriptions: the tissue or organ on which the agent concerned should act and to this a series of clinical diagnoses. likewise the crude anatomic and pathologic conception circumvented by homoeopathy is in no way original and is again brought to light and all differentiating peculiarities in the symptomatology, all individuality, constitutionality thereby falls into discard. Only for a few previously little used and unproven salts are single new indications given by Schussler and which have proven themselves useful. Considered in general, such a sad section from the enormous factual material of the homoeopathic materia medica could be nothing more than an ephemeral episode if such a simplification and compression of medical knowledge had not met the desires of many who could prepare themselves with a few tools and sketchy thoughts.
Now it is still to be considered whether Schussler has not promoted the scientific basis of medicinal action of substances normal to the body, at least to some extent. This too, cannot be affirmed. His general theory consists in the tissue salts balancing a deficit arising in a disease. From Schussler’s own discussion it cannot be said with certainty whether or not the deficit and its balance occurs entirely materially, that is, quantitatively. However, it must be noted that his minimal doses of drugs which he took over from homoeopathy would never be sufficient for this. Many places in his Abgekurzte therapy permit one to suppose that he was thinking more of a functional deficiency of the material in the cell. The general presentation proceeds along the ground that disease has it basis in a disturbance of molecular movements of a salt; from this a deficiency in these salts occurs in the cells; the cure by means of this salt consists in a balance of the deficit. This eventually allows room for the acceptance of the idea that he considered healing as a functional excitation of the disturbed molecular movement which can the n lead indirectly to a balance of material deficits and that he did not have a direct substitution therapy in mind. In any case Schussler does not give any actual details on the how nor could he do so on the basis of the physiologic knowledge available at that time. The adoption of so general an idea as a preliminary working hypothesis, moreover has to little productiveness for it to serve as the sole basis for a therapeutic procedure. To sacrifice drug proving on then healthy as a means of assistance is certainly not progress. Much more Schussler retrogressed to methods which utilized intermediary physiologic chemical actions of a substance, not only for explanation of therapeutic effects, as is correct, but as the sole justified guide in therapeutic management. Such a motivation of use of drugs remains dependent upon the current partial knowledge of intermediary processes and theories built thereon. Actually Schussler’s theoretic foundations raise hardly more than a claim to validity. So remains of his system only that which he took over from homoeopathy for the most part, independent of all theory in respect to useful indications and transmitted according to his manner. All the rest is overwhelmed by the physiologic chemistry of Moleschott on whom he supported himself. Also to some extent arbitrary is the prescription of the sixth or twelfth decimal potency as the only dose.