Even in comparatively recent and uncomplicated cases of chronic diseases, when the symptoms have been suppressed and the whole character of the disease changed, the symptoms that now present themselves must, in the great majority of cases, be our guides, though at times it may be necessary to select from amongst the competing remedies one that is known to have an antidotal relation to the suppressing drug. That is not, however, invariably the case, and it is at times necessary to give the original symptoms the higher rank ad to be guided by them, to the exclusion of those now present.
As an example of this, an otherwise healthy young man, who had suffered for over a year from sciatica, presented himself with stitching, cutting pains in the calf, worse at night, better from heat, worse in motion, relieved by flexing the limb, Coloc. and other drugs failed to give relief. It was found that the disease, which was originally located in the upper part of the nerve, had been vigorously treated by external applications, with the result that not only was the situation of the pain altered but its character and modalities had been completely changed. The original pain was of a tearing nature, and was greatly aggravated by sitting not quite so severely felt while walking and there was almost complete complete relief when lying down. Ammon mur., selected in accordance with these old symptoms, promptly cured.
7. Tonight I can make only passing reference to the so-called primary and secondary effects of drugs, to which some good prescribed have assigned different values in the selection of the remedy. So far as my experience goes, it does not seem to matter in what order the symptoms may appear in a proving if the remedy can produce them, it will also cure them, irrespective of their position in the disease, and, consequently, so far as rank is concerned we cannot differentiate between them.
I stated at the beginning of this lecture that Hahnemann insisted that we must be guided in the choice of the remedy almost exclusively by the symptoms, to the practical exclusion of pathology; but I think there is a good deal of confusion with regard to this matter. So far as I can see, Hahnemann did not object to the use of the pathological changes as guides for theoretical reasons, but only for practical ones.
It is true that to a limited extent it is practical to use pathology as our guide, and we all do so use it. Whenever we have to prescribe for eruptions or ulcers which are, after all, pathological changes we do not hesitate to be governed by anything that is peculiar or characteristic about them, such as their colour, shape and position, because by means of these peculiarities we can differentiate. But, when we come to deal with gross pathological changes in the deeper organs we meet with two difficulties.
In the first place, we are unable in the living patient to determine those minute differences, though doubtless they do exist, which, if discernible, would enables us to differentiate.
And, in the second place, very few of our remedies have had their provings pushed far enough to cause corresponding pathological changes.
These, I take it, are the practical reasons that led Hahnemann to ignore pathology; and, though our knowledge of this subject has enormously advanced since his day, his reasons still hold good.
But we cannot, even in the selection of the remedy, to say nothing of its absolute necessity in all questions of diagnosis and prognosis ignore pathology, for without it we cannot understand the true course and progress of a disease. Only by means of it can we know the symptoms that are common to the disease, and hence those that are peculiar to the patient. We also thereby know, at certain stages of some diseases, no matter how similar the symptoms produced by certain remedies may appear to those of the patient, yet that, owing to the superficial character of their action, it is not possible for them to prove curative.
For example, in pneumonia, in the stage of exudation, while the symptoms may apparently call for Acon., we know that this remedy, owing to the superficial nature of its action, cannot produce such a condition, and closer examination will reveal that some deeper-acting remedy, such as Sulphur or Lyc. needed.
Pathology enables us to decide, when new symptoms arise, whether they are due to the natural progress of the disease or to the action of the remedy. We must clearly understand that it is the patient that is curable, and not the disease, and without a proper understanding of pathology we are liable to err.
Take a case of inflammation of a joint that has gone to ankylosis the suitable remedy will cure the inflammation, but will be powerless to break down the adhesions, and surgical aid must be sought. The same holds good with regard to tumors, for when the patient is cured the tumor will cease to grow and perhaps may be absorbed, but very often it persists, and must be removed by the knife.
Pathology also warms us that it is dangerous to attempt the cure certain conditions of diseases, such as advanced phthisis, or deeply situated abscesses, or where foreign bodies are encysted near vital organs. In such cases, Nature can cure only by ulcerating out the foreign substance, and the exhaustion entailed by such an operation is often fatal. Of course, in such cases, if a surgical operation is not deemed advisable, we can do much to relive by means of short-acting remedies which have no tendency to excite Nature to get rid of the foreign body or dead tissue by suppuration.
I now come to a matter which has given rise to the sharpest controversy in the past, and which many have absolutely rejected, viz., Hahnemanns doctrine of psora. I would not have alluded to it this evening, after having spoken of so many things that I cannot expect all to accept, unless it had been that the discussion of the comparative rank of symptom would not be complete unless this matter was considered.
All are agreed, at any rate, on the existence of the two other chronic diseases, viz., Syphilis and Sycosis, and I would like to indicate, before closing, the views of the man who more than any one even more than Boenninghausen has elucidated the course and progress of these diseases I mean, of course, James T. Kent.
Kent holds that these chronic diseases may exist either in an active or a latent condition and may present themselves in three ways, viz.,.
As a single miasm.
Two or three miasms co-existing or separate, but only one active at a time.
Two or three miasms forming a complex.
But, to come to the point we are interested in this evening, both Hahnemann and Kent teach that we must attack the one that is uppermost at the time, and ignore the symptoms of those that are latent, except in the last monstrous phase, where two or three form a complex, which is a rare thing, seldom brought about except by the prolonged abuse of unsuitable remedies.
Where two miasms, say syphilis and sycosis, co-exist, it is not uncommon to find them alternating, though only one is active at a time. In such a state of affairs we naturally will select the remedy solely in accordance with the symptoms of the now active miasm, and ignore those of the one that has become temporarily latent in other words, only the symptoms of the active one have any value in the selection of the remedy that is required at the moment.
Such, gentlemen, is a very imperfect sketch of the rules that must guide us in determining the comparative value of the different classes of symptoms, a matter of the utmost practical importance in connection with the problem of the cure of complex chronic diseases.
And it is solely by our success in the treatment of this class of diseases that we can hope to convince our brethren of the old school that the true and only law of cure is that of similia similibus curantur.