Relationship Of Pathology And Symptomatology To Homoeopathic Prescription

In this discussion I attack a somewhat broader meaning to the word “pathology” than is given it by the student of disease alone. I include within the meaning of this term, in addition it its ordinarily accepted meaning, the various mechanisms involved in the production of symptoms, be they due to drug action or to disease. These mechanisms may be of many kinds.

In the development of this subject I desire to start with two propositions which are so apparent that their truths cannot be questioned. One of these is that every substance which we call a drug or a medicine produces a reaction when taken by the human being similar to at least some definite disease, regardless of its cause. The other fact is it was ordained by the Omnipotent Power which gives the forces and laws of nature that whenever one of these drugs is given to treat some functional abnormality which presents symptoms similar to that particular medicine the disease disappears.

The homoeopathist makes use of this principle in the treatment and cure of the sick; a principle so dependable and that has received such an abundant amount of clinical and experimental verification that if may rightly be called a law of nature.

Since the homoeopathist makes use of this symptom similarity existing between drug action and disease, he has frequent opportunity and occasion to use the words “symptom” and “similarity.” We employ these words, especially the former, far more frequently than does any one else. A “symptom” may be defined as the reaction of an organism to an irritant. If the irritation has progressed sufficiently far a definite abnormality in cell structure and function results, which is termed “pathology.” This is the standard definition of the latter term, and is another word of which we make frequent use.

In this discussion I attack a somewhat broader meaning to the word “pathology” than is given it by the student of disease alone. I include within the meaning of this term, in addition it its ordinarily accepted meaning, the various mechanisms involved in the production of symptoms, be they due to drug action or to disease. These mechanisms may be of many kinds. They usually consist of processes of stimulation or depression acting directly upon a given organ or through its nerve supply.

They may also be due to an inflammatory state terminating in real tissue change, a definite pathological condition, s the term is ordinarily understood. These mechanisms may be excited or called into action by absorbed drugs circulating in the blood stream, by toxins of disease, by anaphylactic antigens, psychic influences or by idiopathic factors. In addition to symptoms and their cause, pathology, as I am using the word for the purposes of this discussion, also includes the determination of the exact seat or origin of these symptoms. This I like to term “symptom localization.”

Homoeopathic physician have, as a result of their adherence to their principle of treatment, developed by means of their drug provings a vast amount of information concerning drugs and their effects or symptoms. Their knowledge of drugs has been developed to a high degree of perfection. In other words, we have fairly completed lists of the reactions of the human organism to medicinal irritants; while our information concerning many of other drugs in this regard is incomplete and even fragmentary yet it may safely be said we have ample and accurate information concerning at least fifty of them.

Our materia medica, as now developed is, not to any great degree deficient in this particular and, while considerable improvement might be obtained by reprovings and other forms of experimentation, it is so deficient in another direction that we can temporarily lay aside our search for symptoms and develop the other field, which is that of determining the pathology of drugs.

Two factors enter into a correct or scientific homoeopathic prescription. One of them is that a very close similarity between the symptoms of a medicine and a particular disease must exist in order that the abnormality may be corrected. The greater the degree of symptom similarity the more rapid and certain is the subsequent recovery. The founders of homoeopathy laid great stress upon this point and they have very properly emphasized its importance. Those who have given materia medica and homoeopathic philosophy special study realize that very frequently something else must be taken into consideration in prescribing if the anticipated results are to be obtained.

The other factor is equal in importance to mere symptom similarity and consists of a pathological similarity, “Pathological” as meant by the foregoing paragraph. I should define a remedy as being homoeopathic to a certain condition when it is known to have produced symptoms and pathological changes similar to that condition. Unless these two elements are taken into consideration, no benefit will result from the administered remedy in about fifty per cent. of cases.

The latter point, or element, in prescribing has never received its proper mention or emphasis. For some reason or other, we have been content with mere symptomatic similarity between therapeutic agents and diseases and have never given the other factor its proper place or consideration. Several of the earlier homoeopaths hinted at it and occasional mention of it is to be found in the periodical literature.

However, the word “pathology” has been used in these references in its narrow sense. It did not convey the broader meaning suggested. The prescription should include within its pathogenesis the symptoms of the disease and the pathology in either the restricted or broader meaning of the term, as each particular case permits. When the pathological similarity is that of the “restricted” type, it is a rare occurrence for a cure to result for it is outside the province homoeopathy to transform an abnormal cell structure into one of histological make – up. The result may be palliative, arrestive, but it is not curative.

Dr.Thos. H, Carmichael says that “the fact that Phosphorus met. causes fatty change in the heart and liver does not enable you to use it successfully in cases of fatty heart, but if you are a sufficient diagnostician, both of the diseases and the remedy, as to recognize a condition which, if not arrested, will develop a fatty heat, then Phosphorus may prevent the development of changes in the heart, and that arrest the disease.”Journal A.I.H. Sep., 1919. If we will bear this in mind, there will be no danger of riding the “pathological jackass” to death.

When we are prescribing for a disease which presents symptoms due to a pathological change in our broadest understanding of that term, cure can, and ought to be accomplished. Professor W.A. Dewey says, speaking of the indications for Hyoscyamus in typhoid fever, that “this fact should be borne in mind in the treatment of typhoid fever, and drugs selected according to the totality of symptoms; but the pathological condition should be taken into consideration in making up that totality.”

It is not incompatible with the Hahnemannian hypothesis to consider “pathology” in our prescribing. Hahnemann tells us in the Organon that the complete expression of every symptom is that of sensation, location and modality. I have previously state that the location of symptoms is an element in “pathology,” and many times it is the sole element within my meaning of that word.

Now why should pathology, in any of its meanings, be considered in the homoeopathic prescription? My answer is that the “pathology” is one of the symptoms of the disease, as well as any other of its manifestations, and if we do not consider it we are not prescribing in accord with the totality of symptoms. Neither do we individualize the case if we do not properly consider pathology. The doctrine of individualization is the greatest medical maximum, and is the most important and sublime statement ever made regarding therapeutic measures to be employed in the treatment of the sick.

We must beat in mind the important, self – evident and daily occurring fact that it is quite possible for two or more persons to be suffering each with a different pathological condition or localization of symptoms, and for each of these persons or present a group symptom identical to the other groups, but resulting from different causes. Now, it these causes, the pathology – are not given consideration, and if we rely merely upon the symptomatic similarity to that of a given drug, it will happen that sometimes the remedy will effective and sometimes of no avail.

That remedy will be effective in that case when it produces similar pathology and symptomatology; it will be ineffective when it is only symptomatically similar or pathologically similar, but not both. If only one of these similarities is covered by our prescription, we will not be treating the organs affected. It is the purpose of a remedy to act homoeopathically upon diseased tissues and cause them to return to a normal degree of functional activity, a process which cannot take place when the prescription does not cover or include both forms of similarity.

We have asked the question, “Why should pathology be considered in the homoeopathic prescription?” Another answer is, “Because homoeopathy is intimately related to all the sciences regardless of their nature. Especially it is connected with and related to anatomy, chemistry, biology, bacteriology and pathology. If these sciences are not related to homoeopathy and its practical application, the prescription, why are they taught in homoeopathic schools?

If our materia medica cannot be of such a nature as to conform to the facts of these sciences; if our ideas of drug action and their application cannot be supported, confirmed and demonstrated by these branches of the curriculum, then it is time to discard this materia medica and these ideas and to substitute others for them. Fortunately, however, such is not necessary or the case. To my mind the greatest proof of our principle is the truth that it is in perfect harmony and accord with other barnacles of knowledge, and when the attempt is made to bind the whole into a concrete unity, discordant notes are not heard or fallacy revealed.

The writer would offer a forecast. When the time comes as come it must, when perfection of all things is obtained, there will be, in each of our lecture rooms and laboratories, some one gifted and well versed in our art to correlate and unite our facts concerning the action of drugs with the various other sciences. Such a one will, in the dissecting room, in addition to demonstrating the origin, insertion, nerve and blood supply of the right deltoid muscle, also inform the freshman student that Sanguinaria affects that muscle, that Secale modifies its blood supply and that Colocynthis attacks its supplying nerve.

In the clinical laboratory the student will receive just as thorough instruction in the detection of albumin as does his allopathic associate, but he will be taught in addition that Mercurius corrosivus will cause the appearance of albumin in the urine, and that Causticum has an influence upon the excretion of urates. The instructor will also in this lecture on bacteriology point out that, as different bacteria elect certain tissues upon which they act, in a similar manner drugs do the same thing; and so on through the course.

“hooking up” homoeopathic science with other fields of knowledge. What is the use of teaching the microscopical pathology of enteritis unless it bears some relationship to and should be considered in the prescription? At present, all this is left for the teacher of materia medica to accomplish but, try as he may, the result will not be nearly so satisfactory as it would be, could he have the co – operation of other teachers.

We have in homoeopathy what might be called a “homoeopathic technician.” By this term I mean one who has made a special study of drug action, particularly from our standpoint, and who is gifted with the ability to prescribe scientifically for the sick. He knows drugs, their toxic action, their physiological action, their symptomatology, modalities concordant relationships, etc. Such a one has a right to the designation “specialist” or “Homoeopathic technician.”

He who would demonstrate the relationships of the different sciences to the student need not be a “technician,” that we will leave for the materia medicist. It is said by the average student that materia medica is “hard to learn.” When there shall come into effect such a system of demonstration as proposed, such will not be the case and, not until the aim is accomplished, will homoeopathy be a reality to the average student, who, at the present time, leaves his materia medica in the class room and does not associate its truths with the ordinary affairs and phenomena of life.

Let us illustrate how pathology and symptomatology should be regarded in connection with the prescription. Suppose that two persons are suffering with the symptom, “burning pains in the stomach.” For the sake of brevity, we will let this represent the totality of the symptoms. The diagnosis in one case, i.e., the pathology is hyperchlorhydria, and in the other it is a mild form of gastritis. Both conditions give the same symptoms, a fact well known to the diagnostician. The remedy homoeopathic to the former case would be that one which has in its symptomatology “burning pains” and also the ability to cause excessive acid formation.

Such a remedy is CAlcarea phos. The remedy that is homoeopathic to the latter state is one that also has “burning pains” and beside is capable of producing the changes of inflammation. This remedy we will say is Arsenicum. Both these therapeutic agents are symptomatically indicated, yet neither of them has the same cause or pathology for its symptoms of indications as the other. Calcarea phos. will not help the latter case not will Arsenicum be effective in the former. Hundreds of examples of this kind are constantly occurring. We meet them constantly in everyday practice, and failure to prescribe the remedy that agrees both symptomatically and pathologically in a particular case is the most frequent cause of failure to cure the sick.

Another example is the use of Ipecac in the treatment of asthma. Ipecac is homoeopathic to the mere symptoms of many cases; it is quite closely related to the associated bronchitis, but is bears absolutely no relationship, similar or otherwise, to the underlying cause (pathology), which is a bronchial constriction; hence it is not curative in spasmodic asthma. Remedies prescribed for diseases when there is present only one of the important elements of the prescription, namely, a symptomatic similarity or a pathological similarity, cannot cure and all that can be expected of them is to relieve temporarily or to palliate.

We have been guilty of teaching many therapeutic fallacies because the remedies recommended for various diseases did not cover the complete requirements for a prescription. Examples of this are: the use of Gelsemium in labor when the os is hard, unyielding and does not dilate; the use of Uranium nitrate in diabetes; Belladonna in locomotor ataxia; Argentum nit. for Addisons disease: the use of Hepar sulphur in angioneurotic oedema, and Phosphorus in haemophilia. None of these remedies, and many more that can be mentioned, will cure the conditions for which they are recommended because, while symptomatically similar, they are not pathologically so as well.

Suppose we are to prescribe for the following groups of symptoms which are present in each of two persons, the totality being represented by contracted pupil, difficulty in walking and diarrhoea. All of these symptoms are found under the pathogenesis of Physostigmin and Secale. Upon examination, it is discovered that in one case the contracted pupil is due to the fact that the toxin of disease is stimulating the nerve supplying the iris, and in the other case the myotic effect is due to the toxins affecting the iris directly.

Physostigmin is the indicated remedy in the first instance because it contracts the pupil in exactly the same manner as does the disease (nervous effect). Secale will cure the latter condition for a similar reason (direct muscular effect), and the drugs cannot be used interchangeably because, while they are both upon the face of it symptomatically indicated, only the one is fulfilling all the requirements of the correct prescription.

Another illustration is the symptom, “difficulty in swallowing.” Gelsemium will remove this if it is due to a paralysis: Cantharides, when due to inflammation, and Agaricus when caused by muscular contraction. Here the suggestive symptom is the same for each remedy, but the pathology is different, in each instance the remedy must be selected according to the combined indications, the real totality.

Sometimes, in instance of this nature, enough study has been devoted to the pathology of drugs to enable us to prescribe scientifically, but in many more instances we know little or nothing at all concerning the mechanisms involved by drugs in the production of their symptoms. Examples are the heart symptoms of Spigelia; we know nothing at all about the influence of it upon the vagus, accelerators and the myocardium, or whether the effects are central or peripheral.

The cardiac symptoms of Spigelia have not been localized. Studies to determine information of this kind cannot be conducted upon human beings in many instances. Here is where the properly selected animal experimentation comes in to help out and carry on to completion information of this sort which, for obvious reasons, cannot be gained in the case of the human. The science of pharmacology is of the greatest help in this direction, and the proceedings and findings of pharmacological research are of immense importance to the homoeopathist.

The pharmacologist, by determining with exactitude the tissues and organs acted upon by medicine so that he can explain and locate their action, is putting to a practical application the Hahnemannian injunction of “individualizing the case.” When we add to our symptomatology of drugs his findings and utilize them in prescribing, we will he approximately a perfect materia medica.

With the great majority of our medicines we know absolutely nothing of the reactions involved in the cause of their symptoms. Sometimes an inference can be drawn from the effects produced; for example, we regard Kali carbonicum as affecting the lung. This, which is called the “clinical method,” is only applicable in case where the organ involved is of large size and the effects of the medicine upon it of gross action. It will never permit of a fine degree of symptom localization. How could it be determined in this manner that nicotine affects the pre – ganglionic fibers of the vagus or that Belladonna produces dryness of the throat and absence of salivary secretion by a toxic elimination of the function of the terminal nerve endings and not by paralysis of the gland cells?

Who can explain how Phosphorus produces vertigo, hence, in what kind of a case of disorder of this type it will be effective? How does Leptandrin affect the liver? What effect does this drug have on the biliary secretion or the glycogen content? How does Rhus produce paralysis, and is the action central or peripheral? What is the explanation of the vomiting of Aethusa; is it due to local gastric irritation or to central irritation?

We know that medullary depression is the keynote to the action of Gelsemium, but how is it that similar effects are produced by other drugs? Curare produces a paralysis by paralyzing the end organs of motor nerves, but how does Lathyrus act? Hundreds of similar inquiries are continually suggesting themselves and until we find out the explanation we will be forced to put up with indifferent results because we cannot, many times, except by mere chance, prescribe scientifically.

Is this fact alone not a sufficient incentive to homoeopathic research? If we had laboratories working under the guidance of men of scientific attainment, gifted with a knowledge of homoeopathic theory and philosophy, within ten years most of these things could be found out and then we could cure almost at will. Determining the pathology of either a drug or a disease is essentially the same as making a diagnosis; hence diagnosis is of great importance to the homoeopathic prescriber. We are not so unfortunately situated in this regard as is our allopathic confrere, but in most chronic or obscure conditions at least a proper prescription implies a correct diagnosis.

Acute functional inflammatory disease of many persons, in their incipiency, especially in children, need not have assigned to them a designated diagnostic appellation before a very effective prescription can be made. This is because of the fact that in such conditions most of the bodily functions and tissues are in a state of generalized simple irritation and congestion, which is similar to effects, pathologically and symptomatically, of several of our remedies, but even here we knowingly or unconsciously take into consideration the congestion which is practically a diagnosis, and prescribe accordingly. i have no sympathy with those who would allow a child to suffer and receive no benefit unit a correct diagnosis be made; neither can I entertain the idea that a diagnosis is not of the greatest help whenever it is possible in order that the symptoms may be localized, i.e., the pathology determined, and the suitable remedy selected.

It is an observation of mine that as a rule homoeopathic physicians do not carefully examine their cases. This is a consequence of our being taught symptomatic prescribing without, at the same time, considering causes. If we do not examine cases we make no diagnosis, pathology is ignored and a suitable prescription is an accident. How embarrassing it is to prescribe Colocynth for a pain in the sciatic nerve, and later to discover that the trouble was due to a knuckle of bone in one of the lumbar vertebrae, whose removal by surgical means effected a cure.

There are at least two great groups of conditions to which homoeopathy does not apply, regardless of any consideration of pathology and symptomatology in the prescription, and consequently, if such diseases are treated homoeopathically, the prescribing will have no effect and the prescriber need not be disappointed. No system of medicine or rule of any kind should be blamed for not fulfilling expectations which it could not cover from the beginning. One of the exceptions to the successful application of the homoeopathic principle is the attempt to relieve by it conditions which which are surgical in nature.

A. E. Hinsdale