[Read before the Kings County Homoeopathic Medical Society, April, 1923.].
“The history of medicine may be said to be the history of the errors of medical doctrine-errors in method and errors in reasoning”.
Thus wrote Prof. DeGiovanni, head of the department of clinical medicine in the University of Padua, several years ago.
To defend this declaration would be a simple matter indeed; for do we not see the past strewn with wrecks of exploded therapeutic ideas and systems testifying to its truth? And in no less a degree does the chaos of present-day therapeutics declare it. It is doubtful if there ever was greater confusion in medical thought than there is today; and this is quite as true that in the homoeopathic school there is still a more general belief in a therapeutic principle than in other schools, yet when we come to examine the methods of practice of its graduates we find quite as much irrationality as we find among the graduates of other schools.
How can we account for this situation, and what can be done to correct it?.
When we realize that from the days of Hippocrates until now, the one and only subject to receive attention from the medical profession has been disease-ever changing, every varying disease, this something which never exhibits itself in the same way in any two persons, never the same in any two countries, never the same in any two epidemics or separate periods of time-then we begin to understand something of the reason for the constant conflict of ideas, for the ever shifting methods and therapeutic vagaries which have at various times in the past been foisted on suffering humanity.
Because of the great differences in climate, social and economic conditions in different countries and different regions of the globe, humanity is not uniformly constituted, hence there is no uniformity in function and in reaction. How natural then, that confusion results when we attempt to interpret these differences with a set formula and apply the same therapeutic measures.
We have tried to account for this constant variation in clinical manifestation of a given disease on the ground of variation in character of the causative factor. But this explanation does not explain, for if the cause of variation lay with the cause of the disease, then of necessity the same results must be produced in all who are victims of a given etiological factor; and this we know is never the case.
We are forced to conclude, it seems to me, that disease, per se, is not the fundamental factor in our problem, and, therefore, cannot be made the basis of our studies.
But some one many ask, if this is true, what can be made the basis? The answer is, the patient. The homoeopathist has been laboring under the impression that is what he did when he diligently sought all the symptoms-subjective and objective-in the individual case. And so sincere has be been in this belief, that he has often been given to criticizing his colleague in the other school, telling him that he neglected his patient in his ardent study of pathology. But since symptoms are no less a product of a morbid process than are pathological changes, is it not possible that the patient may be as completely overlooked by the symptomatologist as by the pathologist?
The fact is that one may be entirely successful in eliciting the remotest symptom and discovering the minutest pathological change in the tissues and yet learn little or nothing that is fundamental about the patient himself. The facts underlying his predispositions and susceptibilities-the root causes of his diseases-and the cause of his special functions and reactions lie in an entirely different realm.
How an individual functions when well and what his reactions are when sick, and what changes take place in his organs and tissues is very important for us to understand, but since all these things are merely outward expressions of something basic, something more fundamental, we are certain to fail in our investigations if we do not take the trouble to investigate the great field of facts which lies behind these functional phenomena.
We are all more or less deeply concerned about the present medical situation. The problem of the college curriculum is receiving more than the usual amount of attention. Suggestions as to what is best to do, are numerous. The opinion most often expressed is that the college and hospital course should be lengthened. If we will glance back over the past three decades we will see that this is what we have been steadily doing; yet can we say that the results are commensurate with the increased time, money and energy that are being spent? An unprejudiced investigation would probably show that our difficulties are not due so much to the shortness of the course of instruction, as to the materials we are using in the course.
If the proposition is true that disease, per so, is not the fundamental factor in our problem, then it is quite clear that we have been using the wrong material. Instead of asking ourselves, what lies behind disease, we have constantly been asking the question, what is disease? And of course we have received all kinds of answers. For example, as most of us interpret Hahnemann, disease is primarily a disturbance of the vital force, hence the belief that the potentized drug is all that is required to effect a cure. According to the teachings of others, disease is an alteration in the state of the body of some of its organs.
Both definitions are true in a certain sense, but both are incomplete. Were we to trace all evidence of vital force disturbance to its true origin, and the same of the cause and conditions which precede alterations in the tissues, we should undoubtedly find that the fundamental factor is to be found in the inharmoniously developed morphological state of the individual, which state results in inharmonious functions and in turn predisposes and ultimately eventuates in altered tissues and disturbance in the vital equilibrium. What, therefore, has always been considered as the disease and deemed as all-sufficient material with which to work in trying to solve our problem of disease, is merely the product of disease-not disease at all.
This conclusion directs us to another approach to the problem, namely, that of human morphology. Here we begin the study of disease in the character of the organization, in the antecedent conditions, that is, in the soil in which it finds its roots. Following this line of reasoning the evidence of disease is considered only insofar as it reveals matter that contributes to an understanding of the individuals morphology. All the methods of physical diagnosis and laboratory diagnosis are made use of, but distinctly with the idea of fully and accurately revealing the underlying and predisposing conditions in the morphological state. In other words, morphology deals with the fundamentals of the problem.
We begin with certain biological principles as a basis and a working hypothesis. These principles are so obviously true as to justify their being called biological axioms. The facts of experience are not accepted as a working basis, which is contrary to the methods of the modern laboratory. Facts are of essential aid in discovering and elucidating principles, but they are not in themselves principles and, therefore, cannot be used as a basis. This is a point that deserves careful consideration.
The first principle or axiom declares that physical organization is essential to function. That is to say, before we can have physical function, we must have a physical organization. This, of course, admits of no argument, nor does it require explanation.
The second principle, a corollary of the first, declares that, since organization is essential to function, it necessarily follows that the character of organization determines the character of function. Function is directly and intimately related character of cell and of organ and can never be other than the design and structure of both enable it to be. Only as organic structure is modified, can function be modified. This fact at least suggests, even if it does not make entirely clear, the reason for the functional variations in different individuals and, likewise the reason for the variation in reaction to a given drug and to a given disease.
A third principle deals with the matter of the correlation of organs. Since independent function of organs is impossible, that is, since the organism functions as a unit, a definite relation must exist between the organs in order to have balanced functions; a hit-and-miss arrangement will not answer. One organ cannot be abnormally large and another abnormally small and harmonious functions be produced.
A fourth principle declares that the vigor of function of an organs is in relation to the degree of development. That is to say, other things being equal, a large organ has more vigorous functions than a small one. The reason for this is because the larger organ attracts and expels the blood in greater quantity, hence has a more rapid metabolism and a better nutrition.
These several principles, or propositions, are manifestly true. They may easily be elaborated, but they cannot be refuted. They, if carefully studied, make clear that the cause of the special functions of an individual- normal and abnormal-resides n the special morphology of the organism. In other words, a knowledge of the special morphology enables us to understand the reason for the peculiarities of human physiological processes and reactions, and thus enables us to guide the process of unfoldment of the growing child into normal channels, to prescribe rationally and intelligently for any and every condition.
Now every human being presents a morphological problem. Some degree of physical defect is to be found in everyone. Few come into the world without some hereditary defect, and fewer still find themselves placed in an environment which is uniformly beneficent and makes for perfect development. Adaptation results in functional over-activity in some directions and under-activity in others, which, in turn, results, in over-development in some directions and under-development in others. And here we find the true source of organic predispositions and susceptibilities-the root causes of disease. If this were understood, the matter of preventing disease would be much simpler problem than it is today.
Ontology teaches us that from the moment of conception until death, the organism is continuously passing from one physical state into another, and that normal unfoldment necessitates the completion of each state in regular order. Carrying over structural characteristics of an earlier stage creates defects in structure and inappropriate organs for the newer conditions, and, according to the physiological principle which says that between character of function and character of organization there is a direct and intimate relation, results in inharmonious functions and the creation of certain predispositions and susceptibilities.
The question which now presents itself is: What is normal, what is excessive and what is deficient development? In other words, by what standard are we to judge the conditions of the organism at any particular period.
Many standards of the normal have been given us, but so far as I am able to judge, only one meets the requirements of the physician. The one based on the average of results obtained from many thousands of examinations is wholly inadequate and unscientific. Likewise is the anatomical standard of approximate size of organs, inadequate and misleading.
By that I mean, that when we say, for example, that the liver weighs about four pounds, that the intestines are about thirty feet long, that this or that organ is about so and so, we are dealing in generalities and uncertainties. Approximate knowledge is not scientific knowledge, and cannot be made to satisfy the demands of science. if the proposition be true that vigor of function is in relation to degree of development, then it is necessary that we determine accurately the degree development before we attempt to appraise the vigor of the functions.
Approached from the standpoint of physiology we see that normal development and function stand in relation to each other as do supply and demand. To illustrate: The capacity of the lungs to supply oxygen must be equal to the demand of the whole organism for this particular element. Which means that the size of the lungs must bear a definite relation to that of the whole organism. When these are not proportionate, then the excess or defect, whichever may be the case, is accompanied by a corresponding excess or defect in function and the ceration of certain predispositions and susceptibilities.
A deficient development and lowered function causes respiratory insufficiency, imperfect oxygenation of the blood, impoverished arterial blood, venous excess, imperfect metabolism, deficient trophic process, etc. The morbid states which may grow out of this are many; time will not permit an enumeration of them, nor is it necessary to further emphasize this point.
But how can we determine the size of the organs?.
Among other things our anatomical studies have taught us that the contour of the body is determined by the size of its organs. That is to say, a large thorax contains large lungs, a large right hypochondrium contains a large liver, a large lower abdomen contains a large intestinal tract, etc. Bear in mind that in this discussion we are considering morphological states and not pathological or postural deformities. Proceeding on this basis, Prof. DeGiovanni and his associates, after making literally thousands of examinations and autopsies and comparing the results of these with the histories, arrived at the following conclusions:
The stature and bi-lateral reach are equal; the thoracic circumference, the chest at rest, is equal to one-half the stature; the length of the sternum, i.e., manubrium and gladiolus, and the distance from the gladiolus to the center of the umbilicus and from this point to the crest of the pubis are each equal to one-tenth of the stature; the bi-iliac diameter is equal to four-fifths of the length of the abdomen; the length of the spinal column is equal to two-fifths of the stature. Other measurements are taken in the individual case, but these are the chief ones, relating as they do, to the vital organs. These, let me say, are the proportions for the normal adult.
What the normal proportions are for the infant and growing child at different epochs of life has never accurately determined. However, this can be inferred, namely, that with each year of life of the child there must be a nearer approach to the normal proportions of the adult. Failure in this means, the carrying over of infantile characteristics, both of structure and function and the preparation of soil favorable to the development of disease, indeed, actually growing into disease.