[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.
