May I not assume that my readers, too, have gained the impression that in this quotation almost the same thoughts are expressed – “only with slightly different words”-as were previously taught in the days of long ago by Galen?.
Over all these different opinions and views which, when all was said still dealt with reality and resulted from conclusions reached by the consideration of facts and experiences, but was guided throughout solely and alone by the law of “contraria” – over all these swayed, to cap the climax, the science of natural philosophy. For natural philosophy instead of being guided by conclusions based upon facts erroneous as they might be, considered the “WORD” as conclusive. What resulted from this, I wish to show by a few short quotations. I take them from the “Fundamentals of the Science of Natural Philosophy” by Heinrich Steffens. Steffens was a follower of Schelling, the champion of natural philosophy.
He was considered an able man in the scientific world and indeed was highly esteemed by Schelling himself. I infer this from a passage in Schellings polemic against the “Jenaische Allegemeine Literaturzeitung” (“Jena Magazine for General Literature”) in the year 1800. Steffens published his “Principles” in 1806, “for the purposes of his lectures.” In this, one finds the following, page 192: “The relative projection of space into time corresponds to hearing; the projection of time into space corresponds to sight. Through the essential principle of hearing and seeing, however, is the antithesis between both removed”.
Page 200 : “Poison is the phenomenon of the universal counterpoint of an individual function or of the individual counterpoint of a universal function, or, finally, the phenomenon of an external difference as counterpoint of an internal indifference”.
Page 203 : “Health is the transparency of the body for the soul, the complete identity of the soul and the body”.
But diseases are, as one can read on page 198 : “Only to be understood from the total tension of the organisation.” They “arise either because the relative-external (vegetative) tension becomes an internal (animal) tension or because the vegetative stirs in the animal.” And to conclude: “Disease is the effort of a single function to absorb the total form of the organisation in its potency”.
I think these few illustrations will suffice. One can imagine the plight of the unhappy students of science who were obliged not only to listen to but also to memorize this sort of nonsense delivered to them ex cathedra. It was impossible to understand such absurdities.
When one considers that at that time, the entire field of medicine and therefore its practitioners also, food stood under the inhibitive influence of all the movements of which I have just tried to give a short description, it gives one a feeling of great relief of realize that, despite these influences, men appeared who would not allow themselves to be championed from first to last that which they looked upon as true and actually existing, developing their field of research without being restrained by the cult of system. I will mention only two names : Karl Gren and William Hufeland!.
Who still speaks of them today? Especially Karl Gren is probably now completely forgotten. In 1894, I published a sketch of his life in Number 47 of the Berlin Clinical Weekly and endeavored to give an account of the views on the nature of medical science which our colleague from Halle, who died at an early ate in 1789, advocated during the short period of activity allotted to him.
Grens “System of Pharmacology or the Doctrine of Remedies, Studied Critically from their Natural, Historical, Pharmaceutical, and Therapeutical Side” appeared in 1791. As the title plainly shows, this publication of Grens was based on an essentially different conception from that of natural philosophy. In order to give a better idea of the nature of its contents, I will quote Grens own words as to his ideas concerning experience in medicine: “Experience alone can determine the absolute and the relative effect of remedies on the human body.
If, however, the application of experience in determining the healing power of a substance is not to be misleading; if we would, by this means, be absolutely convinced that the results observed really are derived from and by the use of a certain drug, one test is not sufficient but it is necessary that the drug should have the same effect in many instances and under varying circumstances; furthermore, that the resulted observed should not be capable of receiving any other explanation, and that all other circumstances that could cause similar results should be excluded. The real, but also the most difficult knack of observation lies in the ability of the physician to differentiate the actual effects of the drug from incidental, co-operating causes.
The history of medical remedies is full of examples showing that results which had really taken their origin in some other way were attributed to a certain drug. A large number of remedies whose supposed healing powers are merely imaginary have been incorporated into the materia medica through the lack of good judgment. Of the greatest importance and of absolute necessity for the determination of the effect of a drug, is an exact diagnosis of the illness itself.
Furthermore, the remedy whose effect is to be accurately determined by experience must be administered alone without association with anything that would tend to change its nature, if the observation of its effect is not to be deceptive. The observer must be governed by honesty and truthfulness; preconceived ideas and judgements should not blind him. A sufficient degree of scepticism must guard him from too great self confidence as well as from the influence of outside authorities. The love of invention makes the greatest sophist!”.
And further: “To assume causes for happenings in nature concerning which our senses tell us nothing and to ascribe effects to them which, in fact, do not exist within the circle of our experience, is called-not explaining, but inventing”.
These are golden words which will retain their value for all time!.
“William Hufeland, the Berlin clinician, declared himself against all systematization and phraseology on the order of natural philosophy in a very determined manner by establishing his “Journal der praktischen Arzneikunde und Wundarzneikunst” (“Journal of Practical Medicine and Surgery”). He expresses the purpose of his journal in the preface to the second volume, 1796, as follows: “It shall constitute an archive of facts, of experience concerning diseases and the effects of drugs; and, as far as possible, be free from hypotheses, system, and cures a priori.
This seems to me to be the best way to spread and to maintain true practical medicine; to direct the mind of physicians always toward nature and experience and to keep it fastened upon them as the only sources of practical medicine; to guard the medical world from intellectual despotism and forced forms of thought and, by means of a many-sided portrayal of natural phenomena, through the diversity of points of view, through the multiplicity of methods of healing, of maintain that freedom of intellect and opinion which from time immemorial, especially for our science, has been the greatest palladium for truth and perfection.
The history of medicine in its every period acclaims undeniably the fact : “The more one clung to nature and to pure experience just so much more was accomplished in medicine; the more despotically however, names, opinions, and sects ruled, just so much more faulty, limited, and un-natural was always the state of medicine”.
In the same volume of Hufelands journal, beginning on page 391, is an essay written by Samuel Hahnemann. It is entitled: “An Experiment concerning a New Principle for Determining the Healing-powers of Remedies, Together with some Views on those Previously Known”.
This essay of Hahnemanns which gave an impulse toward the establishing and further development of a method of therapeutics quiet unknown up to that time, will be studied in the following pages.
After a detailed review and estimation of the importance of chemistry for the development of useful remedies, Hahnemann develops the methods of research in regard to the effects of drugs as they were conducted in his time. He discusses the more general method in which experiments are made on animals for the purpose of acquiring accurate knowledge concerning the effects of remedies; as well as the particular one in which drugs are brought in contact with certain component parts of the animal body, such for instance as the blood. In this dissertation, he expresses the conclusion that the results of all such research methods are bound to be unreliable, for the simple reason that the animal organism varies so decidedly from the human.
He also calls attention to the fact that it is impossible in the case of some drugs especially those of vegetable origin to draw any definite conclusions, let us say, because of their close botanical relationship as to their homogeneous effect or even their similarity. So he finally concludes that in order to win a correct knowledge of the effects of drugs on the human organism, it is absolutely necessary to experiment with the drug on human beings themselves. Among the observations gains from the effects of drugs unintentionally administered, as for instance, in cases of poisoning, also observations obtained at the bedside. Thirdly, there should be added the drug-provings made on healthy human beings. As the most essential result of his deliberations and experiences, Hahnemann reaches the conclusion expressed as follows on page 433 :
“Every effective remedy creates in the human body a of illness peculiar to itself; and this illness is just so much more peculiar, definite, and severe as the drug is effective.” As an annotation to this, he writes: “The most effective drugs, drugs inducing specific diseases and consequently most active therapeutically are called poisons by the laity.” And then further: “One should imitate nature in that she sometimes cures a chronic disease by means of another which is super-imposed upon the first, and should apply to the disease which is to be cured (especially a chronic one) the remedy which is able to produce, artificially, a disease resembling as much as possible the one to be healed and the letter will then be cured: similia similibus curantur (Like is cured by like)”.
A few pages before this passage, Hahnemann states his position as to the first of the two Hippocratic doctrines, i.e, “Contraria contrariis curantur” (Opposites are cured by opposites). He characterizes this doctrine as only conditionally valid. In regard to this he says on page 423 : “In acute ailments which nature herself will generally cure if we will prevent, even or a few days, all interference with recovery, but to which, if we cannot do that, she succumbs-in acute ailments, I say, the prescribing of drugs (according to the law of contraria) is correct, effective, and sufficient so long as we are not all- knowing and do of recognize the fundamental cause of every sickness nor possess the means with which to give relief; or so long as we have no effective specific”.
And further : “But if the cause of the sickness and the means of relief are plain to see and we, unmindful of this, nevertheless combat the symptoms merely with remedies of this nature, or administer them for the purpose of opposing chronic ailments, this therapeutic procedure-to fight complaints by means of drugs which physiologically produce a contrary effect-is then termed palliative and should be rejected. In chronic cases, the palliative ameliorates only at first and in consequence stronger doses become necessary, but these do not remove the real cause and so the longer they are used the more injurious they are”.
As a proof of this point of view, Hahnemann then brings forth, among their things, the treatment of chronic obstipation with cathartics; and chronic pains with the continued use of medicines derived from “the juice of the poppy” (opiates)-“And even though the greater number of my medical contemporaries were still to cling to this method, I do not hesitate to term it palliative, injurious, and pernicious.
I beg my fellow practitioners to forsake this method-Contraria contrariis curantur-in chronic cases and those acute cases that are just about to degenerate into a chronic form. It is an incorrect way, a temporary woodmans road, leading through a dark forest and ending at the edge of a precipice. The proud empiricist considers this method as the well marked road to victory and is very pleased with himself that he is able with this miserable power to give relief for a few hours, unconcerned as to the fact that the malady takes firmer root under this coat of whitewash”.
I wish to repeat here yet another sentence from page 437, in the chapter on “Palliative Medicine”: “Perhaps the palliative medicines as so injurious in chronic diseases and make them so much more persistent, for the reason that, after the first effect which tends to relieve the symptoms of the disease, they cause an after the first effect which tends to relieve the symptoms of the disease, they cause an after effect that resembles the original illness”.
In the second portion of his essay, Hahnemann produces a large number of proofs for his views in regard to he effectiveness of a therapy according to the principle of “Similia similibus.” From the long series of these, only two will he presented here. On page 465, we read: “I have in my supplement to “Cullens Materia Medica already drawn attention to the fact that Peruvian bark, given in large doses to sensitive people in normal health, will produce an attack of true fever which is very similar to an attack of intermittent fever and therefore, in all probability, overpowers the latter and so cures. Now, after a much greater experience, I wish to add: not only is this probable, but it is quite positive”.
On page 521, there is a passage concerning arsenic: “The true nature of arsenic has not yet been accurately studied. I, myself, have experienced the fact that it has a great tendency to produce spasm of the blood-vessels and a tremor of the nerves. Such attacks are called ague-fits. If one uses it in somewhat stronger doses-one sixth to one-fifth of a grain for an adult- this tremor becomes very positive. This tendency makes it a very powerful remedy against intermittent fever because of the similarity between the symptoms produced by the arsenic and those present in this type of fever.
Indeed, all the more so from the fact that it possesses the power, as I have brought forth, of producing a daily recurrence of the attack (decreasing in intensity, however), even if one discontinues the use of it. In typical ailments of every kind in periodically recurring headaches, etc.-this peculiarity of arsenic for type-production when given in small doses, one-tenth up to never more than one- sixth of a grain in solution, becomes important and may, as I foresee, become quite invaluable to our successors who will, perhaps, be still more courageous, are observant, and also more cautious than ourselves”.
This idea of using arsenic in small doses-one grain equals about five centigrams-must, at that time, have been considered a very audacious and hazardous therapeutical enterprise. Hufeland, at least, cannot resist remarking in a footnote to this passage : “I must here, with due respect to the author, confess that I am as yet not above to agree to the internal use of arsenic, especially in intermittent fever.” That, too, has changed in the course of time!. As one or the other of my readers may not be familiar with the character of Hahnemanns scientific training before he decided to enunciate his views, perhaps it might be well to give a short description of it here. As a medical practitioner, and also as a chemist, Hahnemann was held in high esteem by the contemporaries.
His publications on “Arsenical Poisoning, Its Antidotes and Legal Determination,” “Concerning Signs of Purity and Adulteration of Drugs,” his “Wine Test” under which name was known the method originally devised by Hahnemann to demonstrate, qualitatively, the presence of lead in wine, along with co- existing iron, the former being derived from sugar of lead, a substance formerly often used as an adulterant, created the same well deserved interest among experts of that time as did his communications in Crells “Chemical Annals,” and his methods of preparing the so-called Mercurius solubilis. Mention might also be made here of his “Guide to a Through Healing of Old Wounds and Indolent Ulcers”; his “Instructions for Surgeons concerning Venereal Disease”; and his method of treating carious bone conditions by scraping our the diseased portions and treating the wound with a sublimate solution.
Then in the year 1810, Hahnemann published his “Organon” in which he very clearly made known his views concerning the action of drugs, especially his attitude on the second Hippocratic doctrine, relating to the principle of the action of similars.
In paragraph 29, he says: “Whereas every ailment which does not come within the scope of surgery is due to be peculiar pathological disturbance of the functional activity of our vital force; therefore in the case of a homoeopathic cure where the restoration of the equilibrium of the vital force which has been disturbed by disease has been brought about by means of a drug- potency accurately chosen according to similarity of symptoms, an artificial ailment similar to and stronger than the natural one is induced which is, as it were, substituted for the weaker, similar, and spontaneous pathological state; so that the vital force is now contending against the drug disease alone and is impelled to an increased effort because of the greater intensity of the drug action; however as this intensity of the drug-potency is of short duration, the renewed vital energy becomes supreme and, just as in the first phase, it became free of the spontaneous pathological condition, so it has, in this latter phase, been liberated from the artificial or drug affection and is now capable of again carrying on the life of the organism in health”.
The foregoing sentence which is rather drawn out, requires a careful analysis in order to be properly understood : Disease is, according to the opinion of the present day, the expression of a disturbance of the physiological equilibrium of the organs. By the administration of a drug-potency, according to the doctrine of similia similibus curantur, a disturbance of the equilibrium as nearly as possible identical with, but stronger than the pathological state is produced. The expression, drug-potency, chosen by Hahnemann may, for the present, remain undiscussed. We will have opportunity to refer to it at another time.
The effort, normally present, towards warding off disease, such as for instance, the information of antibodies, the more active participation of the internal secretions, and similar activities are temporarily stimulated by the drug. By this means, the original natural disease is conquered and the physiological balance again restored. The stimulation due to the drug and the disturbance associated therewith are active for so short a period that not further disadvantage arises from them and the consequence especially peculiar to them are quickly remove.
The historical portion of our subject has been completed. Now, we are to concern ourselves with the task of investigating as to whether the principle, “Similia similibus curantur,” in its full import is justifiable or not. We must ask ourselves : Is it conceivable that a drug can produce in a healthy being a symptom complex which resembles one appearing in an illness of the same organ or even of the entire organism-an illness of the same organ or even of the entire organism-an illness due to entirely different circumstances? And further : If that is really so, how is it conceivable that a drug can cure a disease whose symptom complex so closely resembles the effect of the drug itself?.
If we proceed from the assumption that every living cell, every living tissue and organ, every living organism only exists because of the fact that in them all without exception a constant process of creation and destruction is taking place, the intensity of which is to be measured according to the rate of metabolism-if one will go further and compare this with he uniform swinging of a pendulum or the even turn of the analytical scales, one can speak with reason of a “physiological latitude” within which the life process of the individual cells, organs, and organisms play its part.
A foreign factor that in some way influences the even swinging of the pendulum, the uniform turn of the scales, must logically produce changes in the normal course of both of the mechanical appliances. In like manner does each extraneous disturbing influence act on the life process of any organ. It is force out of the normal physiological latitude of its life activity.
The foreign factor has in such a case acted as a “stimulus.” The deviation from the normal physiological latitude corresponds to the reaction of the affected organ to this stimulus.
We draw from the changes in the behavior of the organ and the organism-changes due to the effect of the stimulus, the double conclusion : First and above all, that a reaction occurred-that the factor serving as a stimulus had the power within itself to start a reaction-and Second, that the organ or the organism under discussion was in a condition to react.
Granted that the conditions necessary for the development of a reaction due to stimulation are present, how should this reaction express itself? To begin with, let us choose a very simple and easily comprehensible example. Suppose we take a freshly prepared nerve-muscle preparation of a frog, similar to that used by the physiologist for detection and demonstration of certain reactions which the muscle shows when the nerve which innervates it, is stimulated.