This acts and not the cold.” With our drugs and all our other therapeutical measures, we can never do more than assist the organs to regain their physiological equilibrium. Our therapy can reach no further. No drug exists that can, through its action, in any way directly influences the disease-producing factor. And even in regard to the treatment of infectious diseases, a matter which is today of such great interest, the idea of a Therapia sterilisans magna will always remain only an idea. I have always maintained this point of view; the last time in my treatise: “The Treatment of Diphtheria with Cyanide of Mercury” in the year 1914.
The conception of a direct influence on a disease-causing agent through any therapeutical, that is to say any medicinal measures, be they constituted as they may and act as they will, is based on the first of the two Hippocratic doctrines and the principle of the contrary action of drugs. The fact is however, that in all the cases where we have produced a cure, similarity of action was the guiding principle. Naturally, in making this statement, I exclude all of the cases in which an emergency treatment, according to the law “Contraria contrariis curantur” afforded the organism, through the alleviation of certain symptoms, time and opportunity to rest; thus giving it the possibility of returning to health.
However, in all other cases where it is a question of a complete cure of a diseased state which could not have been brought about through the power of the organ alone without our help, the principle of “Similia similibus curantur” is emphatically established. In every case we have to deal with a direct influence on the diseased organs by means of such drugs as have the power to act upon them, I might say, in a specific manner.
In regard to the nature of the curative process due to at influence of the drug in these cases, we are at present only able to make conjectures. I have already in a previous paragraph referred to the possibility that, in the case mentioned, the natural effort of the organs to produce substances which have the power to neutralize the disease toxin present in the body, is accelerated through the stimulation due to the drug. We must also think of the fact that every stimulation of an organic structure results in a change in its blood supply : Ubi stimulus, ibi affluxus. It is clear how important this would be for the possibility of restoring the diseased organ or tissue to a normal state of existence. The future will no doubt give further opportunity for explanation of this phenomenon. We must, however, guard against accepting and using as sufficiently explanatory, those assertions which, to begin with, either spring from erroneous and untenable hypotheses or introduce crass chemical or physical meanings into the subtle processes of living organs.
And especially must we beware when they are brought forth in the form of enticing catch-phrases, regardless as to where they come from.
Indeed it is “a goal most earnestly to be desired” to know what actually does take place in the interaction between drug and organ. However, we are still far from having this knowledge. Therefore, it is better to be satisfied for the present with established fact and with that which we really know than to concern ourselves with ingenious hypotheses whose viability is of necessity limited and whose real value often very doubtful.
If one would test the second Hippocratic doctrine in practice, one must always keep two points in mind : First of all, the choice of the drug itself for a particular case. We must be absolutely certain that there exists the most intimate relationship between the chosen drug and the diseased organ. This relationship must exist if we are to be sure of having found the special drug capable of bringing about a condition in the normal organ resembling most closely the particular pathological state now present in that one particular organ, in order that it (the organ) may exert with sufficient energy the power peculiar to itself. I have shown the way to do this in previous these. I have repeatedly insisted upon the fact that it is absolutely necessary for us to have the opportunity of observing the effects of drugs upon healthy human beings if we really wish to reach a thorough understanding of this problem. In making this assertion, I am fully conscious of the fact that at present I am not in accord with the majority of those of my colleagues who come into consideration as experts entitled to give an opinion. Time and results must decide.
The other point that we must not disregard if we would thoroughly probe into the practical application of the second doctrine of Hippocrates, is the consideration of the drug- stimulus from the point of view of its intensity and application in individual cases. Right here the fundamental biological law, enunciated by Arndt, is of great importance to us.
For the practical therapeutical application of the second Hippocratic doctrine, quite a different factor comes into consideration than is the case if we wish to administer our therapy according to the law of opposites. It is quite another matter as to whether therapeutic purpose is directed towards alleviating existing symptoms due tot he disease or if its purpose is to eradicate the fundamental cause of these symptoms.
Again and again the physician encounters such cases, in which at first and, at times, later on in their further development, he can do nothing else than make use of the law, “Contraria contrariis curantur.” The pain for instance, which is the result of an inoperable carcinoma, makes it necessary to use such measures, which however can accomplish nothing more than to relieve this pain for a limited period. It would be quite wrong for the physician to waste his time with attempting to eradicate the carcinoma with therapeutical measures that, as yet, offer no definite hope of success, without giving the patient relief for short time, at least, by means of a narcotic. And likewise it would be wrong in the case of an incurable heart affection with its inevitable accompanying disturbances, to direct his therapy other than towards alleviation. To do otherwise would be cruel.
However, if we proposed to deal with the fundamental ailment, and if the circumstances of the case are such that the prospect of success, considering the condition of the affected organs, does not appear absolutely hopeless, we must not forget that it is now of the utmost importance to take into consideration the amount of recuperative power still left in the organs. It is in them that the process of cure will originate. The vitality still remaining in them must be taken into consideration.
We must graduate the medical stimulation accordingly. We must guard against a too strong a drug stimulation, for the reason already explained in a previous paragraph. And as it is no doubt justifiable to assume that the longer the disease process has existed just so much more must the power of the affected organ to resist a drug stimulus have decreased, we must select for chronic affections a correspondingly lower degree of drug stimulation. The results in Balneology confirm this observation. Mineral waters when administered internally, are given in doses which are generally considered very small. Moreover, we must carefully graduate the dosage in acute cases, as well, especially if we use the drastic drugs, that is to say, those that are usually designated as poisons.
This brings us to the question of “small doses.” For many physicians this question is most closely interwoven with homoeopathy. The idea: “Much helps much” which is justifiable for medical therapy as practiced according to the principle of opposites, plays, in this instance, a leading part without ones being aware it. To be sure, according to this idea nothing is to be expected from very small doses. For instance, what would be the result if I should administer a milligram of morphine to a patient in order to temporarily relieve him of unbearable pain? Or if one tried absurd experiment of relieving obstipation with Hippocratic doctrine, “Similia similibus curantur,” involves something entirely different.
Hahnemann experienced the fact that relatively small does of medicine achieved better results than large ones, especially in chronic affections. The medicine itself seemed indeed to be the more effective the greater the dilution. This was the reason for the none too fortunate choice of the expression: “drug potency.” according to which the action of the remedy, not the reactive power of the organ treated by the drug, was apparently the determining factor. Now, this point of view might lead to the assumption that the power f the drug must become increasingly greater with a progressive decrease of its quantitative aspect.
In fact this interpretation has indeed led to the so-called “infinitesimal” doses-to the use of doses whose smallness is just as difficult to conceive as is the success which is claimed for them. That the quantity of the drug in an individual case my really be very low, in fact must be, is admitted without hesitation and, after careful consideration of the action of a diseased organ, is indeed easily understood. But there limits!.
