Geheimrat August Bier.–We arrived at Berlin early in May, having visited London, with all its imposing immensity and beautiful Paris, whose wide and radiating boulevards provide constant interest and entertainment to the traveler, from America especially. A sunny morning found us walking down the Joachimstalerstrasse from the Zoologischer Garten Bahuzhof and soon, at No. 21, we arrived at Prof. Biers commodious Privat Klinik. Stating our name and mission to one of the nurses, we were soon escorted into the presence of the Geheimrat himself, whose strong personality at once becomes apparent in no unmistakable manner, for here is a man of dignified, forceful appearance, of great knowledge, culture and learning, positive in his manner and opinions. He was kind enough to grant us a twenty-minute interview, for he is an extremely busy man, who frequently operates continuously from seven to nine hours a day. We chatted together in German and naturally, with our editorial nose for news, we quizzed him tactfully along homoeopathic lines.
Professor Bier has been long interested in the principles of homoeopathy, which, as the world of homoeopathy now so well knows, he had studied deeply and investigated practically. His knowledge of Hahnemanns philosophy is profound and he compares this philosophy with that of Hippocrates. Said he, “I am not altogether sure, that were I myself sick, I would not prefer to be treated by a physician who follows this philosophy rather than by one, whose sole conception of disease is summed up in the findings of diagnosis.”
He believes, that not only must the physician be cognizant of what is going on and what has occurred in the patient (diagnosis), but also, that the physician, in his endeavor to cure, must know minutely the reactions of the patient to his environment, must know the symptoms, mental and physical, of which the patient complaints; in short, he subscribes warmly to the Hahnemannian concept of the totality of the symptoms.
To the surgeons he relegates without hesitation, all mechanical things, all gross pathologic end-products. He believes in and emphasizes the importance of the Arndt-Schulz law and states, that in Germany, this law has been more readily acknowledged and accepted by scientific men in agricultural and botanical fields, than by physicians. This fact he attributes to the narrowness of medical men.
The law of symptom similarity, Aenlichkeitsgesetz, he naturally places as first in importance in the consideration of things homoeopathic; the question of potency he places less importance upon, though preserving an open mind regarding the efficacy of the high and highest potencies; he believes in the simple remedy and states that homoeopathic physicians are using entirely too many remedies and mixtures, unrelated to their cases. How true indeed, especially in the United States! Above all, he resents narrowness and does not wish to be called a homoeopath or sectarian. He is concerned with principles, not with dogma. Asked regarding the future of homoeopathic principles in Germany, he stated that in his opinion, it is good.
Of interest to homoeopaths will be his assurance that he has found small doses of ether to be of unquestioned value in the treatment of post-operative pneumonia. He likewise made the interesting statement that in a number of diseases the good effects of the waters of various spas or baths, can be duplicated by the hypodermatic injection of simple distilled water which he says, is capable of arousing tremendous reaction. At present, his first assistant, Dr. Zimmer, whose work has been largely concerned with Reiztherapie (irritation therapy) is pursuing his homoeopathic investigations at Stuttgart Homoeopathic Hospital, together with Dr. Stiegele, the resident physician of this institution.
This ended our interview and a half hour later found us at the Potsdamerplatz in the Pschorrbrau Restaurant, digesting our mental pabulum with the aid of a large seidel of Munich beer.
Yatren.-Since the publication of Professor Biers article in the December, 1925, issue of THE HOMOEOPATHIC RECORDER, we have received several inquires regarding “Yatren”. We are now able to state that yatren is an iodin-oxyquinolin-sulphonic acid in which 28 per cent. of iodin has been firmly bound and is often combined with bicarbonate of soda, owing to its acid reaction.
It is said to be of use in lues, when used in combination with bismuth, in amoebic and bacillary dysentery and is similar to quinine in malaria.
Ernst Bischoff Co., Inc., 135 Hudson Street, New York, have recently issued a booklet concerning this drug, entitled “Yatren in Human Practice” and will no doubt be placed to send the same to any interested inquirer.
The Symptomless Case.-Time was when homoeopathic physicians were accused of being symptom-coverers having no regard for causes, diagnosis or underlying pathology. In the days of Hahnemann and of the early provers, pathology, as the science is understood today, had not been born and diagnosis, in the light of modern refinements at least, can scarcely be said to have existed. Small wonder then that the purely subjective, as evidenced in both prover and patient was looked upon as a of paramount importance; the more so, since provings obviously could not be carried to the point of gross tissue change.
Such objective knowledge, as was possessed concerning the gross effects of drugs, was obtained from accidental poisonings or from those produced as the result of suicidal attempts. Even in this day, the knowledge which homoeopathic physicians have, concerning the gross or objective effects of drugs, has been obtained from the same sources, but is augmented by experience gained in the realm of industrial medicine; industry in our present age, being highly developed, especially along chemical lines, offers abundant material for study, such indeed as did not exist even fifty years ago and which, incidentally, is not taken advantage of, as it could and should be.
This fact was frequently pointed out by the lamented Albert E. Hinsdale, who more than anyone else up to the time of his death, had made use of the information to be found in the field of industrial medicine. Hinsdale also demonstrated, albeit on animals, the objective effects or gross pathology of many of our drugs. Witness, for example, his experiments with the bichromate of potash in the production of duodenal ulcer. It is, of course, true that there is danger in translating, as it were, animal into human pathology. Conclusions cannot be hastily drawn and analogies may often be misleading. Nevertheless, such studies in drug pathogenesis in animals have great value, if only in a corroborative or an explanatory way.
It has always been true and it still remains so that as homoeopaths we must rely upon subjective symptomatology almost entirely in our daily prescribing. Theoretically, we prescribe upon the totality of the symptoms, which, of course, includes both subjective and objective manifestations. The phrase “totality of the symptoms,” has indeed achieved a sort of hallowed sanctity and often serves as a militant rampart from which the banner of homoeopathy is defiantly flung. Practically, however, most of us ignore it, wittingly or unwittingly, in the daily routine of our work.
The science of homoeopathy is one thing and rests upon its three major cardinal principles, simile, simplex, minimis, but the art of homoeopathy is quite another thing and depends upon the qualities and qualifications of the individual prescriber, to catch and interpret the spirit and essence of the genius of homoeopathy. This, indeed, is difficult and far too arduous for most of us. It takes much effort, patience and time to become an artist and few of us will or can devote the necessary time to such endeavor. This fact, more than any other, accounts for the lack of progress of homoeopathy as a therapeutic method, in the present age.
Homoeopaths, in their efforts at fitting remedies to patients are, of course, at this advantage, in that, thanks to Hahnemann, they do not try to treat diseases. Instead, they treat patients who have diseases. The old school begins to show signs of enlightenment in this direction, more particularly in its attitude toward “constitution” and all that this word implies. Hence, homoeopaths of necessity must pay heed to such technical details of prescribing as location, sensations, modalities and time. All enter into the correct or even approximately correct prescriptions, for a distinction can in truth be made, between a merely similar, or the absolutely similar remedy.
Location can often be explained by pathology, probably in the majority of instances, though disturbed function, unaccompanied by tangible pathology can and does, of course, exist. Sensation may at times be explained by as well as be based upon pathology, although disturbed function is usually quite sufficient as an interpreter. Modalities may be explained by either pathology or disturbed function, but not necessarily so. The relief of the pains of inflamed varicose veins by cold, as in Pulsatilla, is a modality quite easy of pathologic explanation, but there are numerous other modalities whose reasons for existence are not so clear. The same observation applies to time. Why, for example, should Natrum mur. select 10 A.M. at which hour to make its victims uncomfortable, or why does Lycopodium select the time from 4 to 8 P. M. ?.
Perhaps some day we shall have a definite, logical explanation of these facts!.
However this may be, it is fairly easy to prescribe, if we direct our minds to it, for the case which fully presents the essentials just touched upon. A remedy can usually be recognized, or if not, can be found by means of suitable repertory analysis. But what about the case which presents very few symptoms or none at all, of value in prescribing? Such cases are often met with and can be recognized as definite, diagnostic entities. Symptoms, whether subjective or objective, which reflect pathology only, are of great use in the making of a diagnosis, but are utterly useless as a basis for a homoeopathic prescription.
It is true, that the more pronounced pathology is seen to be, the less applicable is homoeopathy and the more incurable is the case. Pathologic end-products, as has so often been said, commonly belong to the surgeon. The law of similars is helpless, except perhaps, in a purely, palliative way. But surgery cannot, even with all its brilliant modern achievement, master all pathologic resultants. Medicinal therapy may be and usually is required. It needs a nice discrimination to determine, not only the possible incurability of the case and the extent of its pathologic change, but also how far the law of similars legitimately applies, or whether it applies at all. This is a rock upon which many a homoeopathic craft has ingloriously foundered!.
What then, shall be done with the symptomless case? If the surgeon finds no opportunity in it, shall it be permitted to drift into the great school of palliation, orthodox medicine, or shall it be allowed to serve as welcome prey to the vast horde of non-medical cults? This, in truth, is what often happens and to this extent is confidence in the medical man and his methods lost.
What homoeopathy needs more than any other thing today, is drug proving along modern laboratory lines, which will take into careful consideration, all the diagnostic aids employed in the work of blood chemistry, haematology in general, the chemistry of the gastro-intestinal tract, urine analysis, etc. The knowledge to be gained by provings of this kind, made upon humans, will explain, corroborate and strengthen much of our subjective symptomatology so abundantly presented in our existing provings and will also increase our ability to more easily and correctly apply our remedies in the symptomless case, as we now understand this designation.
It will, furthermore, aid us in more precisely defining the scope of homoeopathy and the degree to which it does or does not apply. Not for a moment to do we wish to create even the slightest suspicion that our present provings are to be cast aside, but we do desire to affirm that these provings will be greatly enhanced in value and usefulness, by following the course so briefly hinted at. Greater ability to cure will then be within our power and even the case without symptoms will become more hopeful, so far as aid and even cure are concerned.
There may be those who will object that the proving or reproving of Belladonna, under the auspices of the O. O. and L. Society many years ago, taught us little or nothing of practical value, which we did not know before. Doubtless this is true, certain it is, that no one now uses this reproving in a practical way. But, let us suppose, for example, that a reproving of Hepar sulphur calcareum, with special emphasis upon possible blood changes such as the production of an increased number of leucocytes, should show a more definite applicability to clinical states in which its use is now more or less uncertain, would we not be greatly strengthened in our powers of usefulness, by such knowledge?
Two recent cases, in partial illustration of our argument, come to mind. One was that of a middle-aged women suffering from menorrhagia. The usual remedies were applied in her case and certain improvement was noted. Phosphorus was apparently her basic remedy and did good work. But the beneficial effects proved to be of brief duration; in short, homoeopathic palliation alone, was achieved. Careful gynecologic examination now revealed multiple uterine fibroids and operation followed as a matter of course.
Here then we have a case, in which prescribing over a period of almost ten months, accomplished nothing but temporary relief, remedies being applied to such symptoms as presented from time to time and mostly themselves aroused by the underlying pathology. Even though Phosphorus, in its symptomatology, has much to commend it in haemorrhagic diseases, we do not know that it has ever caused a uterine fibroid nor even perhaps, that it has actually cured one. If it has, was the cure brought about in an early stage of the fibroid growth or not? Certain it is, that in this case at least, no cure was obtained by the remedies prescribed and that these were prescribed largely upon secondary symptoms. There were no others and thus to this extent, the case was symptomless.
To put it another way, pathology had swallowed the patients individuality and this in truth is what often happens or has happened in cases which turn out to be therapeutic failures. To be sure, homoeopathy has never contended, that in order to cure a given objective condition, it must be capable of actually causing such a condition. Yet it must be admitted that the assumption would appear to be a logical one.
The second case in illustration, somewhat puzzling from the angle of diagnosis, proved upon careful examination to be one of typhoid fever. It was a mild case and although presenting a characteristic temperature curve was otherwise provokingly symptomless. The patient, with innocent persistence, denied all discomfort and had in fact, been going about much as usual. The history of the attack that it had begun some three weeks before we had seen him, also that he had been working under unsanitary conditions and had been exposed to noxious emanations during his work in a Southern state. He was now put to bed, upon a soft diet and Pyrogen 30th was given, t. i. d. The temperature almost immediately began to descend and within ten days was normal.
No symptoms appeared, but the patients sense of well-being improved, as did his weight. Pyrogen frankly was an empirical prescription, none of its characteristic symptoms being present, not even the disproportion between the pulse rate and the temperature. The remedy was chosen on account of the causal factor, swamp odors and emanations, suggesting toxic or perhaps even septic influences. Admittedly, malaria officinalis or Echinacea might, with equal appropriateness, have been selected. However, the recovery of the patient left nothing to be desired. It is pertinent to ask, whether Pyrogen had anything to do with the case at all.
Was bed rest alone sufficient? Would the temperature curve have descended so promptly had no medicine at all been given? Practically perhaps, all this theorizing is futile and makes no difference, yet the philosophy of homoeopathy demands and impels us to seek logical explanations for the things we do and the phenomena we observe. It is, therefore, in this spirit of investigation and frank confession, that we have presented this paper for discussion. So far as Pyrogen is concerned, we do know some important things about it, but some characteristics with which this remedy has been endowed, may perhaps have been thrust upon it by enthusiastic, though none too discriminating observers.