I HAVE been asked to speak to you on this occasion regarding the “Further Improvement of our Materia Medica.” The term “further” implies that some improvement has already taken place, from which, as a resting-point we may note progress and survey the ground yet beyond us. The reference is obviously to the Cyclopedia of Drug Pathogenesy, and upon this I would say a few words at the outset.
The work in question consists-as you know-of a collection of the provings of drugs not contained in Hahnemann’s own volumes, with a selection from cases of poisoning by them and of experiments made with them upon the lower animals. These provings, poisonings and experiments have been carefully translated or transcribed from their originals, and are presented in the primary narratives wherever these are given.
The provings themselves are a selection, made upon rules approved by the two National Societies of America and England, and so framed as to exclude-as far as it is possible-all dubious matter. We thus have, in the four volumes of the Cyclopedia, pathogenesis of as many hundred medicines, [The exact number is 413.] as trustworthy as careful choice can insure, and as correct as knowledge and painstaking care can make them, with the additional advantage that, wherever practicable, they are presented in an intelligible and interesting form.
The result gained by the completion of this work is that the lamentatious over the unsatisfactory state of our Materia Medica, which for the last forty or more years have been heard from all parts of the Homoeopathic world, may now sink to silence, or rather be exchanged for gratulation. They were well warranted when Jahr’s Manual, in its various forms, was or sole collection of pathogenesy. Symptomatology was there presented in a form most incredible, unintelligible and repulsive, without ground for its statements or clue to its mazes: it was, as it has been called, “nonsense made difficult.”
Nor were the groans evoked by it altogether assuaged by the appearance of the Encyclopedia of Dr. Allen, great advance through this was. Our scattered provings were there, indeed, brought together and referred to their authors, besides being much enriched from general medical literature; but they remained unshifted, and were all broken up into the categories of the Hahnemannian schema. Our Materia Medica, even in “Allen,” continued to be dubious and unattractive.
Now it is neither. The student can read the narratives of proving, poisoning and experiment contained in the Cyclopedia of Drug Pathogenesy with as much confidence and as lively interest as if they were cases of idiopathic disease; and the practitioner can, with firm reliance, utilize them in his practice. If doubtful matter still remains, as where, with little or no information as to their origin, we merely have a list of symptom, the statements made as to their character, and (generally) the inferior type in which they are presented, will suffice to warn off from possible quicksands or quagmires.
But I must not leave the Cyclopedia without a word as to the pathogenesis given us by Hahnemann himself, to which it contents itself wit referring, evidently implying that they also should be possessed by the reader. Those of the Chronic Diseases, indeed, are still a sealed book to most from the back of an adequate and accessible version. The Materia Medica Pura, however, has been now retranslated for us by the competent hand of Dr. Dudgeon, and can be obtained by any one. There may be read the results of the master’s primal essays at drug-proving, with his own illuminative introductions and notes.
The symptoms are arranged in schema- form, indeed, and there is little information as to how they were elicited; but the latter deficiency is supplied from other sources, and many of the individual symptoms are themselves groups which have association and sequence. When I speak of our Materia Medica as we English-speaking nations have it, it must be understood that I include these two volume of Hahnemann’s as well as the four of the Cyclopedia which supplement them.
And now, from the standpoint of what has been gained, let us inquire what remains to be done towards the improvement of this Material Medica of ours. Let us clear the way be seeing what should not be done.
The first thing to be deprecated is the view that the narratives of the Cyclopaedia constitute so much “raw material” only, and must be worked up into a schematic symptoms list before they can be made available for practice. Why should this be? For readiness of reference, it is replied: when we want to know what spinal symptoms Cicuta induces, we can turn to them at once in Allen, but in the Cyclopaedia we have to hunt them through a number of records. My answer is, that this need should be p[provided for by an index, as it is in other books. We do not, in these, cut up the text into categories that individual items may be the better discovered; nor should we do so here.
Hahnemann unfortunately took this course with his own provings; and nothing, I think, has done more to rob him of his honor in the profession at large, to hinder conversion to Homoeopathy, and to drive practitioners of the system into empiricism, than the distortion which has resulted. I maintain further that symptoms placed singly, divorced from their sequence and concomitants, often convey a false idea as to the pathogenetic action of drugs: so that the schema is not only unnecessary but misleading.
[ These theses are defended to detail in a paper on “The Presentation of the Materia Medica,” read by me at the International Homoeopathic Congress of 1886, and published in the TRANSACTIONS, p. 121.] The abandonment of this mode of presenting our Materia Medica is one of the most important features of the Cyclopaedia; and it would be to “further improvement” if we were to build again that which we had destroyed.
In is under the influence of these considerations that I do not feel as sympathetic as otherwise I should be towards another plan for reconstructing our Materia Medica-that advocated from Boston by Drs. Wesselhoeft and Sutherland, and taken up (with some modifications) by the Baltimore Investigation Club. It is mainly a trying of the symptoms of our pathogenesis by the test of their recurrence in more than one subject of the drug’s influence-only those which stand the ordeal being retained.
I am not quite sure about the soundness of the method; there must be some flaw in a mode of proceeding which leads to the rejection of Cactus as inert, and to the reduction of the symptom-list of Gelsemium (upon one proposed method) to four items only. [See New England Medical Gazette for December, 1888, and North America. Journal. of Homoeopathy for June, 1889. The principle, however, is excellent; it is that upon which I am to a large extent acting in making the index to the Cyclopaedia.
I am referring only to such apparent effects of drugs as “by the force of their occurrence or the constancy of their recurrence witness to organic connection with their assumed causes.” [+ See “The Index to the Cyclopaedia” in the Monthly Hom. Review for November, 1890.] But suppose I were to write down these symptoms as I indexed them, and, casting them into the categories of a schema, were to public them as the tried residuum of our symptomatology. Genuine they might be; but a Materia medica so constituted would retain all the remaining faults of those of old; it would be as unintelligible, as repellant, as misleading as these were.
One of our journals, in noticing the Cyclopaedia, says that “it totally ignores a host of old Homoeopathic landmarks.” By this is probably meant the “clinical symptoms” which swell the bulk of so many of our Materia Medicas-meaning by this term morbid states which have (not appeared, but) disappeared while their subjects were taking certain medicines. Hahnemann made some, though sparing, use of such symptoms only, however, when they occurred in provers of drugs, [++ The symptoms list of Iodium in the Chronic Disease is the sole exception to this statement.] and always nothing that they were Heilwirkungen.
Jahr introduced them more freely, indicated their character by affixing a small circle (O) to each. So far little harm, if little good, was done. More recently, however, the practice has grown up of mixing pathogenetic and clinical symptoms, together with guesses, therapeutic suggestion, and hypothetical inference, in one indiscriminate mass, and calling this conglomerate the Homoeopathic Materia medica. men imagine that they are applying the law of similars when they work with such books, whereas they are very often practicing the merest empiricism.
I do not wish, on the present occasion, to go further into detail on this subject. I have often expressed myself upon if and always feelingly; for I deplore the procedure in question as one of the greatest calamities that has ever befallen us. My sole reason, however, for mentioning it now is to support the opposition I would make to any vitiation of our symptomatology with matter of a clinical kind. It is not that I undervalue the usus in morbis or despise therapeutic suggestion; but I would have these kept separate from the pure Pathogenesy. They may appear in prefaces and notes, as in Hahnemann’s publications; or they may occupy a separate volume, as must be in our case. There they find scope for abundant usefulness; but mixed up with the results of provings and poisonings they are confusing, illusory, destructive of all scientific thought and practice.
Not therefore by schematizing, by reducing in number, or by blending with clinical material, the drug-effects on the healthy we have brought together, do I conceive that the Materia Medica of Homoeopathy will receive further improvement. In fact, I am of the same mind now as I was n 1879, when reviewing attempts at reconstruction by Drs. Jousset and Espanet. [See British Journal of Homoeopathy, xxxvii., 257.] I deprecated any attempt to substitute such studies of drugs for our existing symptomatology. “Let this,” I wrote, “stand as it is, [+ Of course, neither there nor here am I minimizing the need of fresh provings.
But on this score I spoke so fully at the International Homoeopathic Congress of 1891, that it is needless to repeat myself on the present occasion.] and let our work upon it be something like that of theologians upon their sacred books. As with them, let our best endeavors be made to enrich, to purify, and to illuminate the text. Then let those competent for the task give so commentaries upon it, elucidating its language. Let the teachers of Materia Medica in our schools publish from time to time their systematic lectures, embodying (as these must do) al the side slights which from toxicology, from the physiological laboratory, and from therapeutic experience they can bring to bear upon its study.
These will answer to treatises on doctrinal and practical theology; and then, for the sermons which expound and apply particular texts, let us have clinical records showing the bearing of pathogenetic symptoms upon the phenomena of disease. In this way, while we shall lose no grain of fact which can be made available in the comparison of drug-action with morbid conditions, there will be supplied to every student of the Materia Medica a general knowledge of its constituents, of their sphere and kind of action, of their characteristic features and ascertained effectiveness, which shall send him forth fully equipped for using them in the treatment of disease.
There is thus abundance of work for all who desire to labor in the field of Materia Medica, and the more there is done of the kind the better for the future practitioners of our method.”.
Now that, in the Cyclopaedia, the text of our Materia Medica has been enriched, purified and illuminated, I the more earnestly urge its being left alone, and no attempt being made to substitute for it the result of any extractive or other process. The rest of the work suggested remains open; as it is adequately performed, the further improvement desiderated will accrue. I would especially call for commentaries, elucidative and exegetical; and would suggest that those most competent for such a task are the specialists of our school-the neurologists, the oculists, the aurists, the gynecologists.
To the study by such men of the symptomatology of disease, aided by post-mortem examination and experiments on animals, we owe the great advances in pathology which have marked the last sixty years. May not similar investigation, when directed to pharmacology, achieve like results? The phenomena of drug-disease have also their meaning, and lend themselves to patient interpretation. They are not themselves to be forgotten, and the phrase which explains them substituted, and more than the clinical features of idiopathic disease are to be merged in its nosological name. But the explanation illumines them, makes them coherent, intelligible, memorable; they become part of our mental furniture, and are not mere strings of symptoms to be learned by heart.
A series of studies, by experts in each departments of the neurotic a phenomena of the oxalic and picric acids, of Agaricus Bisulphide of carbon, Hypericum, Lathyrus, Osmium Phosphorus, Physostigma, Secale, Zinc.; of the eye-symptoms of Ammoniacum, Aurum, Digitalis, Euphrasia, Macrotin, Naphthaline, Ruta, Santonine and Spigelia; the tinnitus of Quinine, the Salicylica, Coca and Chenopodium; and the pelvic disorder occasioned by Ferrum, Lilium, Murex, Sabina and Xanthoxylum-a series of such studies, I say, would enrich the very life-blood of our practice, and make us all better fitted to deal with the morbid states come daily before us.
THE CHAIRMAN: Before the discussion of this paper I would like to announce that the action of surgery will meet in this room at 3 o’clock this afternoon under the charge of Dr. John E. James, temporary chairman. I would also give notice on behalf of the World’s Congress Auxiliary that it desires all members in attendance upon the Congress to register in the basement at the official registry. This is distinct, ladies and gentlemen, from your registration in Room 2 under the auspices of the Congress and the American Institute of Homoeopathy.
The discussion on Dr. Hughes’s paper will be opened by Dr. J.P. Dake, of Nashville, Tennessee.
DR. DAKE: Ladies and Gentleman: It seems hardly necessary for me to say anything upon this paper of Dr. Hughes. Dr. Hughes and I have been associated in work for several years and we quite agree in our views. However, there are some points in which I must place a little dissent from the address. While I agree with him fully that the proper publication of all provings should be in the narrative from just as the symptoms have occurred from the first day or the first hour until the last; still, for the convenience of the profession and the busy practitioner, I hold that it is necessary to have some sort of minor arrangement or, as Dr. Hughes calls it, extractive work applied.
I must confess that my use of the Materia Medica, as we have had it in its schematic form, has been useful to me, and I only not agree as yet to cast it aside. Of course, the cutting up of symptoms by an arrangement, as we have had from Hahnemann down, does separate them and take them out of their connection, but the physician, while using the schematic form to find what he is after, ought, in my judgment, to refer constantly to the original record, and particularly when he has a case that requires much study of remedies.
There you have it in those connections, and we must look upon the effects of drugs as drug diseases. Belladonna produces a Belladonna disease, and we ought to take it in its entirely as we do a case for which we are prescribing.
I cannot entirely agree, therefore, with Dr. Hughes in what the says in regard to the work in Boston by Drs. Wesselhoeft and Sutherland, and in what he says with regard to the work being done in Baltimore by the Investigation Club.
I have had in years past a little controversy with some of my English friends in regard to this matter. I hold that when the symptomatology of a drug is properly taken and properly studied that it is possible, by a study of those records, to know something of what are the characteristic symptoms of the drug. I hold that there is no other way safely to determine what are the characteristic symptoms of a drug. To depend upon clinical experience will not do. We have been misled often by such attempts.
I once made this point, in answer to some of my English friends, that while we may have a map of the United States in detail, giving every river and every county line, and the location of every city, and perhaps of every village, still it should be possible to give an outline map of the United States that will not be misleading, even if it does not give us all the information that we may desire.
For that reason I hold that it is possible, when provings are rightly made and rightly recorded, to have an abstract of Materia Medica that will comprise the characteristic or more prominent and persistent symptoms of each drug.
I will not detain you, but wish to make this remark, that the future improvement of the Materia Medica depends not so much upon the arrangement of the material we now have as upon the production of better material. The provings should be made with all the care, and recorded with all the case, that you may see in any other department of science. This is a matter of experiment. Experiments ought to be performed with every precaution that is possible, against illusion, against error and corruption.
It is a fact, that I may have occasion to mention again before we get through with our Congress, that provings have been made here and there and everywhere by busy physicians, by people who are full of theoretical ideas and of pathological notions, that make their appearance in their provings. Provings have been made by persons who are not even acquainted with anatomy, so as to be able to locate their symptoms in attempting to describe them.
These are faults which must be remedied, and to do that we will ave to have this matter conducted by persons competent to supervise it, by provers who are in the right conditions to have the effects of the drug reflected properly, and to have all the symptoms recorded in a plain and proper manner.
THE CHAIRMAN: The paper by Dr. Hughes will be further discussed by Dr. T.F. Allen of New York City.
Dr. ALLEN said: Ladies and Gentlemen: I have listened with the greatest interest to the reading of Dr. Hughes’s paper, but confess my disappointment that in it be alludes to the Cyclopaedia of Drug Pathogenesy, or the improved Materia Medica, standing as it is, a the sacred books of the Bible.
At the meeting in Deer Park I, a minority of one, protested against the doctrine and the principle upon which this new Materia Medica was based. I have not since that time changed my opinion; and the Materia Medica as incorporated in the Cyclopaedia of Drug Pathogenesy cannot stand, in my opinion, as the sacred books of the Bible. I do not now, and never have, believed in the method of arrangement as practical and adapted to the wants and necessities of the homoeopathic physician. In that respect I differ from Dr. Hughes when he says that he regrets that Hahnemann saw fit to put his Materia Medica into the schematic form, and perhaps that, therefore, Homoeopathy suffered. I believe, as an humble follower of Hahnemann, that he did the best thing for Homoeopathy, and that if he had not put his Materia Medica into the schematic form it would have almost died in its birth.
I differ now, have always and must always differ, from Dr. Hughes on the point. I cannot conscientiously do otherwise as a teacher and practitioner of Homoeopathy. The narrative form is extremely valuable for study. The narrative form of the Cyclopaedia is a book I prize most highly.
It is on the front shelf of my desk. I consult it constantly, but in prescribing for my patients I use the Schema, not the Narrative form. In studying for the preparation of lectures, for the working our of the points, the characteristic features of the action, and study of the, if I might almost coin a word, the Pathognomonic of the drug, I use the Cyclopaedia; but Hahnemann wanted to make it practical, and that is, I think, what the Homoeopathic profession of to-day needs. So Dr. Hughes’s paper goes on principally at first to speak of the arrangement of the Cyclopaedia.
Next he states that, in his opinion, improvement of the Materia Medica will come not from the improvement of the Materia Medica, mind you, as he says, but from exigencies. That we must have lectures upon it; it must be eliminated; we must have talks and sermons upon this Materia Medica itself, and, therefore, I wish to submit a few words on the subject-matter of Dr. Hughes’s address, rather than on the address itself.
The improvement of the Materia Medica has taken hold of the minds, I am happy to see, of many of the younger men as well as the older men in the profession, and Materia Medica clubs have been formed in various parts of our country; the Boston Club, the Baltimore Club, the New York, Materia Medica club, all having for their object the study and improvement of the Materia Medica.