MY friend, professor Helmuth, presents to this Congress a plea, just and able, of course, as well as eloquent, in behalf of surgery as an indispensable force in the Homoeopathic school. The title of my paper, however, whilst in no way impugning his position, assumes the converse view, as equally just and even more essential.
The special field of homoeopathy, viz., Chronic Diseases, owing to insufficient obedience to the tenets of the Founder, having been largely relegated to surgery, we are being hurried along to practical oneness with the palliative school; and our testimony to curative medicine grows, I fear, more and more feeble.
“Distinct and commanding1” Less than this, I cannot for one moment admit, as the true status of our God-given system; and must demand for it, and for its study, universal recognition as such.
The Civil War played an important part in American medicine; firstly, by abstracting from ordinary practice and teaching the bulk of the surgical talent of the country; secondly, by the intensification of surgical enthusiasm and skill, in connection with a large military experience; and thirdly, by the initiation of a characteristic surgical talent of the country; secondly, by the intensification of surgical enthusiasm and skill, in connection with a large military experience; and thirdly, by the initiation of a characteristic surgical epoch, with imperious fashions and some fads of its own, on the return of peace. (this epoch, further stimulated by the Franco-Prussian war, now involves the whole civilized world.).
The effect of all this upon Homoeopathy has been almost revolutionary. Our surgeons, in the army and navy, were numerous, despite hostile regulations. These, upon returning to civil life, observed with indignation the decadence of anatomy and surgery, and of the scientific branches in our colleges, and bent their energies to their rehabilitation. Disruption of the faculties, reorganization and reform were the immediate and general results; and from that time our school has herein maintained, as the very least, a parity with the senior branch of the profession, this, also, having passed through a similar travail.
This happy conclusion, so creditable on our part, and so important, has not, however, proved an unmixed good to us. Nay, so far has the pendulum swung in the new direction that those of us who helped to set it in motion, with unaffected loyalty to Homoeopathy and to its founder, may fairly take counsel with conscience, and ask ourselves if this revolution be not tinctured with elements of retribution. Of old, surgery did obeisance to the genius of Homoeopathy, in our colleges and societies; now, it would almost seem, it is largely busy in trying to snuff her out!.
The loyalty of her true adherents of the American Institute is assertive, but to many this whole subject is but matter for the merest toleration, as one tolerates a demented patriarch, who must soon pass away and cease from troubling the now active generation.
The loyal spirit has, I believe, succeeded in putting the profession on record as demanding that the “Institutes of Homoeopathy,” including the Organon of Hahnemann, shall be taught in all our colleges. Yet how is this demand complied with? How? by thorough drill, beginning with the Freshman year, maintained in the Junior, and enforced and perfected in all the practical departments throughout the senior year, and in the post graduate curriculum, to which all Allopathic converts must needs look? Nay-not a bit of it?
Homoeopathic Institutes, being confused with the methods of the Old School-as if these were equally important (sometimes, indeed, and therefore called “Methodology”); These sacred truths of which we are the stewards, are cast, as an inert fragment of obsolete history, into the arena of the students’ novitiate, alone; and the post-graduate, as well as the senior, is, above all, not permitted to waste his precious time with them, or their teachers, at all, or to abate his attendance upon surgical and special sub-clinics, a single hour, for their sake.
The common complaint of both, in the East and in the West, is, that on leaving the Homoeopathic college, they feel themselves “utterly incapable of the systematic and thorough study of a Homoeopathic remedy.” This, I personally know.
A faithful teacher of Homoeopathic Institutes may have succeeded in germinating the genuine seed in the minds of the freshmen, all unprepared and unfit as he has found them (since the highest type of medical intellect is needed for its just appreciation and culture).
But in the succeeding years this seed is too often found to have been sown by the wayside, where the fowls of the air find and devour it, in its germinal immaturity; or, among the thorns of the semi-allopathy which spring up and choke it, as if through deliberate purpose. Indeed, if the second and third and post-graduate years had been planned for this obliteration of Hahnemannism, the result could scarcely be more complete. Our grand old man, Dr. Hering, if yet alive, would not hesitate, me thinks, to apply the moral of the parable, and say, “This is the work of the devil!”.
Indictment of the present, however just, can, however, do no good, unless the way out of its errors can be shown. A long intimacy with Hering and others of our “old guard,” seems to emphasize my duty here. Permit me, therefore, to attempt this task. My first remedy has already been hinted at, viz., the study of Homoeopathic Institutes continuously, throughout the three or four undergraduate, and also the post-graduate years!
All the chairs in our colleges should he committed to faithful support of this programme, whilst neglecting nothing belonging specifically to themselves. With the adoption of the four years’ curriculum, no plea of “lack of time” can be admitted, in the future, at least. Unfaithfulness to Homoeopathy alone can account for its neglect hereafter.
Secondly, the science and art of Homoeopathy must receive a logical classification in order for purpose of parallel and progressive study and teaching, in regular form. The intrinsic difficulties of this work heretofore have, indeed, been the sufficient excuse for much of the neglect here indicated, the reasons for which are evident, and need to discussion here. I offer the following suggestions in the hope of giving help, such as the hard experience and study of the pat thirty-eight years, my Homoeopathic period, based upon an original Allopathic education and practice of some years, have brought to myself.
Such a “classification in order” may be thus stated:.
PART I.-Hahnemann’s Organon, divided into chapters, according to general subjects. This reduces the mass of profound discussion to a simple and orderly arrangement, easy to study, and agreeable to read; Wesselhoeft’s edition, modified, being the preferred text. This should be studied in every year, in a continuity of evolution, by the parallel use of the following parts; that is, the several parts should be so taught, as so enforce, from their several standpoints, the principles laid down in the Organon itself; and in like manner, the other branches of medicine should be taught in the same spirit, and with the same tenacious purpose, from year to year.
PART III.-Symptomatology; Physiological; Pathological; Diagnostic; Pathognomonic; Pharmacodynamic;; Prognostic; Therapeutic. Also, Dietetic; Curative; Toxical; Pathogenetic; Surgical.
PART IV.-General Pharmacodynamics; i,e, the philosophy of drug-action, with reference to primary, secondary, and the more remote evolution of drug-effects; and in assimilation with the known development of “natural diseases,” in the order of febrile action, and typified in every paroxysm of an intermittent fever. Provings, rearranged thus, become a “speaking picture!”.
PART V.-Special Pharmacodynamics; the study of the individual provings, that is, of the Materia Medica proper, in accordance with Part IV. and with the aid of such classifications and generalizations as have proved helpful in the work of selection and individualization.
PART VI.-Clinical Therapeutics; the verification of provings at the beside; thus, the discovery of “characteristics” of the drugs, aided by the observation of repeated cures of symptoms not yet recorded in any proving. Besides, the illumination of pathology itself, and of its relation to various drugs, and hence the interpretation of symptoms-both of natural and of drug diseases. This part, in other words, has to do with the Homoeopathy of experience.
Let these six parts be now successively presented in detail.
PART I.-Chapter I.-The “Introduction.” Pages 17 to 46, called by Hahnemann, “A Review of Physic,” with old-time historical intimations of Homoeopathy, Criticisms, with Notes. Pages 47 to 63.
Chapter II.-The Functions of the Physician. Pages 65 and 66, Aphorism 1 to 6.
Chapter III.-The Autocratic Vital Force, the real seat of life and of disease, and the only proper Object of Treatment; its Sufferings, i,e, so-called “Symptoms,” Cure. pages 67 to 70, 7 to 18.
Chapter IV.-How Drugs Cure. Pages 70 to 76, &n 19 to 34.
Chapter V.-Disease versus Disease; Unlikes and Likes. Pages 77 to 91, aphorism 35 to 52.
Chapter VI.-The Methods of Medication, viz.: Allopathic, Antipathic or Enantiopathic, Homoeopathic. (Etymology.) Exposition. Pages 91 to 104, aphorism 53 to 71.
Chapter VII.-The Study of Diseases, Acute and Chronic, and their Management. Pages 105 to 111, aphorism 72 to 82.
Chapter VIII.-Examination of a Patient with Acute, Chronic, or Epidemic Disease. The “Genius Epidemicus.” The “Genius Chronicus.” Pages 111 to 119, aphorism 83 to 104.
Chapter IX.-Agents of Cure; the Study of Drug-Effects; “Primary” and “Secondary” Effects; Provings and Cures; Idiosyncrasies; Individualization; Conduct of Provings; a True Materia Medica. Pages 119 to 135, aphorism 105 to 145.
Chapter X.-Practical Directions and Suggestions; Selection of the Homoeopathic Remedy; Similitude of Symptoms in”Totality;” in “Characteristics;” Drug-Action during Treatment; Dosage; Drug- aggravation; Question of External Treatment; Management of Drug- Remedies; “Local Diseases;” Antecedents; The Three Miasms of True “Chronic Diseases;” Previous Allopathic Treatment; other circumstances. Pages 135 to 157, aphorism 146 to 209.
Chapter XI.-Special Mental Symptoms; Insanity: Paroxysmal Diseases (Intermitting, Recurrent, Alternating); Intermittent Fever, etc., Cure. Pages 157 to 170, aphorism 210 to 244.
Chapter XII.-Additional Practical Directions; Management of Cases and Remedies; Dosage; Repetition; “Favorite Remedies.” Pages 170 to 177, & 264 to 271.
Chapter XIII.-Pharmacy; Selection and Preparation of Medicines. Pages 177 to 179, aphorism 264 to 271.
Chapter XVI.-The Single Remedy; The Minimum Dose; Proportional Effect of Various Doses; Dynamic Nature of Drug- Effects; Forms of Administration; Susceptibility of Living and Diseased Parts to Drug-action; Transmission of Effects, by Sympathy, to Other Parts; The Use of the Skin as a Channel of Medication, etc. Pages 179 to 186, aphorism 272 to 292.
Chapter XV.-(Restored to place); Mesmerism or “Hypnotism,” (“Suggestive Therapeutics”); with Notes. Pages 227 to 230.
Chapter XVI.-Notes upon the General Text. Pages 187 to 225.
Index. Pages 231 to 244.
PART II.-After the special part just discussed the next is AEtiology. No one doubts the importance of this, and it night seen sufficient here to name it as essential in a complete course on Clinical Medicine in any college of any school.
In Homoeopathy, however, it acquires extraordinary importance, inasmuch as a successful prescription so often pivots upon the clear perception of causes, often remote in time and recondite in nature. Ever alert, ever suspicious of this, we should be!.
I recall a most important case of metrorrhagia. Large sums of money, spent in both medical and surgical endeavors, and years of time, had brought the patient to feel that the pursuit was well nigh in vain, when a Homoeopathic physician in Heidelberg, Germany, inquiring into the antecedents of the attack in the beginning, elicited the fact that it began after bathing in icy cold water, six years before, on the coast of Maine. Cure was then promptly initiated by giving Rhus tax., 1x, twice a day, on this exact indication.
Previous abuse of drugs is a common aetiology. Cathartics, mercurials, and quinine are every-day drugs, and the recognition of their part in complicating, and even in originating, disease symptoms, is our daily duty, Besides, the latent remains of the original maladies, require treatment. Dr. Raue insists upon and initial dose of Nux vomica, after prior Allopathic treatment, in every case.
A strain years ago, or a wound of nervous tissue, or an old bruise may, when recalled, be of prime significance, demanding a corresponding remedy, as Rhus tax, Hypericum, of Arnica.
Constitutional hindrances often requires the interpolation of Sulph, Calc. etc.
To ignore causes is, in our school of practice, to tie our hands behind us and to insure many failures.
In this connection, “Baffling Causes” deserve special notice, for, by these our best work may be, and sometimes is, spoiled. Thus, bad nursing, disobedience to orders, and many things of detail may ruin an otherwise good cure. As a glaring example, a young man, the subject of gonorrhoea and under Homoeopathic treatment, but, preparing for a pharmacy examination, was required to taste some thirty different drugs within a few days; got worse, naturally, but did not think to mention it until many days afterwards. Many such cases occur.
PART III.-Physiological, pathological, diagnostic, pathognomonic, pharmacodynamic, prognostic, therapeutic. Also, dietetic, curative, toxical, pathogenetic, and surgical.
This is the most essential of all studies in the practice of medicine, and as above outlined, most comprehensive. It belongs exclusively to no one school, and deserves universal prominence in the college curricula and in medical writing. The writers recognize this, but no college does it even scant justice. In Homoeopathy, above all, it is the sine qua non, and at least as much time should be given to it as is assigned, for instance, to the study of Obstetrics.
The above order is planned for a graded course. The pathological, the pharmacodynamic, and the prognostic divisions require subdivision, thus; The first two into “general” and “special;” the last, the prognostic, into prognosis; of natural diseases, of the action of remedies, and of the interaction of both.
Considering these divisions seriatim, we note:.
1. Physiological Symptomatology.-This is simply a narrative of abundant life, with its conditions, causes, susceptibilities, and powers. Its “totality” is the rule of comparison for all the rest, and should be ever before the mind of the thorough physician, as mens sana in corpore sano. Deviations from this standard are Diseases. A few lectures under this head, following the “schema” of Hahnemann, viz.: the anatomical and physiological order, would be fruitful of intelligent interest in the subsequent study of abnormal symptomatology, whether natural or of drugs, artificially applied. It is in the physiological field that symptom-interpretation should begin, and it should thenceforth never be neglected.
2. Pathological Symptomatology is as yet taught only incidentally in the lectures on “Practice of Medicine,” and in connection with the special diseases discussed. Even if there be a separate chair of pathology this is now held to mean tissue- change, plus bacteriology, almost solely; hence, symptomatology comes to be regarded by the student as inferior, and later on he will he heard denouncing the fine art of “symptom-hunting”-for “fine art” it is.
One pathological specialty is characteristic of Homoeopathy, viz., “chronic miasms,” according to Hahnemann. Chronic diseases, when transmitted to offspring undergo “potentization” in successive generations; resulting in latent, but all-powerful poisoning; whereby family life is more and more vitiated. Family similarity is often available in choosing remedies for one after another of its members. For the symptoms, see Hahnemann’s Chronic Diseases, vol., i., also the Organon.
As the medical mind is now constituted, even among the Hahnemannians, there are many important symptoms in any “totally” which are overlooked in the selection of the remedy, or at least belittled, until their significance is demonstrated by physical exploration. Thus, a physician prescribing for a neuralgic rheumatism of the left thigh found no suggestion in a co-existing trivial complication, viz., a semi-occasional slight back or cough, until, being requested to “sound the lungs,” he discovered (only) a blowing sound in the mitral region of the heart, due to an unsuspected and incipient endocarditis. Thereupon the whole malady acquired a new character and the curative remedy was speedily found by the totality of symptoms, before unseen, viz., Aconite.
In a similar but older case the cough remained uncured and very troublesome until the totality was added to by a cholera morbus, requiring Arsenicum. After this drug the cough also got well, but the pathological suggestion, when offered, was resented, as tending to “wreck true Homoeopathy.” Yet this is truly symptom-hunting of the best type.
In pathological symptomatology, also, the Hahnemannian schema is our best guide, and a good repertory is the ever-ready handbook for its orderly and interpretative study. The best for this purpose is that found in Jahr and Possart’s Manual, and which should be separately bound. Its introductory comparisons of drugs, antidotes, etc., come into play at a later stage of the same studies.
The detail of symptoms as here given is both comprehensive and suggestive, and may be extended at will. Bath “general” and “special” pathology are here represented. However,this book needs to be supplemented by the works of Tanner, Findlayson. etc., on “Clinical Medicine;” for this is what it is, and this phrase will be a proper title of the full professorship of this whole subject. As all professors should hold clinics, the title must no longer imply a faculty scapegoat.
The interpretation of symptoms here finds a special function, of course; but a warning is required-not to spin cobweb theories therefrom unto vague pathological prescribing.
Interpretation of symptoms relates to the following subjects, viz.:.
1. The nature of the morbid process; as, hyperaemia, active or passive; cardiac tone, or atony; connective-tissue growth; parenchymatous inflammation; suppuration; reflex nervous states, etc.
2. Lesions of function.
3. Tissue-lesions, e.g., of epithelium; of nerve substance, etc.
4. Gross lesions of organs, e.g., heart, kidney, etc.
Each of these classes is, to the experienced therapeutist, at once suggestive of a group of remedies bearing pathogenetic and therapeutic relations thereto, as judged by provings and by clinical observations. Yet the physician must never be dominated by past experience, but ever push forward in fresh research.
Hahnemann’s Chronic Miasms and Modern Pathology.-A pertinent question here is, how does Hahnemann’s doctrine of Chronic Diseases appear in the light of modern pathology? Are his “three chronic miasms” thereby consigned to oblivion as the “disorderly fancies of the master’s senility?” Or do they appear therein, in a new dress, irradiating the field of current literature, and giving inspiration to current practice? First, is “repelled psora” a whim, of a grave pathological fact? Second, is constitutional syphilis a mere illusion, or a terrible reality? Third, is “sycosis,” or systemic gonorrhoea, the conceit of a narrow doctrinaire, or is it a sad fact in the history and in the pathology of modern diseases?.
One modern word will embrace the whole of these, namely, “septicaemia”; duration, or chronicity, is, then, the only thing left to question. Its prevention demands one prime condition, whatever its form, viz., absorption; and, again, this is the sure consequence of nondrainage. Add to this the local use of absorbent lotions, ointments, with frictions, plasters and all conditions of systemic poisoning are met. “Repelled eczema” (the “itch,” or “psora” of Hahnemann’s day) has, in my own experience, been immediately followed by hydrocephalus; everybody knows the syphilitic taint; and Ashhurst’s Surgery is good authority for the reality of gonorrhoeal septicaemia, or pyaemia.
All authors of our day confirm the Hahnemannian doctrine of repelled or absorbed organic poison. Advanced anatomy elucidates it. The “superficial cutaneous lymphatics” lie just beneath the epidermic cells, open between them, and communicate by perforating the cutis with the deep lymphatics, thus furnishing a direct route to the circulating blood, and to every living cell in the body.
Microbes are the elements of mischief according to modern views; but the facts, as clinically seen by Hahnemann, were just as real as now, and were the sound basis of his theory, and the perfect justification of his practice and of his advice. Even his nomenclature, antique though it may be, when technically understood, is no worse than the modern; e.g., “amyloid,” etc.
The chronicity of psora, or septicaemia, using the modern phrase, and its protean expression, to many unfortunate surgeons in our day, who have been victims of “blood-poisoning,” are indubitable facts. Certainly, such may well be Hahnemannians. General loss of vitality and susceptibility to morbid influences and processes, so graphically described by Hahnemann in volume one of the Chronic Diseases-these have since been their constant experience. See also a quotation from Reynolds by Prof. L. L. Danforth, TRANSACTIONS of the American Institute of Homoeopathy, vol., 1892, page 267, in “Antisepsis in Obstetrics”.
Some years since the writer contributed to the Transactions of our Pennsylvania State Society a paper, in which the unity of origin of all constitutional taints was considered at length from the standpoint of evolution.
Action and Reaction.-No range of doses monopolizes either the “primary” or the “secondary” effects of a drug; nor are the “double and opposite effects” ascribed to all drugs to be wholly found in the action of opposite grades of dosage, large and small. Nevertheless, it is true that large doses display the primary in a far greater measure than do the small, whilst in regard to the secondary effects the predominant display is just the reverse. Primary action is the attack of an enemy. Secondary action is the repulse of that enemy. In both are signs of battle- i,e,. symptoms.
The primary effect, in the language of Allopathy, is called “the physiological action.” This being transient, is regarded as of little or no specific individuality or significance for any given drug; yet in such quarters it is held to be the only possible medicinal action of any drug, to be maintained by ever- increasing doses, according to the surgical idea. From this point of view, the doses, as well as the specific individuality of Homoeopathic remedies, are absurd beyond description.