The second method of comparison consists in writing the symptoms, especially the emphatic or characteristic ones, of the two chosen drugs, in parallel columns, upon foolscap paper, under the usual rubrics, and in such a way that those opposite to each other shall relate to the same subject, and shall thus display their similarity or antagonism in a striking and practical way. In this arrangement, the usual anatomical order of the Materia Medica as prescribed by Hahnemann, is the most convenient. Gross’s comparative Materia Medica is the type of this method. Lippe, Hering, Morgan, Farrington and others have extended the work, and in journals, etc., have further illustrated the method.
The Materia Medica of A. Teste, M.D., of Paris, translated by Hempel, hot now out of print, is a good example of the comparative method of study, upon Hahnemannian principles. Recent studies of Epiphegus and of Latrodectus, by Dr. S.A. jones, are also models in their way; having a pathological bent (American Homoeopathic Observer, etc.).
The “clinical method” of comparison, herein discussed (see Therapeutic Symptomatology), and also Boenninghausen’s last division, “Relationship,” may here be added.
The literature of our Materia Medica is now ample. The works of Drs. C. Hering and T.F. Allen stand first, without doubt. Next, that of Dr. A.C. Cowperthwaite. Many of the older physicians still rely upon Jahr’s Symptoms Codex, and Lippe’s work; Hering’s Condensed Materia Medica is satisfying to many of the juniors.
The Pharmacodynamics of Dr. Richard Hughes, like his Therapeutics, is well suited to those who, having a knowledge of Old School medicine, but believing in Homoeopathy, seek to enter upon its study and practice, as novices.
PART VI.-“Clinical Therapeutics,” or the “Homoeopathy of Experience.”.
Here, as always, Hahnemann and his Organon are first. His Aphorisms of the Treatment of Chronic Diseases, collected by Dr. S. Lilienthal, and published not long before his death, in The California Homoeopath (1889), under the title, Catechism, is of great importance, and should be printed in book form. So also is the first volume of his Chronic Diseases. All invite and deserve careful research and study.
Again, an easy his teachings, by Dr. C. Hering, entitled, Hahnemann’s Three Rules, is of immense practical value. It was published in volume one, number one, of the Hahnemannian Monthly.
Verification of Provings is a leading part of our clinical study. A certain amount of scepticism of the reliability of the pathogenetic records prevails, and is natural enough; whilst, in a convert from ancient medicine, it is of times debilitating and painful. All evidence of the truth of these is therefore of the greatest value. Every symptom and symptom-group confirmed at the beside by successful practice thus becomes a permanent addition to our therapeutic wealth.
In connection with the question of reliability of symptoms, in our Materia Medica and Repertories, most physician doubt the “pure provings,” as to which symptoms are due to the drug under trial, and which to the environment, or, above all, to the subjectivity of the prover. This is quickly answered; every symptom in a proving is a composite of all three of these factors, in varying proportions. But so, also, are the clinical symptoms, in every case of disease we are called to treat; and the “similarity” of the curative drug must be found in all of these three lines, if we arrive at the similimum. Lack, in either line, impairs the validity of the selection. Even the very personal trails, the texture and color of skin, hair and eyes,a re significant; much more, the passing sensations, even if trivial.
Secondly, other sceptics are concerned as to the inclusion of symptoms in the Materia Medica and repertories, which, being observed in the sick, have disappeared after the remedy under consideration has been taken. This question is to be settled only by critical observation. Our best and most experienced prescribes testify that so far from being deceptive or unreliable, these symptoms are often of the most characteristic nature. That they have not yet appeared in a proving does not invalidate this, and this appearance, some day, must be expected.
Dr. Hering humorously said: “Such symptoms are like children, well born, but coming into the world by a breech- presentation”.
Thirdly, other sceptics insist that either class of symptoms, if separated from their natural and observed grouping, and succession, are meaningless and useless. The answer is, that in pathological studies this is partly true; but that pathological studies are inadequate in prescribing, and that we are largely dependent upon pure symptomatology, in its most primitive form, at the besides.
At the last, the testimony of experienced prescriber must decide this question also. Hering, Boenninghausen, Jahr, Lippe, Dunham, Guernsey and a host of others have found that this theoretical and aesthetical objection is unpractical and misleading at the beside, and that such symptoms are valid, and do not disappoint the user of them.
“Cured symptoms” are recognized by most physician as bearing the very best credentials, but only an abundant experience can enable one to say that in new and strange combinations, or even standing isolated, they remain true to nature, are true and essential segments of a natural whole, and are reliable in drug selection. Experience, however, is too unanimously in favor of this conclusion to permit of further doubt, with all deference to those highly esteemed colleagues who hold the contrary view. Not yet found in a proving in a healthy body, Nature’s law predicts and requires that some day they shall so appear; and if already in a pure proving, also, the evidence becomes final.
Rank of Symptoms.-One of the practical difficulties encountered in the practice of Homoeopathy is the maze of symptoms, seemingly of equal value, of which every “totally” is composed, both in the chronically sick and in the provings-the materia medica. There are three methods, or systems, in vogue of the practical solution of this difficulty. Individual physicians combine these, at will:.
1. The pathological method, in which the provings are subjected to diagnostic grouping in advance, and the symptoms of the patient after similar diagnostic and pathological collation are compared, as a whole, with the pathological symptoms-groups in waiting in the materia medica.
2. The key-note or “characteristic” system. The latter term is Hahnemann’s own. The former phrase is, to the disease caused by any drug, somewhat as is the word “pathognomonic” to an idiopathic disease; it names the drug; subject, however, to exceptions. In other words, it is super-characteristic: it stand at the head of the characteristics of that drug, with which the whole drug-tune harmonizes, and is almost always found in the cases cured by that drug. And it is often irrelevant to any noble organ;; is, indeed, often trivial, apart from its drug identification. We owe the term and its application mainly to Dr. H.N. Guernsey.
3. The system of graded rank of symptoms. Thus, of all clinical indications, the highest rank is conceded, in a general way, in acute cases, to the latest symptoms. In chronic diseases, however,-not their acute outcroppings, which resemble other acute cases, and include recent drug-effects-in pure and simple chronic errors-the highest rank belongs to the long-suppressed skin affections, believed to be the rot of the whole. After these, the symptoms of the noblest organs take rank and precedence in the picture-the “totality”.
Lastly, the psychic symptoms-intellectual, moral, and emotional, with the will, plus and minus, outrank, ceteris paribus, all others in both acute and chronic diseases.
Heredity becomes, often, the ranking indication for drug- selection and for hygienic measures. And it is here needful to say that, in the view of modern pathology, the scrofulous taint, a form of “psora,” is little else, to use the phrase of Dr. F.F. Maury, than “quarternary syphilis.” The skin-clinic of Professor Duhring, in the University of Pennsylvania, has confirmed this view, to which he assents. A child, born with syphilitic pemphigus, for instance, and “cured” by routine treatment, reappears at two and a half years of age with scrofulous sore eyes, etc., to other known aetiology existing.
Pregnancy-the ante-natal period-is the right time to begin the cure in such cases, judging of remedies by the symptoms of the mother, and of the other children if any there be, and of the father also. After birth, continuous and strict Homoeopathic auspices are necessary to fit the young person to produce healthy offspring, and to live in health to old age.
Ante-natal treatment of a child is also the mother’s opportunity; for she, herself, is the prime field of curative activity, in which her child, as part of hers simply shares.
In girls and boys, the ages of teething and of puberty, and the years, more or less, before and after these periods, offer special opportunities of constitutional and radical treatment by the methods of Hahnemann.
All of these are in the line of physical evolution. The edge of involution, also-called, in women, the climacteric-is truly held to be “the critical age,” when chronic taints, with special symptoms, often seek to reassert themselves. Then, we should be prepared to give them the coup de grace.
Nosodes; “Isopathy.”-The virus of any disease producing such material, according to Dr. Hering and others, is, when potentized, a similar, not identical, remedy to the same. Others insist on the identity; hence reject this sort of therapy as isopathic (isos, equal; pathos, disease). Hering, however, by proving these on healthy persons, established their right to a place in the Materia medica and defined their particular indications; for instance, Lyssin, the attenuated virus of hydrophobia, which has a wide therapeutic range (see Guiding Symptoms). Tuberculin, too, is our ancient possession.
Dr. Samuel Swan, not hesitating to push this idea, extended it, with provings, to preparations of milk (Lac), human and other; to beef (Carnis bovis); to sugar (Saccharum officinales); to oatmeal (Arena), and many others; given versus cravings, repugnances, and ill effects alike; asserting great clinical success.
Typical Drugs.-Whilst individualization is the invariable duty of the physician in treatment, it is restful and helpful always to initiate this mental process from an anchorage in the consideration of a few pathological drug-types; thus in dysentery one must instantly perceive the type in Nux vomica and Mercurius; in pneumonia, Bryonia, Phosphorus, Tartar emetic, etc.: in acute fever, Aconite; yet none of these may be finally selected. Nevertheless, they were as fixed points whence we can the more readily proceed in comparison and differentiation.
A small Domestic Practice, by Samuel Morgan, M.D., may be recommended to beginners for this precise purpose. It can be carried in the breast-pocket.
Special Drugs.-Two common drugs (and doubtless many more) are of special interest, owing to the fact that they cure, on the one hand, certain perilous states, and, on the other hand, they severaly control some common and troublesome but merely inconvenient conditions. These two drugs are Aconite and gelsemium. Aconite is the remedy for profound, acute congestion, even with loss of consciousness. it also cures nervous anxiety, unwillingness to tell symptoms, omodynia, etc. Gelsemium cures scarletina, with stupor and sudden outcries from ear-pains; also mild but active delirium in typhoid states. Again, it helps in neuralgia of the cervical plexus, in gastralgia, and in alcoholic and other forms of insomnia, viz., the “wide-awake” kind.
These two drugs often follow each other very well, and so are especially “complementary.” They outflank and overlap the spheres of many other drugs, performing their apparent but mistaken duty. Thus after failure, in children’s diseases, of Chamomilla, Bryonia, Podophyllum, etc., Aconite has repeatedly cured. Years ago, Dr. C.J. Hempel so taught; but he wrongly substituted Aconite-mother-tincture of the root-for proper attenuations of true curative and “similar” drugs, and reaction and neglect followed. Gelsemium often supersedes Mercurius, Pulsatilla, etc.
Yet another drug deserves a special place, viz., Mercurius. Most of its uses are well known. One, little if at al recognized, is in that mild but depressing periostitis which remains often after internal diseases. The ribs, the bones of the head or face, the coccyx, or the edges of joints, are tender on pressure with the thumb mail. Mercurius cures.
Hering’s Analytical Therapeutics-particularly its sections on “Mind,” and on “Typhoid Fever,” are types of Homoeopathic clinical study. Hering’s and Horne’s Materia Medica cards or similar ones, home-made, are partly “clinical” in origin and character, and are very helpful for self-quizzing; having characteristics printed or written on one side, and the name of the drug upon the other.
Farrington’s Clinical Materia Medica is substantially Dr. Hering’s teachings interpreted and extended by an able, young and enthusiast6ic editor. Happy it is for Homoeopathy that he lived and taught and wrote!.
Dr. Carroll Dunham performed a similar office for his teacher, von Boenninghausen, besides much original work. His Homoeopathy, the Science of Therapeutics, is one of our “sacred books”.
The Pocket Repertories, both of Jahr and of Bryant, quite diverse in plan, and now nearly or quite out of print, were exceedingly useful. Jahr’s Clinical Guide, so-called, is founded upon the former, edited by Dr. S. Lilienthal.
Lilienthal’s Clinical Therapeutics is an extension of the Guide, so far as concerns the detail of known drug indications, in particular diseases; is thus well-suited to recent converts, and to beginners generally. A repertory of the “symptoms” is greatly needed.
Hering’s Guiding Symptoms, in ten volumes, is the most complete and reliable summary of Homoeopathic experience and of verified provings, in existence. Among our English colleagues, the method itself is disapproved; they preferring pathological prescribers, it has proved an essential aid. The author was, through life, wont to record the symptoms of his cases and when these disappeared after a well selected remedy, that fact was noted by means of his colored pencil. In constructing his book the varying phraseology of many different patients in describing the same symptom, has been largely preserved; enabling the reader to study drug characteristics from so many sides, as to give assurance of exact meaning in each instance. For example, see the “rattling respiration” of Tartarus emeticus, in this work.
Now whilst this method is, as already shown, not above theoretical and scientific criticism, it is, to some mental organizations, indispensable. Therefore, let us be devoutly thankful for its existence.
Dr. T.S. Hoyne’s Clinical Materia medica, after the plan of Renckert’s Therapeutics, affords a vast mass of experience, which might now be much extended. Such books ever need an Index and Repertory to be quite available. Allen’s Index is often essential.
Hale’s New Remedies contains much valuable, but largely empirical information.
Raue’s Annual Record of Homoeopathic Practice; also his Pathology and Therapeutic Hints, afford a rich field of clinical study.
Guernsey’s Therapeutic key is really a condensed pocket summary of all the authorities, and its many editions prove its necessity.
Our numerous monographs on special diseases, of which the type is “Bell on Diarrhoea,” etc, are justly held in high esteem.
Gentry’s Concordance Repertory affords a rapid alphabetic reference to clinical and proving symptoms, and their remedies.
A number of systematic text-books on Practice, Surgery and Obstetrics, are published within our ranks, and are worthy of attention.
The Repertories and the Materia Medica are here, as they everywhere, in place.
Lastly, our numerous journals, and society Transactions, are full of therapeutic experiences of moment, which well employ the leisure of post-graduates, in with other literature.
True Homoeopathy has nothing to fear, and everything to gain by clinical study.
Besides “Bell on Diarrhoea,” etc., we have others in the field of the Specialties; on the Nervous System, the Eye, Ear, Nose, Throat; Genito-Urinary Organs; Disease of Woman; of Children; of the Rectum, Hemorrhoids, etc.
Diagnosis has too much hindered our progress here, by apparently demonstrating lesions hopeless of medical cure; but the Homoeopathic of forty years ago must have cured them; for these patients had a wonderful fashion of getting well. membranous dysmenorrhoea, ovarian tumors, endometritis, cancer, etc., were cured. Just before the death of Dr. H.N. Guernsey, a great cure of the first-named malady was effected by me, through his counsel; and I have witnessed much more of the same kind, and so have others.
Original Work.-Such work as this is identical with that of the founder and the pioneers. Expressed in scientific form, it belongs to the department of Original Work! This it is that has furnished School, the so-called “usual symptoms,” by which they always hasten to their prescriptions, and earn their money; and which are literally their “stock in trade;” they being personally incapable of the said “original work;” and who habitually sneer at their benefactors.
The Cyclopaedia of Drug Pathogenesy, as condensed, synoptical work, recently published by the joint efforts of the British and American national societies, supplies a former lack in this line, and with its Repertory will undoubtedly advance us in the future without superseding books.
Reading Between the Lines.-This is a common exercise of the human intelligence, since not all things are as they seem. In the repertory and in the Materia Medica, interpretation is often needed, in order to get the just meaning of a symptom; it may say too much, or too little. Rash interpretation must be avoided, but the mind should be on the alert in this way. For instance, Dr. Lippe complained to Boenninghausen that “aggravation by wearing the hat” was not to be found in the extant edition of his Pocket Book. His reply was: “Yes, it is necessarily included in ‘worse by covering the head.'” Such reading between the lines is always in place.
Again, Gelsemium produced intestinal symptoms under depressing excitement; but it has been successfully applied when no intestinal symptoms were present.
Dr. Hering, being a Swedenborgian, laid stress upon a branch of this subject, falling under “the doctrine of correspondences.” A special thought of his was, that certain persons correspond to, and represent certain animals of known physiology and habits and symptoms. Thus, a hog, human or other, will grovel in the dirt; and Sulphur presents a physical, and hence, a psychical affinity to both and thus a physiological and pathological adaptation to both.
Again, long before Schussler wrote he has said, “Wherever an inorganic substance exercise a physiological function in the nutrition of the tissues, there it is sure to be an important remedy in sickness.” (Sulphur in all albuminoid tissues) He compared people who cannot vomit with the horse, which also cannot vomit. In the language of Evolution, this kind of correspondence would be called “physiological homology.” Hausmann, Schussler, Grauvogl, Morgan have pursued this subject in old publications.
Dr. Samuel Freedley informed me of his curing himself of an “old man’s ulcer” of the leg by Tarentula cubensis. I reasoned that an animals so low represents degraded human tissue, and is homologous with low disease-changes. Hence I have used Cimex with benefit, in ulcer of the rectum, and Apis in gonorrhoea, etc. All of which is “reading between the lines”.
The germ-doctrine as related to Homoeopathy has agitated many among us. The first impression of such was that it might render infinitesimal doses in germ diseases absurd, indeed, and that the rational treatment of such diseases must needs be germicidal. Diphtheria, in particular, was the field of conflict; for the Hahnemannians held their ground by faith and cured their cases, as before, with the similimum.
The latest light of bacteriological science fully justifies them. It is now determined, firstly, that, internally at least, germicides are improper; secondly, that healthy blood-serum and other fluids of the body destroy the life of the disease-germs, and that then the white globules devour and digest them; thus, thirdly, the one thing needful above all the versus germ diseases is to maintain or to restore the vigor of the organs and tissues which generate these germicide fluids and globules continuously during life. This is the special office of Homoeopathic medication, supplemented by hygienic care. Doubters may now rest in peace.
The “orificial philosophy” in medicine. The surgical successes of this new element in the healing art have done much to divert Homoeopathic physicians from their own specialty and to aid in the dominance of “the surgical epoch.” This is scarcely necessary. Many orificial lesions are still amenable, as they have always been, to Homoeopathic remedies skilfully chosen and administered.
Our present concern is the recognition of the inlets and outlets of the body as special disease foci. An old doctrine is here brought prominently into view but in a new dress, in a new light and with great extension, viz., vital sympathy. Not alone the sympathetic nervous system, but the spinal reflex system as well must be considered in this philosophy; and both not only as to the motor reflexes, but also as to reflex sensation and functions, and trophic or nutritive reflexes affecting the most remote and diverse tissues and organs.
In looking over our written notes of former cases we are struck with the many anomalies-not always paralleled in the Materia Medica-in all these particulars which have distressed the patients and distracted the doctor. And now the orificial philosophy has come to teach the profession how in grasp and utilize these and give them a natural grouping; to “read between the lines” in this new direction, and to aid the Homoeopathic physician in exposing the occult “totality of symptoms” to objective recognition by eye tests, by the rectal speculum, and by all the modern methods of examination.
Me thinks Hahnemann himself would delight in these were he with us, and would insist that our drug-provings be perfected by like means, that our selections might be more and more precise. No one more than he has valued positive objective demonstration of morbid alterations, but in his day this way sadly restricted by the limitations of general knowledge. Let our future prescribing intelligently reflect our present advantages!.