Homoeopathy claims to be “the Science of Therapeutics.” This claim involves the assumption that prior to the establishment of Homoeopathy on a scientific basis, Therapeutics, as a science, had no existence. It is incumbent on Homoeopathists to show the justice of this assumption. To accomplish this it will be necessary to prove that such a science is possible, to demonstrate what its nature and conditions must be, and to show that medicine hitherto has not furnished the means for the construction of a science which fulfils these conditions.
It is the object of this paper, first, to discuss the nature and conditions of the only possible science of Therapeutics, to show that these conditions are not fulfilled by what is called rational medicine, and to inquire in what degree they are fulfilled by Homoeopathy. And, second, to examine the methods by which this science may be most successfully studied and made subservient to the practical art of medicine.
But on the threshold of the discussion we are met by the necessity of defining the term Therapeutics. It will be found that, though still sufficiently comprehensive, it is used by us in a much more restricted sense than that which, in popular thought, is attached to it.
Therapeutics being etymologically the science of curing diseases, it would seem to comprise the entire function of the physician. It is evident, however, on slight consideration, that the medical man in general practice brings into requisition too great a variety of scientific knowledge to admit of comprehension under a single term. To show how great this variety is and at the same time to give an indirect definition and limitation to the term Therapeutics, let us analyze a series of cases which shall not be ideal cases, but drawn from records of actual practice.
The physician is called in haste to an elderly person whose only intelligible complaint is of great anguish in the precordia, and which appears by its violence to endanger his life. If he be in immediate danger of death, the state of his affairs renders it desirable that his family should be informed of the fact and how long he will probably live. The prognosis is demanded and its correctness is a matter of great importance. The medical man must rely on his knowledge of Pathology* [Throughout this paper, as always by its author, Pathology is used with a meaning totally distinct from that of Pathological Anatomy. The former is the science of morbid processes and functions and is abstract; the latter is the science of morbid organs and tissues and is concrete. A corresponding distinction obtains between Physiology which is the science of healthy processes and functions and Physiological Anatomy, which is the science of healthy organs and tissues] for a conclusion respecting the nature, cause and probable termination of the disease. With this, if it be a fatal case, the function of the physician ends. Yet how important may this function be to the survivors! Here is as yet no question of Therapeutics. It is merely a problem in the natural history of disease which the physician regards just as a Naturalist would a problem in Physics, and just as if the idea of curing disease had never entered the head of man.
Again, he is called to a man who lies in an epileptiform convulsion. It is well known that convulsions may arise from the most various proximate causes. They may result from physical irritation of the nervous centres or of the extremities of the nerve-filaments, and in this case they will cease to recur so soon as the cause of irritation is removed; or, on the other hand, from modifications of the vital functions, such as are beyond our observation and which we can rectify only indirectly by the action of specific agents. The first problem before the physician is to determine by a study of the phenomena which the patient presents, to which of these great classes the case before him belongs. It is indispensable to determine this question, because the treatment of the case must depend directly upon it — in the former case it may be mechanical or hygienic; in the latter it must be therapeutic. He determines, we will suppose, in the case before us, that the convulsion is eccentric in its origin and reflex in its nature, and he sees reason for suspecting that it depends on some cause of irritation in a nerve-filament of the lower extremity. He seeks, in the history of the case, and by a physical examination for this irritating cause, and discovers that the patient had, years ago, received a gunshot wound in the thigh. There is no evidence that the ball was ever extracted. A close examination seems to confirm the conjecture that it still lies embedded in the muscles of the thigh. An exploratory operation is performed and the ball is actually found lying upon a branch of the sciatic nerve. It is removed and the patient has no more convulsions.* [This occurred in the practice of a distinguished Surgeon of Massachusetts.]
In this case the physician's knowledge of pathology enabled him to discriminate between the varieties of convulsion as to their proximate causes; his acquaintance with physiology familiarized him with the phenomena of reflex-nervous action and enabled him to detect the seat of the irritation, and finally his dexterity in practical surgery placed it in his power to cure the patient of a dreadful malady. But, in this case from beginning to end, Therapeutics were not call into play.
Again, the patient, a child of two and a half years, is subject to epileptiform convulsions, which occur daily, often twice a day. They first appeared when the child was fourteen months old and soon after it was weaned. They are now producing a very sad effect upon the child's intelligence. The same question of proximate cause, which the last case gave rise to, suggests itself, first of all, to the mind of the physician. Careful investigation satisfies him that there is probably a constant or a frequently repeated source of irritation in the digestive apparatus. What so probable cause of irritation in these organs as improper food? The question is put at once, “What food does your child take? Nothing whatever, except molasses cake and milk. How do you make molasses cake? Three cups of flour, one of butter, one of milk, one of molasses, one egg and a teaspoonful of pearlash! Very bad for your child! Give it good wheat bread and milk and nothing else, except this powder” (of sugar of milk as a placebo). The diet of the child is thus reformed, but no medicine is administered and the case is carefully watched. For one week the spasms steadily decrease in frequency and in violence, at the end of that period they cease and they never recur.* [This case occurred in 1857. There has been no recurrence of spasms. The child on good diet is healthy.] Thus an abnormal state of things, which would certainly have had a fatal issue, is rectified by the application of a knowledge of Physiology, Pathology and Hygiene; but Therapeutics has no part in it.
Errors in diet being perhaps the most numerous of all of which the community are guilty, instances like this might be accumulated to an indefinite extent. It is clear that a large part of a medical man's practice is made up of similar cases, and consequently that a great many serious cases may be successfully treated without recourse to medicine — without the aid of Therapeutics.
Again, a patient presents herself with the following history: Within three months she has rapidly emaciated; her sleep is disturbed, her appetite gone; she has night-sweats, is prone to diarrhea; takes frequent deep inspirations, which fatigue her; has a dry, hacking cough; complains of extreme weakness and despondency. A careful physical examination fails to discover organic disease of thoracic or abdominal organs, nor does an investigation of her domestic or social relations disclose any source of mental or affectional anxiety. The case is perplexing as to its inducing cause, and the physician inclines to ascribe it to dynamic causes and to have recourse primarily to specific remedies for its cure — in other words to call Therapeutics to his aid — when he discovers that the patient is nursing an infant of twelve months. Her milk is very abundant, but a microscopic examination shows that it is extremely deficient in oily matter. It is now clear that the patient is unequal to the drain to which nursing subjects her; she is suffering from consequent anaemia. It is ordered that she wean her babe at once. As soon as she does so, appetite returns, the cough and night-sweats disappear, and strength and flesh are restored. Now it is true that, in such a case, the decline of vigor may be retarded and after weaning, the restoration may be accelerated by a judicious application of Therapeutics; but it is unquestionably true that Therapeutics would play a very subordinate part, since no administration of medicines could be an offset to the drain which is exhausting the patient.
In cases of similar exhaustion, facial Neuralgia of a regularly intermitting character sometimes occurs and bids defiance to Therapeutics, the patient meanwhile declining rapidly in strength and health until, medicine being perhaps altogether discarded, but the patient induced to wean her infant and thereby enabled to take hearty food, strength and flesh return, and the Neuralgic pains cease. In this case, also, the restoration may be accelerated by a judicious recourse to Therapeutics, but here too Therapeutics must be subordinate to Hygiene.
Once more, a patient, who exhibits signs of depraved nutrition, complains of a burning pain under the angle of the right scapula, with a tight aching across the back between the scapulae. I fear that repeated prescriptions will fail to relieve this burning pain unless the physician's knowledge of pathology shall have suggested to him that the symptoms result ultimately from a too steady use of the needle with too rapid a motion, and unless his skill in Hygiene shall have enabled him so to order her mode of life as to combine due recreation and exercise in the open air with her necessary labor. Here, as in other cases, Therapeutics may of course come in and play a subordinate part.
Finally, a patient has severe darting and aching in the shin, especially at evening, with coldness of the extremity, and, after the pain has lasted an hour, great sensibility to touch, relieved by warmth and by continued motion. This case has been treated by a variety of Therapeutic agents in the hands of several learned practitioners, but with no success. It is noticed that the patient, in the course of his business, incurs great exposure to dampness and cold. A woollen stocking is advised, and he enjoys ever after adopting it almost complete freedom from suffering, and which is rendered absolutely complete by a few doses of Rhus tox. It must be remarked that this remedy had been previously administered in every variety of potency and dose.
Instances of a similar character to these might be indefinitely multiplied. They go to show — not that medicines are vain or unnecessary — but that very many cases of severe suffering and even of what threatens to become fatal disease occur in general practice, which call for and are successfully met by the application of scientific knowledge apart from Therapeutics. They show that an extensive and thorough knowledge of Physiology, Pathology and Hygiene are indispensable to the physician, to enable him to make that preliminary analysis of a case by which he shall determine under what category the case belongs, and whether or not it calls for treatment by medicines in part or entirely, whether it comes under the domain of Therapeutics or not. They show, moreover, that, in as much as Homoeopathy directly involves the science of Therapeutics alone, there is a large field which is occupied and cultivated in common by Homoeopathists and practitioners of the old school. They serve in part, also, to mark the boundaries of that field in which “Rational Medicine” may legitimately claim dominion, in which her chief honors have been won, and in which the great advances which she boasts of having made in the treatment of diseases within the last thirty years have almost exclusively been achieved — the field of Hygiene. It is fitting that we study for a few moments this territory of Hygiene which is common to practitioners of all the varieties of Therapeutic faith and practice; this science on which, together with the science of Therapeutics, the whole art of medicine is based; its subjects, limits, conditions and mode of growth.
The Nature and Limits of the Sciences of Hygiene and Therapeutics. — The living organism possesses a susceptibility to the action of certain general stimuli such as light, heat, electricity, aliment, atmospheric air, etc. The action and reaction of these stimuli and this susceptibility are the conditions of life. So long as they act upon it in a due relative proportion as regards intensity and quantity, the equilibrium of the functions is preserved and the organism continues in healthy action. The absolute withdrawal of one of the stimuli for any considerable length of time results in death. A disturbance of their due proportion in respect of intensity or quantity produces an abnormal performance of function in the organism — a deviation from health — disease. But these stimuli are continually varying in proportion, or, in other words the relative susceptibility of the organism is continually changing. Why does not disease constantly exist? Because the organism is endowed with either a faculty of provisionally supplementing to a limited extent one stimulus by another or with a kind of elasticity, a power of enduring for a certain time a disturbance of the equilibrium of these stimuli, and. of rebounding to a normal performance of functions again so soon as the natural proportion of the stimuli is restored or the deficiency made up. In this respect the living organism differs from an inorganic machine which cannot, in the nature of things, possess any power to endure a disturbance of that equilibrium of forces which is the condition of its normal working, without a disorganization from which it has no inherent power to recover.
But, in the organism this elasticity has its limits. This “vis medicatrix natures” is not inexhaustible. If the due proportion of the stimuli remain too long disturbed, the functions of the organism become permanently deranged — at least to such an extent that no restoration of the balance of the stimuli will cause a return to their normal performance. The functions are and remain deranged — disease has occurred; or, if we choose to call every deviation from a state of equilbrium disease, then we may say that now disease ensues which has no tendency to revert to health, without the intervention of some extraneous influence foreign to the organism and different from the general stimuli aforesaid. Since, then, the general stimuli will not bring back the organism to a healthy action, a new element must be sought for and introduced, the action of which upon the susceptibilities of the organism may cause a restoration to health. This new element will be a special stimulus. Being foreign to the organism and different from the general stimuli, not only must it act upon susceptibilities in the organism which the latter do not awaken — but the formula which shall express its relations to those susceptibilities, and which shall furnish the rule for its employment, can never be discovered by a study of Physiology, for Physiology concerns herself with the relations of the general stimuli aforesaid and the general susceptibilities of the organism. This formula of the relations of special stimuli and special susceptibilities can be discovered only by the application of induction to a multitude of instances of the action and reaction of such stimuli and susceptibilities and confirmed by subsequent deductive verifications. This formula will constitute an empirical law, which will be the law or fundamental principle of Therapeutics. For the application of special stimuli to the diseased organism is the domain of the science of Therapeutics, while all that concerns the restoration and maintenance of a proper equilibrium of the general stimuli appertains to the science of Hygiene.
These propositions may be more intelligible if illustrated by a reference to daily experience. A healthy man is exposed to an unusual degree of cold; in other words, there exists for him a deficit of heat, one of the general stimuli which are necessary to maintain life. Nature has anticipated variations in the supply of this stimulus from external sources by her liberal provisions of calorific apparatus within the organism. Despite the operation of this provision, he is chilled and suffers from rigors, etc. After a time he seeks shelter, sits by a fire, takes a warm drink; in other words receives from external sources an excess of that general stimulus from deficiency of which he has been suffering. His functions resume their normal play. He is in perfect health. Here the equilibrium of the functions has been disturbed and (if we use terms with extreme rigor) disease has been produced, but not to a degree beyond the provision of the vis medicotrix noturoe, the natural tendency to a restoration of the balance of the functions. The case was treated upon “general principles” in accordance the maxim causa sublato tollitur effectus. And this maxim represents, in fact, the great law of Hygiene, viz.: that it be ascertained what stimulus has been deficient or excessive in quantity or abnormal in quality and that the equilibrium of the stimuli be restored.
But let us suppose that the same man has again been exposed to cold, perhaps to a greater degree. He seeks shelter and essays to restore the lost heat, but without avail Despite the fire and warm drinks, the rigors continue and are succeeded by fever and quickened respiration, cough, etc., or by rheumatic pains, redness and swelling, etc. Why this difference between the cases? This case too has been treated on “general principles” The cause has been removed, why has not the effect ceased? The equilbrium of the general stimuli has been restored and the loss made good, why is not the normal equilibrium of the functions re-established?
The normal proportion of the general stimuli, it is true, has been restored, but during the disturbance a new element had been introduced into the problem. The organism had suffered a dynamic and then an organic change. The functions are permanently modified. The general stimuli may henceforth be balanced never so carefully, and in strictest accordance with the rules of Hygiene; the organism will not respond.
Its functions are performed after a new fashion. The organs are not susceptible to the wonted stimuli applied according to the laws of Hygiene. The organism has passed from a state of health into one of permanent disease. The general stimuli which, modified and balanced under the laws of Hygiene, sufficed to steady it as it rocked and swayed in its rapid course along the rough and crooked railway of life, will no longer answer the purpose, for in its rocking it has run off the track and is now bumping along over the crossties, making headway it is true, but towards its own destruction. It needs now the intervention of some new agent acting under a new law — of a jack-screw and levers operated by forces from without — to reinstate it on the road of healthy action. The wonted general stimuli under the laws of Hygiene being insufficient, new stimuli of a special character must be applied according to a new law. This new law, whatever it be, is the Therapeutic law, and these new stimuli are Therapeutic agents and the study of the law, and of the agents constitutes the science of Therapeutics.
Having thus marked out its limits, we have next to inquire what the nature of any possible science of Therapeutics must be. Its subject is the modified functions and organs of the body. Its agents are special stimuli drawn from whatever region of the external world. By what sort of a formula can these agents be applied to that subject? Can the Therapeutist act on “general principles” as the Hygienist does? Can he act on the maxim causa sublata tollitur effectus! Obviously he cannot In so far as the cause of disease can be discovered in external influences, the treatment falls within the limits of the science of Hygiene as already discussed. In so far, however, as the cause of disease is identical with the essential cause of the modification of function or organ which we recognize as the disease, it can never be discovered for it is the same, in its nature, as the cause of healthy functional or organic action; in other words, it is life itself, the nature of which, as of every first cause is inscrutable. It being impossible then to ascertain the essential cause of disease, and to apply a remedy according to the rational method — as the Hygienist does — the Therapeutist is necessarily thrown back from an attempt to investigate causes, to the study of phenomena and to the adoption of the empirical method. In accordance with this method the subject of his researches will be respectively the phenomena manifested by the patient, and the phenomena produced by the special stimulus, and his endeavor must be to discover & general formula which shall express a constant relation between these two series of phenomena and shall serve as the Therapeutic law. In thus acting, and upon this method, he will do precisely what the student of every branch of Natural Science does and has done. For in his inability to find out the essential cause of the phenomena that form the subject of his study, the physician finds himself in the very same predicament as the Naturalist who likewise has vainly sought to discover the essential causes of the phenomena of gravitation, of light, of chemical action, and of electricity. As the physician is unable to discover the essential nature of life and organism, whether normal or modified, to ascertain the cause, of health or of disease, and is therefore unable to treat disease upon the principle “tolle causam” (except in matters of Hygiene as before stated), or “on general principles;” so the Naturalist has been compelled to abandon the rational method such as Aristotle proposed and philosophers elaborated up to the time of Bacon and Newton, and to adopt an empirical method in which the fundamental principle is an empirical law or generalization expressing the relation between two series of phenomena. The science of Physics, for example, consists of the phenomena respectively of two bodies, or series of bodies, so far as density and volume are concerned, and of the law of gravitation which expresses the relation between these respective phenomena.
The Therapeutist, then, abandoning all idea of constructing a science of Therapeutics on the rational method, must have recourse to the empirical as the elaborators of other natural sciences have done. The elements of his science will be as follows: He has to deal with a subject known by its phenomena — the sick body; with an agent known also by its phenomena — the drug; and with a law which shall tell how to apply the agent to the subject for the accomplishment of a cure — a law which shall express the general relation between the drug and the morbid organism.
The following tabular statement will show more clearly the nature of Therapeutics as a science and its harmony with other Natural Sciences; for every Inductive Natural Science (except those of classification) consists elementarily of two series of independent phenomena, connected by the formula of their general relation:
|Morbid Functions & Organs Or, Pathology and Pathological Anatomy, Or, Sick-Phenomena,||Therapeutic Law.||Toxic Functions & Organs, Or, Pathogenesis & Pathogenetic Anatomy. Or, Drug-Phenomena.|
|Phenomena of the Sun, as regards Volume and Density,||Law of Attraction,||Phenomena of the Earth, as regards Volume and Density|
|Properties of Potassa,||Law of Chemical Affinity and Definite Proportion||Properties of Sulphuric acid|
|Properties of the Luminious Body,||Law of the Diffusion of Light.||Properties of the Light-receiving body.|
Though thus simple in theory, Therapeutics is in reality the most complex of all the natural sciences. Each of the classes of phenomena requires for its study the aid of several auxiliary sciences. Thus, in order to know thoroughly the phenomena of disease, we must call to our aid Anatomy and Physiology, Chemistry, Physics and Psychology. To know and understand thoroughly the phenomena of artificial disease or pathogenesey, we must avail ourselves of the same auxiliary sciences. The more imperfect our knowledge of these sciences, the less complete will be our acquaintance respectively with the phenomena of Pathology and Pathogenesy and the converse. But, however complete or partial may be our knowledge of these two classes of phenomena, the relation between them, as known, remains the same and is always expressed by the therapeutic law. The same is true of Physics and of all the natural sciences. Our knowledge of the physical properties of matter is continually increasing. The more complete it is the more exact will be our application of the law of attraction. But complete or incomplete the law is equally applicable and pro tanto available.
The Conditions of a Science of Therapeutics. — We come now to consider two conditions to which every natural science must be subject, and which may therefore serve as tests of its fitness to be regarded as a “Science” The first of these is a capability of infinite progress in each of its elements without detriment to its integrity as a whole. — We have already seen that the science of Physics is capable of such progress in the phenomena with which it deals. (Our knowledge of these phenomena is continually growing more comprehensive and more minute, and new elements of knowledge are continually coming into our possession with regard to them; yet their relation to each other through the law of attraction remains the same, and the science in its nature and structure receives no modification. But not only are its subjects, the phenomena, capable of progress; the law itself may advance from a minor to a grander generalization, as it was advanced step by step, by Newton, and still without destruction of the previous steps. The same is true of Chemistry. As our means of investigation become more exact and extensive, our knowledge of the properties of bodies increases; yet the law of Chemical Affinity in definite proportions remains undisturbed. Furthermore, this law itself becomes the subject of more extended generalizations. The law as established by Black and Cavendish was suspended, yet not overthrown (nor the science disturbed) by the wider generalization of Dalton's Atomic Theory; and this again forms but a part of Faraday's Theory of the Identity of Chemical Affinity and Electrical Attraction, and amid all these revolutions in abstract theory, the science of practical Chemistry has held an even way.
In the science of Optics, again, the phenomena of the luminious body and those of the light-receiving body are connected by the law of the transmission and diffusion of light. This structure of the science and all that is based upon it, rests undisturbed through all the mighty changes which recent discoveries have wrought in our knowledge of Optics — enriched but not revolutionized by them. But while the progress of the science has been thus rapid and uninterrupted, philosophers have been and remain at variance respecting the very nature of light and its mode of propagation. One school holds to the theory of emission; another to the undulatory theory. Now, let us suppose that the science of Optics instead of being based upon an empirical law, the result of induction, and which expresses the relation between two series of observed phenomena had been based upon a theory of the essential nature of light and its mode of transmission. It is very evident that the whole structure that might be built upon the theory of emission would be toppled over so soon as the theory of undulation should be established. And should subsequent observation again lend countenance to the theory of emission, down would go, of necessity, the whole science as built upon the undulatory theory. And, thus, inasmuch as experience and sound philosophy render it tolerably certain that we shall never attain absolute knowledge on this subject, we should have, through all time, an endless succession of half completed fabrics and hopeless ruins, but no infinitely progressive science of Optics.
This furnishes an exact illustration of what would be the history of any science of Therapeutics not constructed upon the empirical plan already elaborated. Let us suppose that instead of taking as the subject of action, the phenomena of disease as derived from observation with all the aid which auxiliary sciences can afford, we should take a theory of disease — its essential nature and mode of development — and upon this theory should construct a science. All would go wall, until facts should show that our theory was insufficient and untenable (and facts would show this since, as we have already seen, the essential nature of disease is inscrutable). Now our whole structure would be overthrown, nor would the fragments even be available for the construction of another science on another theory, for they would consist of observations made, not independently, but on the basis of a theory and with reference to it There could thus be no possibility of steady, uninterrupted, infinite progress in the science. There would be a succession of dynasties of theory, each based on the overthrow of a former, and each in turn demolished by its successor. That this is the history of the Therapeutics of the old school of medicine up to the present day is admitted by common consent. It will continue until attempts to erect a rational science of Therapeutics upon a theory of disease, confounding the law with the phenomena, shall give place to the construction of an empirical inductive science.
“What then!” it may be asked, “shall we not investigate and theorize upon the nature of disease in general, or of diseases in particular?” By all means investigate and theorize just as physicists do upon the nature, properties and transmission of light — but do it as studying the science of Pathology, not that of Therapeutics — and avoid most carefully, making these theories which can be at best no more than temporary aids to the observation and grouping of phenomena, the basis of a practical science. If, however, they throw light on the study of phenomena, render our observations of them more keen and more exact, or afford no connecting links between isolated groups of phenomena — and they will do all this — they will render valuable indirect aid to the science of Therapeutics, just as similar investigations of light have advanced our knowledge of Optics.
A second condition or test of a natural science, and therefore of any proposed science of Therapeutics, is that it shall provide for the prediction of future events within its own domain. It must furnish means of prevision. The problem must be as follows: Given the law and one series of phenomena, to state the corresponding series of phenomena on the other side. This condition is admirably stated by Whewell: “Men cannot help believing that the laws laid down by discoverers must be in a great measure identical with the real laws of nature, when the discoverers thus determine effects beforehand, in the same manner in which nature herself determines them when the occasion occurs. Those who can do this must to a great extent have detected nature's secret — must have fixed upon the conditions to which she attends and must have seized the rules by which she applies them. Such a coincidence of untried facts with speculative assertions cannot be the work of chance, but implies some large portion of truth in the principles on which the reasoning is founded. To trace order and law in that which has been observed, may be considered as interpreting what nature has written down for us and will commonly prove that we understand her alphabet. But to predict what has not been observed, is to attempt ourselves to use the legislative phrases of nature; and when she responds plainly and precisely to that which we thus utter, we cannot but suppose that we have in a great measure made ourselves masters of the meaning and structure of her language. The prediction of results even of the same kind as those which have been observed, in new cases, is a proof of real success in our inductive processes ”Whewell Philosophy of the Inductive Sciences, Vol. II, pp. 64, 65.
The discovery of the planet Neptune by Leverrier and Adams affords an instance of this prevision, in Astronomy, the details of which are familiar to all. The problem was: Given the law of attraction and a series of phenomena, consisting of certain unexplained perturbations of Jupiter — to find the other and corresponding series of phenomena. The calculations were made; the resulting phenomena were stated to be those of an undiscovered planet of a given size and orbit and a definite location, the existence of which was accordingly affirmed and its discovery predicted. Physical investigation confirmed the induction.
This condition applies to all natural sciences, and of course to Therapeutics. The problem would be: Given the Therapeutic law and a certain series of phenomena of natural or drug-disease, to find the corresponding series of phenomena of drug or natural disease.
Does “Rational Medicine” Fulfil these Conditions? — This being the nature and these the conditions and tests of the only possible science of Therapeutics, we come now to inquire whether the old-school Therapeutics are of this nature or will sustain these tests. The works of the foremost men of the old school abound in admissions of their lack of a Therapeutic law and of the chaotic state of their practice. See Forbes, Bennett, Tod, Holmes and others. But the efforts of these men to remedy this sad state of things show a constant misapprehension of the philosophy of the science they are striving to construct.
We may divide old school Therapeutics into two methods. The one bases the plan of cure upon a theory of the nature of the disease,*[Thus Prof. Geo. T. Elliott in his recent Valedictory to the Graduating class at Bellevue College Hospital says: “In these wards, by those bedsides, hare you seen the patient application of the searching analytical laws by which we seek to discover the essentiality of disease.”] endeavors so to study the pathology of the disease as to form a sound hypothesis of its modus operandi and then essays the cure upon “general principles.” It undertakes in fact to act in Therapeutics upon what we have seen to be the true method in Hygiene. There are three objections to this method, any one of which would be conclusive were there not a prior difficulty in the simple impossibility of arriving at a knowledge of the nature of disease, which is modified life. A simple example will show this impossibility. In Pneumonia, the blood contains an excess of fibrine. How happens this? Why, either the elimination of fibrine has been retarded or its fabrication has been accelerated. What are the agents of these respective processes? Cells — which are essentially similar in all parts of the body — and yet whose structureless walls possess the power of separating from the circumambient fluids the most diverse substances in different organs, nay, even of manufacturing new substances. Now, until we can learn the secret of this mysterious power of the cell-wall, which begins and ends with life, which we can neither comprehend nor imitate nor simulate, we shall not-arrive at an understanding of the nature of any disease.
Of the other objections to this method the first two are somewhat paradoxical. The method constitutes rather a congeries of sciences of Therapeutics based on theories of isolated groups or types of disease, than a single, all embracing science founded on one comprehensive theory of disease. Hence a new science must be formed for every new type. It is too special. On the other hand, it is too general to embrace all the phenomena of each individual case. For observation shows incontestably that, so great are the varieties of temperament and relative organization and condition among men, that no two cases of the same disease, so to speak, are exactly alike.
Such a Therapeutics must be necessarily based on a theory which is a generalization and which therefore overlooks those phenomena of a given case which are peculiar to the individual patient and takes cognizance only of those phenomena which are common to a great number of cases. Now a method which requires such generalization and makes no provision for the strictest individualization is radically vicious.
The eye of science regards natural phenomena with the most absolute impartiality. In her view there are no trifles no events, subjective or objective, which are “irrelevant” and “of no moment.” A method of Therapeutics, however, which selects a few symptoms, calls them pathognomonic of Pneumonia, constructs upon them a theory of the disease and from this deduces a mode of cure, must disregard many phenomena of every individual case. It arbitrarily pronounces them “accidental” — but Nature knows no accidents.
So far is this method from meeting the requirements of inductive science, that it is not too much to say that this process of generalization actually leads to the treatment of cases which have no real existence and never had any, in fact, to the treatment of abstractions. For who ever saw a case in which none but the pathognomonic symptoms of Pneumonia were present — or of Rheumatism or Dysentery? Who ever saw ideal cases of these diseases? We all see cases which present the pathognomonic symptoms plus certain others peculiar to the individual, but these vary with the individual and thus make each case different from every other. We see and treat the Pneumonia or Rheumatism of John Doe or Richard Roe, each of which presents, in addition to the pathognomonic signs of the disease, certain peculiar modifications impressed upon these signs by the temperament and idiosyncrasies of these persons, along with with other symptoms peculiar to each. For such an individualization of disease as would give equal (or, as they deserve higher) rank to these peculiarities of the individual patient, the method under consideration makes no provision. This fallacy was perceived and well exposed by the Leipsic Professor, who recently exclaimed to his class: “Gentlemen, we have to do with patients and not with diseases”
The next objection to this method is that it does not fulfill the first condition of a physical science. It is not capable of infinite progress. This point needs no elaboration. It was fully considered when the condition was stated. In confirmation of what was then said, I need only refer to the successive rise and decline of Brunonism, Broussaisism, the humoral and solid pathology, the theory of the dyscrasias and the reign and decadence of Iron, Iodine, Cod Liver Oil, etc.
The second method of Old School Therapeutics is the Methodical which discards theory and founds its rules for treating disease upon numerical data obtained from observation or by experience upon the sick.
Given records of three series of cases, 1000 in each, and under three modes of treatment. Under treatment A 500 recovered; under B, 300; under C, 200. A is adopted as the established mode of treatment for the disease — “Risum teneatis, Amici?” An elaborate criticism of this method is unnecessary. It is enough to say that it does not fulfill either condition of a physical science. It is incapable of infinite progress. The addition of 500 cases to the 3000 above named might modify all conclusions and place treatment C in advance of A or B. There would result a complete revolution in practice and in the direction of investigation.
But it utterly fails to enable us to foresee and provide against new forms of disease. If a thousand or two of cases must be seen and experimented upon, in all conceivable ways, before definite and trust-worthy conclusions as to the best treatment can be arrived at, who would not pray that his turn might come among the third or fourth thousand? Who would not pity the victims among the first thousands?
Notwithstanding these obvious objections, this method of constructing a science of Therapeutics upon observation, whether at random or based on experimentation upon the sick, has the sanction of some of the highest names in the profession — among which it is sufficient to name Louis and Forbes. It demands therefore a more extended consideration. As it involves the application of both Mathematics and Logic, the opinion of the highest authorities in these respective sciences should be conclusive as to the soundness of the method and we content ourselves with quoting two of them:
M. Auguste Comte, one of the first living mathematicians and who would therefore be disposed to apply mathematical methods to the natural sciences wherever this were possible, expresses himself in the following manner concerning the numerical method in medicine:
“Indeed, the spirit of calculation tends in our day to introduce itself into this study (Physiology), especially into that part of it which relates to medical questions by a far less direct method under a far more deceptive form and with infinitely more humble pretensions. I wish to speak of that assumed application of it which is called the Statistics of Medicine, from which so many savans expect great things and which, from its very nature, can lead only to profound and direct degradation of the medical art (which would be reduced by it to a method of blind enumeration). Such a method, if we may be allowed to call it by the name of method at all, cannot in reality be anything else than absolute empiricism, disguised under the frivolous garb of mathematics. Pushed to its extreme logical consequences, it will tend to make all rational medication radically disappear from medicine, by conducting the practitioner to make random trials of certain therapeutic measures with the object of noting down, with minute precision, the numerical results of their application. It is evident, on principle, that the continued variations to which all organism is subject, are necessarily more pronounced in pathological than in a normal state, and as a consequence of this fact, the cases must be even less exactly similar, whence results the manifest impossibility of making a judicious comparison between two curative methods derived from data, furnished by statistical tables alone, independent of some sound medical theory. No doubt some direct experimentation, restrained under proper limits, might be of great importance to medicine as well as to Physiology, but it is precisely under the strict condition that it shall never be merely empirical, but shall always attach itself either in institution or in its interpretation to an entire system of corresponding positive doctrines. Notwithstanding the imposing aspect of the forms of exactness, it would be difficult to conceive of an opinion in Therapeutics more superficial and more uncertain than that which rests solely on the easy computation of fatal and favorable cases, to say nothing of the pernicious practical consequences of such a manner of proceeding, when one could not beforehand exclude any kind of attempt.
It is really deplorable that geometricians have sometimes honored with some kind of encouragement, such a profoundly irrational aberration by making vain and puerile efforts to determine by their illusory theories of chances, the number of cases sufficient to make these statistical results legitimate.” — Cours de Philosophie positive par M. Augusts Comte, Tom. III, pp. 418, 420.
And with a direct reference to the method of obtaining a correct system of Therapeutics by experimenting with individual medicines and individual cases of diseases, and forming of the results statistical tables from which deductions are to be drawn by the numerical method, the highest modern authority in philosophy, John Stuart Mill, speaks in his System of Logic (Harper's edition, 1848, p. 260). “Let the subject of inquiry be the conditions of health and disease in the human body; or (for greater simplicity) the conditions of recovery from a given disease; and in order to narrow the question still more, let it be limited, in the first instance, to this one inquiry — Is or is not a particular medicament (Mercury for instance) a remedy for that disease?
The experimental method would simply administer Mercury in as many cases as possible, noting the age, sex, tem perament and other peculiarities of bodily constitution, the particular form and variety of the disease, the particular stage of its progress. etc., remarking in which of these cases it produced a salutary effect and with what circumstances it was on those occasions combined. * * *
When we devise an experiment to ascertain the effect of a given agent, there are certain precautions which we never if we can help it, omit. In the first place, we introduce the agent into the midst of a set of circumstances, which we have exactly ascertained. It need hardly be remarked how far this condition is from being realized in any case connected with the phenomena of life; how far we are from knowing what are all the circumstances which preexist in any instance in which Mercury is administered to a living being. This difficulty, however, though insuperable, in most cases, may not be so in all; these are sometimes (though I should think never in Physiology) concurrences of many causes in which we yet know accurately what the causes are. But when we have got rid of this obstacle, we encounter another still more serious. In other cases, when we intend to try an experiment, we do not reckon it enough that there be no circumstances in the case, the presence of which is unknown to us. We require also that none of the circumstances which we do know of, shall have effects susceptible of being confounded with those of the agent whose properties we wish to study. We take the utmost pains to exclude all causes capable of composition with the given cause; or if forced to let in any such causes, we take care to make them such that we can compute and allow for their influence, so that the effect of the given cause may, after the subduction of those other effects, be apparent as a residual phenomenon.
These precautions are inapplicable to such cases as we are now considering. The Mercury of our experiment being tried with an unknown multitude (or let it be a known multitude) of other influencing circumstances, the mere fact of their being influencing circumstances implies that they disguise the effect of the Mercury, and preclude us from know whether it has any effect or no. * * *
Anything like a scientific use of the method of experiment in these complicated cases is therefore out of the question. We can in the most favorable cases, only discover, by a succession of trials, that a certain cause is very often followed by a certain effect.”
Has “Rational Medicine” Accomplished Nothing? — But it may reasonably be asked, can it be possible that a large number of men of every generation since Hippocrates, and among them some of the brightest intellects the world has known should have been engaged in the study and practice of medicine, with no better result than this — a simple vacuity? I admit the rare intelligence and devotion of the laborers. But, in the first place, the task is mightier than any other essayed by man; may it not reasonably require ages to complete its plan? Again, labor however intelligent and devoted, if misdirected, must fail of its end. If one generation of intellectual giants erect a towering fabric and their equally lusty successors demolish it, what does the third inherit save a heap of rubbish which it may require the best years of its life to clear away. Generation after generation of wise men labored to construct the physical theory of the universe, yet not until the recent day of Newton did we learn how to begin aright. True, Newton's predecessors from the earliest ages observed and stored away a mass of isolated facts of the greatest value, but they knew not the magic word wherewith to charm them into order. In like manner, it is not denied that we are indebted to our predecessors for a vast number of isolated facts of incontestible value as materials to be Used in the construction of a science of Therapeutics. We are indebted to them also for the elaboration of those subsidiary sciences — Anatomy, Physiology, Pathology, Chemistry and the like, in which, indeed, the great glories of the medicine of today have been won, and without which, we cheerfully admit, Therapeutics as a science could not exist.
But it is said that Therapeutics must have advanced in as much as the rates of mortality have steadily diminished. One sort of improvement we gladly acknowledge. Simultaneously with the spread of Homoeopathy, old school physicians began to learn to abstain from mischievous modes of treatment formerly pursued, and which terribly enhanced the natural fatality of diseases. Professor Bennett in the the introduction to his work on Clinical Medicine, specifies following diseases in treating which he says: “Great improvements have been made, and he adduces this as a a proof of the advancement of medicine, Apoplexy, Pneumonia and Pleurisy, Syphilis, Small Pox, Phthisis, Bright's disease and Favus.” A reference to the chapters in which ho treats of these diseases shows that he conceives the improvement in their treatment to consist in abstinence from methods which were formerly employed and which he clearly proves were very mischievous. For example, Blood-letting in Apoplexy, Pneumonia, Pleurisy, Phthisis and Bright's disease — the immoderate use of Mercury in Syphilis — heroic medication and external warmth in Small Pox, and avoidance of all internal medication for Favus which he conceives to be a vegetable parasite. This improvement then is purely negative, a very poor ground on which to claim positive advancement in the construction of a science, however deserving of the gratitude of suffering humanity. The formula for improvement of all kinds is, “Cease to do evil; learn to do well.” We admit that the old school are learning to obey the former, the negative clause. We invite them to advance and join us in the latter, the positive.
Again, an extended knowledge of the remote causes of disease and of the principles of Hygiene have enabled medical men to prevent the occurrence or the spread of many forms of disease. And far be it from us to undervalue, through any love of a newly constructed science of Therapeutics, this branch of a physician's function, the forestalling or arrest of maladies by Hygienic means. As increased knowledge in this department of science has enabled us to dispense with therapeutic agents in many cases in which they were formerly resorted to, so we firmly believe that, with the advancement of learning, Hygiene will more and more curtail the boundaries of Therapeutics until the day shall come when the physician shall be prized as the preserver rather than solely the restorer of health, and shall be consulted respecting the means of preventing rather than solely of curing disease, and the “family doctor” shall be regarded as the confidential adviser, valuable in proportion as he keeps his client out of bed, just as the family lawyer is confided in, for the purpose of keeping his clients out of court! In that day there will be fewer apothecaries.
Does Homoeopathy Fulfil the Conditions of a Science of Therapeutics? Returning now to our argument, we find that the field is open for a science of Therapeutics. In the light of what has been said we proceed to examine the claims of Homoeopathy to the honor of being that science.
In its structure as a science, Homoeopathy conforms to the model we have delineated. It consists of a law or formula which expresses the relation between two series of phenomena, those of a given case of disease on the one hand and those of a given drug-proving on the other. The elaboration of each of these series is the province of various subsidiary sciences, and they are analogous in their mode of elaboration. Each series, however, is entirely independent of the other. Each may be pursued independently, as a branch of Natural Science and under the heads of Pathology and Pathogenesy respectively, researches may be made in each without any view to a practical application in the cure of the sick. It is only when connected by the law of their relation (the formula of similarities) that they constitute the science of Therapeutics.
Their application moreover, in obedience to this law is based upon no hypothesis respecting the essential nature of either variety of phenomena or of their modus operandi where brought into operation. This may surprise some who know how earnestly Hahnemann argued on these very points in his Organon. But these arguments were no essential parts of his system. They were the results of an endeavor to commend his discovery to the prevalent way of thinking. They constitute the only controvertible part of his writings and are the only positions of his which have not triumphantly withstood the assaults of his critics.
Coming now to apply to Homoeopathy as tests the condition to which we have shown that every inductive science must conform, we find in the first place that it is capable of infinite progress in each of its elements, without' such progress involving the destruction or denial of what has been previously constructed or received. The study of the phenomena (whether of disease or of drug-action) was limited at first to the observation of external manifestations and subjective sensations as these might present themselves to our senses unassisted by any of the aids by which modern science has sharpened them, or to our minds unaided by that knowledge of the connection and mutual relations and dependences of symptoms for which we are indebted to modern discoveries in Chemistry and Pathology. But these advances in Pathology, great as they have been, have not altered the relation which the phenomena of natural disease bear to those of drug-disease. These phenomena respectively, whether rudely apprehended or clearly and fully understood in all their relations and inter-dependencies still bear the same relation to each other — expressed by the law Similia Similibus Curantur. And we can imagine no possible development of the sciences of Pathology and Pathogenesy which could alter this relation.
And then the law itself may be but a stepping-stone to a still wider generalization which shall one day embrace both it and something beside, and which shall make clear some things which we now see darkly. But should this occur, as the like has occurred in other Natural Sciences, there will be, there can be, no revolutionary action in it. It may be that the edifice, as we now occupy it, is still unfinished — it may be that other stories are one day to be added — but assuredly, as the tower is to the spire, as the buttress to the pinnacle, bo will this generalization be to that which may be constructed upon it — a basis — an indispensable first step in the construction of the science.
The complete manner in which the second condition, that of prevision, fulfilled by Homoeopathy is a source of inexpressible benefit to the race. It follows from the very terms of the science that if the phenomena of a given case of disease be known, the law of relation will at once point to the appropriate remedy (if this be contained in the Materia Medica) and this indication may be relied upon with implicit confidence, even though no such case of disease have ever heretofore been subjected to treatment. Conversely, when the properties of a given drug have been investigated and its toxic phenomena well ascertained, the physician is able to pronounce with certainty what form of disease it will cure, even though no such disease has ever been witnessed or treated by himself or by anybody. An illustrious example of this prevision was afforded by Hahnemann. The terrible fatality of Asiatic Cholera on its first invasion of Europe is well known. In extenuation of their lack of success, physicians of the old school pleaded that the disease was new to them — they had had no opportunities to study it and to ascertain by experiment the effects of remedies upon it. The plea was plausible, but fatal to the pretensions of their science. In fact it was good for nothing. For surely the first thousand cases should have afforded means enough for learning the pathology of the disease and how to cure it, if this were to be learned from Pathology. But hundreds of thousands perished and yet the percentage of mortality remained the same.
While the disease was still on the confines of Europe — before it had invaded Germany — long before either he or any of his disciples had ever seen a case of it, “Hahnemann guided by the unerring therapeutic rule he had discovered, at once fixed upon the remedies which should prove specific for it and caused directions to be printed and distributed over the country by thousands, so that on its actual invasion the Homopathists and those who had received Hahnemann's directions were fully prepared for its treatment and prophylaxis, and thus there is no doubt many lives were saved and many victims rescued from the pestilence. On all sides statements were published testifying to the immense comparative success that had attended the employment of the means recommended by Hahnemann before he had seen or treated a single case. This one fact speaks more for Homoeopathy and the truth of the law of nature on which the system is founded than almost any other I could offer, viz.: that Hahnemann from merely reading a description of one of the most appallingly rapid and fatal diseases could confidently and dogmatically say such and such a medicine will do good in this stage of the disease, such and such other medicines in that; and that the united testimony of hundreds of practitioners in all parts of Europe should bear practical testimony to the accuracy of Hahnemann's conclusions.” — Dudgeon's Lectures on Homoeopathy, p. 37.
We may add that in the second Epidemic of Cholera in 1849, the old school, despite their experience in 1831-34, had but little better success, while again the justice of Hahnemann's conclusions and the claim of Homoeopathy to that prevision which characterises a true science were vindicated by the splendid success of the homoeopathic treatment.
John Stuart Mill, in the portion of his work on Logic from which we have already quoted, in speaking of the three methods of investigation — that of observation, that of experimentation and that of deduction — after showing conclusively that the two former are inapplicable to medicine, speaks of the deductive method in terms which are (unintentionally of course, and for this very reason they are the more conclusive) a description of the philosophy of Homoeopathy. “If, for instance, we try experiments with Mercury on a person in health, in order to ascertain the general laws of its action upon the human body, and then reason from these laws to determine how it will act upon persons affected with a particular disease, this may be a really effectual method, but this is deduction”
III. How to Study the Science of Therapeutics. — The method of studying the two series of phenomena which, together with the law of relation, constitute the science of Therapeutics, follows from what has been said.
When first brought into the presence of a concrete case of disease, the business of the physician is to ascertain what branch of medical science he is called upon to exercise. Is the case one which requires Hygienic management or Therapeutic, or both, or is the patient beyond the reach of art? To answer these questions a diagnosis and prognosis must be made and to make these a knowledge of the remote and proximate causes, and of the course and termination of diseases is required. In a word a knowledge of Physiology and Pathology is indispensable on the very threshold of medical practice and before any question of Therapeutics has arisen.
When these preliminary questions have been settled and the case has been found to come within the domain of Therapeutics, its phenomena are to be studied in such a way that all deviations from a normal state may be perceived as well those which are common to a number of similar cases, as more particularly those which seem to be peculiar to the individual case in hand, and which therefore serve to give it individuality and to distinguish it from all other and similar cases. The case is to be then individualized as sharply as possible, and a complete picture of the morbid phenomena obtained in their natural groups and connections.
Now morbid phenomena are deviations from healthy phenomena. How can we recognize the deviations unless we are familiar with the standard? How can we appreciate morbid phenomena save through a knowledge of Physiology which is the science of healthy phenomena?
In like manner, we are able to get a complete picture of the morbid symptoms only by an orderly and methodical investigation; and such an investigation is possible to those alone who are familiar with the relations and sequences of morbid phenomena — that is to say with Pathology, A simple reference to practical experience will prove this. A patient complains of pain in her left hypochondrium, distress and faintness in the epigastrium, vertigo and various symptoms of dyspepsia but never thinks of mentioning — perhaps is unconscious of — certain evidences of uterine disease to which the attention of the physician is instantly directed through his knowledge of the connection and sequence of symptoms. So of the connection of certain forms of vomiting with disease of the brain or of the kidneys, etc., etc.
Clearly then Physiology and Pathology are quite indispensable to the physician, and they speak with little thought who affirm that these sciences are of no value to the Homoeopathist and are disregarded by him. They are the sciences respectively of healthy and morbid phenomena. He cannot take the first step in the study of disease or of Materia Medica save by their aid. But, he restricts them to their legitimate function. Pathology is for him not a guide in Therapeutics, but an instrument which he uses in studying those phenomena which are to be respectively the subject and the agents of his therapeutic operations.
Having, by the aid of Pathology, arrived at a complete and comprehensive knowledge of the morbid phenomena, he passes on beyond the confines of that science to a higher and more complex science, whose domain is the relation of the phenomena of which he has thus acquired a knowledge, with other phenomena. Through Pathology he learns to know disease, but it is through Therapeutics alone that he can cure it! And it is quite time that it were well understood not only by the profession but also by the public, that to know the nature and course of a disease is not of necessity to know how to cure it! It may be a necessary preliminary step — but it is nothing more. Nor is this true of medicine alone. My carriage breaks down, I well know where it has broken and why and how, yet this knowledge does not involve the knowledge how to forge and weld the iron that has broken and so to mend it. For that I require knowledge of another sort. The nature of Pneumonia, of Cholera, or Rheumatism is as well known as those of any disease can be; “their Pathology,” as Doctors say, “is well understood,” yet this gives no clue to their therapeutic treatment — it is no guide to the special stimulus which must be brought to bear on the diseased organs to lead them back to healthy action. This stimulus must by discovered by quite another method; its discovery is the object of a distinct process.
Thus Pathology restricted to its proper sphere is an indispensable auxiliary to the study of the subject of Therapeutics. It may be further subservient in enabling the physician to group the symptoms of a case in such a way as more readily to marshal and retain them in memory. Nor is generalization of this kind at all repugnant to the letter or spirit of Hahnemann's method or of homoeopathic science. The generalization to which Hahnemann objected was to that of disease in general upon nosological hypotheses made on theoretical grounds, and then applied a priori to individual cases. That to which we refer is a generalization made specially in each case, consisting of a grouping of connected symptoms under one general term and extending only to such pathological states as are well defined and constant, such, for example, as Anaemia, Plethora, the proportion between the affections of different parts of the nervous system, etc., under which we may group a number of generic symptoms to the great relief of our memory, while at the same time the individual or characteristic symptoms are not only not obscured by the process but are even brought more sharply into view, as will be evident when we consider this matter more at length under the head of the Study of the Materia Medica.
The Study of the Materia Medica. — The method by which any subject may be most successfully studied must depend on the use which is to be made of the knowledge thus gained. It is proper then to enquire at the outset in what way the knowledge of Materia Medica is to be made subservient to the treatment of disease.
In accordance with the homoeopathic law we select for the cure of each individual case of disease, that remedy of which the pathogenetic effects are most similar to the symptoms of the case. In the process of making this selection we must pass in mental review the various drugs which compose the Materia Medica, take a comprehensive view of the pure effects of each and institute a comparison between each in turn and the case for which we are prescribing. This is the theory of the process.
Now it is evident that, in order to select from a number of candidates one which most nearly resembles a given standard, we must be familiar, not merely with the general properties of all the candidates or of certain classes into which they may be divided, but also with certain properties more or less peculiar to each one of the candidates, and which shall serve to distinguish each of them from all the others. In fact our method requires the strictest individualization of both disease and remedy. We are so to study Materia Medica as, above all, to bring into strong relief and fix firmly in memory those peculiarities of each drug which are not met with in any other, and which therefore serve to individualize and give character to the drug that produces them and which are called its “characteristic symptoms“This term having been much and loosely used of late, it may not be unprofitable to devote a few words to the subject of characteristic symptoms.
By some writers the leading and most obvious and most frequently recurring symptoms are called characteristic. — Thus Bennett calls fever a characteristic of the Exanthemata. By others the pathognomonic symptoms of a class of diseases are called characteristic. By others the Pathological Anatomical.
Now the signification of such a word as characteristic is not absolute. It depends on the connection in which you please to use it and which is determined by the question ”Characteristic of what?“In the instances just adduced, the varieties of symptoms cited may indeed be called characteristic but — characteristic of what? Of classes (the Exanthemata) of groups (nosological) — but not of individuals. But the only sense in which Homoeopathists can use the term is in its application to individuals. Hence a characteristic symptom must mean one which is possessed by none other than the individual drug of which it is predicated, and to which therefore it gives character as an individual. In this sense it corresponds precisely to those features of a man by which his friends are enabled to distinguish him from other persons and to recognize him at a glance.
It is obvious that these characteristic symptoms so precious to the Therapeutist may seem to be of little or no pathological value — may even seem accidental to those who forget that there are no accidents in Nature. They would be valueless if we did not need to individualize but could be content with grouping our diseases and remedies.
To the Naturalist whose object it is to group his specimens, it is sufficient to know that John Doe has a vertebral column is a mammal, has two hands and is a Caucasian — because this enables him at once to place John Doe in the variety Caucasian of the species man, and his analysis goes no farther. From this his whole physiological status follows. But these items of general knowledge would hardly enable the sheriff to recognise John Doe in Broadway. It is of no importance to the Naturalist that he has such “accidental” peculiarities as an aquiline nose, black eyes and hair, and a brown mole on the left ala nasi; but these very peculiarities are all important to the sheriff, for they give him the means of detecting the object of his search upon the crowded street. It must not be forgotten, however, that the points on which the Naturalist laid stress are equally important to the sheriff; for if the latter should bear in mind only the individual peculiarities of the object of his quest and should forget that he is a Caucasian, he might find the former in the person of an Indian or if he should forget that he is a bimanous creature, he might arrest a monkey!
To drop the figure, then, it is evident that we must seek to discover among the symptoms of every drug certain ones that are produced by no other drug, and which shall serve to distinguish it from all other drugs similar in other respects; that these symptoms will often be unimportant and trivial in a physiological point of view; furthermore, that we must, for convenience sake, when the number of drugs in our Materia Medica has become considerable, endeavor so to group them, on the basis of certain clearly defined symptoms or collections of symptoms, that for the purpose of preliminary examination and comparison, these groups may be regarded and compared as though they were individual drugs.
Let us suppose a case of uterine hemorrhage. As many as forty drugs probably produce uterine hemorrhage. On the basis of this symptom they form a group isolated from the three hundred and forty remaining drugs of the Materia Medica. We select this group from the Materia Medica and now we must select a remedy from the group. It were a tedious task to consider and compare them one by one. But we group them again; ten of them produce dark colored and ten florid hemorrhage, ten a limpid and ten a clotted discharge. Our case has a dark colored discharge. Our choice is now restricted to ten drugs. But of the ten which produce a dark discharge only five produce simultaneously a congestive headache. Thus we are limited to five drugs. Thus far the distinctions on which our grouping has been based (or which have been characteristic of the groups) have had a pathological significance and importance. We can find no such basis for any further sub-division into groups. But we observe in the case a peculiar subjective symptom. The patient complains “as though a living body were moving through the abdomen.” This may seem trivial. It is equally however a symptom produced by Crocus which is one of the five remedies to which our choice had been restricted, and it is produced by no other drug in the Materia Medica. It is, then, a characteristic symptom of Crocus, enabling us to individualize Crocus and to distinguish it from all the other drugs which in many other respects agree with it.
It will be observed that dark colored uterine hemorrhage though produced by Crocus cannot be said to be characteristic of it. It is a characteristic symptom of a group to which Crocus belongs, but not of Crocus, for it is produced by the other members of this group as well as by Crocus.
Characteristic symptoms must of necessity be for the most part subjective and seemingly trivial phenomena. A list of them alone, if presented as the pathogenesis of a drug would be as meaningless and at first sight as ridiculous, as a list of the colors and marks, and angles and curves by which friends recognise each other would be if presented alone as the sum total of the properties of certain genera and species of the Animate Creation. As a background to the latter, there must be a series of phenomena capable of morphological and organic arrangement, and as the basis of the former we must have a series of objective and organic symptoms capable of physiological and pathological arrangement and of approximate explanation. But it must never be forgotten that without the characteristics, as we have described them, there can be no individualization and without this there can be no accurate homoeopathic prescription.
The truth of this is made apparent by a glance at the history of Homoeopathy. Certain of Hahnemann's followers discarded the apparently trivial subjective phenomena from the provings of drugs, retaining only the objective, organic symptoms. They thus lost the means of distinguishing between the individual members of the groups of remedies. It was thence-forward useless for them to discriminate closely between individual cases of any one type of disease. Hence inevitably arose the fashion of prescribing a specific remedy for a disease — as the phrase went — putting the leading members of respective groups of drugs and diseases to represent the whole groups. These were the so-called “specifikers” who had one or two remedies for dysentery, one for hooping cough, one or two for scarlatina, etc., “of whom the world is weary.”
But the characteristic is not always a definite symptom. Sometimes it is so as in the case of Crocus and as in the peculiar diplopia of Stramonium. But sometimes it resides in a peculiar condition which attaches to some symptom common to two or more drugs. This condition may be of time, or circumstance or concomitance. Thus if two drugs have the symptom “dry cough from tickling in the suprasternal fossa” — but to one is added the condition “occurring only in the evening” — this condition of time is the characteristic of that drug in so far as the dry cough is concerned — or if one have this condition of circumstance that “the cough is aggravated by inspiring cold air” — this condition is the characteristic — or if one have the concomitant that the cough is attended by retching — this condition of concomitance is the characteristic.
Every drug-proving then is to be studied in a two-fold way. — On the one hand, so as to enable us to attach it in our memory to certain groups of drugs to which it shows marked general resemblances; and on the other hand, so as to bring out clearly into view those characteristics which distinguish it from all the other drugs of these groups in particular and of the Materia Medica in general. Our study will be at once synthetic and analytic.
Such a study is of necessity comparative in its nature. Each positive step in the study of a drug involves a question of the correspondence or difference of other drugs in respect of that step. An isolated study of all the remedies would not give us an available knowledge of the Materia Medica. It is not enough to know that Pulsatilla, Nux vomica and Chamomilla each produce diarrhea of a certain kind. We must also know and fix in our minds the similarities and differences of each of these diarrheas to those of the two other and of all other drugs. The study of one drug if, in fact, then the study of the whole Materia Medica. One is never so competent to thoroughly master a proving as when he has already mastered all other provings. The first effort must necessarily be the least satisfactory, the most imperfect.
This is the task to which the student of Materia Medica is invited and at which his predecessors have been laboring for fifty years. Why, he may ask, has not this been wrought out and systematised by those who have gone before? Why is the Materia Medica left in the same state in which Hahnemann placed it fifty years ago?
Our Materia Medica consists of the provings of drugs upon the healthy, made by Hahnemann and his disciples. These provings, as we have them, are, for the most part, a formal arrangement of the symptoms subjective and objective observed by the prover or his friends. No attempt is made, with but few exceptions, to trace any pathological connection between symptoms, or to give any physiological explanations or to distinguish between characteristic and generic symptoms. The symptoms alone are given, just as the symptoms of a case of disease would be given by an intelligent but uninstructed patient who unfolds his case to us in as plain untechnical words as he can, leaving to us the task of tracing connections and contriving explanations. There they stand, records of facts made in the plain vernacular. intelligible so long as the language shall endure. But Hahnemann had a much higher idea of the kind of knowledge of Materia Medica which a physician requires than this statement would imply. In an Essay on “The Power of Small Doses,” in Hufeland's Journal, he describes this knowledge as follows: “What organs it (the drug) deranges functionally, what it modifies in other ways, what nerves it principally benumbs or excites, what alterations it effects in the circulation and digestive operations, how it affects the mind, how the disposition, what influence it exerts over some secretions, what modification the muscular fibre receives from it, how long its action lasts, and by what means it is rendered powerless, etc., etc.” Why then did he not construct his Materia Medica on this model? Unquestionably because, with a wonderful sagacity which together with his brilliant genius and his prodigious learning made him the “double-headed prodigy,” which Jean Paul Richter called him, Hahnemann clearly perceived the following truths: that the positive facts with which a physician has to deal in constructing a Materia Medica are the observations of the prover recorded in plain, unfigurative, non-hypothetical language. That the construction which he saw to be so desirable must be the result of the application of the sciences of Physiology and Pathology to these facts. That the facts of the proving being of the nature of positive observation are enduring and unchangeable. But that the sciences of Physiology and Pathology, being incomplete and progressive, are continually undergoing change and that their terms must therefore be ever varying in significance as the theories on which the sciences are based vary. That, consequently, a Materia Medica constructed by him out of these two elements, one constant and the other variable, would of necessity be transient — could not be enduring — would soon grow obsolete and in its decline would carry out of sight the constant element also, and thus the labor of the provers would soon be lost to the world. Such a structure would have involved an intermingling of the current physiological theories with the facts derived from observation. The precise point and extent of the intermingling would soon become undistinguishable and thus a vitiated record would be transmitted to posterity such as the advance of science would soon render useless. A comparison of the present state of Physiology with that of 1800, of which the very terms are almost obsolete, makes the great wisdom of this view apparent. On the other hand the pure records of observed facts, untainted by theoretical speculations, come to us from the Master's hand as pure, as intelligible, as available as when first recorded.
We have the same material for the construction of a physiological theory of the drug-action that Hahnemann had, and we can construct it with the advantage in our favor of the great advances which Physiology and Pathology have made since Hahnemann's day. This is the work which each of us must do for himself. No other can do it for him. The result of his labor may and will differ somewhat from that of every other student — for with the light of the auxiliary sciences he forms a judgment concerning observed facts — and the significance of a fact is measured by the capacity of the observer.*[Lest by an omission I expose myself to misconstruction, I may say that inasmuch as advances in collateral medical sciences are affording continually new aids to observation, it is incumbent on each generation to reprove to a certain extent the remedies of the Materia Medica so as to bring these aids to bear on the study of Pathogenesy.]
The Study of the Materia Medica Continued. — The student should seek his knowledge of Materia Medica at the fountain head, in the original publications of Hahnemann's Materia Medica Pura and Chronic Diseases in the provings in Stapf's Archiv and in the Austrian and other journals.
The Manuals, however convenient for reference in the hurry of practice are not suitable for systematic study. In some of them, the phraseology of the prover has been altered. In others, the symptoms, as reported by the prover have been arbitrarily sundered into fragments and these fragments are scattered throughout the record. Or symptoms ex usu in morbis have been introduced and the names of diseases supposed to have been cured by the drug are incorporated with the pure symptoms. In all of them, the arrangement is somewhat altered. In many, attempts at abbreviation have been made; and with no better success than if one should squeeze one's lemons to lessen the bulk of one's luggage and yet hope to have good lemonade at the end of one's journey; for it always happens, and must from the nature of the case, that the skins are the part retained while the juice is thrown away.
If a Manual must be employed, that of Noack and Trinks seems preferable; for it preserves the phraseology of the prover and does not to any great extent sunder groups of symptoms, while it places under distinct headings the pure symptoms, and the clinical effects of the drugs and the theoretical speculations of the compilers, so that the student is in no danger of mistaking the one for the other, a danger to which Jahr's Manual does certainly expose him, and for which reason Jahr's work is less desirable than that of Noack and Trinks.
We have dwelt at some length on the sources from which the student should seek his knowledge of Materia Medica — and with good reason! “For can a bitter fountain send forth sweet waters?” “Do grapes grow on thorns, or figs on thistles?” If the student should fall among false or incompetent teachers, could the doctrine and practice he learns be true and successful? Now it will be observed that the records of provings and the Manuals of Materia Medica to which we have commended the student are all German works, while nine-tenths of our American and English practitioners and students are unacquainted with the German language. It is humiliating to us to be compelled to say that there are no trustworthy manuals in the English language and no translations of the German works which we have named on which reliance can be placed. We have translations of Hahnemann's Materia Medica and Chronic Diseases and of Stapf's Contributions to the Materia Medica, by Dr. Hempel. But either (perhaps we should say both) from lack of moral capacity or of intellectual and professional acquirements, or from haste and carelessness, the translator has so marred these works by errors of omission and of translation that they are to the student and practitioner what false lights on a difficult coast are to the unsuspecting mariner.
Dr. Hempel translated also Jahr's New Manual or Symptomen Codex, and claims to have incorporated with it nearly all that is valuable in the Manual of Noack and Trinks, thus making it the most complete and perfect work of the kind in existence, and the best possible in the present state of our science. This translation was published with a preface by Dr. C. Hering and under the high sanction of his name and that of Dr. Gray, of New York. It is almost universally used in this country and in England, and the knowledge of the Materia Medica and of the true practice of Homoeopathy possessed by the rising generation of practitioners is, in the main, what this manual is capable of affording.
If now, I should say that this translation and compilation contains all the errors, omissions and perversions which rendered Dr. Hempel's former translations untrustworthy, along with many others peculiar to this work, I should surely hear in reply that Dr. Hering has expressly in his preface commended the diligence and accuracy and zeal of the translator, and I should be referred to page six of the preface (Jahr's New Manual or Symptomen Codex, pref. vi) where Dr. Hering is made to say, “the Editor has, with extraordinary minuteness and labor, compared the two manuals and has transferred to the manual of Jahr all additional drugs and pathogenetic effects contained in Noack and Trink's work.” What could I say in offset to this endorsement by Dr. Hering? There is a word to say on the subject of this preface. It was unquestionably written originally by Dr. Hering in German. The English translation, by whomsoever made, seems not to have been altogether satisfactory to Dr. Hering (as well it might not be), for the German original was published by him (a verbatim copy” as he says) in The Hom. Allg., Zeitung, Vol. XL, Nos. 23 and 24, February and March, 1851. The English preface to Jahr's New Manual differs from this German original far more widely than the license of scholarship will at all justify. In a foot note to the original of the passage we have quoted above in commendation of the Editor and translator of Jahr's New Manual, Dr. Hering says (Allg. Hom. Zeitung), “After comparison of the translation with the original, the above endorsment is hereby altogether and completely withdrawn.”*[Dies wird hiermit nach Vergleichung der Uebersetzung mit dem Original ganz und gar zuruckgenommen.] Thus, in an obscure foot note in a German periodical, seen by not more than one in a hundred of those American and English students who are induced by Dr. Hering's commendatory preface to place confidence in Dr. Hempel's translations and compilations, Dr. Hering vindicates his fame as a good scholar and a faithful champion of our science by withdrawing his commendation of Dr. Hempel.
If those whose confidence has been misplaced by reason of this endorsement in English, canceled in German only, should, with a measure of just indignation, demand of me why the retraction was not made in the language and in the country in which the commendation was suffered to be published — why Drs. Hering and Gray, acknowledged leaders of our school in America, did not suppress this so-called translation or expose its false pretensions, in words as intelligible and as widely read as those in which their support of it was permitted — Alas! I have nothing to say.
To plead that, in a matter which involves the education or perversion of a whole generation and the healthy progress and soundness of Homoeopathy wherever the English language is spoken, in such a matter the engrossments of business or tenderness towards a delinquent individual kept them silent, would be to cast a doubt upon the estimate in which they hold scientific truth, a doubt inadmissible in gentlemen of their position.
It avails not to say, why find fault with these translations and this manual, inasmuch we have no others. Had the unworthiness of these been made known, had they not, on the contrary, been endorsed by high authority, we had long since had others and trustworthy. An exposure of the imperfections we have spoken of would have created a demand for other works, and it is not less true in science than in trade that “demand creates a supply.”
Having selected a remedy on which to commence his studies, the student should gather together all the reports of provers whether in the form of their daily records, in which form our dear and lamented colleague Dr. Joslin published his admirable proving of Rumex crispus as did also the Austrian provers, or in the Hahnemannian anatomical scheme and should carefully peruse them. We will assume that he has selected Pulsatilla and will use this remedy to illustrate what we have further to say. We have no other proving of this drug than the very perfect one of Hahnemann in Vol. I of Mat. Med. Pura.
During the first perusal, and several may be necessary for the purpose, the student should endeavor to make a general analysis of the proving. This analysis would enable him to place the drug along with several others in one or other of certain groups into which he will find as he advances in his studies the Materia Medica arranges itself. Among the chief points of this general analysis will be the following:
I. Sphere of action in the drug. It will be seen that every drug affects some organs or systems of organs or tissues more decidedly than others. Pulsatilla, for example, acts preeminently upon the vegetative system, upon the organs of reproduction and their appendages and upon the composition of the blood, depressing the action of the former systems and producing in the latter a condition similar to that of one form of chlorosis. We learn these facts by bringing a knowledge of Physiology to bear upon and interpret the symptoms of the intestinal tract and of the urino-genital organs — those of the vascular system and the symptoms of the head and disposition. For in these we have retarded digestion, vertigo, audible pulsation of the carotids, momentary loss of sight and hearing on sudden exertion, palpitation, paleness, retarded and scanty menstruation with syncope and exhaustion; depressed melancholic disposition. On the other hand, the student will notice that Pulsatilla exerts but little action upon the bones, skin and glands, and this will be another important step towards grouping.
II. The extent to which the organic substance is affected. From some provings it must be gathered, Spigelia for example, that the organic substance is but slightly affected or only in isolated localities — while in other provings the effect is profound and general; Carbo veg. and Lachesis. In others again, the affection of the organic substance and the irritation of the nervous system are equal in degree and both are great, Arsenicum. Conclusions on this head are drawn from the following symptoms: those of the complexion and of the skin generally, as regards color and temperature, which enlighten us respecting congestions, if there be any, and the color and character of the congesting fluid. Those of the evacuations from the bowels, bladder, uterus and all secreting glands and surfaces. Those of the cutaneous eruptions and ulcers. Finally, those which denote the existence of dyscrasias of whatever variety, e.g., dropsies, phthisis, cancer, gout, rheumatism, etc. Under this head we find in the proving of Pulsatilla no evidence of any further action than that above mentioned — a hydraemic dyscrasia and which is further corroborated by the abundant serous or thin mucous discharges from secreting glands and surfaces.
III. The action of the drug on the vital power, correlative of the above, and shown in the symptoms of the nervous system as they are given conjointly with the symptoms of the various organs to which the different parts of the nervous system are distributed. He may consider the nervous system under five heads, a. The sensorium of which the symptoms are found chiefly under the rubrics Head and Disposition. b. The general sensibility. c. The general mobility. Data respecting these heads are found in the symptoms of the tissues to which the nerves of sense and motion are distributed. d. The special sensibility, as exhibited in the symptoms of the organs of special sense — the eye, ear, nose and tongue. e. The sympathetic system — as exhibited in the symptoms of organs containing involuntary muscles — in the intestinal tract and in all the sphincters.
In forming conclusions on any one of these points, regard must be had to the entire remaining action of the drug. We should otherwise reach a very false judgment. Pulsatilla, for example, produces blindness and deafness. We might regard these as very important affections of the special senses, did we not learn also that these phenomena occur simultaneously with scanty and difficult menstruation, and with palpitation and throbbing of the carotids, and conjointly with great pallor and frequent syncope. These concurrences compel us to regard the blindness and deafness as sympathetic symptoms occurring in a chlorotic patient, and connected perhaps. with a hydraemia produced by Pulsatilla.
These three sections of a general analysis having bee elaborated during a first perusal, the student will already be in a position to arrange many drugs in groups by their similarities and differences in these respects. He will note, for example, that in their sphere of action Pulsatilla and Nux v. are closely allied, while again they differ widely in their mode of action both on the organic substance and on the vital power, etc.
The practical use of such an analysis is this: that when such fundamental facts are known of two or more drugs, it is enough to have clearly in mind, in any case of disease, what are the effects of the disease in these three fundamental respects. If then, the action, for example, on the organic substance, be similar to what we have seen to be the effect of Pulsatilla, there can be no possibility of Nux vom. being applicable in the case and no need therefore of studying that drug further for the case. This process of elimination by means of a general analysis may be relied on wherever we have good and complete provings of drugs, and where the case of disease presents clear and definite symptoms. — When we are dealing with fragmentary provings and obscure cases it is of course not practicable.
As further examples we may adduce the following: Spig. and Sil. both affect the special senses remarkably and similarly; yet they are extremely different in their action on the organic substance. Hyoscyamus and Carbo veg. affect the sphincters similarly though in other respects so unlike.
After thus generalizing in a comprehensive way, the student will observe certain phenomena of a more special character, for example, that among the variety of sensations recorded as having been produced by the drug, there is a certain uniformity in general character throughout most of the organs affected. But here he meets difficulties arising from inaccuracy of provers, or rather from the fact that, all descriptions of sensations being clothed in figurative language, the imaginations of different provers suggest to them different modes of expression. The wealth of the German language in synonyms has not diminished this difficulty. An approximate analysis of sensations such as has been made by Dr. Dudgeon would be of service in this regard. The individuality of some drugs is much more strongly marked than that of others by this feature of their effects, and pro tanto it serves as their characteristic. Thus Bryonia and Squilla are distinguished by sticking and Ars. by burning pains.
Another point to be noted and which may serve still further to individualize the drug is periodicity, which in many drugs is well marked and of a definite type, e.g., Ars., Ipecac., Nat. mur., Nux vom. In Pulsatilla it is very marked but the type is not constant.
But, perhaps, the most important of all the considerations in which resides the individuality of a drug are the conditions and concomitants of the symptoms. The conditions are the phenomena of time, place and circumstance on which the symptoms depend. For example, Pulsatilla produces tearing pain in the hip. So do several drugs, but that of Pulsatilla occurs in the afternoon, condition of time; it occurs and is aggravated in a warm room, condition of place; occurs during and is aggravated by repose, condition of circumstance. A concurrence of this phenomena and these conditions is found only under Puls. Here these conditions are the characteristic. The concomitants are those phenomena, whether we call them sympathetic or secondary, which always accompany any symptom or group of symptoms. Absence of thirst is a concomitant of many groups of symptoms under Puls. So likewise are chilliness, cold feet, wake fulness in the evening and sleepiness in the morning, etc., Nux vom. has the reverse. So is cold sweat of the forehead under Verat.
Having thus made a general analysis of the proving, obtaining, first, a general view of the action of the drug on the great divisions of the organism and of the pathological conditions which it produces; and, second, a general view of the characteristics of its action, the student may proceed to a special analysis, which will involve a similar study of the action of the drug on each organ and anatomical region of the body. In this he cannot do better than follow the Hahnemannian scheme.
The points to be considered in each region and under each rubric are the following: the organic changes; the sensations, their nature, locality and direction; the conditions of time, place and circumstance and the concomitants. Thus, for example, in studying the Head he may consider
1. Vertigo, its nature, conditions of time, place and circumstances and its concomitants. Thus the vertigo of Puls. is a staggering; it occurs after eating, in a warm room and during repose (there is a rare alternate affect); the concomitants are heaviness in head on stooping, paleness and internal heat in the head.
In this manner the student will examine the effect of the drug upon each organ and tissue of the body, as will be more clearly shown by a schema for the study of the Materia Medica which will be appended to this essay.
The result will be an accurate knowledge of the action of the drug, in so far as the proving is complete, upon the whole organism in general and in detail. The special analysis will serve to correct certain errors into which the general analysis might lead the practitioner. Conditions are not always uniform for all the organs. Thus although the general conditions of Puls, are occurrence and aggravation in the afternoon and evening, during repose and by heat, with relief by motion and cold, and must be so stated in a general analysis, yet there are a few special symptoms to which the opposite conditions attach and this fact is brought out by the special analysis.
The study of a proving to be practically available must be comparative. After ascertaining the properties of each drug by positive investigation and analysis in the manner detailed, the next step is to ascertain what drugs resemble it and in what features they are like and how they differ. To make such a comparison as this in studying the Materia Medica, a repertory is indispensable and this need alone, if a repertory were not equally indispensable in daily practice, would be a sufficient reply to those who idly talk about such a work being superfluous or mischievous.
Such is a method of studying the Materia Medica which after much reflection and trial of various plans I venture with unfeigned diffidence to unfold. It is elaborate and and requires a wearying application which those alone can appreciate who have engaged in similar tasks. To complete such a systematic study, even in comparative leisure might require seven years of unremitting labor — just the period for which a lad is apprenticed to learn his trade! Should we shrink from devoting so long a time to the mastery of the most complex and difficult, and the noblest science and art which are possible to man on earth.
The one consists in prescribing from a general analysis of drugs without regard to the characteristics which individualize them. This is equivalent to prescribing any member indifferently of a whole group of drugs, and necessitates a corresponding generalizing view of disease. It is the method of the old school which seeks to arrange drugs and diseases in groups and which ignores characteristics and individuals.
The other error consists in prescribing on the strength of one or two characteristics which may be detected, without however examining whether the general effects of the drug correspond to the general features of the disease. Now, characteristics, for the most part, as we have seen, derive their value from their association as concomitants or conditions with some symptom which is not in itself a characteristic. Disconnected from this, they are as void of significance as a man's nose would be if cut off from his face, though while on his face, it might have been the chief feature by which his friends recognize him. I will not deny that by this method, great successes, “lucky hits” I would call them, are sometimes made. But I do stoutly affirm that atrocious and inexcusable blunders are much more frequently the result.
I admit too that in certain cases of disease there is no possibility of making such an analysis as we have advised, and that certain drugs are so incompletely proved that we know of them only one or two characteristic symptoms and cannot study them as recommended. All that can be said of such cases is that they are incomplete and come under no rule. We must do the best we can and adopt a defective method, which is nevertheless sometimes successful rather than make no attempt to cure. Better cure by a “lucky hit” than not at all. But let not this lead us astray where we might do better.
If one had to traverse a wilderness he would desire first of all a compass. If this were not to be had, he might “steer by the stars.” If these were obscured he might judge from the direction of vegetation and of hills and rivers. Failing these, he might even “guess” and his guess might lead him right. Nevertheless few travelers of sound mind would be led by such a success to prefer a “guess” to a “compass.”
A Scheme for the Study of the Materia Medica. — In the hope that what has been written may serve not only to explain the method in which I have thought the study of Materia Medica may be best pursued, but also to assist those who are entering upon that arduous study, I publish herewith a schedule drawn up originally for my own guidance and which, I think, was a great assistance to me.
1. Action on the Vital Power — as exhibited in the action of the remedy upon — a. The sensorium; b. The special senses; c. The sphincters; d. The other involuntary muscles; e. The power of locomotion.
2. Action on the Organic Substance; as exhibited in a. The complexion (showing, viz.: the state of vessels and the nature of their contents); b. The evacuations; c. Ulcers, if any which previously existed are modified by the remedy or if any are produced by the remedy; d. Eruptions; e. General affections of a dyscrasic nature, such as dropsy, tuberculosis, etc., etc.
4. Sensations. What kind of sensations predominate among those ascribed to the remedy in the proving and what relation, if any, appears to exist between certain varieties of sensation and certain classes of organs or tissues.
6. Peculiarities. There are few good provings which do not ascribe to the remedy certain peculiarities of action which are incapable of classification, which run through the whole action of the remedy and which are peculiar to one remedy and are therefore important characteristics.
These peculiarities constitute the conditions of time, circumstance, aggravation and concomitance, which are attached to the symptoms and often give individual character to them as belonging to one remedy in particular, and as incapable of being ascribed in mass to any other drug. A symptom being recorded as produced, for example, by Pulsatilla, the questions “When did it occur?” “When was it aggravated?” “When was it ameliorated?” When did it cease?” give the conditions of time which attach to that symptom. In like manner the questions “Under what circumstances (viz., of rest or motion, of heat or cold, etc., etc.,) did it occur, was it aggravated, was it ameliorated,” give the conditions of circumstance and aggravation which attach to the symptom.
It will be observed of almost every remedy that certain symptoms or series of symptoms are accompanied by one or several other symptoms. This fact is the condition of concomitance to which we refer. For example, many symptoms of Pulsatilla are accompanied by a disposition to weep, of Nux vom. by fugitive chills, of Arsenicum by inordinate weakness, of Veratrum by cold sweat of the forehead, etc.
7. Resume of the Characteristics of the Remedy. This will include everything in the above analysis which is shown by a comparative study of other drugs, to be peculiar to it. It will comprise in particular the conditions of time, circumstance, aggravation and concomitance, and the periods of the day at which the action of the drug is most marked.
a . Sensorium, comprising the subdivisions: 1. Vertigo; 2. Intelligence; 3. Memory; 4. Illusions. Each of these subdivisions is to be studied in respect of sensations in so far as they can be predicated of it; of periodicity; of conditions of time, circumstance, aggravation and amelioration; and of concomitance. And under the latter rubric it is to be especially inquired what symptoms affecting other organs, or systems, occur simultaneously in evident physiological connection with the symptom under consideration.
b . Headache, The points to be investigated are: 1. The location of the pain if it be stationary — its course if it move, 2. The sensation; 3. The conditions of time, circumstance, aggravation and amelioration, as above explained in detail; 4. Concomitance.
c . Organic changes, These affect the material substances and tissues of the head, and comprise all deviations from a normal material condition of which we can in any way become cognizant — affections, for example, of the skin, glands, vessels, organs of special sense, etc.
a. The Orbit . 1. Location; 2. Sensations; 3. Conditions; 4. Concomitance; 5. Organic changes. These subdivisions here and throughout the scheme, wherever used, are to be understood and studied as already explained in the general analysis and under the title “Head.”
N.B. After each such study of a single organ, a physiological estimate should be made of the significance of the symptoms. For this purpose a faithful study of the concomitance is of inestimable value. For example the proving of Pulsatilla gives sudden loss of vision. Is this Amaurosis? The concomitance shows that the loss of vision is accompanied by loss of hearing, by syncope, and occurs at a period of menstrual irregularities. The symptom is at once explained. This is only a very obvious instance of what is not always an easy though always a most necessary task.
11. Throat and Fauces, 1. Location; 2. Sensations; 3. Aspect; 4. Organic changes (including tumefaction, secretion, deposits, etc.). Respecting these divisions, a. The conditions; b. The concomitance.
13. Stomach, 1. Location; 2. Sensations; 3. Organic changes; 4. Special function modified, as respects, a Appetite; b. Thirst;, and these modifications may be exaltation, diminution or perversion; c. Nausea; d. Vomiting. Respecting these divisions and subdivision, observe, a. The conditions; b. The concomitance.
(Here and wherever the rubric comprises a region which contains a number of organs, endeavor to make by the aid of the sciences of Physiology and Pathology a rational appreciation of the organs involved, and in this study, pay especial regard to the concomitance, in order to gain the full physiological significance of the symptoms. For example, in affections of the right hypochondrium where the liver may be supposed to be implicated, the concomitance will justify the supposition if it show simultaneous and corresponding symptoms of the tongue, stomach, head, stool, skin, back, etc., etc. So of the left hypochondrium and the uterine system.)
16. Stool, 1. Sensations, their character, location and course. a. Before stool; b. During stool; c. After stool. As regards these three subdivisions note, a. The conditions; b. The concomitance. 2. Organic phenomena, viz., color, odor, consistence, composition, e. g. — digested or not — consisting of feces alone or combined, etc.
17. Anus and Rectum, 1. Location; 2. Sensations; 3. Organic changes (including secretions, tumors, condylomata, etc., etc.) Respecting all of these divisions note, a. The conditions; b. The concomitance.
2. Sputa. 1. Character; 2. Consistence; 3. Color; 4. Smell; 5. Taste; 6. Locality from which it appears to come; 7. Mode of evacuation; 8. Sensations which precede and follow its evacuation; 9. Conditions; 10. Concomitance.
23. Back, 1. Location, dividing the back into regions from below upwards and appreciating the organs and tissues involved, as well as the concomitance will admit; 2. Sensations; 3. Organic changes. Under these, a. Conditions; b. Concomitance.
1. Eruptions. 1. Aspect; 2. Color; 3. Sensations; 4. Secretions. a. Their color; b. Consistence; c. Odor; d. Quality, e. g., acrid or bland, etc.; 5. Scabs. a. Quality; b. Tenacity; c. Color; d. Odor; e. Conditions of subjacent tissues or secretions.
|Source:||The American Homoeopathic Review Vol. 03 No. 01-07, 1862-1863, pages 09-15, pages 61-71, pages 103-111, pages 156-160, pages 203-210, pages 262-272, pages 305-313|
|Description:||Homoeopathy The Science of Therapeutics; How to study Materia Medica.|
|Editing:||errors only; interlinks; formatting|