Remedies Related to Pathological Tissue Changes


James Tyler Kent, The Homoeopathician, Journal for Pure Homoeopathy, No. 2. August 1912.

Provings of remedies are not continued to the extent of producing tissue alterations-indurations, infiltrations, suppuration, caries, etc. Most of the indications for the use of remedies in these conditions must be learned clinically; from the use of remedies in patients when these conditions have developed. When a remedy has been prescribed for a patient in whom tissue-changes have occurred, the prescription being based on the symptom-image, resolution of the existing tissue-changes has occurred, as a result of the reaction to the remedy. These become reliable clinical symptoms of the remedy: demonstrations of the power of the remedy over the altered tissue. These remedies are then recognised to be suited to constitutions in which these pathological changes can develop. Hence they are as important to the prescriber as though they had appeared actually in the proving.

In many instances such cure of pathology has occurred as a delightful surprise to the physician, who realizes in this evidence the accuracy of the prescription, which not only restored the functional activities but altered the nutrition to the extent of removing the products of disorder.

The difficulty in prescribing for patients with such altered tissue – cataract, hepatization (in pneumonia), induration of glands, arterio-sclerosis, fibroids, cancer, etc. – rests in the fact that when these tissue-changes occur, the symptoms on which a prescription should be based – the symptoms of the patient – have disappeared. The symptoms present at the time are symptoms of the pathology. If the symptoms that preceded this condition can be learned, and considered together with the later results of disorder – the pathological tissue – it may be possible to select a remedy that is sufficiently related to both the patient and his pathology, to effect a cure of both, provided always that the reaction and vitality of the patient are sufficient to permit the resolution.

Caust., Graph., Lyc., Nit-Ac., Staph., Thuja and many other remedies relate to excrescences. Skin indurations are met by Ant-C., Calc., Con., Lyc., Phos., Rhus., Sep., Sil., Sulph. and similar remedies. Indurated glands find suitable remedies in Ben-Ac., Brom., Calc., Calc-F. and remedies of similar depth, while such remedies as Caust., Bry., Con., Kali-C., and Lyc. are found suited to muscle indurations. 

Acon., Bapt., Gels., Ipec. and remedies of this scope have never been known to produce any alteration by induration and infiltration, hence the wise prescriber will not select these remedies for patients with the aforementioned conditions, when he has those, from which to select, which are preeminently related to the exact condition present. The final selection of a remedy, when these conditions are present, is to be determined by the character of symptoms that preceded, or what may be present and indicative of the patient himself.

In pneumonia, in hepatization period, when the symptoms point to Arsenicum, the patient will die if Arsenicum is prescribed, for this remedy is not deep enough to include that infiltration: Sulphur, Lycopodium, Phosphorus, Calcarea, etc., must take up the work where Arsenicum could not proceed. One of these remedies will clear out the lungs, in a few hours, with a disappearance of all the symptoms dependent upon the infiltration, and the patient, freed of the burden, will be restored to health promptly, instead of succumbing to the mechanical interference and consequent air-starvation.

In arterio-sclerosis, in cataract, in induration of liver or other glandular structures, the same principle holds. Ars., Bry., Puls. and other short and mediumly-short-acting remedies are insufficient because they have not power to take hold of this condition, while Silica, Calcarea Fluorica, Sulphur and such deep-acting remedies have been known to remove the tissue change by their deeper action, hence more similar, and from them one may be selected which will prove curative.

By reference to the repertory the prescriber may find remedies which have thus been established as suitable for suppuration, those suited for cancer, those suited for tuberculosis, those related to apoplexy, etc., and as an intelligent prescriber, the physician should select a remedy for the patient similar to the condition of the ultimated disorder. This is totally different from prescribing on the pathology alone, or seeking a specific for the name of the ultimate, regardless of the patient.

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Observations on the scarlet-fever (Hahnemann, 1808)


The malignant scarlet-fever that has prevailed in Germany for eight years and proved fatal to many thousands of children and older persons, often so unexpectedly, so rapidly, and with symptoms never before heard of under such circumstances, this murderous disease, termed scarlet-fever by almost every one, is really anything but scarlet-fever; it is a new disease never seen in Germany before the year 1800, which, on account of the red rash that usually accompanies it, might be termed purpura miliaris, and which, then for the first time, spread from the west, over Hesse, Bamberg, Beyreuth, Thuringia and Voigtland, to Saxony, and thence since that time has extended in all directions.

If it can be proved that this is a new disease and is widely different from the old genuine scarlet-fever (which old people can still very well remember to have noticed in their youth in themselves and others), we can very well understand how it happened, that the medical men did not know how to act in this new disease, and that at first all who were likely to die, slipped through their hands; indeed that their endeavours did more harm than good, as they were always under the delusion that they had to do with the old genuine scarlet-fever, and thus they were misled by this extraordinary confounding of names and things, to treat the new disease in the same way as they had been used to treat the true scarlet-fever (by means of keeping the patient warm, administering elder-flower tea, andc.). Such a mistake, such a confounding in diagnosis and treatment of two such very different diseases, must naturally have a very unfortunate result, as experience has shewn it to have had by the many thousands who have fallen victims to this new disease.

This disease is new among us, I repeat, for there is not the slightest trace of such a purple miliary fever having ever before prevailed in Germany.

The epidemic in Strasburg, described seventy-three years ago by Salzmann, was a white miliary fever-white vesicles on a white skin-and differed from our new miliary fever in this, that children and old people were almost entirely exempted from it, and it chiefly affected youths and adults between twenty and forty years of age; sore throat was very rarely met with in it.

The miliary epidemic described by Welsch, of Leipzig, 150 years ago, consisted of a white, millet-seed size dexanthema, and only affected lying-in women; probably it was a disease brought on by keeping them too warm.

The most recent miliary epidemic which Brüning observed thirty-six years ago, in the neighbourhood of the Lower Rhine, differs also from our new disease in this, that children of five years and under generally remained free from it, and women were more frequently attacked than men,-that it had its critical days, and was likewise a white miliary rash, resting for the first few days on red spots, which went off on the seventh day, leaving the white miliary rash standing from three to seven days longer on the white skin.

 The epidemics that bear the greatest resemblance to our present purple miliary, are those observed by David Hamilton, long ago (1710) in India, and Charles Allione (in 1758) in Turin.

 Other observers only mention having occasionally observed a miliary fever in single individuals, which were usually only brought on by the use of heating) diaphoretic remedies, especially of opiates, did not prevail epidemically, and are described by them in a most vague manner.

 That our miliary fever is new and very different from the true scarlet-fever, the following comparison will shew. 

The new red miliary-fever The old genuine scarlet-fever
attacks persons of all ages; attacks only children until their 12th year (Sim. Schulze)-attacks only children, almost never adults (Plenciz, Sennert);
the eruption consists of purple-red (Jani), of dark red spots (verging on brown), which on being pressed with the finger do not leave a white spot but remain unchanged, of a dark red colour, the redness of the skin is an erysipelatous fire-coloured redness (Sennert);-a bright scarlet redness, resembling erysipelas in colour and in this, that it immediately disappears on pressure with the finger and shews a white spot, which however immediately resumes its red colour (Navier); the redness is like the colour of a boiled lobster (Act. med. Berol.);-a cinnabar redness (Plenciz).
of sharply defined, discrete patches of redness, The smooth shining redness of the skin runs imperceptibly into the neighbouring white parts, in unnoticeable shades, like erysipelas, and is never well defined;-it becomes from time to time, now a little paler, now a little redder, and almost every instant it spreads imperceptibly farther, and then retires to its original seat (Navier).
Always thickly studded with dark-red miliary papulae, which are not so much elevated above the level of the skin as stuck deep in it, yet distinctly perceptible to both the eye and the touch. None of the above-mentioned authors allude to miliary elevations of the bright red parts of the skin;-the skin of the reddened parts is quite even and smooth (Hahnemann);-the red parts of the skin are quite smooth and destitute of inequalities or elevations (Plenciz, Op. tract. iii, p. 49)-and in this the scarlet-fever differs from every kind of miliary fever (Plenciz, ib., p. 58).
This exanthema attacks in an indeterminate manner, now this, now that part of the body-there is no part of the body for which it has a peculiar affection, or to which it attaches itself in a peculiar manner (Stieglitz). Most frequently the favourite spots for its attack are the covered parts and flexures of the joints; most rarely the face. The rash is usually accompanied by swelling (Stieglitz). The redness of the true scarlet-fever prefers attacking first the uncovered and but slightly covered parts, which swell as far as the redness extends. At first the redness and swelling occur on the face (De Gorter, Plenciz)-at first in the face, neck, and chest (Plenciz)-the scarlet redness first appears, with some swelling, on the face (neck and chest), the hands, and the outside of the feet and from these parts it spreads out in an erysipelatous manner (in the worst cases) all over the body (Hahnemann).
This exanthematous fever has not a determined, regular course, like other exanthematous fevers (Stieglitz);-the eruption remains here and there for an indeterminate period, often several weeks; there is no fixed period for its departure. In every genuine scarlet-fever the redness appears on the parts named simultaneously with the febrile heat, and in mild cases is perceptible for from three to four days (Plenciz, Sennert), in bad cases, seven days (Plenciz)-and goes off by becoming gradually paler from day to day. The parts that first became red, become first pale (Plenciz).
The red miliary rash often disappears suddenly at indeterminate times, with increased danger to life, usually followed suddenly by death. None of the above authors makes mention of the sudden disappearance of the redness of true scarlet fever during the fever. After the gradual fading of the redness up to the fixed days mentioned above, there occur apyrexia and desquamation (Sennert, Plenciz, De Gorter, Sim. Schulze). Even after death the hitherto red spots remain coloured and turn violet (Navier.
The eruption may be copious or almost not at all present, the mildness or malignancy of the disease not depending on that (Stieglitz). Where the eruption is almost imperceptible the danger is often greatest, the fever most malignant;-where there is a general full eruption, the disease is often mild and slight. The fuller and more extended the redness of true scarlet-fever is, the more malignant is the fever always (Hahnemann).
It is only the dark red miliary patches that perspire, and it is only when the whole body is covered with it that the patient perspires all over, as in the epidemic at Wittenberg None of the reddened parts in true scarlet-fever perspire during the disease (in all this the authors I have mentioned are agreed), if the skin is moist, it is so only on the parts that are not yet reddened. No erysipelas perspires, and as little does the scarlatina redness. It is only when the fever comes to an end, and the redness has gradually gone off, that there sometimes occurs general perspiration, and thereafter desquamation of the skin (Sim. Schulze), and the disease may also go off without any perspiration.-(Act. med. Beral.)
This new miliary disease, falsely said to be scarlet-fever, which first appeared about the middle of the year 1800, and, like every new pestilence, raged as a most murderous epidemic where it first appeared (there was no mild epidemic of it), and then from time to time recurred, often several times in a year in the same place (not unfrequently attacking the same persons a second time), during the first years still attacked several families in succession; during the last years did not, it is true, cease for any length of time, but did not prevail quite epidemically again, but rather attacked single families, or even single individuals, in one place (though it was not less fatal)-it seems in the course of a few years to have a tendency to become extinguished completely, like the English sweating-sickness at the commencement of the 16th century. The true scarlet-fever is an old disease, which has been accurately observed for two centuries in Germany and other countries, always appeared only as an epidemic and pandemic, always attacked indiscriminately, and with scarcely any exception, every child that had not had the disease (never those who had already had it), seldom prevailed in malignant, often in mild, sometimes in perfectly mild epidemics (Sydenham, De Gorter, Nenter, Junker), scarcely proving fatal to one child in a thousand, never, or very seldom, occurred sporadically, and the reason of this was, that as it almost always attacked pandemically all children who had not previously had it, there were not under 6 or 8 years enough subjects to infect in order to show its epidemic character, hence it almost never recurred in less than 6, 8, or 12 years, and on account of this rarity of its recurrence, the oldest practitioners scarcely ever saw it oftener than three times in their lives, and it was quite unknown to our younger practitioners.
Besides the diaphoretics, elder-flower tea, andc., and the warm beds wherewith it was sought to retain the eruption on the skin (usually without success), purgatives, especially mercurial medicines, are said to have done good in this exanethematous fever; but aconite, along with a moderately cool regimen saved the most. It were foolish to judge of the power of belladonna from its administration in this new miliary fever, which, as we see, is anything but scarlet-fever. In this old, true scarlet-fever, belladonna is useful, both as a prophylactic, and as a remedy.

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Cure and prevention of scarlet fever


(published as a pamphlet by Hahnemann in 1801)


Had I compiled a large book upon scarlet fever, I should have obtained, through the usual channels of publication, at least as much in the way of honorarium as by the subscription for this little book. But as, according to Callimachus, a great book is a great evil, and is soon laid aside, one of my chief aims, to wit, to excite a great interest in a subject of so much importance to humanity as this is, in order clearly to ascertain the truth, by bringing the observations of many to bear upon it-could not have been fulfilled so well by the large book as by the mode I have adopted.: 

Up to this period it is impossible that the corroboration of my assertion could be complete. The extract of belladonna, which I caused to be delivered to my subscribers, might have lost its power by the great distances it was sent, and by the long period it had been kept. Occasionally it fell into the hands of some who had neither the ability nor the good will to administer its solution in an appropriate manner. The precautions laid down in this book could not all be enumerated in a small paper of directions, where on account of the danger of misusing the medicine, it was necessary to direct that only the very smallest dose should be administered. Moreover it is probable, that the thorough admixture of the few drops with a sufficient quantity of the fluid in which it should be taken, was generally neglected; a circumstance the neglect of which makes this and every other medicine many hundred times less powerful than they would be were they properly combined with the diluting fluid. The hurry and inaccuracy of young doctors of the present day are well known, and we know also how little dependence we can place on our private patients.: 

In addition, very inclement weather, and in general what is understood a chill (which I have forgotten to allude to in the text), present obstacles by no means slight to the power of belladonna as a preventative of scarlet-fever. Children should be carefully preserved from it, without however completely excluding them from the open air, and if this precaution be neglected, the dose of the remedy should at all events be increased.: 

There may also be many other circumstances unknown to me to diminish the power of belladonna. The philanthropic physician ought to endeavour to discover and to avoid them.: 

It is only in accordance with my well known maxim (the new principle) that small-pox, to give one example from among many, has an important prophylactic in the cow-pox, which is an exanthematous disease, whose pustules break out after the sixth day of innoculation, with pain and swelling of the axillary glands, pain in the back and loins, and fever, and surrounded by an erythematous inflammation-that is to say, constituting altogether a disease very similar to variola. And, in like manner, a medicine which causes symptoms so similar to those of the invasion of scarlet-fever, as belladonna does, must be one of the best preventive remedies for this children’s pestilence. It should however be put to the test with candour, carefulness and impartiality-not cursorily or hurriedly, not with the design of depreciating the originator of it at the expense of truth.

But if its efficacious prophylactic power has incurred and may still incur opposition from prejudiced, ill-disposed, weak-minded and cursory observers, I may be allowed to appeal against their conduct to the more matured investigation of the clear-sighted, dispassionate portion of the public, and to trust to time for a just verdict. I should esteem myself happy if I should see, some years hence, this scourge of mankind in any measure diminished by my labours.

At the commencement of the year 1799 small-pox came from the neighbourhood of Helmstadt to Königslutter which spread slowly around, and though not mild in character, the eruption was small, warty looking, and accompanied with serious symptoms, especially of an atonic kind. In the village it came from, the scarlet fever was prevalent at the same time, and, mixed up with the latter, the small-pox made its appearance in Königslutter. About the middle of the year the small-pox ceased almost entirely, and the scarlet-fever then commenced to appear alone and more frequently.

In its main symptoms this epidemic of scarlet-fever resembled the scarlatina of Plenciz. In some families the disease was of a mild form, but generally it was of a bad kind.

When it occurred in the mild form it generally remained mild in the whole family living together. There occurred a slight feeling of weariness, a kind of faint-heartedness, some difficulty of swallowing, some fever, red face and hot hands. There then appeared, usually the very first day, alone with slight itching, the spots of various shape, and sometimes paler, sometimes redder, on the neck, the chest, the arms, andc., which disappeared again in from three to four days, and the desquamation that followed was scarcely observable on the fingers, and almost nowhere else. Towards evening only the patients laid down in bed for a short time, but the rest of the day they went about. The sleep was pretty tranquil, the bowels usually somewhat less open than when in health, the appetite usually not much diminished.

Very different was the course, of the bad form of scarlet-fever that prevailed in most families. Generally the seventh day after the infection had been communicated it broke out suddenly and unexpectedly, without any previous feeling of illness seldom was it that horrible dreams on the previous night served as a prelude to it. All at once there occurred an unusual timidity and fearfulness, rigour with general coldness, especially in the face, the hands and the feet, violent pressive headache, especially in the forehead, above the orbits. Pressure in the hypochondria, chiefly in the region of the stomach; in most cases there occurs a very unexpected attack of violent vomiting, first of mucus, then of bile, then of water recurring at intervals of from twelve to twenty-four hours, accompanied by an ever increasing weakness and anxiety, with trembling. The parotid and sub-maxilliary glands swell and become hard and painful, swallowing becomes very difficult, with shooting pains. After rigours that last from twelve to twenty-four hours, the body becomes excessively hot, accompanied with itching burning, the head, neck, hands (forearms) and feet (legs) are hottest, and swollen so as to present a shining appearance, which lasts to the end of the disease. (Almost every paroxysm of heat terminates in profuse sweat, which, however, only affects the rest of the body, but not the head, hands and feet.) On these swollen parts, but first in the pit of the throat, then on the arms and legs, there appear about the second day variously shaped cinnabar coloured spots of various sizes that readily grow pale on any slight chill; these spots are scarcely raised above the level of the skin, and are always accompanied by smarting, itching, burning; as the disease advances they spread-out into a connected, but less vivid redness. On the outburst of the eruption, the fever does not diminish; on the contrary, the greater the redness the more violent is the fever. In the meantime the sore-throat increases, swallowing becomes very painful, in the worst cases almost impossible. The interior of the mouth, the tongue and the palate are inflamed, very painful, raw, and as if ulcerated all over. In very bad cases the swelling of the cervical glands almost closes the jaws, and from between the teeth, which can be but slightly separated, there flows almost incessantly a very viscid and very fetid saliva, which can scarcely be expelled from the mouth in consequence of the tongue being so painful. In like manner, in the worst cases the lining membrane of the nose is ulcerated. At this period the voice becomes weak, suppressed and unintelligible, and respiration difficult. The taste in the mouth is putrid; the stools, which are usually rarely passed, have the odour of assafoetida. A drawing pain in the back and cutting bellyache are characteristic symptoms, which, together with pressive headache, in bad cases persist in alternation day and night, but in less dangerous cases only recur in the evening after sunset, along with increase of anxiety and timidity. In the very worst cases there are alternate paroxyms of agonising tossing about, raving, groaning, grinding of the teeth, floccitations, general or partial convulsions and comatose stupefaction or sopor, with half-shut eyes and head bent backwards. The urine, which is light-coloured, and the faeces, are passed involuntarily, and the patient sinks down to the bottom of the bed. The grumbling, complaining disposition increases from day to day. The smallest quantity of food, even in the slighter cases, perceptibly and immediately increases the anxiety, more than in any other disease.

From the fourth to the seventh day, if death do not ensue, the skin rises up, or rather the pores of the skin on the reddest places become elevated, especially about the neck and the arms, in small, close, pointed miliary vesicles (somewhat resembling goose’s skin), which at first, as the redness of the rest of the skin declines, appear extremely red, but afterwards, or when cold is applied, grow pale and at length quite white; they are however empty, and contain no fluid.

Neither the greater intensity nor the more general extension of the redness of the skin, nor yet the occurrence of these empty miliary vesicles, diminish the fever after the manner of a critical eruption; the former indeed is rather a sign of an increased intensity of fever which can only subside as this redness decreases.

The bad form of scarlatina lasts from nine to fourteen days, and the disgust at food lasts about the same time. As the appetite returns, the patient first wishes for fruit, then meat, he generally prefers pork.

During the fever, blood-red spots now and then appeared on the sclerotic; in some the cornea of one or both eyes was completely obscured; others (probably badly treated patients) were rendered imbecile.

At length the epidermis gradually peels off on the places where the redness appeared, and even where there was only burning itching without subsequent redness; on the hands and feet it comes off in large pieces, like pieces of a torn glove, but on the other parts only in larger or smaller scales. In one case the nails of the fingers and toes also fell off. The falling off of the hair only commenced some weeks or months after the fever; in one case it went the length of total baldness.

Among the after-sufferings the following were prominent: long-continued debility, a very disagreeable feeling in the back, as if it were asleep (narcosis), pressive headache, a painful sensation of constriction in the abdomen only felt on bending backwards, abscesses in the interior of the ear, ulceration of the lining membrane of the nose, ulcerated angles of the mouth, other spreading ulcers in the face and other parts of the body, and generally a great tendency of the whole skin to ulceration (unhealthy skin as it is termed). In addition to the above, a great hurriedness in speaking and acting, fits of sleepiness by day, crying out in sleep, shuddering in the evening, puffiness and earthy colour of the countenance, swelling of the hands, feet and loins, andc.

Any one who chooses may read for himself in the works of the various authors the infinity of medicines and modes of treatment invented for this disease (from blood-letting and leeches to bark, from gargles and clysters to blisters, from antispasmodic, derivative, antiseptic to refrigerant, resolvent, purgative, involvent, humectant, alexiteric, incitant, asthenic, and God knows what other ingenious modes of treatment) intended to meet the thousand imaginary indications. Here we often see the ne plus ultra of the grossest empiricism: for each single symptom a particular remedy in the motley, mixed, and repeated prescriptions; a sight that cannot fail to inspire the unprejudiced observer with feelings at once of pity and indignation!

For my own part, when summoned to cases of the fully developed disease (where there was no question of prevention or suppressing its commencement), I found I had to combat two different states of body that sometimes rapidly alternated with one another, each of which was composed of a convolute of symptoms.

The first: the burning heat, the drowsy stupefaction, the agonising tossing about with vomiting, diarrhoea, and even convulsions, was subdued in a very short time (at most an hour) by a very small quantity of opium, either externally by means of a piece of paper (according to the size of the child, from a half to a whole inch in length and breath) moistened with strong tincture of opium, laid upon the pit of the stomach and left there until it dries; or if there is no vomiting, internally, by giving a small quantity of a solution of opium.

For external use I employed a tincture formed by adding one part of finely pulverised crude opium to twenty parts of weak alcohol, letting it stand in a cool place for a week, and shaking it occasionally to promote the solution. For internal use, I take a drop of this tincture and mix it intimately with 500 drops of diluted alcohol, and one drop of this mixture likewise with other 500 drops of diluted alcohol, shaking the whole well. Of this diluted tincture of opium (which contains in every drop one five-millionth part of a grain of opium) one drop given internally was amply sufficient in the case of a child of four years of age, and two drops in that of a child of ten years, to remove the above state. It is unnecessary to repeat these doses oftener than every four or eight hours, in some cases not more than every twenty-four hours, and that sometimes only a couple of times throughout the whole fever, for which the more frequent or more rare occurrence of these symptoms must be our guide.

Where also, during the further progress of the disease, the same symptoms appeared accompanied by constipation of the bowels, opium so applied externally, or given internally in such doses, never failed to produce the desired effect. The result, by no means of a transient character, appeared at most in an hour, sometimes within a quarter of an hour, and just as rapidly from the external application as from the internal administration.

Larger doses than the above, occasion raving, hiccough, unappeasable peevishness, weeping, andc.-an array of factitious symptoms which, when they are not severe, disappear spontaneously in a few hours, or may be more speedily removed by smelling at a solution of camphor.

The second morbid condition that occurs in the course of this disease: the increase of fever towards evening, the sleeplessness, the total loss of appetite, the nausea, the intolerable lachrymose peevishness, the groaning, that is, the state where opium does and must do harm,-this state was removed in a few quarters of an hour by ipecacuanha.

For this end, immediately on the occurrence of this state, or during its persistence, I gave, according to the age of the child, ipecacuanha, either in substance in the dose of a tenth to half a grain in fine powder; or I employed the tincture prepared by digesting in the cold for some days one part of the powder with twenty parts of alcohol, of this one drop was mixed with a hundred drops of weak alcohol, and to the youngest children a drop of this last was given, but to the oldest ones ten drops were given for a dose.

I found these two remedies as indispensable as they were generally completely sufficient not only to ward off the fatal termination, but also to shorten, diminish and alleviate the scarlet-fever. I cannot imagine a more suitable mode of treatment, so rapid and certain in its results I found it.

As regards moral and physical accessory dietetic means in the treatment of a fully developed case of scarlet-fever, I would advise that we should try to dispel all fear by means of kind and cheering words, by nice little presents, by holding out hopes of a speedy recovery-and on the other hand, we should allow the patient a free choice of all kinds of drinks, and warmer or cooler coverings to suit his feelings. The patient’s own feelings are a much surer guide than all the maxims of the schools. We must only take care kindly to keep the patient from taking solid nutriment too soon, or in too great quantity during his convalescence.

But even under the most appropriate and certain medical treatment of developed scarlatina of a bad type there is always risk of death, of the most miserable death, and the amount of the countless sufferings of the patients is not unfrequently so great that a philanthropist must wish that a means could be discovered by which those in health might be protected from this murderous children’s pestilence, and be rendered secure from it, more especially as the virus is so extremely communicable that it inevitably penetrates to the most carefully guarded children of the great ones of the earth. Who can deny that the perfect prevention of infection from this devastating scourge, and the discovery of a means whereby this divine aim may be surely attained, would offer infinite advantages over any mode of treatment, be it of the most incomparable kind soever?

The remedy capable of maintaining the healthy uninfectable by the miasm of scarlatina, I was so fortunate as to discover. I found also that the same remedy given at the period when the symptoms indicative of the invasion of the disease occurs, stifles the fever in its very birth; and, moreover, is more efficacious than other known medicaments in removing the greater part of the after-sufferings following scarlatina that has run its natural course, which are often worse than the disease itself.

I shall now relate the mode in which I made the discovery of this specific preservative remedy.

The mother of a large family, at the commencement of July, 1799, when the scarlet-fever was most prevalent and fatal, had got a new counterpane made up by a semptress, who (without the knowledge of the former) had in her small chamber a boy just recovering of scarlet-fever. The first mentioned woman on receiving it, examined it and smelt it in order to ascertain whether it might not have a bad smell that would render it necessary to hang it in the open air, but as she could detect nothing of the sort, she laid it beside her on the pillow of the sofa, on which some hours later she lay down for her afternoon’s nap.-She had unconsciously, in this way only (for the family had no other near or remote connexion with scarlatina patients), imbibed this miasm.-A week subsequently she suddenly fell ill of a bad quinsy, with the characteristic shooting pains in the throat, which could only be subdued after four days of threatening symptoms.

Several days thereafter, her daughter, ten years of age, infected most probably by the morbific exhalations of the mother or by the emanations from the counterpane, was attacked in the evening by severe pressive pain in the abdomen, with biting itching on the body and head, and rigour over the head and arms, and with paralytic stiffness of the joints. She slept very restlessly during the night, with frightful dreams and perspiration all over the body, excepting the head. I found her in the morning with pressive headache, dimness of vision, slimy tongue, some ptyalism, the submaxillary glands hard, swollen, painful to the touch, shooting pains in the throat on swallowing and at other times. She had not the slightest thirst, her pulse was quick and small, breathing hurried and anxious; though she was very pale, she felt hot to the touch, yet complained of horripilation over the face and hairy scalp; she sat leaning somewhat forwards in order to avoid the shooting in the abdomen which she felt most acutely when stretching or bending back the body; she complained of a paralytic stiffness of the limbs with an air of the most dejected pusillanimity, and shunned all conversation; “she felt,” she said, “as if she could only speak in a whisper.” Her look was dull and yet staring, the eyelids inordinately wide open, the face pale, features sunk.

Now I knew only too well that the ordinary favourite remedies, as in many other cases, so also in scarlatina, in the most favourable cases leave everything unchanged, and therefore I resolved in this case of scarlet-fever just in the act of breaking out, not to act as usual in reference to individual symptoms, but if possible (in accordance with my new synthetical principle) to obtain a remedy whose peculiar mode of action was calculated to produce in the healthy body most of the morbid symptoms which I observed combined in this disease. My memory and my written collection of the peculiar effects of some medicines, furnished me with no remedy so capable of producing a counterpart of the symptoms here present, as belladonna.

It alone could fulfil most of the indications of this disease, seeing that in its primary action it has, according to my observations, a tendency to excite even in healthy persons great dejected pusillanimity, dull staring (stupid) look, with inordinately opened eyelids, obscuration of vision, coldness and paleness of the face, want of thirst, excessively small, rapid pulse, paralytic immobility of the limbs, obstructed swallowing, with shooting pains in the parotid gland, pressive headache, constrictive pains in the abdomen, which become intolerable in any other posture of the body besides bending forwards, rigour and heat of certain parts to the exclusion of others, e. g., of the head alone, of the arms alone, andc. If, thought I, this was a case of approaching scarlet-fever, as I considered was most probable, the subsequent effects peculiar to this plant-its power to produce synochus, with erysipelatous spots on the skin, sopor, swollen, hot face, andc.-could not fail to be extremely appropriate to the symptoms of fully developed scarlatina.

I now earnestly desired to be able if possible to preserve the other five children of the family perfectly free from infection. Their removal was impossible and would have been too late.

I reasoned thus: a remedy that is capable of quickly checking a disease in its onset, must be its best preventive; and the following occurrence strengthened me in the correctness of this conclusion. Some weeks previously, three children of another family lay ill of a very bad scarlet-fever; the eldest daughter alone, who, up to that period, had been taking belladonna internally for an external affection on the joints of her fingers, to my great astonishment did not catch the fever, although during the prevalence of other epidemics she had always been the first to take them.

This circumstance completely confirmed my idea. I now hesitated not to administer to the other five children of this numerous family this divine remedy, as a preservative, in very small doses, and, as the peculiar action of this plant does not last above three days, I repeated the dose every 72 hours, and they all remained perfectly well without the slightest symptoms throughout the whole course of the epidemic, and amid the most virulent scarlatina emanations from their sisters who lay ill with the disease.

In the mean time I was called in to attend in another family, where the eldest son was ill of scarlet-fever. I found him in the height of the fever, and with the eruption on the chest and arms. He was seriously ill, and the time was consequently past to give him the specific prophylactic remedy. But I wished to keep the other three children free from this malignant disease; one of them was nine months, another two years, and the third four years of age. The parents did what I ordered, gave each of the children the requisite quantity of belladonna every three days, and had the happiness to preserve these three children free from the pestilential disease, free from all its symptoms, although they had unrestricted intercourse with their sick brother.

And a number of other opportunities presented themselves to me where this specific preventive remedy never failed.

In order to prepare this remedy for preventing the infection of scarlet-fever, we take a handful of the fresh leaves of the wild belladonna (atropa belladonna, Linn.) at the season when the flowers are not yet blown; these we bruise in a mortar to a pap, and press the juice through linen, and immediately (without any previous purification) spread it out scarcely as thick as the back of a knife, on flat porcelain plates, and expose it to a draught of dry air, where it will be evaporated in the course of a few hours. We stir it about and spread it again with the spatula, so that it may harden in a uniform manner until it becomes so dry that it may be pulverized. The powder is to be kept in a well stopped and warmed bottle.

If we now wish to prepare from this the prophylactic remedy, we dissolve a grain of this powder (prepared from well preserved belladonna extract evaporated at an ordinary temperature) in one hundred drops of common distilled water, by rubbing it up in a small mortar; we pour the thick solution into a one-ounce bottle, and rinse the mortar and the pestle with three hundred drops of diluted alcohol (five parts of water to one of spirit), and we then add this to the solution, and render the union perfect, by diligently shaking the liquid. We label the bottle strong solution of belladonna. One drop of this is intimately mixed with three hundred drops of diluted alcohol by shaking it for a minute, and this is marked medium solution of belladonna. Of this second mixture one drop is mixed with two hundred drops of the diluted alcohol, by shaking for a minute, and marked weak solution of belladonna; and this is our prophylactic remedy for scarlet-fever, each drop of which contains the twenty-four millionth part of a grain of the dry belladonna juice.

Of this weak solution of belladonna we give to those not affected with scarlet-fever, with the intention to make them uninfectable by the disease,-to a child one year old, two drops (to a younger child one drop), to one two years old, three-to one three years old, four-to a child four years old (according to the strength of his constitution), from five to six,-to a five years old child, from six to seven,-to a six years old child, from seven to eight,-to a seven years old child, from nine to ten,-to an eight years old child, from eleven to thirteen,-to a nine years old child, from fourteen to sixteen drops; and with each successive year up to the twentieth, two drops more (from the twentieth to the thirtieth, not above forty drops)-a dose every seventy-two hours (well stirred for a minute with a teaspoon in any kind of drink) as long as the epidemic lasts, and four (to five) weeks thereafter.

Should the epidemic be very violent, it would be safer, if the children could bear it, to let the second dose be taken twenty-four hours after the first, the third dose thirty-six hours after the second, the fourth forty-eight hours after the third, and thereafter to let the subsequent doses be taken every seventy-two hours until the end, in order that the system may not at first be taken by surprise by the miasm.

This course of medicine does not disturb the health of the children. They may and indeed ought to follow the mode of life of healthy individuals, and keep to their usual drinks, food, and ordinary recreation and exercise in the open air, but they must take care to avoid excess in any of these things.

The only thing I must prohibit is the use of too much vegetable acid, of sour fruits, of vinegar, andc. The action of belladonna is thereby enormously increased, as my experience (contrary to the assertions of ancient writers) has taught me.

In case of the occurrence of such a case of the injurious and too violent action of belladonna (from this or any other cause), we should make use of its peculiar (according to my observations specific) antidote, opium, externally or internally, in doses similar to those I have above indicated, for the external or internal treatment of natural scarlatina.

There are, however, cases in which we are forced to give the above doses of belladonna oftener than every seventy-two hours. A delicate girl, three years of age, who was successfully using the belladonna as a preservative, in the above dose, beside her sister who had scarlet-fever, bruised her hand severely one day with the door of the room, and thereby fell into a mental and bodily condition so favourable to the reception of the infection, that, notwithstanding that she had taken the prophylactic the day before, she presented in a few hours all the signs of approaching scarlet-fever; but two drops of the weak solution of belladonna given immediately removed these symptoms just as quickly, without any further effects. From that time forward she took the medicine only every three days (as previously), and she remained quite free from the scarlet-fever and well.

We would therefore do well in the event of such sudden accession of violent mental depressions, occasionally, when requisite, to give one or two extra doses. We will also sometimes meet with children who possess naturally such timorous, tranquil dispositions, that in them the dose above indicated for children of their age will not suffice to protect them from scarlet-fever; the physician may therefore be allowed to increase it somewhat, and to stir the drops up with somewhat more fluid, and for a minute longer. I may observe, that it is scarcely credible how much this and every other medicine loses in power (so as even to be unserviceable for protecting from scarlet-fever), if we allow it to be licked simply and unmixed with anything from a spoon, or give it only on sugar, or, though dropping it into a fluid, administer it without stirring it well up with it. It is only by stirring, by brisk, long-continued stirring, that a liquid medicine obtains the largest number of points of contact for the living fibre, thereby alone does it become right powerful. But the well stirred dose should not be allowed to stand for several hours before it is administered. Water, beer, milk, and all such excipient fluids, when allowed to stand, undergo some decomposition, and thereby weaken the vegetable medicinal agent mixed with them, or even destroy it completely.

I would, moreover, advise that the medicine bottle should be locked up after every time of using it. I once saw a little girl of four years old fill up a medicine bottle with brandy, whence, as she confessed to me, she had previously drunk out all the medicine, which was also made with spirit and colourless. She had mounted on the table, had taken the bottle down from a high cupboard in the wall, and was about to fill it up with what she supposed to be a similar fluid, in order that her parents might not discover what she had done, when I entered the room.

Although a practitioner will seldom be so fortunate as to accomplish this extinction of the fever in question in its birth by means of belladonna, because it is not usual to send for him at the very beginning when the miasm attempts its first partial onslaught, and when uneasy dreams, paralytic stiffness of the limbs, pressive headache, rigour over one or other limb and over the head, constitute almost the only symptoms of the still feeble reaction of the system, yet it is a real fact, and, according to my by no means small experience, beyond all doubt, that it is capable of extinguishing the approaching fever with all its concomitant symptoms in the course of from twenty-four to forty-eight hours, and of restoring the previous state of health without the slightest bad consequences. To accomplish this object I found it best in this case to administer the half of the dose recommended above as a preventative every three hours, until all the symptoms had disappeared, and then to continue giving a full dose only every seventy-two hours in order to protect the patient from all further infection.I have, indeed, even in cases where there was already shooting pain and swelling of the cervical glands and increased heat of skin, that is, when a more considerable degree of natural reaction against the miasm was present, always succeeded in attaining my object by similar doses given at similar intervals of time, but I cannot recommend this practice to any practitioner who is not a most accurate observer, because should he chance to overlook symptoms of a more advanced stage that may be present, it must always remain a doubtful matter, whether, in such a case, by the addition of a new and powerful agent, the advanced disease would be suppressed and extinguished, or a tumultuous commotion be excited in the diseased system without any good result.

But least of all is it probable that our object would be attained by giving belladonna, and it is certainly not advisable to attempt it, if there are present greater heat, redness of face, great thirst, inability to leave the bed, vomiting and cinnabar-coloured eruption, in other words, fully developed scarlatina. It does not seem suited for administration in the height of the fever, just as Peruvian bark cannot be given in the middle of the hot stage of a paroxysm of intermittent fever with advantage or without producing a bad effect on the system.

On the other hand, belladonna displays a valuable and specific power in removing the after-sufferings remaining from scarlet-fever-an object that our forefathers, as we know, vainly strove to attain. Most medical men have hitherto regarded the consequences of scarlatina as at least as dangerous as the fever itself, and there have been many epidemics, where more died of the after-affections than of the fever.

The puffiness of the face, the swelling of the hands and feet, andc., the cachexy, the slow evening fever with shuddering, the stiffness of the limbs, the sense of constriction of the abdomen on holding the body erect, the formication and sleeping (narcosis) in the spine, the inflammation of the glands, the suppuration inside the ears, the ulcers on the face, on the lining membrane of the nose, at the angles of the mouth, andc., the extraordinary debility of the whole body, the sleepy, dull disposition, alternating with excessive hurry in talking and acting, the calling out in sleep, the pressive headaches, andc., will be specifically and rapidly removed by the same doses of this remedy as suffice (v. supra) for prophylactic purposes, or accordingly as the practitioner judges expedient by smaller or larger doses of it. Sometimes all that is required is to give the doses somewhat more frequently.

It is only in some particular cases, where the original disease was very violent, and advice has been sought for the after-sufferings too late, that I have witnessed what is termed the unhealthy skin, that is, the tendency to a solution of continuity in the solid parts, to ulceration, sometimes to such a degree, that belladonna is no longer of service. In such and other similar cases the most excellent remedy was the inspissated juice of the matricaria chamomilla, dried at a natural temperature in the air-of this a grain was first of all dissolved in 500 drops of water and mixed intimately with 500 drops of alcohol, and of this solution one drop was mixed with 800 drops of diluted alcohol-of this last diluted solution one drop (1/800000th of a grain of the inspissated juice) was given every day to a child of a few years old, two drops to one of ten years of age, and so forth; the medicine being well mixed with any liquid, and in a few days all tendency to ulceration of the skin was removed, the so-called unhealthy skin was cured-a disease in every case much dreaded by every medical man who does not know of this excellent but very heroic remedy.

The suffocating cough that sometimes follows the disease is also removed by chamomilla, especially if there is at the same time a tendency to flushing of the face, accompanied by horipilation over the limbs or back.Share this ...

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A Contribution to the Judgement Concerning The Characteristic Value of Symptoms (Boenninghausen, 1858)


BoenninghausenA Contribution to the Judgement Concerning The Characteristic Value of Symptoms (Boenninghausen, 1858)

It is now over three years since the great Homoeopathic Congress was held in Brussels, Germany being, I am sorry to say, but little represented. In the last session of this meeting after several propositions had been read, my resolution was adopted and a prize-question was proposed, to answer which a period of two years was granted. This prize essay, as the Homoeopathic journals have also made known, was intended to call out a “Treatise concerning the greater or lesser (characteristic) value of the symptoms occurring in a disease, to aid as a norm or basis in the therapeutical selection of the remedy.” The answer to this question was not limited to Belgium or to France, but it was handed over to the competition of the whole medical world, and it was thus unanimously acknowledged to be a subject of the greatest importance. Nevertheless, this question, in spite of the daily increase of the homoeopathic literature, has thus far remained unsolved. This silence extending far over the time set, which was computed liberally enough, seems to justify the assumption that the solution of the question has met with considerable difficulties, though every homoeopath must every moment find himself in the position to ask himself this question, and to have to answer it. It might not appear altogether proper for me, the author of the question, to also now enter among the competition for this prize. But the old practitioner will be pardoned for furnishing at least some contribution to the solution, and thereby again calling attention to the question.
The teaching of the Organon in this matter really contains the proper, true kernel of the answer, and this, of course, deserves to be first premised. It is found in the great Paragraph No. 153 (5th Ed.) and is as follows:
“In seeking for the specific homoeopathic remedy, i.e., in this juxtaposition of the phenomena of the natural disease and the list of symptoms of the medicines, in order to discover a morbid potency corresponding in similitude to the evil to be cured, the more striking, particular, unusual and peculiar (characteristic) signs and symptoms of the case should especially and almost solely be kept in view; for there must especially be some symptoms in the list of the medicine sought for corresponding to this, if the remedy should be the one most suitable to effect the cure. The more general and indefinite symptoms, such as lack of appetite, headache, weariness, disturbed sleep, uncomfortableness, etc., in their generalness and undefinedness deserve but little attention, unless they are more especially pronounced, as something of such a general nature is seen in almost every disease and in almost every medicine.”
It is seen, however, that it is here left to the physician to judge what is understood by the “more striking, particular, unusual and peculiar” symptoms, and it might, indeed, be difficult to furnish a commentary to this definition, which would not be too diffuse and, therefore, easily understood, and on the other hand would be complete enough to be properly applied to all these cases. Whence is it that we are unable to show any such definition in our literature? Even what Hahnemann adduces in §86, and those that follow, only contains some examples which are given without any systematic order, and are therefore but little suited to impress themselves on the memory, a requirement which in all such matters must appear to be of very great importance.
After looking about in the whole of the medical writings, allopathic as well as homoeopathic, for an aid, I remembered that in the middle ages they were accustomed to bring all such matters into the form of verses, in order that the memory might thus be assisted. The modern learned world knows, e.g., the diet of the Schola salernitana, dating from the beginning of the twelfth century, drawn up in leonine verses, as is supposed, by a certain John of Milan, from which some parts are quoted even to this day. But though I did not find here anything for the present purpose, I yet found something which, as it seemed, might prove useful with writers of quite a different doctrine. There is, namely, a hexameter dating from this same period but from the theologic scholastics; this is, indeed, of a somewhat jolting construction, nevertheless it contains briefly and completely the various momenta according to which a moral disease is to be judged as to its peculiarity and grievousness. The verse is the following:
“Quis? quid? ubi? quibus auxiliis? cur? quomodo? quando?”
The seven rubrics designated in this maxim seem to contain all the essential momenta which are required in the list of the complete image of a disease. May I be allowed, therefore, to attach my remarks to this scheme, with the desire that this hexameter, which was formerly used only by theologians, may now be also impressed on the memory of homeopaths and be put to use by them.

1. Quis?
As a matter of course the personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it.
To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both, if possible, separated, according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice.
The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies. In all such cases we have all the more cause to fathom these states with all possible exactness, as in them frequently the bodily ailments recede to the background, and for this very reason offer but few points for our grasp, so that we may be able to make a sure selection among the remedies which compete.
Paragraph 104 of the Organon makes it a duty of the homoeopath to make a written scheme of the image of the disease, and whoever has once acquired a certain facility in this will easily know how to satisfy this requirement and gradually acquire a certain specializing penetration, which will prove to him of ever increasing usefulness. For as every man presents an individual nature different from every other one, and as every medicine must be exactly adapted to this individuality, in agreement with the symptoms, which it is able to produce in the total man, so, an once, at this first investigation as to the Quis? A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient.
The spiritual and dispositional individuality of the patient here gives the most important, often almost the only deciding points for the selection of the remedy, where the disease involved is one of the mind or spirit, and generally the two disturbances present themselves so conjoined into one that the signs of the one only receive their full and definite character from the other. Hahnemann, indeed, recognized the importance of this two momenta from the beginning, but the necessity of weighting the two in their connection with one another he only recognized later on it its full measure; and he then placed the symptoms proper to the two, which in the first provings had been separated, one making the beginning and the other the end, in the “Chronic Diseases” immediately one after the other, an improved arrangement, which we also find in the best works on Materia Medica Pura of later times.
Many other things belonging to this rubric, but concerning the bodily individuality and presenting, as it were, the chief features in the portrait of the patient, are contained in those books under the heading of “general.” It would be desirable and would greatly facilitate the use if everything not pertaining thereto should be excluded, and the former be brought under a particular rubric denominated either “Individual” or “Personal,” in such a way that the corporeal would present a separate picture, as has been done with respect to the spiritual and mental.

2. Quid?
Of course this question refers to the disease, i.e., to its nature and peculiarity.
It may be unquestionably received as an axiom that we must first know an evil accurately before we are able to give any effectual aid against it. That occasionally relief may be given, without having first recognized the nature of the evil, as little refutes this axiom as the fact that an unexpected event occurs frequently which lies outside of our computation, and which either leads to good or evil, while neither the good will, nor the knowledge of the physician have the least to do with it.
But this axiom must be associated with another, which is no less true and no less important, namely this: That we must also know and possess the means which are able to relieve the evil when it is recognized. Where these are lacking, the former are of course of no avail.
Since the times of Hippocrates, thus since more than two thousand years, very much has been done with respect to the first point, and we have especially enjoyed a great progress and enlightenment within the last century and up to modern times. The path of pure observation and experience, which for a time had been pretty much forsaken, and on which that ancient Father of the healing art had gathered his valuable material, has again been entered upon. At the same time our contemporaries possess and use the great advantage enuring to them from the fact that they stand on the shoulders of their predecessors, and can thus view a greater circle of vision and, more especially, that astonishing progress has been made in all the subsidiary sciences, especially in chemistry and anatomy; so also they have had the advantage offered them by many physical instruments, which it must be confessed they have used with industry and care. By these means the modern physiological school, and, at the same time, the diagnostics of diseases, have reached an excellence not attained in earlier times.
The only thing of which every Homoeopath has to complain in this matter, is that things are conducted in too general a manner for his doctrine, and that almost universally diseases are described and treated of under the same name, which differ essentially in their nature, and require for their cure very different medicines.
An immediate result of this failing is, that Homoeopaths can make only a very limited use of the great advance made by the dominant school in diagnostics, since their generality excludes every special direction as to the suitable remedy.
Now since the modern Materia Medica of allopathy, as well as the older one, moves in the same generality, the conclusion follows almost inevitably that even the most cultivated allopath often stands undecided when he is to make a choice of remedies, so that almost every one of them will order something different, and that he is usually compelled to mix many thins together in order to cover the various indications.
More about this will be found in the course of this short treatise in a more suitable place, where the other questions are also discussed. Here I can only say so much about it.
a. That the most penetrating and most indubitable diagnostic as offered by the best allopathic manuals is rarely of ever sufficient for the Homoeopath, so as to enable him to make a sure selection of the remedy, and that
b. Such a diagnostic at most, and even then not always, may serve to exclude all those remedies from the competition which do not correspond with the common genius of the disease, but seem to act chiefly on other parts of the organism.

3. Ubi?
The seat of the disease really makes a part of the former question, but it nevertheless deserves to be more particularly emphasized, as it frequently furnishes a characteristic symptom, since almost every medicine acts more and also more decidedly on certain particular parts of the living organism.
These differences not only enter into consideration in certain so-called local diseases, but also in those diseases which are called by more general names, as affecting the whole body, e.g., gout and rheumatism. For it is probably never or very rarely the case that all parts of the body are affected in the same degree; even if it should be merely the case that the right side is more affected than the left or the reverse. But the examination of the parts affected is most necessary and most required when the whole to which they belong is larger, and is described merely in that general way which allopaths seem to delight in. Such names as headache, eyeache, toothache, colic and the like can in no way contribute to a rational choice of a remedy, not even when also the kind of pain is indicated.
Of course, the exact individualization of the ubi is most necessary in local ailments. Every Homoeopath knows from experience how necessary it is, e.g., in treating toothache, to select a remedy which in accordance with its provings on healthy persons has shown its action on the especial tooth to be treated. Among the most striking and decisive phenomena in this respect we should especially number the sores on the upper side of the joints of fingers and toes, which under allopathic treatment frequently prove very obstinate, and not infrequently become malignant, and necessitate an amputation, and, as I had an opportunity of witnessing here in two cases, may even have a fatal result. Every Homoeopath knows the efficacy of Sepia in these ulcers of the joints, which have no otherwise distinguishable features when this remedy is taken internally; without any external medication it will have a sure effect. Medicines which correspond to similar ulcers on other parts of the body in such cases are utterly useless.
If the practice of auscultation and percussion, as well as the use of the stethoscope, the plessimeter, etc., had been as well known to Hahnemann and his pupils as to our young physicians, they would no doubt have made the most extended use of the same for gaining a more exact knowledge and delimitation of interior ailments. They would have found out in lung troubles, e.g., definite local signs pointing to the use of certain remedies, and would have indicated them more accurately, and would not have limited themselves to defining them as being on the left or on the right side or at the top or below. To bring up to date and to specify more closely might be one of the chief duties for those who make additional provings at the present time, and might serve to an important and essential enrichment and completion of our Materia Medica more than a whole mass of confirmations of older symptoms or the finding out of new ones, which mostly have a lack of individuality.
At the same time it will be conceded from the allopathic side that the closer delimitation of the part affected, even though it may be of moment in the completion of the diagnosis, will be of no use to allopathic therapy, because this school is unacquainted with the peculiarities of the various medicines. No allopathic Materia Medica gives any information that the one remedy, e.g., corresponds more to the anterior or the posterior lobe of the liver, more to the upper or the lower part of the lungs, on the right or the left side, according to which the choice of the remedy may be made. Even if we Homoeopaths do not as yet know this as to all remedies, we do know it with respect to many of them, and for what is lacking we find a substitute in other signs, since, as is well known, all of these correspond to the remedy to be selected, at least they must not be opposed to it. Thence it may be seen that these new inventions, the value of which I am not in any way inclined to undervalue, have far less value in a therapeutic direction than in prognosis, where they show the extent and the dangerous nature of the malady.
Finally, we must yet consider in this question that neither the internal changes, which can be determined by these instruments, nor the material external changes, which manifest themselves openly to our notice, never present the dynamic disease itself, but are only its products, and are only developed in the course of the disease. When, therefore, these first beginnings are checked by the suitable remedy before those disorganizations take place, then these latter would not come to be developed, and it would be an inexcusable procedure to allow these sufferings to advance to a point where these material changes can be recognized in an artificial manner. It was necessary to mention this, in passing, in order that it may be shown how Homoeopathy proceeds, and to deny most decidedly the objection sometimes made that Homoeopathy is merely an expectative method, which allows the disease to develop without hindrance until it is too late to help. On the contrary, Homoeopathy knows and uses in infections diseases sure prophylactic remedies, which are always and exclusively such as have the power to heal the disease itself, and they never omit their use for the protection of those around the patient.

4. Quibus Auxiliis?
If the hexameter which we are following had been originally written for our doctrine, probably a more suitable expression would have been used in this instance, e.g., quibus sociis or quibus comitibus? Still the name does not matter, and it is manifest that it must refer to the accompanying symptoms.
Now since in Homoeopathy the chief aim consists in ascertaining the remedy which most completely corresponds to the totality of the symptoms, it is evident that this point is of the greatest importance and deserves the most careful consideration.
For every disease presents in its recognizable phenomena a more or less numerous group of symptoms, and it is only their totality which presents its complete image. This image may be compared to a portrait, which can only then claim to be a striking likeness when all the features of the original are faithfully presented in it. It is not sufficient that mouth, nose, eyes, ears, etc., should be presented in such a manner as characterizes man, and distinguishes him from the monkey and other animals but as every human physiognomy possesses its peculiarities and is distinguished from every other, so also here the more or less strongly pronounced abnormalities must most carefully and with the greatest faithfulness and truthfulness be presented and given their prominence. If therefore, retaining our former comparison, the nose should have a most peculiar form, color or size, it would not be sufficient to present this alone, though it should be most lifelike, and to add all the rest according to fancy, but also the secondary parts, which, as it were, form the background, must present a whole, such as it exists in reality, in order to give a perfect likeness.
It is from this point of view that the concomitant ailments are to be regarded when we select a remedy according to the motto: Similia similibus. Thence it is evident that the rare, striking and peculiar symptoms which present themselves demand a more prominent place than the common ones, because on them chiefly though not exclusively the similitude depends.
From this it naturally follows that the value of such concomitant symptoms for the purpose intended varies widely. But it would too far transcend the purpose of this contribution if I should adduce and explain all the many categories of value. I shall therefore limit myself to the presentation of a few of the most important points here involved:
First of all, those symptoms which are found in almost all diseases may be left out of our count, unless they manifest themselves in a striking manner.
The same obtains as to those ailments which are wont to appear as constant concomitants or at least as usual in the disease under consideration, unless they should be distinguished by some rare peculiarity and in this respect offer something characteristic.
On the other hand, all those attendant symptoms should be carefully noted which (a) rarely appear in connection with the leading disease, and are, therefore, also found rarely among the provings; (b) those which belong to another sphere of disease than the chief ailment, and (c) lastly, those which have more or less of the characteristic signs of one of the medicines, even in case they have not before been noticed in the present juxtaposition.
Now if besides this among the last mentioned concomitant symptoms there should be one or another in which the genius of one of the remedies should be plainly and definitely portrayed, so that it would be plainly pointed out, this one symptom thereby would acquire such an importance that it would even outweigh those of the chief ailment, and many then be at once considered as the most suitable. Such a symptom would be included among those which Hahnemann calls “striking, strange, unusual and peculiar (characteristic) signs,” and which are then “almost alone to be considered” because they preeminently give to the whole disease its individual character.
One circumstance deserves to be particularly mentioned here which particularly shows the importance and value of concomitant symptoms, namely, that several very efficient and in part specific remedies in certain diseases were discovered almost exclusively through them, the other symptoms indicating the main disease not having pointed in that direction, nor indeed could they have given such an indication, because the noticeable proximate signs could not sufficiently indicate the real peculiarity of the disease. This same system of concomitant symptoms also gives to Homoeopathy a much greater sureness in the treatment of diseases as compared with Allopathy, which first constructs for itself a frequently deceptive diagnosis of the disease, which at most only points out the genus of this disease, and where there are important attendant symptoms it endeavors to help itself by adding to the leading remedy given for the genus of the disease one or another remedy to cover the concomitant ailments.

5. Cur?
Why? The causes of the disease play a prominent part in pathological books, and justly. But a large part of this amounts only to guesses and attempts at explanation, which mostly have only a very subordinate value or none at all in the proper therapy of the disease, and which are too remote for our doctrine which is directed merely to the practical.
The causes of diseases are most generally and, indeed, very properly divided into external and internal. The internal causes properly refer only to the general natural disposition, which in some cases amounts to a peculiar supersensitiveness (idiosyncrasy). The external causes or occasional causes embrace everything which, where there is such an internal disposition to disease, may produce disease.
The general natural disposition which is also called the proximate cause, really belongs to the first question (Quis?) which respects the individuality of the patient. It only belongs here in so far as the consequences of a former disease may have modified the original natural disposition, and thus it deserves mention.
The occasional cause, however, is the matter with which the present question occupies itself and which deserves to be more closely considered. As to the natural disposition notified through previous diseases, this either depends on the miasmatic-chronic nature of those diseases as yet unexterminated, among which in agreement with the teachings of Hahnemann many homoeopaths even at this day count psora, syphilis and sycosis, or it is derived from the remains and after-effects of acute diseases, which when they do not belong to the former, as is frequently the case, constitute the numerous class of medicinal diseases or poisonings. Not infrequently, however, we meet with cases where both these momenta have cooperated to undermine the natural health, thus producing a monster of a disease which is even more deeply in-rooted and more difficult to combat.
As to the recognition and treatment of the first mentioned miasmatic diseases and their complications, Hahnemann himself in his masterly work on the Chronic Diseases left us the most complete directions, founded on many years’ experience. The much disputed division of medicines into antipsorics and non-antipsorics need not be considered here. It is enough to know that the former far excel the latter in their effectiveness in chronic diseases, and that their originator has nowhere excluded them from use in acute diseases. Later experience has also taught us that additional medicines from our medical treasury should be numbered in this category which have not been thus treated of in that excellent work. I am only sorry that Hahnemann has not been able to fulfill the promise which he gave me in writing, that he would treat as thoroughly and completely the images of syphilis and sycosis with his accustomed mastership as he had done in the above mentioned work (Vol. 1, p. 58 f. of the Second Ed.) with respect to latent and re-awakened psora.
Whether we may believe in what many somewhat derisively call Hahnemann1/4s Psora-theory, or reject the same, the attentive practitioner must frequently have found cases where even the remedy chosen with perfect correctness, in some acute disease, did not unfold its proper and decided effect before one of the so much criticized antipsorics – frequently Sulphur – had first been used, when psora had been involved, or an antisyphilitic or antisycotic when syphilis or sycosis had been present before and had remained uncured. It must, however, be confessed to be one of the most difficult tasks of the physician to always make the most suitable choice among the antipsoric remedies, as most of them have almost the same symptoms and very few truly characteristic symptoms are found with the different remedies. The more necessary is it for the homoeopath to study with continuous industry these lists of symptoms and to compare them with each other in order that he may pick up the scattered grains of gold for his use.
Poisonings and medicinal diseases are in one line and it makes no difference by whose hand any one has been deprived of his health by means of a substance injurious to his organism; among these substances medicines as well as poisons find their place. Of course, it is always of the greatest importance to know in every case the medicines or poisons, in order that they may be met by the proper well-known antidotes. The simple poisons may be pretty easily and surely recognized by their effects! It would have required but one case of poisoning occurring before the eyes of a Homoeopath for him bo have recognized the effects of Arsenic, which yet remained unknown to all the allopathic physicians, in the case of the thirty murders of Gessina Timme in Bremen, until the facts were obtained. In the medicinal diseases this is much more difficult, because seldom or never is one medicine given by itself, but always mixed with others; it can not, therefore, yield a clear and definite image. With these, therefore, it is necessary, as in the other case it is desirable, and it facilitates the treatment, if we can have a reliable account of what has preceded, and to be able to look over the prescriptions. Since this may be of use even later on, as the treatment proceeds, the journals of many Homoeopaths have a special rubric reserved for this subject.
We must consider these symptoms, called anamnestic, as being of special importance in this question. Although the ordinary consequences of such morbiferous circumstances and events are mostly already contained in the lists of symptoms of the medicines proved on healthy people, yet homoeopathic practice has long ago shortened and made sure the tedious and troublesome path of such investigations, and indicated for most of these cases the remedies which are foremost in their usefulness in such cases. This is e.g., very much simplified in cases of contusions, sprains, burns and the like. In other cases, e.g., in colds, the matter is already somewhat more complicated, since the kind of a cold and the part of the body affected offer differences which again point to different remedies. Thus there is a great difference in this respect as to whether the person has been simply exposed to the cold, or whether this took place while the body was in a perspiration, or if he at the same time got wet through. So also it is well known that different remedies are indicated when internal parts (stomach, abdomen, chest) have been exposed, or merely external parts (head, feet, back), and this must be carefully weighed in every case.
All this, as before said, is found among the symptoms in the Materia Medica; but when once it is known that a cold in the head from exposure to cold air, after previously being in a heated room, or after having the hair cut, points to Belladonna or Sepia; after taking cold in the feet, to Baryta or Silicea, and when at the same time there has been a wetting, to certain other remedies, then the attention will first of all be directed to these, and only comparison be made with others which are also occasionally indicated when the first are not sufficiently suitable.
Finally we must yet add a word under this question about infectious diseases, about which in pathological manuals we read so much that is contradictory and unreliable; the influence of which teachings is, however, much more far reaching than is generally supposed. To meet these diseases, which often spread until they become a real calamity, Homoeopathy has the most sure and approved prophylactics, and these, indeed, are the very same which have the power of healing those diseases when they have developed. Therefore, when we find in a family a case of infectious typhoid fever, there the same remedy, which has been given the patient in accordance with his symptoms, will also be sure to protect those in the house from infection, as it destroys the natural disposition thereto, and it will even in the shortest time restore those with whom there may have already been apparent the beginning of the disease. This last fact is the more important, as these first beginnings are usually so poor in symptoms that no certain choice can be founded on them; but the known occasional cause fully makes up for what is lacking. Of course, such a cure is not so brilliant as when the patient has been at the verge of the grave, but the gain for him and the consciousness of the physician is his sufficient reward.

6. Quomodo?
From his etymology, this preposition excellently describes the essence and the scope of the question before us. For the word Modus in the old classics not only refers to the manner and mode in general, but also to all the modifications which can take place in anything, thus the measure, the rule, the aim, the relations, changes, etc.; thus whatever, with the exception of time, which is included in our last question (Quando), possesses the ability to produce a modification, aggravation or improvement with the patient, naturally belongs, according to the usage of the language, to this rubric. This question has a double importance to Homoeopathy, first, because it was first discovered and developed by Homoeopaths, and is, therefore, their indisputable and exclusive property, and secondly, because all the results of provings and experience, without exception, belong to the more or less characteristic signs, of which no one is a matter of indifference, not even those of a negative kind.
Allopathy has never given any general attention, which might have been of use to therapy, to this momenta. At least its manuals on Pathology, Therapy and Materia Medica contain nothing of importance on this subject. Homoeopathy, on the other hand, soon after its discovery, recognized its great therapeutic value, and we find the first but already clear traces of it in Hahnemann1/4s “Fragmenta de viribus medicamentorum positivis,” which appeared in the year 1805. But during the progressive development of our science its importance appeared more manifest, and it was soon declared to be indispensable, so that in the later provings the attention was more and more directed upon it. On this account the latter provings are the more complete, with the exception of those made by Hahnemann in the Materia Medica Pura, which were elaborated with especial industry and on account of their constant use accompanied with copious notes.
If we compare the lists of symptoms of the medicines which have been proved somewhat fully, even a superficial survey will show that we find in almost every one of them the general indications of almost every disease; headache, colic, pain in the chest, diarrhoea, constipation, as well as dyspnoea, pains in the limbs, fever and cutaneous ailments, etc., are in no case quite absent. But if we study these indications somewhat more closely, with respect to the special parts of the body and the different sensations, then, indeed, differences will appear, and we frequently discover symptoms which appear more or less frequently in one remedy and are totally lacking in another. But the number continues too large to bring the decision to a sure and indubitable point, and we soon feel the need of securing additional points in order that we may find the true and suitable simile among the competing medicines. But the Quomodo with the Quando generally solves the riddle in the most satisfactory manner, and not only removes every doubt, but also furnishes the proof for the solution which we may have before supposed to be the right one. That in such investigations and comparisons we must also, as in what precedes, occupy the especial standpoint, is a matter of course. It is not sufficient, e.g., to merely consider motion in general in contrast with rest in the body, or in the part affected, we must also consider incipient and continuous motion, as well as the different kinds and degrees of motion. The same applies to lying down, we must not only consider the kind of position (on the back, on the side, doubled up, horizontal, etc.), but also aggravation or improvement in the parts affected by lying on the painful part, or the part not painful; all this is to be found out accurately and adapted to the remedy.
Quite a prominent part in this rubric is occupied by the partaking of food and drink, and this not only in diseases of the digestive organs, but also in fevers and other internal and external affections. Here it is not so much the amount of appetite, or thirst, to which also allopathy in some cases gives a proper importance, but especially the dislike or the desire for particular kinds of food and drink, and more especially also the change of condition after partaking of one or another article of food that often gives the most important hints as to the medicine to be selected. All experienced Homoeopaths have therefore always given the greatest attention to this subject, and it is very much to be desired that whatever different persons have discovered in this direction should be collected and published.
It was mentioned above, in passing, that even negative signs, so far as they belong to this rubric, should not be neglected. An example will show best what is meant by this: when a patient, for whose condition Pulsatilla seems suitable according to the five preceding questions, feels best while at rest in a warm room, while he feels uncomfortable in the open cool air, and also is fond of fat foods and bears them well, or offers other peculiarities which are in conflict with the characteristics of Pulsatilla, this would give an urgent cause to doubt the applicability of it to his case and to look for another remedy which also in these points corresponds with the symptoms.
I am sorry that the space for these contributions, which anyways may seem to have been already greatly exceeded, does not permit me to enter more in detail on one and another matter belonging to this division, as I may openly confess that I consider the indications obtained from this and the following question as the most important, indubitable, and therefore the decisive ones for therapeutical purposes. Even the numerous class of reflex actions, almost all of which fall into these two rubrics, do not by their internal contradictions diminish this importance, as soon as we know their mutual value, and are, therefore, enabled to estimate properly the worth of each.

7. Quando?
This last question concerns the time of the appearance, of the aggravation or the improvement of the ailments, and follows in natural order after the preceding, and is hardly of less importance in therapy than the last one.
From the time of Hippocrates and his commentators up to our times great attention has been bestowed on the periods of time in the various phases and stadia of the disease. The endeavor has been made to fix the period and continuance of the beginning, of the increase, the acme, the decrease and of the end of the disease. This would, indeed, make a useful contribution to the recognition and the characterization of the disease. But only in case it should be left altogether to itself and not be modified by medical interference. But on the other hand it can not be denied that this cannot give the least aid in the selection of the remedy, if only owing to the fact that the medicines cause disturbances in the natural course of the disease, which frequently lie altogether outside of all computation. Least of all can they be of any advantage to allopathic therapy, because it lacks all criteria from which to indicate the one or the other. I hope that I may not here hear the objection that, e.g., the periodical return of a fever points to an actual or a disguised intermittent fever and therefore indicates Quinine in its various preparations; for we are not likely to find a homoeopath who has not in his practice had to treat numerous victims of this error.
Homoeopathy intends something quite different in this question, having nothing in common with what precedes. But it is concerned with two momenta which have an immediate effect on the choice of the remedies, namely (a), the periodical return of morbid symptoms after a longer or shorter cessation, and (b), the aggravations and alleviations depending on the time of the day. These two will require but a few words.
The periodical return of morbid phenomena often coincides with periods of time which carry with them particular occasional causes. Among these are to be numbered the menstrual ailments, as well as those which are conditioned by the seasons, the weather, etc. Where such definite secondary causes cannot be discovered, and where as is mostly the case, the attacks are not closely bound to any sharply defined periods, they have no therapeutic value for homoeopaths as they lack the quality of a useful indication.
But of the greater importance are the aggravations and alleviations at particular times of the day, and this with respect to those which refer to single symptoms as well as those that refer to the general health. In this respect Homoeopathy possesses a great and valuable treasury of well proven experiences which are being more and more enlarged by careful observations. For there is hardly any disease, from the malignant internal fevers down to local ailments, in which during the different times of the day there does not manifest itself a more or less decided and distinct aggravation or alleviation. Now since homoeopaths have learned these peculiarities also in the various medicines during their provings on healthy persons, they are enabled to make extensive and blessed use of this peculiarity in their therapeutics, and they are obliged to do this in order that they may satisfy the rule Similia similibus also in this respect.
To demonstrate the preceding with some special facts, I will only adduce here the importance which the time of the day has on coughs with respect to the expectoration, as well with respect to the greater ease with which it is discharged, as also the consistence and the taste. Something similar we know about the stools, and although most of the remedies have diarrhoea among their indications, we so far know only of two (Conium and Kali carb.) where this takes place only by day and not by night.
With respect to the ailments which have a typical return, independent of other causes, we have a considerable series of remedies corresponding to this, without on that account excluding others, when they are indubitably indicated by their symptoms. Only in cases where this return is sharply and definitely pronounced, as for example in the evening from 4 to 8 o’clock (Helleborus and Lycopodium), or exactly at the same hour (Antimon. crud., Ignatia and Sabadilla), we should give it a special importance and only be careful that there may be no contraindications.

I conclude these contributions, which I have only hastily sketched down, with the hope that I may have succeeded in putting into the true light the difference between Allopathy and Homoeopathy and to incite my colleagues on their part to treat these important themes more at length, even if this be done only with respect to some one of the questions indicated at a time.

Clemens Maria Franz, baron von Boenninghausen 1858Share this ...

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On the Study of Homeopathic Materia Medica, Constantine Hering


heringThe ordinary mode for acquiring knowledge of remedial agents – namely, merely by experience during practice – cannot be termed studying the medicines, and no directions are required for it.
Much time and labor may be expended in this mode without ever attaining a complete command of the medicinal agents. Many a homeopathic practitioner will find himself in the situation of walking on a treadmill – setting machinery in motion, without moving from the spot.  He who trusts solely the experience and observations of others, and thinks that by means of published collections of cases he will also attain accuracy in the selection of medicines in individual cases, or find a similar accuracy in his general views of medicinal agents – such a one constantly remains in a state of dependence, moving merely in the narrow circle which others have chalked out.
In another country amidst other customs, and at other times when a different character of disease is present – indeed, during the prevalence of individual epidemic diseases – he stands helpless and bewildered. His pockets are full of paper money that is not current there, and his hands are destitute of any available coin.
He who relies only on his own experience for knowledge of medicines can only attain a very limited understanding. His personal knowledge will be quite imperfect as regards individual remedial agents. If, perchance, one or other property appears peculiarly prominent, then the others will be but seldom or never attended to.
For example, consider the case of Aconite, which certainly is of frequent use in inflammations, but much more often in cases where no inflammation exists. Or consider Belladonna, which is frequently employed where it does not answer at all, and where Hyoscamus., Arsenicum., Bryonia., or some other remedy, should be used instead.
So understanding acquired only in this way will be imperfect, in fine, as regards our whole material-medica – because by this method the knowledge of materia medica cannot but always be very deficient. Only a small number of favorite remedies will be retained in memory – merely such ones as are known, or thought to be known, to possess some general determinate properties which render their selection easy.
In the greater number of cases that come under daily observation, these favorite remedies will very frequently be given where they are not of the slightest use. A number of remedies will be employed for merely single symptoms. And a large number will never be  prescribed at all.
In cases of a more serious and rarer description, even where the most careful research is employed, it is often all in vain. For sometimes many remedies seem to be equally indicated, so it is difficult to make a selection from among them. At other times no single remedy seems applicable. The more intimate our acquaintance with the medicines, the more seldom will such cases occur, and the nearer is the physician to the attainment of complete mastery of his subject. Tyros, who have merely glanced at the remedies, imagine that it is not possible to become acquainted with a single remedy which has such a vast number of symptoms – just as a country clown on coming to town is at a loss to conceive how the people know which way to go among such a number of houses. And yet, in the course of time, he himself finds no difficulty in doing this. Let us observe how this happens. It may help us a little in studying the materia medica. It is well known that a perso n who has been in many large towns can much sooner find his way than other strangers who have not. This is true without there being much resemblance between the towns. He must unconsciously have invented some method by which he becomes quickly at home in every new town.
In like manner, many homeopaths have unconsciously adopted a method of studying the material medica. Our present object is to make this method known.
Learning the materia medica “by heart,” would be a highly absurd plan – and not only impossible on account of the extent of the undertaking, but even if possible, still, utterly useless. In order to acquire a foreign language, what good would it do to learn the dictionary from beginning to end? One who could repeat the list of symptoms of a remedy in their regular order would not thereby possess knowledge of the combination of symptoms – and it is that knowledge of which we stand in need. In practice, we never make use of the whole range of symptoms, but only of a particular combination of a small portion of them. To the general symptoms of every form of disease, corresponding ones may be found in a large number of remedies – and every remedy contains the indications of a vast variety of diseases.
The Goal Of Study
Every medicine has its peculiar characteristic traits which must occur in each of the groups that are mentioned above. There cannot be the least doubt about this fact. But this only shows the goal from afar – a goal that we may reach by a careful study of the materia medica. Up to this time, only a few fragments of such characteristic traits have been discovered. Anyone may soon learn these by heart; but this can never be called studying the medicines. Properly speaking, the study of the medicines is rather the road to a fresh discovery of those traits which, during practice, are continually presenting themselves to us. And, at the same time, it will show the fallacy of many well-known dicta proceeding from some who have attained the reputation of great authorities through the indolence of others.
The homeopathic physician who knows little more than the characteristics of a few polychrest medicines (with the addition, perhaps, of a few other scraps of knowledge which he himself picked up) has only a one-legged stool – we may turn ourselves hither and thither, but it will fall to the ground if not sat on by someone with two legs. The homeopathic physician who knows no more than this is like a bad chess player – someone who only knows one or two methods of giving checkmate which he has learned from studying the fag ends of games played by celebrated players – put together with but a few other modes he has discovered himself. The master of the game commands all the pieces in every situation. He shows his skill even when checkmated, and, properly speaking, he never loses. Even though the physician at the bedside of the patient has ever so carefully compared a medicine with the case before him, this will tend but little to advance his knowledge of it. And such a comparison cannot be termed a study of the medicine, as it is only viewed in connection with the case thus before him.
To study a remedial agent is to attentively observe its symptoms and curative powers, without any reference to particular cases or particular diseases. It is to consider all its effects as connected with one another. All its individual symptoms are seen as separate parts of a whole. The many changes produced in the sensations by its action, which have been separately observed and collected together, are to be regarded as symptoms of one and the same artificial disease. They are seen to belong to one morbid picture. The proper mode of studying the whole materia medica consists of first making one’s self the complete master of a few medicines. Afterwards comes the mastery of those medicines most nearly connected with the first few, and so on. There is always a comparing of the new ones with those that were first studied. On this account, I call this the diagnostic method. After one or more families of nearly related substances have thus been worked out, the others follow much more easily. After pursuing the study in this manner with unremitting diligence for several years, then any new medicine may be made available after only one perusal. By carefully reading it over only once, so much remains impressed on the memory by the unconsciously acquired habit of comparison, that in a case of disease in which it is indicated, it is easily recalled to mind. He who can do this will not complain of the number of imperfectly proved medicines, or of the fewness of their recorded symptoms, while at the same time finding fault with the large number of symptoms presented by other medicines. Be the symptoms as numerous as they may, he can make himself be the master of them. Be they ever so small in number, he understands how to avail himself of them. He who has not the requisite foundation finds all additions to the materia medica a disagreeable burden. He shows by his discontent that he has not yet made himself master of the old matter. Methinks most of those who complain of our materia medica, are either totally ignorant of, or have but a scanty acquaintance with, our medicines.
Before we proceed to give specific directions, we shall:
1. Endeavor to defend the method we have proposed
2. Show how a single medicine is to be studied
3. Show how the others are to be connected to this one
A Defense Of The Method We Have Proposed
The assertion that one remedy must first be perfectly known, and that then the rest will be acquired with less difficulty, and still more easily the farther we advance, is founded on the principles and practice of mnemonics. This diagnostic method, indeed, appears to me to be the only practical plan of studying the material medica, or at any rate, the shortest and most direct way of attaining the end proposed. There are certainly two other possible methods. One is to learn what are called the principal symptoms of each medicine. The other is to study each substance by itself, and thus, all of them unconnectedly. A fourth and last method would be, not to study the materia medica at all. (Exempla sunt odiosa!)
To learn the so-called principal symptoms – e.g., to extract from an epitome like Jahr’s Manual, the most prominently marked sentences, and to get these off by he art – is the shortest way to practice. But, at the same time, it is the surest way to permanent mediocrity. Let him who is forced to make a trade of his profession, adopt this method. It will bring him soonest into the center of the woods. But let him not forget to secure at the same time a permanent possession. If not, he will resemble the squatters in the far west, who establish themselves without troubling their heads about their right to the soil. And when the buyer of the land chases them off, they remove to a distance, out of one wretched wooden hut into another. They barely support their existence by the scanty profits arising from ill cultivated ground, and the uncertainties of the chase. This superficial, unmeaning sort of life has charms for them. And their labors, together with those of the destructive wood louse, lighten the task of the settler. Those qualities that we at present term the principal symptoms of the medicines are, for the most part, unsatisfactory – nay, they prove an obstacle in the way of accurate individualization, and lead to carelessness. It is much more convenient to administer to patients a dozen homeopathic remedies according to this principle, than any plan of the old school. And one may, by such practice, be pretty sure, that by the end of the year a number of p atients will have recovered. These principal symptoms are, moreover, in many instances incomplete, and in many others perfectly false. They can only be known with certainty, and have their due value assigned them, by a careful study of the various medicines, having especial regard to their relations one with another. A mere acquaintance with these principal symptoms cannot be called studying the remedies. If we were in possession of a scientific arrangement of the materia medica, we might make it the basis of our study of the medicines. But at present, we cannot expect to construct anything satisfactory on such an uncertain and incomplete basis. He who seeks to study the medicines according to their symptoms, but each medicine separately and without instituting a comparison between them, will, with the very best memory, not advance far before forgetting what he had previously learned. The memory is incapable of retaining any thing but what is presented to it in connection with something else. An idea is easily brought to the recollection only when in connection with others.
We would remind him who has had no experience of the comparative method, either on himself or others, that acquiring a knowledge of the symptoms of medicines, is exactly similar to the mode in which the chemist, the mineralogist, the botanist, and the zoologist acquire a knowledge of the objects connected with their respective sciences. We should, therefore, set about it in a similar manner. Let it be considered what a multitude of signs are so perfectly at the command of the zoologist, that he can easily recall them to his recollection. Although no one is capable of giving a complete description of all animals, a repetition of all their characteristics “off the book,” as the saying is. Yet the zoologist can at once tell a new animal when he sees it. He can instantly determine to what class it belongs, and point out its particular characteristics. By merely looking at each animal, he already knows its characteristic peculiarities, or at least has no difficulty in discovering them. The homeopathic physician must do just the same with his medicines. Let it not be alleged that zoology and the other branches of natural science are things quite different from our science. It must be regarded and dealt with in exactly the same manner as the natural sciences.
Let it not be said that those sciences are so far advanced, and the system so perfect, that every thing connected with them is much easier. Suppose that our materia medica were at present as little advanced as a natural science – as zoology in the time of Aristotle. This should not deter us from regarding it as such, working it out as such, and studying it as such. By this means we should make as much progress in it as was then made in zoology – and that is a good deal in comparison to knowing nothing at all, or to wandering in benighted ignorance amidst a profusion of everything. I refer to those who possess a real knowledge of our materia medica, if that has not been obtained in the way I have just pointed out – and I doubt not that some now see that they have unconsciously obtained their knowledge in the same manner. There can only be one right way. But this may have been pursued without the individual being exactly aware of it himself, as has happened to those proficient in many of the arts. 
When one remedy has been accurately studied, and the art has been acquired of classing others along with it according to their resemblance and of distinguishing the differences between them, then each subsequent group that is studied in a similar manner costs far less trouble. The result will be that he who has thus made himself master of a hundred medicines will require for the second hundred scarcely so much time and labor as he expended on the first ten. An increase of the medicines, therefore, ad infinitum, will never prove too much for human capabilities. Entomologists can easily acquire knowledge of a number of new insects. It requires little trouble on the part of the botanist to learn an endless succession of new plants. This they do by a speedy conception of the resemblances and differences among them – and the more practice they have, the easier it is. It may be urged that no such laborious mode need be adopted to acquire of one of the natural sciences, but that the general characteristics of the various classes are soon learned. In the present state of the natural sciences, all the relationships existing among the various classes and orders may be seen at a glance, and the study of them thereby greatly simplified. But, as we have not brought our materia medica to such a pitch of perfection – and from the short time of its existence, it has been impossible to advance it farther than it is at present – we must dispense with this simplifying glance. We must, however, on this account, follow the only path that leads to this end – laborious though it be at present. As the progress of inventions facilitates commerce and travel more and more, so the progress of science always lightens the task of learning what has been discovered. The same will be the case as regards the materia medica. Until that time comes, we must study the remedies as we find them. The time is, we hope, not far distant, when we shall be able to talk about the objects of our science in the same manner as natural historians do of theirs – when, like them, we may be able to give complete descriptions of these objects without touching upon unimportant information.
The time, we hope, is at hand when we shall know what is and what is not important in our material medica.
How Is A Single Medicine To Be Studied?
How can a remedy be studied, if the symptoms are not learned by heart? It can be learned through the same principle as the whole materia medica – by comparison. The symptoms of a medicine are to be read through carefully several times. This should be done from beginning to end, in the first years of study, with the pen always in hand. While reading, one thing or other is always to be particularly attended to.
— The First Reading —
At first attention should be directed to the organs in which the symptoms occur. It will be at once noted that many organs or tissues are particularly attacked. The organs that show the greatest number of symptoms are to be regarded according to their physiological relationship. In this, our previous studies are a great assistance, just as every physiological dogma, every hypothesis, even though false, is an aid to the memory.
Thus, the ear is said to be the peculiar organ of the osseous system. Therefore, when pains or nodes in the bones occur, I would observe attentively the symptoms of the ear. And, in this manner, many individual symptoms would appear more significant where connections exist. For instance, between the functions of the skin and kidneys, symptoms occurring in the one system will always call to our mind those of the other – whether those symptoms harmonize with or are opposed to one another. In our comparison, pathology will also be of use, and that will be so whether its theories are true or false. Thus, where symptoms referable to the liver occur, I would always compare the pains in the right shoulder, and vice versa. Where turbid urine is passed in small quantity, I would pay attention to the symptoms which point to the serous cavities. In doing this, for example, when studying Aurum, a number of symptoms would thereby appear more important, and consequently be more deeply impressed on my mind. And this remedy would occur to my memory not only in cases of effusion into the pericardium, but also in hydrothorax and ascites.
The important observation of Neumann – that diabetes is always preceded by a diminution in the activity of the kidneys – will be often serviceable in our consideration of the medicines. It will, for example, help to confirm the supposition that not much is to be expected from Argentum in cases of diabetes, and that this disease is mentioned in our repertories in connection with silver in this manner: Hahnemann, distrusted the alleged diuretic properties of nitrate of silver. Rather he ascribed to it powers that are exactly the reverse. But as far as I know, he does not adduce a single instance of its efficacy. While studying the symptoms of Phosphoric acid, we should call to mind the same observation that is also the recorded experience of its efficacy in several cases of milky urine – a kind of diabetes. In this manner we will see that a large number of the symptoms may be pathologically connected. During the first reading and comparison, the symptoms arrange themselves, as it were, into some sort of definite form. Thus we gain a collective impression of the whole that we retain in the memory, and recall to mind in all cases where the remedy is suitable.
— The Second Reading —
During a second perusal of the medicine, attention should be directed at the character of the symptoms. The former perusal was but a preparation for this step. The character of the pains in different parts should be compared – all pains or other sensations of the same, or a similar or a nearly related kind, that occur in different parts should be carefully observed. If this is done, it will be found, for example, that burning pains occurring frequently in various parts are not peculiar to Arsenic and Carbo-vegetabilis alone, but they also occur in Phosphoric acid and other substances. The mind will take a comprehensive view of them, and a complete picture of them will be retained.
At the same time, attention must be paid to the parts where these pains principally occur. Thus, we note whether the burning pains are more in the mucous membranes, or in the serous cavities, or in other parts. For instance, the burning pain in the case of Arsenic occurs most frequently internally, in the blood vessels. In the case of Carbo veg. pain is seen more externally, in the skin and joints. Both substances cause burning in the stomach and bowels, but Arsenic to a greater degree.
On the other hand, Carb. veg. causes much more in the breast – and so forth. In every substance where the same description of pain prevails, an attentive examination will show the characteristic features of each. We will soon discover that certain kinds of pain prevail in certain organs and tissues, e.g., tearing in the muscles, dartings in the chest, cuttings in the abdomen, pressure in the head, compression in the ears, boring in the bones, etc. But this we shall enter into more particularly in another place. This tends much to assist the memory, both directly and indirectly – the circumstance of an unusual pain occurring in any organ would be the more observed. A number of isolated symptoms are, moreover, more easily remembered in connection – when placed side by side.
For example, with respect to Aurum, it produces determination of blood to the head, to the chest, to the eyes; toothache from a similar cause; determination of blood to the legs; and many other symptoms that may be found to be connected with these.
An accordance of many of the symptoms of different organs may often be observed. Thus Caust. has sparks, flickerings, figures, an appearance of gauze before the eyes. Also, it has ringing,whistling; singing, chirping in the ears. On the other hand, Phosph. has points and spots, dark, black, and gray veils before the eyes; loud noises, buzzing, throbbing in the ears. After the moral symptoms have been arranged in groups, they may be easily impressed on the memory by comparing them with the corresponding symptoms of other organs. Thus anxiety, melancholy, etc., are to be compared with the symptoms of the heart and chest – or a weak, wandering, or obstinate state of mind, is compared with the frequently analogous symptoms of the digestive organs. And so forth.
— The Third Reading —
At the third reading, the conditions under which the symptoms take place should be noted. This must always be done pen in hand, even though Ruckert’s comparative work be employed. Doing it one’s self has great advantages, especially at the commencement of the study. One is exercised thereby; and all that has been previously learned is at the same time revised. It should be observed whether the symptoms take place on the right side or the left. If this has not been done previously, note at what part of the day they occur, when our pathological knowledge will be of great assistance to us. Observe in what attitudes, positions, during what motions, etc., the symptoms occur. Care should be taken not to indulge in vague generalities, such as “aggravation in the evening,” “worse on motion,” and the like. This is of small use in acquiring knowledge of the medicine, and it is an obstacle in the choice of it as a remedy. What we wish to know is, what symptom is aggravated in the evening or on motion. When possible, this symptom should be noted along with some connecting idea. Since Hahnemann taught us to distinguish between Bryon. and Rhus. by pointing out their opposite qualities – motion producing aggravation in the one case and rest in the other – it has frequently happened that too much value has been assigned to this circumstance in the choice of Bryon. Many other similar remedies are distinguished by possessing a similar pair of opposite properties – Bell. and Hyosc.; Nux. and Puls.; Chin. and Seneg.; Phos. and Nitr.; Sulph. and Con.; Carb. And Dros.. These along with many other substances bear the same relation to each other as Bryon. and Rhus.
Bell. has a far larger number of symptoms that are worse on motion than Bryon. – yet the symptoms that are worse on motion are perfectly distinct. As regards Bell., they occur mostly in the vascular system. With Bryon. they are chiefly to be found in the joints. The symptoms of the respiratory organs with Bryon. are not aggravated by motion. However, those produced by Bell. are decidedly so. One should be careful of coming to a converse conclusion. I mean to say, in the case of a remedy having a number of symptoms that are aggravated by rest, it does not follow that they will be ameliorated by motion, and vice versa. Thus Dulc. has many symptoms that are better on motion, but very few that are worse when at rest.
— The Fourth Reading —
The remedy may be perused yet a fourth time, with particular attention being paid to the combinations of the symptoms. The student may carefully observe what symptoms follow each other or occur simultaneously. However, the attention must have been previously directed to this point. When this was not the case, the student should seek to bring these combinations into connection with his former observations. Care should be taken not to adopt the notion that a remedy can cure groups of symptoms in a patient only if they occur in the order it produces them. A remedy is capable of curing groups of symptoms which it does not produce in the same combination at all – groups whose component parts were observed in a number of different provers, and frequently in quite a different order. From a pathological point of view, a special study of a medicine which compares it at the same time to different forms of disease may be useful after a thorough knowledge of the symptoms of the medicine has been acquired. Experience teaches us that a number of apparently perfectly different diseases, which are far asunder in pathological works, may still be cured with the same remedy. It would consequently be necessary to go over almost all diseases in connection with the remedy. This would be a great waste of time, and would not lead to a perfect knowledge of the remedy after all – our pathological systems are very far from being complete enough for this. It would be well, however, to compare the description of individual forms of disease, with many classes of remedies. Thus, for instance, those catarrhs which indicate Mercury and allied medicines are very dissimilar to those in which Arsenic, and medicines of its class, are efficacious.
How Other Medicines Are To Be Connected To This One
After a thorough acquaintance with one or more remedies has been gained in the above manner, the student must then pass on to others. The best course will be to go on next to those most nearly allied. The study of the second remedy is already somewhat easier. This is partly owing to the practice that has been had in acquiring knowledge of the symptoms, and partly because deviations from the character of the last studied medicine become more vividly impressed upon our mind. We must, consequently, have a very clear perception of these differences. They must assist us to attain a distinct idea of the peculiarities of the second medicine, as well as to stamp the knowledge of the first more forcibly on our memory. Therefore we must search for resemblances and observe differences in the more prominent symptoms – and in those that are more easily remembered, rarer, and more striking. I have called attention above, in the examples of Bryon. and Bell., Caust. and Phosph., Arsen. and Carb. veg., to the fact, that medicines which otherwise present great similarities in their symptoms, are yet widely different in certain respects. No regard needs to be paid to slight differences, nor even to whole groups of symptoms which one of the medicines has, and the other has not. No attention need be given to the fact that, in one case many symptoms are known, while with the other, very few are.
These factors may, however, demand our attention in cases where the different characters of the remedies are thereby marked – as in the case of Bell. compared with Bryon. regarding the moral symptoms, the effects upon the organs of the senses, the symptoms of the throat, etc. The differences sometimes lie in the combinations of symptoms, whereby they may present resemblances to perfectly different diseases.
More frequently, and much more clearly, these differences are expressed in the conditions under which the symptoms occur. These are often exactly opposite. Thus the very similar headaches produced by Bell. and Bry. occur in the former in the evening, in the latter in the morning. These differences are sometimes very subtle. For instance, most of the exacerbations of Acid. nitr. occur in the evening, but those of Acid. mur. are before midnight. Those of Acid. sulph. are after midnight, and those of Acid. phosph. are seen towards the morning. But all the acids present nocturnal aggravations. Symptoms of an opposite character are rare. But differences in nature are very frequent, as is the case in the gastric symptoms of Bell. and Bry., Bry. and Ant. crud., Ant. crud. and Ipec., etc. Symptoms in opposite situations are more frequent. Thus, similar symptoms are often distinguished by occurring in one case on the right, in another on the left side – as happens with Arn. and Lach and others. The catarrhal affections of Bell. are distinguished from those of Dulc. in that those of the former occur more in the mucous membranes of the head and neck – in the region of the carotids – where those of the latter occur more in the chest and abdomen – in the course of the descending aorta, etc. Beginners are apt to attend too much to specialties when making these comparisons. This over attention becomes a very laborious task, and is apt to lead to a total abandonment of the study.
There is, however, no better way of avoiding this error, and of learning how to make one’s self quickly the master of the generalities, than to surmount undauntedly the laboriousness of the beginning.
On a second comparison, the mind is more accustomed to the work. According to the talents and previous acquirements of the student, will it be a longer or shorter time before he comes to be able to complete the comparison of two remedies in a few days. We must caution those who pay too much attention to specialties not to be so very minute, but above all things to seek for points of crystallization. We must point out to those who are disposed to be superficial that important discoveries for practice may be made by a careful comparison. The comparisons may be very easily made by means of Ruckert’s systematic tables. The remedies to be compared are to be sought out in each division, their symptoms carefully read, and the result committed to writing. A separate column is assigned to each medicine. Those symptoms which both have in common should be written in the middle. When there is only similarity, the sign of similarity should be placed in the middle between them. Where opposites, or well-defined differences exist, they should be distinguished by an interposed arrow, etc. It cannot be expected that anyone, least of all a beginner, will compare every remedy with every other. The student should select remedies for this purpose that he considers to be analogous, and which are known to possess important properties. All remedies that are closely related by the source of their derivation, must also be related with respect to their symptoms. All that are chemically allied must be so medicinally. Those possessing similar odors – as are Phosph., Ars., All. sat., Asaf., and Bufo. – must possess resemblances in their symptoms, etc. The chemical preparations may be arranged in natural families, according to one or other system. Those nearly related are thus compared, e.g., Sulph. and Phosph.; Chlor. and Iod.; the carbons and Graph.; the oxygenous acids, Nitr. ac., Sulph. ac., and Phosph. ac. are compared with each other, and with the hydrogenous acids, Mur. ac., Hydrocyan. ac. Further, Sil., Alum.; the carbonates of potash, soda, and ammonia; Bar. and Stront.; Calc. And Magn.; the muriates of soda and Am., Bar. and Magn. The acetates of Cupr., Ferr., Plumb., Mang.; the metals Aur., Plat., Stann., Arg., and Zinc. Interesting comparisons may be made between Phos. ac. and Phos.; Sulph. ac. and Sulph.; as also Sulph. and Hep., Hep. and Calc.
Medicines From The Vegetable Kingdom
Among medicines belonging to the vegetable kingdom, those which may be compared as being nearly allied, are:
Anac. and Rhus.
Bryon. and Coloc.
Ind. and Tong.
Op. and Chelid.
Spig. and Menyanth.
Viol. od. and Jac.
Thuya. and Sabin.
Coff., Ipec., Chin.
Colch., Verat., Sabad.
Euphr., Dig., Grat.
Lauroc., Prun. sp., Amyg. am.
Led., Rhod., Nux vom., Ign., Oleand.
Arn., Cham., Cin., Leont.
Asa., Cic., Con., Aet., Phell.
Bell., Caps., Hyosc., Stram., Tab., Verb.
Acon., Clem., Hell., Puls., Staph., Ran. bulb., and Sol.
The cryptogamous plants, Agar. musc., Bov., Lycop., are too remote from each other – and yet their symptoms are much more similar than those of the more nearly related families of Solaneae and Ranunculaceae. Sec. can only be judged from from the cures it has effected – the symptoms of it derived from epidemic diseases are not to be relied on.
It is worthy of observation that the differences of those substances which are allied in their origin lie principally in the conditions of the symptoms; whereas those substances nearly connected by the similarity of their symptoms alone, agree merely in single departments of symptoms, but in others have quite a different character and seat. Families of substances that are related only in their symptom may be formed from such medicines as may be employed with advantage in succession – or which serve as antidotes to each other. In the present state of homeopathic literature, the formation of such families is a very hazardous experiment. But they are of much greater practical value than those formed from their natural affinity.
It is perfectly evident that substances that have a similar origin must produce many similar symptoms. Our business should be to search for the differences, in order to avoid confusion. When, however, minerals, plants, and animals, widely different from each other, produce similar groups of symptoms, there must be some deeper reason for this. It must indicate the similarity of the medicinal to the natural diseases. Such allied medicines are in general the best antidotes of each other. However – as must happen from the rules laid down above – among the metals that form several families, there are antidotes which are never found among those that are nearly connected, but always among those that are widely separated. Thus it follows that Sel., Ars., and Am.; Plat. and Argent.; Stan. Plumb., Zinc. and Nic.; Ferr. And Mang. do not antidote each other. But the metals Plumb. and Plat.; Ferr. and Ars.; Am. and Merc. do.
Among plants there must be antidotes in each family, and perhaps in each genus. There are, indeed separate parts in every plant and animal, which seems to have a power of neutralizing the effects of the others. Other homeopathic writers have pointed out a close connection between the two naturally allied substances Nux. and Ign., on the one hand, and the symptomatically allied Puls. – to which may be added Cham., Coff., and Caps. We may, I think, also reckon Ambr. among these. Another family is Ars., Verat., Ipec., Asar., to which we may add Ferr. and Chin.; perhaps also Staph., and Ac. sulph. Sulph., Calc., and Lyc. are well known as doing well in succession – to which may be joined Led., and in another point of view, Therid.
One of the most remarkable and beautiful families is Hep., Merc., Bell., and Lach. Between these and those allied to Arsen., may be placed Phos. ac. and Carb. veg., and those related to them, as also Cupr., and on another account Aur. Anyone who has thoroughly made himself master of two or three families, and then from time to time makes a comparison between two remedies which appear to him to be related – and between which he has frequently needed to make a most accurate choice in practice, as for instance, Sulph. and Ferr.; Phos. and Caust.; Ars. and Carb. v.; Bell. and Bry.; Bry. and Rhus.; Rhus. And Dulc., etc. – this homeopathic doctor gradually obtains such an extensive basis of knowledge that all the rest of the remedies are acquired without difficulty. If a crystal of salt is suspended in a saturated solution of the same salt, the most beautiful crystals collect upon it.
So, one who is acquainted with a large number of medicines in the above manner, can thereafter compare every medicine with every other in a very short time – and without many quires of paper. This must happen before our materia medica, which ought to belong to the natural sciences, can be looked upon as one of them.

from “Wirkungen des Schlagengiftes”
Allentown und Leipzig, bei C. Kummer, 1837
British Journal Of Homeopathy
vol. II 1844 no. 7Share this ...

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Are the obstacles to certainty and simplicity in practical medicine insurmountable?


Are the obstacles to certainty and simplicity in practical medicine insurmountable?

1 Dr. Herz’s essay “On the Medicinal uses of the Phellandrium aquaticum,” andc., in the first part of the second volume of the Journal der practischen Arzneykunde, plunged me into a sort of melancholy, which only by dint of long continued reflection has given place to a remote but lively hope.
Here one of the most thoughtful physicians of our time, after twenty years of active practice, finds himself obliged repeatedly to make the open, but most melancholy acknowledgment: (p. 40.) “That we can lay no claim to the attainment of the ideal of simplicity in medical treatment.” “That the hope of ever arriving at perfect simplicity in medical practice, cannot be otherwise than very feeble” (p. 47).
The obstacles to pure observation of the effects of medicines in the various diseases, he enumerates with most overwhelming fullness of detail, and there he leaves us alone in the old well-worn path of uncertainty, almost without a cheering glance at a better futurity, a simpler, surer method of cure; unless we are to reckon his very complaints as foreshadowing coming improvements, just as the impassioned warmth of the sceptical casuist has always appeared to me a proof of that immortality he would deny.
I myself felt the external hindrances to our art more than I could have wished; they continually beset my sphere of action; and I, too, long considered them insurmountable, and had almost made up my mind to despair, and to esteem my profession as but the sport of inevitable accident and insuperable obstacles, when the thought arose within me, “are not we physicians partly to blame for the complexity and the uncertainty of our art?”

Obedience of patients

I have seen medical men take under their care patients who had only half confidence, and from whose demeanour any one might perceive that they put themselves under the physician whom they had chosen, not from any enthusiastic regard for him, nor from a strong desire to be relieved from their sufferings. How could implicit obedience be expected from such persons? And even when they spoke of, and commended in commonplace terms, strict attention to the physician’s orders, could he trust them, and with confidence ascribe the issue to his prescriptions, his medicines? By no means!

Diet and regimen

It is a constant complaint of physicians that patients will not observe the prescribed diet.

“Who shall give them assurance of such compliance? and how impossible, then, is it to determine the issue of a disease, or the effect of the remedies employed, since on this point in no case can any certainty be attained?”

Pardon me! We may be perfectly sure of such as with implicit confidence entrust themselves to the care of their almost worshipped physician. Of course, others are less to be relied upon. Methinks, however, that medical men when thus complaining, do not draw a sufficient distinction between, 1st, the errors of diet which produced and kept up the patient’s disease; 2d. their ordinary indifferent diet; and, 3d, the new dietetic regulations laid down by the physician.
If, with respect to the first of these (the correction of the errors of diet), the physician thinks that he does not possess sufficient authority with his patient, who will not pay strict attention to rules, rather let him dismiss such fickle-minded persons; better no patients at all than such! Who, for example, would undertake to cure a drunkard of induration of the liver, who merely consulted the physician en passant, because, perhaps, he met him in the street; or had some business-matters to arrange with him; or, because the physician has come to reside in the neighbourhood; or has become a connexion of his; or for some other trifling reason, but not from having implicit confidence in his skill? What immense influence the medical man must have with such a confirmed debauchee, to feel assured that he will pay attention to his orders, and daily diminish his allowance of the poisonous liquor!
A patient with such bad habits, must show by some considerable sacrifice, that he intends to submit himself entirely to the will of the physician. The physician would do well to try to dissuade him from submitting to treatment; to represent to him, in strong terms, the difficulties which his ruinous vice throws in the way, and the magnitude of the disease. If he return repeatedly, and express his willingness to make any sacrifices, then, what should prevent the physician trusting him, so long as he sees indubitable proofs of his resolution? If he cannot withstand temptation, then let him go his way; he will, at any rate, not bring discredit on the art, nor disappoint the hopes of the much-deceived physician. Are there not enough of patients, who, when solicitously advised by a universally esteemed physician, will, for example, scrupulously abstain from eating pork during a quartan fever, and for months afterwards; who will carefully avoid potatoes, if they are asthmatic or leucophlegmatic; sedentary occupations, if they are gouty; and sour wine, if suffering from the wasting diseases of youth brought on by venereal excesses?

In the case of a woman affected with a nervous disorder, should not a good physician be able to effect a gradual diminution in the quantity of coffee taken; or, if otherwise, will he not be able to perceive that she will not follow his advice?

From my own experience I can say, that it is no uncommon circumstance to meet with both these cases; and in each the physician may reckon with certainty on his observation. If we go to work in this manner, we shall attain to a high degree of empirical certainty. Is this not certainty? Or does the statesman, the teacher, the lawyer, the merchant, the general, possess any other than empirical certainties? Or is there any other positive rule to guide us, in any imaginable profession in which the free-will of man is involved?

But is the ordinary diet of those classes of the community who are not altogether corrupted, of such an objectionable nature, that we are compelled, in every disease, to prescribe a new one? This is one of the rocks on which so many physicians split.

In every acute or chronic disease that comes under their notice, they earnestly insist on a very complicated artificial system of diet, withholding many things, and ordering a host of others. Do we physicians, however, know with such extreme precision, the effects of all kinds of food, as to be able with certainty to say, in this case such and such an article of diet is to be taken, and this and that other to be avoided! How does experience refute our fancied omniscience! For what a length of time did our forefathers insist in their so-called acute (putrid) fevers with diminished vital power, on watery drinks, tea, andc.; and exclaimed against beer and wine as little better than poison-which, however, the patients long for so much, and which is now the main support of our practice! How long did we forbid fresh meat in cases of haemorrhage from passive plethora, in wasting pulmonary complaints, in scurvy, and in most other chronic non-gastric diseases, where it is now reckoned, if not a perfect panacea, at any rate indispensable!

A universal diet, like a universal medicine, is an idle dream; but speaking generally, nothing is more wholesome than fruit in abundance, and green vegetables ad libitum; and yet they frequently oppress the stomach of those who have poverty of the blood, of exhausted persons, and those suffering from the effects of a sedentary life, and increase in them the disposition to acidity, flatulence and diarrhoea! Roast beef and raw ham are considered more difficult of digestion for a relaxed stomach than veal boiled to rags. Coffee has the reputation of strengthening and assisting digestion, and yet it only hastens the expulsion of half-digested food from the bowels. I have seen children deprived of the breast-milk, crammed to death with wafer-biscuits, and perishing in numbers of jaundice. My expostulations on the indigestible nature of this unleavened and hard-baked mass of dough, were of no avail against the plausible folly of my colleagues-“it is impossible to imagine any thing lighter (in weight), or more delicate (to the touch)!”

I once knew an ignorant over-officious practitioner prescribe such a severe diet to a healthy young woman after a favourable first-labour, that she was on the eve of starvation. She held up for some days under this water-gruel diet-all meat, beer, wine, coffee, bread, butter, nourishing vegetables, andc., were denied her; but at last she grew excessively weak, complained of agonising after-pains, was sleepless, costive, and, in short, dangerously ill. The medical attendant attributed all this to some infraction of his dietetic rules. She begged to be allowed some coffee, or broth, or something similar. The practitioner, strong in his principles, was inflexible: Not a drop! Driven to desperation by his severity and her hunger, she gave way to her innocent longings, drank coffee, and ate in moderation whatever she fancied. The practitioner found her, on his next visit, much to his surprise, not only out of danger, but lively and refreshed; so he complacently noted down in his memorandum-book the excellent effects of slop-diet in the treatment of lying-in-women. The convalescent took good care not to hint to him her natural transgression. This is the history of many, even published observations! Thus the disobedience of the patient not unfrequently saves the credit of the physician. Is the error calculi, in such a case, the fault of the art or the patient, or is it not rather the fault of the physician? The artificial diet prescribed by the physician, is frequently much more objectionable than the accustomed diet of his patient; or, at least, he frequently does wrong in rejecting the latter all at once. As the physician would do well, in order to observe more distinctly and simply the course of the disease and the effects of his medicines, not to give any orders at all about the diet, except with regard to articles of which he possesses a positive knowledge, and these will be but few; he would also be consulting the good of his patient by not depriving him of anything which long habit had rendered innocuous, or perhaps indispensable.

A country midwife fell sick of a gastric fever. I purged her. I ordered her for drink, water and weak beer, and extreme moderation in eating. At first, things went on very well; but, after a few days, a new continued fever, with thirst, wakefulness, weariness, confusion of ideas, came on to such an extent as to render her state dangerous. I left none of the ordinary remedies untried. All in vain. I now left off every thing, from the sulphuric acid to the soup (at the time I was not sufficiently acquainted with the properties of opium), and promised to prescribe something on my return. I informed the relations of the danger I apprehended. The following day I was told that the patient was recovering, and that I need not give myself any further trouble. To my astonishment, I saw her pass my window, a few days afterwards, perfectly recovered, I subsequently learned, that when I had discontinued the medicine, a quack had been called in, who had given her a large bottle of essence of wood, his universal medicine, and told her to take so many drops of it. No sooner had she tasted the brandy in it than she gained, as it were, new life. She took the drops by table-spoonfuls, and, after a good sleep, she rose completely cured. This happened when I first began practice, else I should have ascertained at the commencement that, when in health, she could not live without her daily dram, consequently could not recover without it.

It is far less frequently necessary than most physicians think, to make a material alteration in the diet of patients suffering from chronic complaints, at least in ordinary cases; in acute diseases, the awakened instinct of the patient is often considerably wiser than the physician who does not consult nature in his prescriptions. I do not now allude to cures effected by dietetic rules alone, which, if simple, are not to be despised, and which are very serviceable in many cases. What I particularly call attention to is, the frequently useless change of diet, when treating a case with medicine, whereby the simplest method of treatment is rendered complex, and a composite result is produced, of which I would defy OEdipus himself to guess what part was owing to the new diet, and what to the medicine. We must certainly prohibit what we know to be hurtful in this or that complaint; but this can at the most be but two or three articles of diet in chronic diseases; the gradual disuse of which (for sudden suppression is always dangerous in such affections), cannot produce any great revolution in the system; cannot, therefore, have much effect in deranging the pure action of the medicine we are using.

If it be necessary to make considerable changes in the diet and regimen, the ingenious physician will do well to mark what effect such changes will have on the disease, before he prescribes the mildest medicine. A deeply rooted scurvy can often be cured by the united action of warm clothing, dry country air, moderate exercise, change of the old salted meat for that freshly killed, along with sour-crout, cresses, and such like vegetables, and brisk beer for drink. What would be the use of medicine in such a case? To mask the good effects produced by the change of diet! Scurvy is produced by a system of diet opposite to this, therefore it may be cured by a dietetic course-the reverse of that which produced it; at any rate, we may wait to see the result of this method, before we begin with our medicines. Why should we render the syphilitic patient, for example, worse than he is by a change of diet, generally of a debilitating nature? We cannot cure him by any system of diet, for his disease is not produced by any errors of the sort. Why then, should we, in this case, make any change? Since this occurred to my mind, I have cured all venereal diseases (excepting gonorrhoea), without any dietetic restrictions, merely with mercury (and, when necessary, opium); the metal has not a debilitated constitution to act upon, and my patients recovered more rapidly than those of my colleagues. I also knew for certain, that every change that took place, either for the better or the worse, was owing to the medicine.

An old colonel, with “fair round belly,” and apparently fond of the pleasures of the table, had suffered for the last forty years from ulcers almost all over the legs, and issues on the thighs. His food consisted of the strongest and most nutritive materials-he drank a good deal of spirits, and, for several years past, he had been in the habit of taking a monthly purge. Otherwise, he was vigorous. I allowed the issues to heal up, made him keep his legs rolled up in a narrow flannel bandage, and immerse them daily a few minutes in cold water, and afterwards dress them with a weak solution of corrosive sublimate. I made not the slightest alteration in his diet; I even did not forbid the monthly purge, as he was so constantly in the habit of taking it. In the course of a year his legs gradually healed, and his vigour rather increased than diminished in this his seventy-third year. I watched him for two years, during which he remained perfectly well, and I have since had good accounts of his health. The legs have always continued completely healed. Can I suppose that he would have recovered more rapidly or permanently had I deprived him of his eight or ten dishes, and his daily allowance of liquors? Had I changed his diet, and had he grown worse, would I have known whether this unfavourable turn proceeded from the food so much lauded in works on dietetics, but so different to what he had been accustomed to, or from my external applications, for I gave nothing internally? It would have been easy for me to conform to the schools, and sacrifice my patient methodically to the ordinary dietetic regulations; but how could I at the same time abide by my conviction, my conscience, and that prime guiding principle of the physician, simplicity!

I have no intention of exalting myself at the expense of my brethren, when I acknowledge that I have cured the most difficult chronic diseases, without any particular change of diet. I consider that I do quite enough if I advise moderation in all things, or diminish or forbid altogether particular articles of diet, which would be prejudicial to the object I wish to accomplish; as, for example, acids, when I am employing stramonium, belladonna, foxglove, monkshood, or henbane (the effects of these medicines being entirely counteracted by vegetable acids); or salted meats, when I prescribe oxyde of mercury; or coffee, when I am giving opium. Thus, if my treatment fail, I know that I have done no harm by an artificial system of diet (how much that is dangerous and hypothetical is there not in our dietetic regulations!), I know it is owing to the medicine used that the case grew worse, or, at least, did not improve. If amendment ensue, then I know that the medicine produced it, as it certainly was not owing to any change in the diet. Hippocrates, himself, if I recollect right, hints at something similar in his aphorisms, when he says, that medicine and the vis naturae produce much more considerable and profound changes in diseases than any small irregularity in diet. How near was this great man to the philosopher’s stone of physicians-simplicity! and to think that after more than two thousand years, we should not have advanced one single step nearer the mark! on the contrary, have rather receded from it! PAGE 315 Did he only write books? or did he write much less than he actually cured? Did he do this so circuitously as we? It was owing to the simplicity of his treatment of diseases alone, that he saw all that he did see, and whereat we marvel.

Climate, weather, state of the barometer, etc.

Should we abandon ourselves to despair, because we do not know, to a nicety, what is the exact influence which a slight change in geographical position, a small variation of the hygrometer, the barometer, the anemometer, the thermometer, andc., exercises upon the action of our medicines or our patients? According to many observations of the first medical men, it is not so very difficult to arrive at a pretty accurate general knowledge of the differences produced by a warmer or colder climate on the nature and treatment of ordinary diseases. They are, for the most part, merely differences in degree. The most opposite climates never produce a completely opposite code of medical laws. Is not bark as efficacious for the cure of pure intermittent fever in Mexico as in Norway; in Batavia and Bengal (the only difference, being in quantity), as in Scotland? The venereal disease is cured in China by mercury, just as it is in the Antilles. In our country, we have, inflammations and suppurations of the liver of the same nature as in the tropics; although, in the latter regions, they are twenty times as numerous as here, that makes not the slightest difference in the treatment, as in both situations mercury and opium (or something better still) are serviceable. Typhus, and similar fevers, are here as there fatal, if treated by bloodletting and nitre (not, indeed, so rapidly here as there)! They must also be treated in our country with bark and opium (not, indeed, in such large doses as there), in order to increase the strength. These varieties of climate do not change the treatment in nature, but only in degree, and such differences are determinable. But that the powers given by nature to man and habit will triumph over all variations of climate, to the preservation of life and health, is proved by there being inhabitants in the island of Terra del Fuego, as well as on the banks of the Ganges, in Lapland, as well as Ethiopia, in the seventieth as well as the third degree of latitude. And are we so ignorant of the other influences which the nature of the soil and country have upon diseases; so very ignorant that we cannot reckon the influence they would have on our practice? Do we know nothing of the different effects produced by a residence in a hilly country and on the sea-coast, on haemoptysis and phthisis; nothing of the action of the effluvia from marshes and seething intramural grave-yards in the production of intermittent fever, and diseases of the liver and lymphatic system; nothing of the power of pure air on those affected with rickets and those debilitated by sedentary occupations; nothing of the advantages of a level country over confined Alpine valleys, the cradle of cretinism, goitre, and idiocy; nothing of the peculiar power of certain winds and seasons in the production of inflammatory, or asthenic diseases, or of the effect of a low state of the barometer on the apoplectic; nothing of the influence of the air of hospitals in the production of gangrene and typhus? PAGE 316 And it is only these, and similar great and important differences, which exercise a marked influence on health and life itself, which it is necessary for us to know in our treatment of diseases. We do know them, and can calculate their influence. The influence of the finer shades of these differences is too insignificant to prevent us treating successfully the ordinary diseases. The vital power and the proper medicine generally obtain the victory over any influence which such very fine shades of differences could exert. What might be said of the Creator, who, having afflicted the inhabitants of this earth with a vast host of diseases, should at the same time have placed an inconceivable number of obstacles in the way of their cure; to discover the influence of each of which would defy the greatest efforts of the physician-a knowledge of which in their full extent (if they were of such great importance) could not be attained by the greatest genius? We cure diseases in pestilential dungeons, although we cannot, at the same time, impart to the patient the vigour of the mountaineer. Who would desire us to transform the delicate city lady into the buxom peasant girl? We remove, however, most of the ailments of the former. The sedentary man of business seeks at our hands only tolerable health, for the nature of things denies us the power of giving him the strength of the blacksmith, or the ravenous appetite of the porter. “But,” objects some one, “look what a perceptible influence a slight variation of the temperature, moisture, or relative proportion of oxygen and nitrogen in the atmosphere, a slight change in the wind, a higher or lower state of the barometer, a greater or less quantity of atmospherical electricity, and a thousand other physical powers, small though they may be, which are perhaps, as yet unknown to us, sometimes have upon diseases, at least upon the nervous, hysterical, hypochondriacal, and asthmatic!”

Shall I speak out what I think? It appears to me much less profitable to endeavour to ascertain (which is moreover impossible) all the degrees and varieties of the influence of those physical impressions, when they approach the minute, than to do our endeavour to fortify the sufferers against all these innumerable impressions, by implanting in them a certain degree of strength, whereby their system will be enabled to resist these, and many other still unknown physical impressions; just as I consider it much more practicable to dispel the morose ideas of the melancholic by medicine, than to abolish for him the countless evils of the physical and moral world, or to argue him out of his fancies. Or could all the physical and moral adverse circumstances of the atmosphere, and of human life, be more effectually prevented exercising their pernicious influence on the gossamer nervous system of yon nervous, spasmodic, chlorotic girl, did we, with angels’ understanding, completely investigate and maturely weigh, in quality and quantity, all these impulses in their full extent, than if we should restore her monthly periods? I do not believe that it is the smallness of our knowledge, but only the faulty application of it, that hinders us from approaching, in medical science, nearer to certainty and simplicity. Share this ...

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The Medicine of Experience


HahnemannThe medicine of experience
– Samuel Hahnemann, 1805
Often considered to be the “precursor” to the first edition of the Organon

Man, regarded as an animal, has been created more helpless than all other animals. He has no congenital weapons for his defence like the bull, no speed to enable him to flee from his enemies like the deer, no wings, no webbed feet, no fins,- no armour impenetrable to violence like the tortoise, no place of refuge provided by nature as is possessed by thousands of insects and worms for their safety, no physical provision to keep the enemy at bay, such as render the hedgehog and torpedo formidable, no sting like the gadfly, nor poison-fang like the viper; – to all the attacks of hostile animals he is exposed defenceless. He has, moreover, nothing to oppose to the violence of the elements and meteors. He is not protected from the action of the water by the shining hair of the seal, nor by the close oily feathers of the duck, nor by the smooth shield of the water beetle; his body, but a slight degree lighter than the water, floats more helplessly in that medium than that of any quadruped, and is in danger of instant death. He is not protected like the polar-bear or elder-duck by a covering impenetrable to the northern blast. At its birth the lamb knows where to seek its mother’s udder, but the helpless babe would perish if its mother’s breast were not presented to it. Where he is born nature nowhere furnishes his food ready made, as she provides ants for the armadillo, caterpillars for the ichneumon fly, or the open petals of flowers for the bee. Man is subject to a far larger number of diseases than animals, who are born with a secret knowledge of the remedial means for these invisible enemies of life, instinct, which man possesses not. Man alone painfully escapes from his mother’s womb, soft, tender, naked, defenceless, helpless, and destitute of all that can render his existence supportable, destitute of all wherewith nature richly endows the worm of the dust, to render its life happy.

Where is the benevolence of the Creator, that could have disinherited man, and him alone of all the animals of the earth, of the bare necessities of life?

Behold, the Eternal Source of all love only disinherited man of the animal nature in order to endow him all the more richly with that spark of divinity-a mind-which enables man to elicit from himself the satisfaction of all his requirements, and a full measure of all conceivable benefits, and to develop from himself the innumerable advantages that exalt the children of this earth far above every other living thing-a mind that, indestructible itself, is capable of creating for its tenement, its frail animal nature, more powerful means for its sustenance, protection, defence and comfort, than any of the most favoured creatures can boast of having derived directly from nature.

The Father of mankind has chiefly reckoned on this faculty of the human mind to discover remedial agents, for his protection from the maladies and accidents to which the delicate organism of man is exposed.

The help that the body can afford itself for the removal of diseases is but small and very limited, so that the human mind is so much the more compelled to employ, for the care of the dïseases of the body, remedial powers of a more efficient kind than it has seemed good in the Creator to implant in the organic tissues alone.

What crude nature presents to us should not form the limit for the relief of our necessities; no, our mind should be able to enlarge her resources to an unlimited degree for our perfect well-being.

Thus the Creator presents to us ears of corn from the bosom of the earth, not to be chewed and swallowed in a crude and unwholesome state, but in order that we should render them useful as nutriment by freeing them from the husk, grinding and depriving them of everything of an injurious and medicinal nature, by fermentation and the heat of the oven, and partaking of them in the form of bread-a preparation of an innocuous and nutritious character, ennobled by the perfecting power of our mind. Since the creation of the world the lightning’s flash has destroyed animals and human beings; but the Author of the universe intended that the mind of man should invent something, as has actually been done in these latter days, whereby the fire of heaven should be prevented from touching his dwellings-that by means of metallic rods boldly reared aloft he should conduct it harmless to the ground. The waves of the angry ocean reared mountains high threaten to overwhelm his frail bark, and he calms them by pouring oil upon them.

So he permits the other powers of nature to act unhindered to our harm, until we can discover something that can secure us from their destructive force, and harmlessly avert from us their impressions.

So he allows the innumerable array of diseases to assail and seize upon the delicate corporeal frame, threatening it with death and destruction, well knowing that the animal part of our organism is incapable, in most cases, of victoriously routing the enemy, without itself suffering much loss or even succumbing in the struggle;-the remedial resources of the organism, abandoned to itself, are weak, limited and insufficient for the dispersion of diseases, in order that our mind may employ its ennobling faculty in this case also, where the question concerns the most inestimable of all earth’s goods, health and life.

The great Instructor of mankind did not intend that we should go to work in the same manner as nature; we should do more than organic nature, but not in the same manner, not with the same means as she. He did not permit us to create a horse; but we are allowed to construct machines, each of which possesses more power than a hundred horses, and is much more obedient to our will. He permitted us to build ships, in which, secure from the monsters of the deep and the fury of the tempest, and furnished with all the comforts of the mainland, we might circumnavigate the world, which no fish could do, and therefore he denied to our body the piscine fins, branchiae and float, that were inadequate to perform this feat. He denied to our body the rustling wings of the mighty condor, but on the other hand, he allows us to invent machines filled with light gas, that with silent power lifts us into far higher regions of the atmosphere than are accessible to the feathered tenants of the air.

So also he suffers us not to employ the process of sphacelus, as the human corporeal organism does for itself, in order to remove a shattered limb, but he placed in our hand the sharp, quickly-dividing knife, which Faust moistened with oil, that is capable of performing the operation with less pain, less fever, and much less danger to life. He permits us not to make use of the so-called crisis, like nature, for the cure of a number of fevers; we cannot imitate her critical sweat, her critical diuresis, her critical abscesses of the parotid and inguinal glands, her critical epistaxis, but he enables the investigator to discover remedies wherewith he may cure the fever more rapidly than the corporeal organism is capable of producing crises, and to cure them more certainly, more easily, and with less suffering, with less danger to life and fewer after-sufferings, than unassisted nature can do by means of crises.

I am therefore astonished that the art of medicine has so seldom raised itself above a servile imitation of these crude processes, and that it has at almost all periods been believed that hardly anything better could be done for the cure of diseases than to copy these crises, and to produce evacuations in the form of sweat, diarrhoea, vomiting, diuresis, venesections, blisters or artificial sores. (This was and remained the most favoured method of treatment from the earliest times till now: and it was always fallen back upon, when other modes of treatment founded on ingenious speculations disappointed the hopes they had raised.) Just as if these imperfect and forced imitations were the same thing as what nature effects in the hidden recesses of vitality, by her own spontaneous efforts, in the form of crises! Or as if such crises were the best possible method for overcoming the disease, and were not rather proofs of the (designed) imperfection and therapeutical powerlessness of our unaided nature! Never, never was it possible to compel these spontaneous endeavours of the organism by artificial means) the very notion implies a contradiction), never was it the Creator’s will that we should do so. His design was that we should bring to unlimited perfection our whole being, as also our corporeal frame and the cure of its diseases.

This design has hitherto been in part fulfilled by pure surgery alone. Instead of acting like unassisted nature, which can often only throw off a splinter of bone in the leg by inducing a fever attended by danger to life, and a suppuration that destroys almost all the limb, the surgeon is able by a judicious division of the irritable integuments to extract it in a few minutes by means of his fingers, without occasioning any great suffering, without any considerable bad consequences, and almost without any diminution of the strength. A debilitating slow fever, accompanied by intolerable pains and uninterrupted torturing to death, is almost the sole means the organism can oppose to a large stone in the bladder; whereas an incision made by a practised hand frees the sufferer from it often in a quarter of an hour, spares him many years of torment, and rescues him from a miserable death. Or ought we to attempt to relieve a strangulated hernia by an imitation of the mortification and suppuration, which are the only means, besides death that nature possesses against it? Would it suffice for the rescue and preservation of life, did we not know of any other mode of stopping the hemorrhage from a wound in a large artery than by causing a syncope of half-an-hour’s duration, as nature does? Could the tourniquet, bandage and compress be thereby dispensed with?

It has always been a matter worthy of the greatest admiration to see how nature, without having recourse to any surgical operation, without having access to any remedy from without, does often when left quite unassisted, develop from itself invisible operations whereby it is able,-often it is true in a very tedious, painful and dangerous manner-but still really to remove diseases and affections of many kinds. But she does not do these for our imitation! we cannot imitate them, we ought not to imitate them, for there are infinitely easier, quicker and surer remedial means which the inventive faculty implanted in our mind is destined to discover, in order to subserve the ends of medicine, that most essential and most honourable of all earthly sciences.

Medicine is a science of experience; its object is to eradicate diseases by means of remedies.

The knowledge of diseases, the knowledge of remedies, and the knowledge of their employment, constitute medicine.

As the wise and beneficent Creator has permitted those innumerable states of the human body differing from health, which we term diseases, he must at the same time have revealed to us a distinct mode whereby we may obtain a knowledge of diseases, that shall suffice to enable us to employ the remedies capable of subduing them; he must have shewn to us an equally distinct mode whereby we may discover in medicines those properties that render them suitable for the cure of diseases, – if he did not mean to leave his children helpless, or to require of them what was beyond their power.

This art, so indispensable to suffering humanity, cannot therefore remain concealed in the unfathomable depths of obscure speculation, or be diffused throughout the boundless void of conjecture; it must be accessible, readily accessible to us, within the sphere of vision of our external and internal perceptive faculties.
Two thousand years were wasted by physicians in endeavouring to discover the invisible internal changes that take place in the organism in diseases, and in searching for their proximate causes and a priori nature, because they imagined that they could not cure before they had attained to this impossible knowledge.
If the fruitlessness of these long-continued endeavours cannot be regarded as a proof of the impossibility of this undertaking, the maxim of experience that they were unnecessary for the cure, might suffice to shew its impossibility. For the great Spirit of the Universe, the most consistent of all beings, has made that only possible which is necessary.

Although we never can attain to a knowledge of the internal corporeal changes on which diseases depend, yet the observation of their external exciting causes has its uses.

No alteration occurs without a cause. Diseases must have their exciting causes, concealed though they may be from us in the greater number of cases.

We observe a few diseases that always arise from one and the same cause, e. g., the miasmatic maladies; hydrophobia, the venereal disease, the plague of the Levant, yellow fever, small-pox, cow-pox, the measles and some others, which bear upon them the distinctive mark of always remaining diseases of a peculiar character; and, because they arise from a contagious principle that always remains the same, they also always retain the same character and pursue the same course, excepting as regards some accidental concomitant circumstances, which however do not alter their essential character.

Probably some other diseases, which we cannot shew to depend on a peculiar miasm, as gout, marsh-ague, and several other diseases that occur here and there endemically, besides a few others, also arise either from a single unvarying cause, or from the confluence of several definite causes that are liable to be associated and that are always the same, otherwise they would not produce diseases of such a specific kind, and would not occur so frequently.

These few diseases, at all events those first mentioned (the miasmatic), we may therefore term specific, and when necessary bestow on them distinctive appellations.
If a remedy have been discovered for one of these, it will always be able to cure it, for such a disease always remains essentially identical, both in its manifestations (the representatives of its internal nature) and in its cause.

All the other innumerable diseases exhibit such a difference in their phenomena, that we may safely assert that they arise from a combination of several dissimilar causes (varying in number and differing in nature and intensity).

The number of words that may be constructed from an alphabet of twenty-four letters may be calculated, great though that number be; but who can calculate the number of those dissimilar diseases, since our bodies can be affected by innumerable and still for the most part unknown influences of external agencies, and by almost as many forces from within.

All things that are capable of exercising any action (and their number is incalculable), are able to act upon and to produce changes in our organism which is intimately connected with and in conflict with all parts of the universe-and all may produce different effects as they differ among themselves.
How various must be the effects of the action of these agencies, when several of them at once and in varied order and intensity exercise their influence on our bodies, seeing that the latter are also so variously organized and present such diversities in the various conditions of their life, that no one human being exactly resembles another in any conceivable respect!

Hence it happens that with the exception of those few diseases that are always the same, all others are dissimilar, and innumerable, and so different that each of them occurs scarcely more than once in the world, and each case of disease that presents itself must be regarded (and treated) as an individual malady that never before occurred in the same manner, and under the same circumstances as in the case before us, and will never again happen precisely in the same way.

The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for the purpose of curing it, expresses itself by the symptoms, as they present themselves to the investigations of the true observer in their whole extent, connexion and succession.

When the physician has discovered all the observable symptoms of the disease that exist, he has discovered the disease itself, he has attained the complete conception of it requisite to enable him to effect a cure.
In order to be able to perform a cure, it is requisite to have a faithful picture of the disease with all its manifestations, and in addition, when this can be discovered, a knowledge of its predisposing and exciting causes, in order, after effecting the cure by means of medicines, to enable us to remove these also-by means of an improved regimen-and so prevent a relapse.

In order to trace the picture of the disease, the physician requires to proceed in a very simple manner.
All that he needs is carefulness in observing and fidelity in copying. He should entirely avoid all conjectures, leading questions and suggestions.

The patient relates the history of his ailments, those about him describe what they have observed in him, the physician sees, hears, feels, andc., all that there is of an altered or unusual character about him, and notes down each particular in its order, so that he may form an accurate picture of the disease.
The chief signs are those symptoms that are most constant, most striking, and most annoying to the patient. The physician marks them down as the strongest, the principal features of the picture. The most singular, most uncommon signs furnish the characteristic, the distinctive, the peculiar features.
He allows the patient and his attendants to relate all they have to say without interrupting them, and he notes down everything attentively-he then again inquires what were and still are the most constant, frequent, strongest and most troublesome of the symptoms-he requests the patient to describe again his exact sensations, the exact course of the symptoms, the exact seat of his sufferings, and bids the attendants once more detail, in as accurate terms as they are able, the changes they have observed in the patient, and which they had previously mentioned.

The physician thus hears a second time what he had formerly noted down. If the expressions correspond with what was already related, they may be considered as true, as the voice of internal conviction; if they do not correspond, the discrepancy must be pointed out to the patient or those about him, in order that they may explain which of the two descriptions was nearest the truth, and thus what required confirmation is confirmed, and what required alteration is altered.

If the picture be not yet complete, if there be parts or functions of the body regarding whose state neither the patient nor his attendants have said any thing, the physician then asks what they can remember respecting these parts or functions, but he should frame his questions in general terms, so as to cause his informant to give the special details in his own words.

When the patient (for, except in cases of feigned diseases, most reliance is to be placed on him as regards his sensations) has, by these spontaneous or almost unprompted details, put the physician in possession of a tolerably complete picture of the disease, it is allowable for the latter to institute more particular inquiries.

The answers to these last more special questions however, which have somewhat the character of suggestions, should not be accepted by the physician at the first response as perfectly true, but after making a note of them on the margin he should make fresh inquiries respecting them, in a different manner and in another order, and he should warn the patient and his attendants in their answers to make accurate replies, and to make no additions, but merely to tell the exact circumstances of the case.

But an intelligent patient will often spare the physician the trouble of making these particular inquiries, and in his account of the history of his disease, will usually have made voluntary mention of these circumstances.
When the physician has completed this examination he notes down what he has silently observed in the patient during his visit, and he corrects this by what the attendants tell him how much of this was or was not usual with the patient in his days of health.

He then inquires what medicines, domestic remedies, or other modes of treatment have been employed in former times, and what have recently been used,-and especially the state of the symptoms before the use or after the discontinuance of all medicine. The former form he regards as the original state; the latter is in fact an artificial form of the disease, which however he must sometimes accept and treat as it is, if there is any pressing emergency in the case that will not admit of any delay. But if the disease is of a chronic character, he lets the patient continue some days without taking any medicine, to allow it to resume its original form, until which time he defers his more particular examination of the morbid symptoms, in order that he may direct his treatment towards the persistent and unsophisticated symptoms of the chronic malady, but not towards the evanescent, ungenuine, accidental symptoms, produced by the medicines last used-as it will be necessary to do in acute diseases where the danger is urgent.

Finally, the physician makes general inquiries as to any exciting causes of the disease that may be known. In ten cases we shall not find one where the patient or his friends can assign a certain cause. If, however, there have happened one respecting which there can exist no dubiety, it generally occurs that has been voluntarily mentioned by them at the commencement of their account of the disease. If it is necessary to make inquiries respecting it, it usually happens that very uncertain information is elicited on this head.

I except those causes of a disgraceful character, which the patient or his friends are not likely to mention, at all events not of their own accord, and which, consequently, the doctor should endeavour to find out by dexterously framing his questions, or by private inquiries. With these exceptions it is a hurtful, or at all events, a useless task to endeavour to ferret out other exciting causes, by means of suggestions, especially as the medicinal art knows very few of these (I shall mention them in their proper places) on which we can base a trustworthy mode of treatment, regardless of the particular signs of the disease they have induced.

By exercising all this zealous care the physician will succeed in depicting the pure picture of the disease, he will have before him the disease itself, as it is revealed by signs, without which man, who knows nothing save through the medium of his senses, could never discover the hidden nature of any thing, and just as little could he discover a disease.

When we have found out the disease, our next step is to search for the remedy.

Every disease is owing to some abnormal irritation of a peculiar character, which deranges the functions and well-being of our organs.

But the unity of the life of our organs and their concurrence to one common end does not permit two effects produced by abnormal general irritation to exist side by side and simultaneously in the human body. Hence our
First maxim of experience.

When two abnormal general irritations act simultaneously on the body, if the two be dissimilar, then the action of the one (the weaker) irritation will be suppressed and suspended for some time by the other (the stronger);

and, on the other hand, our Second maxim of experience.

When the two irritations greatly resemble each other, then the one (the weaker) irritation, together with its effects, will be completely extinguished and annihilated by the analogous power of the other (the stronger).

(Illustration of the first maxim.) If a person be infected at the same time by, for instance, the miasmata of measles and small-pox (two dissimilar irritations), and if the measles have appeared first, it immediately disappears on the day of the eruption of the small-pox, and it is only after the latter is completely gone that the measles again returns and completes its natural course. The red rash that had already commenced to shew itself disappeared, as I have frequently observed, on the eruption of the small-pox, and only completed its course when the small-pox was dried up. According to Larrey, the plague of the Levant immediately remains stationary whenever the small-pox begins to prevail, but again returns when the latter ceases.
These two corporeal irritations are of a heterogeneous and dissimilar character, and the one is therefore suspended by the other-but only for a short time.

(Illustration of the second maxim.) If the two abnormal corporeal irritations be of a similar nature, then the weaker will be entirely removed by the stronger, so that only one (the stronger) completes its action, whilst the weaker was quite annihilated and extinguished. Thus the small-pox becomes an eradicator of the cow-pox; the latter is immediately interrupted in its course whenever the miasm of the small-pox that was previously latent in the system breaks out, and after the small-pox has run its course the cow-pox does not again appear.
The cow-pox miasm, which in addition to its well-known effect of developing the cow-pock with its course of two weeks’ duration, has also the property of giving rise to a secondary eruption of small red pimples with red borders, particularly in the face and forearms (and under certain unknown circumstances it produces this effect usually soon after the desiccation of the pocks), permanently cures other cutaneous eruptions wherewith the inoculated person was already, though ever so long before, affected, if this cutaneous disease was only tolerably similar to that cow-pox exanthema.

These two abnormal irritations cannot exist simultaneously in the same body, and thus the morbific irritation that appears last removes that which previously existed, not merely for a short time, but permanently, in consequence of being analogous to the latter; it extinguishes, annihilates and cures it completely.

It is the same thing in the treatment of diseases by means of medicines.

If the itch of workers in wool be treated by strong purgatives, such as jalap, it gradually yields almost completely, as long as the purgatives are continued, as the action of these two abnormal irritations cannot co-exist in the body; but as soon as the effect of the artificially excited irritation ceases, that is to say, whenever the purgatives are discontinued, the suspended itch returns to its former state, because a dissimilar irritation does not remove and destroy the other, but only suppresses and suspends it for a time.

But if we introduce into a body affected by this itch a new irritant-of a different nature, it is true, but still of a very similar mode of action-as for example the calcareous liver of sulphur, from which others besides myself have observed an eruption produced very similar in character to this itch, then, as two general abnormal irritations cannot co-exist in the body, the former yields to the latter, not for a short time merely, but permanently, as the last introduced was an irritation very analogous to the first; that is to say, the itch of the wool-workers is really cured by the employment of the calcareous liver of sulphur (and for the same reason by the use of sulphur powder and sulphureous baths).

Those diseases also which the casual observer considers as merely local are either suppressed for some time by a fresh irritation applied to this part, where the two irritations are of dissimilar or opposite tendency, as, for example, the pain of a burnt hand is instantly suppressed and suspended by dipping it in cold water, as long as the immersion is continued, but it immediately recurs with renewed violence on withdrawing the hand from the water-or the first is entirely and permanently destroyed, that is to say, completely cured, when the last irritation is very analogous to the first. Thus, when the action of the remedy, e. g., the artificial irritation applied to the burnt hand, is of a different nature, it is true, from the burning irritation of the fire, but of a very similar tendency, as is the case with highly concentrated alcohol, which when applied to the lips produces almost the same sensation as that caused by a flame approached to them, then the burnt skin, if it be constantly kept moistened with the spirit, is-in bad cases in the course of a few hours, in slighter ones much sooner-completely restored and permanently cured of the pain of the burn. So true is it that two irritations, even when they are local, cannot co-exist in the body without the one suspending the other, if they are dissimilar, or the one removing the other, if the added one have a very similar mode of action and tendency.

In order therefore to be able to cure, we shall only require to oppose to the existing abnormal irritation of the disease an appropriate medicine, that is to say, another morbific power whose effect is very similar to that the disease displays.

As food is requisite for the healthy body, so medicines have been found efficacious in diseases; medicines, however, are never in themselves and unconditionally wholesome, but only relatively so.
The pure aliments of food and drink taken until hunger and thirst abate, support our strength, by replacing the parts lost in the vital processes, without disturbing the functions of our organs or impairing the health.
Those substances however which we term medicines are of a completely opposite nature. They afford no nourishment. They are abnormal irritants, only fitted for altering our healthy body, disturbing the vitality and the functions of the organs, and exciting disagreeable sensations, in one word, making the healthy ill.
There is no medicinal substance whatsoever that does not possess this tendency, and no substance is medicinal which does not possess it.

It is only by this property of producing in the healthy body a series of specific morbid symptoms, that medicines can cure diseases, that is to say, remove and extinguish the morbid irritation by a suitable counter-irritation.

Every simple medicinal substance, like the specific morbific miasmata (small-pox, measles, the venom of vipers, the saliva of rabid animals, andc.), causes a peculiar specific disease-a series of determinate symptoms, which is not produced precisely in the same way by any other medicine in the world.

As every species of plant differs in its external form, in its peculiar mode of existence, in its taste, smell, andc., from every other species and genus of plant-as every mineral substance, every salt differs from all others both in its external and internal physical qualities, so do they all differ among themselves in their medicinal properties, that is to say, in their morbific powers; each of the substances effects an alteration in our state of health in a peculiar, determinate manner.

Most substances belonging to the animal and vegetable kingdoms, are medicinal in their raw state. Those belonging to the mineral kingdom are so both in their crude and prepared state.

Medicinal substances manifest the nature of their pathogenetic power, and their absolute true action on the healthy human body, in the purest manner, when each is given singly and uncombined.

Many of the most active medicines have already occasionally found their way into the human body, and the accidents they have given rise to have been recorded.

In order to follow still farther this natural guide and to penetrate more profoundly into this source of knowledge, we administer these medicines experimentally, the weaker as well as the stronger, each singly and uncombined, to healthy individuals, with caution, and carefully removing all accessory circumstances capable of exercising an influence, we note down the symptoms they occasion precisely in the order in which they occur, and thus we obtain the pure result of the form of disease that each of these medicinal substances is capable of producing, absolutely and by itself, in the human body.

In this way we must obtain a knowledge of a sufficient supply of artificial morbific agents (medicines) for curative implements, so that we may be able to make a selection from among them.

Now, after we have accurately examined the disease to be cured, that is to say, noted down all its appreciable phenomena historically, and in the order in which they occur, marking particularly the more severe and troublesome chief symptoms, we have only to oppose to this disease another disease as like it as possible, or, in other words, a medicinal irritation analogous to the existing irritation of the disease, by the employment of a medicine which possesses the power of exciting as nearly as possible all these symptoms, or at all events, the greater number and severest, or most peculiar of them, and in the same order,-in order to cure the disease we wish to remove, certainly, quickly and permanently.

The result of a treatment so conformable to nature may be confidently depended on, it is so perfectly, without exception, certain, so rapid beyond all expectation, that no method of treating diseases can shew anything at all like it.

But here it is necessary to take into consideration the immense difference, that can never be sufficiently estimated, betwixt the positive and negative, or as they are sometimes termed, the radical (curative) and the palliative modes of treatment.

In the action of simple medicines on the healthy human body there occur in the first place phenomena and symptoms, which may be termed the positive disease, to be expected from the specific action of the medicinal substance, or its positive primary (first and principal) effect.

When this is past, there ensues, in hardly appreciable transitions, the exact opposite of the first process (especially in the case of vegetable medicines), there occur the exact opposite (negative) symptoms constituting the secondary action.

Now, if in the treatment of a disease we administer those medicines whose primary symptoms, or those of its positive action, present the greatest similarity to the phenomena of the disease, this is a positive or curative mode of treatment, that is to say, there occurs what must take place according to my second maxim of experience, rapid, permanent amelioration, for the completion of which the remedy must be given in smaller and smaller doses, repeated at longer intervals, to prevent the occurrence of a relapse; if the first, or first few doses have not already sufficed to effect a cure.

Thus, to the abnormal irritation present in the body, another morbid irritation as similar to it as possible (by means of the medicine that acts in this case positively with its primary symptoms) is opposed in such a degree that the latter preponderates over the former, and (as two abnormal irritations cannot exist beside each other in the human body, and these are two irritations of the same kind) the complete extinction and annihilation of the former is effected by the latter.

Here a new disease is certainly introduced (by the medicine) into the system, but with this difference in the result, that the original one is extinguished by the artificially excited one; but the course of the artificially excited one (the course of the medicinal symptoms), that has thus overcome the other, expires in a shorter time than any natural disease, be it ever so short.

It is astonishing that, when the positive (curative) medicine employed corresponds very exactly in its primary symptoms with those of the disease to be cured, not a trace of the secondary symptoms of the medicine is observable, but its whole action ceases just at the time when we might expect the commencement of the negative medicinal symptoms. The disease disappears if it belong to acute diseases in the first few hours, which are the duration allotted by nature to the primary medicinal symptoms, and the only visible result is-recovery-a real dynamic mutual extinction.

In the best cases the strength returns immediately, and the lingering period of convalescence usual under other modes of treatment is not met with.

Equally astonishing is the truth that there is no medicinal substance which, when employed in a curative manner, is weaker than the disease for which it is adapted-no morbid irritation for which the medicinal irritation of a positive and extremely analogous nature is not more than a match.

If we have not only selected the right (positive) remedy, but have also hit upon the proper dose (and for a curative purpose incredibly small doses suffice), the remedy produces within the first few hours after the dose has been taken a kind of slight aggravation (this seldom lasts so long as three hours), which the patient imagines to be an increase of his disease, but which is nothing more than the primary symptoms of the medicine, which are somewhat superior in intensity to the disease, and which ought to resemble the original malady so closely as to deceive the patient himself in the first hour, until the recovery that ensues after a few hours teaches him his mistake.

In this case the cure of an acute disease is generally accomplished by the first dose.
If, however, the first dose of the perfectly adapted curative medicine was not somewhat superior to the disease, and if that peculiar aggravation did not occur in the first hour, the disease is, notwithstanding, in a great measure extinguished, and it only requires a few and always smaller doses to annihilate it completely.

If, under these circumstances, in place of smaller doses, as large or larger ones are administered, there arise (after the disappearance of the original disease) pure medicinal symptoms, a kind of unnecessary artificial disease.

But the case is quite different with palliative treatment, where a medicine is employed whose positive, primary action is the opposite of the disease.

Almost immediately after the administration of such a medicine there occurs a kind of alleviation, an almost instantaneous suppression of the morbid irritation for a short time, as in the case cited above of the cold water applied to the burnt skin. These are called palliative remedies.

They prevent the impression of the morbid irritation on the organism only as long as their primary symptoms last, because they present to the body an irritation that is the reverse of the irritation of the disease; thereafter their secondary action commences, and as it is the opposite of their primary action, it coincides with the original morbid irritation and aggravates it.

During the secondary action of the palliative, and when it has been left off, the disease becomes aggravated. The pain of the burn becomes worse when the hand is withdrawn from the cold water than before it was immersed.
As in the (positive) curative mode of treatment in the first hour a slight aggravation usually ensues, followed by an amelioration and recovery all the more durable, so in the palliative method there occurs in the first hour, indeed almost instantaneously, a (deceptive) amelioration, which, however, diminishes from hour to hour, until the period of the primary, and in this case palliative, action expires, and not only allows the disease to reappear as it was before the use of the remedy, but somewhat of the secondary action of the medicine is added, which, because the primary action of the remedy was the opposite of the disease, now becomes the very reverse, that is to say, a state analogous to the disease. This state is an increase, an aggravation of the disease.

If it is wished to repeat the palliative aid, the former dose will now no longer suffice; it must be increased, and always still further increased, until the medicine no longer produces relief, or until the accessory effects, whatever these may be, of the medicine continued in ever increased doses, are productive of bad consequences, that forbid its further employment, bad consequences which, when they have attained a considerable height, suppress the original malady that has hitherto been treated (in conformity with the first maxim of experience), and, in place thereof, another new and at least as troublesome disease appears.

Thus, for instance, a chronic sleeplessness may be frequently suppressed for a considerable time by means of daily doses of opium given at night, because its (in this case palliative) primary action is soporific, but (in consequence of its secondary action being sleeplessness, accordingly an addition to the original disease) that only by means of ever increasing doses, until an intolerable constipation, an anasarca, an asthma, or other malady from the secondary action of opium, prohibits its further employment.

If however, but a few doses of the palliative medicine be employed for a habitual malady, and then discontinued before it can excite an important accessory affection, it is then speedily and clearly apparent, that it is not only impotent against the original malady, but that it moreover aggravated the latter by its secondary effects. This is truly but negative relief. If for instance, in the case of chronic agrypnia sought to be cured, the patient only obtained too little sleep, in that case the evening dose of opium will certainly immediately cause a kind of sleep, but when this remedy, which here acts only in a palliative manner, is discontinued after a few days, the patient will then not be able to sleep at all.

The palliative employment of medicines is only useful and necessary in but few cases-chiefly in such as have arisen suddenly and threaten almost immediate danger!

Thus, for example, in apparent death from freezing (after friction to the skin and the gradual elevation of the temperature) nothing removes more quickly the want of irritability in the muscular fibre, and the insensibility of the nerves, than a strong infusion of coffee, which in its primary action increases the mobility of the fibre and the sensibility of all the sensitive parts of the system; and is consequently palliative as regards the case before us. But in this case there is danger in delay, and yet there is no persistent morbid state to be overcome, but whenever sensation and irritability are again excited and brought into action even by a palliative, the uninjured organism resumes its functions, and the free play of the vital processes maintains itself again, without the aid of any further medication.

In like manner, cases of chronic diseases may occur, for example, hysterical convulsions or asphyxias, where the temporary assistance of palliatives (as eau de luce, burnt feathers, andc.,) may be urgently demanded, in order to restore the patient to his usual undangerous morbid state, for the cure of which, the totally different durable aid of curative medicines is required.

But where all that is capable of being affected by a palliative is not accomplished in a few hours, the bad consequences spoken of above commence to make their appearance.

In acute diseases, even such as run their course in the shortest time, we would better consult the dignity of medicine and the welfare of our patients, by treating them with curative (positive) medicines. They will thereby be overcome more certainly, and on the whole more rapidly, and without after-complaints.
However, the bad consequences of the palliative in slight cases of acute diseases are not very striking, not very considerable. The chief symptoms disappear in a great measure after each dose of the palliative, until the natural course of the disease comes to an end, and then the organism, which has not been very seriously deranged during the short time by the secondary effects of the palliative, again resumes its sway, and gradually overcomes the consequences of the disease itself, together with the after-sufferings caused by the medicine.

If, however, the patient recover under the use of the palliative, he would also have recovered equally well and in the same space of time, without any medicine (for palliatives never shorten the natural courses of acute diseases), and would thereafter more readily regain his strength for the reasons just given. The only circumstance that can in some measure recommend the physician who practises in this way, namely, that the troublesome symptoms are occasionally subdued by his palliatives, offers to the eyes of the patient and his friends some apparent, but no real advantage over the spontaneous recovery without the use of medicine.
Hence the curative and positive treatment possesses even in diseases of a rapid course, a decided advantage over all palliative alleviations, because it abridges even the natural periods of acute diseases, really heals them before the time for completing their course has expired, and leaves behind no after-sufferings, provided the perfectly suitable curative agent has been selected.

It might be objected to this mode of treatment, “that physicians from the earliest periods of the existence of the medical art, have (to their knowledge) never employed it, and yet have cured patients.”
This objection is only apparent; for ever since the existence of the art of medicine, there have been patients who have really been cured quickly, permanently, and manifestly by medicines, not by the spontaneous termination of the course of acute diseases, not in the course of time, not by the gradual preponderance of the energy of the system, but have been restored in the same manner as I have here described, by the curative action of a medicinal agent, although this was unknown to the physician.

In order to determine this, we must select the cases detailed by some perfectly truthful and accurate observer, where some disease not of an acute character, limited by nature to a certain short course, but some long-lasting disease, was cured permanently and without any sequelae, not by a mixture of all sorts of different drugs, but by a single medicinal substance. This we should certainly find to have been a (curative) medicine very analogous in its primary effects to the disease. Had it been a palliative, given in ever increasing doses, the apparent cure would not have been permanent, or at least, not without some after-disease. Unless by the instrumentality of a positive (curative) medicine, no rapid, gentle, permanent cure ever took place, nor in the nature of things, could it ever occur.

Occasionally, however, physicians suspected that it was that property of medicines (now confirmed by innumerable observations)-of exciting (positive) symptoms analogous to the disease, by virtue of a tendency inherent in them-which enabled them to effect real cures. But this ray of truth, I confess, seldom penetrated the spirit of our schools, enshrouded as they were in a cloud of systems.

When the remedy has been discovered by this mode of procedure, so conformable to nature, there still remains an important point, namely, the determination of the dose.

A medicine of a positive and curative character, may, without any fault on its part, do just the opposite to what it ought, if given in too large a dose; in that case it produces a greater disease than that already present.

If we keep a healthy hand in cold water for some minutes, we experience in it a diminution of temperature, cold; the veins become invisible, the fleshy parts become shrunken, their size is diminished, the skin is paler, duller, motion is more difficult. These are some of the primary effects of cold water on the healthy body. If we now withdraw the hand from the cold water and dry it, no long time will elapse before the opposite state ensues. The hand becomes warmer than the other (that had not been immersed), we notice considerable turgescence of the soft parts, the veins swell, the skin becomes redder, the movements more free and powerful than in the other-a kind of exalted vitality. This is the secondary or consecutive action of the cold water on the healthy body.

This is, moreover, almost the greatest dose in which cold water can be employed with a permanent good result, as a positive (curative) medicinal agent in a state of (pure) debility analogous to its above described primary effects on the healthy body. I repeat, the “greatest dose”; for if the whole body should be exposed to the action of this agent, and if the cold of the water be very considerable, the duration of its application must at least be very much shortened, to a few seconds only, in order to reduce the dose sufficiently.

But if the dose of this remedy be in all respects much increased above the normal amount, the morbid symptoms peculiar to the primary action of the cold water increase to a state of actual disease, which the weak part it was intended to cure by its means cannot or can scarcely remove again. If the dose be increased still more, if the water be very cold, if the surface exposed to the water be larger and the duration of its application much longer than it ought to be for an ordinary curative dose of this agent, there then ensue numbness of the whole limb, cramp of the muscles, often even paralysis; and if the whole body have been immersed in this cold water for an hour or longer, death ensues, or at least the apparent death from freezing in healthy individuals, but much more speedily when it is applied to feeble individuals.

The same is the case with all medicines, even with internal ones.

The reaper (unaccustomed to the use of spirits) exhausted by heat, exertion and thirst, who, as I have said above, is restored in the course of an hour by a small dose, a single mouthful of brandy (whose primary action shews a state very similar to that sought to be combatted in the present instance), would fall into a state of (probably fatal) synochus, if under these circumstances he were to drink, in place of a single mouthful, a couple of pints at once;-the same positive remedial agent, only in an excessive, injurious dose.
Let it not be supposed that this injurious effect of excessively large doses appertains only to medicinal agents applied in a positive (curative) manner. Equally bad results ensue from excessive doses of palliatives,-for medicines are substances in themselves hurtful, that only become remedial agents by the adaptation of their natural pathogenetic power to the disease (positively or negatively) analogous to them, in the appropriate dose.

Thus, to give an example of negative (palliative) medicines, a hand very much benumbed by cold, will soon be restored in the atmosphere of a warm room. This moderate degree of warmth is efficacious in this case as an agent of antagonistic tendency to the numbness from the cold, that is to say, as a palliative; but its employment is not attended with any particular bad effects, because the dose is not too strong and the remedy need only be used for a short time, in order to remove the moderate and rapidly produced morbid state it is wished to cure.

But let the hand which has become completely benumbed and quite insensible from the cold (frost-bitten), be quickly immersed for an hour in water of 120° Fahr., which is not too great for a healthy hand, and the part will inevitably die; the hand mortifies and falls off.

A robust man, much over-heated, will soon recover in a moderately cool atmosphere (about 65° Fahr.) without experiencing any appreciable disadvantage from this palliative; but if immediately after being so over-heated he has to stand for an hour in a cold river (wherein he might probably have remained without any bad result when not in a state of heat), he will either fall down dead, or be effected by the most dangerous typhus.
A burnt part will be alleviated in a palliative manner by cool water, but will become sphacelated if ice be applied to it. And the same is the case with internal remedies also. If a girl, excessively over-heated by dancing, swallow a quantity of ice, every one knows what usually ensues,-and yet a small tablespoonful of cold water or a minute quantity of ice would not do her any harm, although it is the same palliative, only in a smaller dose. But she would be certainly and permanently cured, even though excessively over-heated, if she were to chose a small, appropriate dose of a remedy whose primary effect is analogous (curative) to the state she is in; for instance, if she should drink a little very warm tea mixed with a small portion of heating spirituous liquor, (rum, arrack or the like), in a moderately heated room, walking quickly about;-but a large glass of alcoholic liquor would, on the other hand, throw her into a high fever.

None but the careful observer can have any idea of the height to which the sensitiveness of the body to medicinal irritations is increased in a state of disease. It exceeds all belief, when the disease has attained a great intensity. An insensible, prostrated, comatose typhus patient, unroused by any shaking, deaf to all calling, will be rapidly restored to consciousness by the smallest dose of opium, were it a million times smaller than any mortal ever yet prescribed.

The sensitiveness of the highly diseased body to medicinal irritations increases in many cases to such a degree, that powers commence to act on and excite him, whose very existence has been denied, because they manifest no action on healthy robust bodies, nor in many diseases for which they are not suited. As an example of this, I may mention the heroic power of animalism (animal magnetism), or that immaterial influence of one living body upon another produced by certain kinds of touching or approximation, which displays such an energetic action on very sensitive, delicately formed persons of both sexes, who are disposed either to violent mental emotions or to great irritability of the muscular fibres. This animal power does not manifest itself at all between two robust healthy persons,-not because it does not exist, but because, according to the wise purposes of God, it is much too weak to shew itself betwixt healthy persons, whereas the same influence (quite imperceptible when applied by one healthy person to another) often acts with more than excessive violence in those states of morbid sensibility and irritability,-just as very small doses of other curative medicines also do in very diseased bodies.

It is analogous to the medicinal powers of the application of the magnet in disease and the contact of a morbid part with the other metals, to which the healthy body is quite insensible.

On the other hand, it is as true as it is wonderful, that even the most robust individuals, when affected by the chronic disease, notwithstanding their corporeal strength, and notwithstanding that they can bear with impunity even noxious irritants in great quantity (excesses in food and alcoholic liquors, purgatives, andc.)-yet as soon as the medicinal substance positively appropriate to their chronic disease is administered to them, they experience from the smallest possible dose as great an impression as if they were infants at the breast.
There are some few substances employed in medicine which act almost solely in a chemical manner-some which condense the dead fibres as well as the living (as the tannin of plants), or loosen them and diminish their cohesion or their tension (as the fatty substances)-some which form a chemical combination with hurtful substances in the body, at least in the primae viae (as chalk or the alkalies which combine with some deleterious metallic oxydes or some acrid acid in the stomach-sulphuretted hydrogen water with the most dangerous metals and their oxydes); others which decompose them (as alkalies or liver of sulphur do the noxious metallic salts); others which chemically destroy parts of the body (as the actual cautery). With the exception of these few things and the almost purely mechanical operations of surgery on the body, amputation which merely shortens the limb, and blood-letting which merely diminishes the amount of that fluid, together with some mechanically injurious and insoluble substances that may be introduced into the body – all other medicinal substances act in a purely dynamic manner, and cure without causing evacuations, without producing any violent or even perceptible revolutions.

This dynamic action of medicines, like the vitality itself, by means of which it is reflected upon the organism, is almost purely spiritual in its nature; that of medicines used in a positive (curative) manner is so most strikingly with this singular peculiarity, that while too strong doses do harm and produce considerable disturbance in the system, a small dose, and even the smallest possible dose, cannot be inefficacious, if the remedy be only otherwise indicated.

Almost the sole condition necessary for the full and helpful action is that the appropriate remedy should come in contact with the susceptible living fibre; but it is of little, almost of no importance how small the dose is which, for this purpose, is brought to act on the sensitive parts of the living body.

If a certain small dose of a diluted tincture of opium is capable of removing a certain degree of unnatural sleepiness, the hundredth or even the thousandth part of the same dose of such a solution of opium suffices almost equally well for the same end, and in this way the diminution of the dose may be carried much farther without the excessively minute dose ceasing to produce the same curative result as the first; of which more will be said in the special part.

I have said that the contact of the medicinal substance with the living, sensitive fibre is almost the only condition for its action. This dynamic property is so pervading, that it is quite immaterial what sensitive part of the body is touched by the medicine in order to developed its whole action, provided the part be but destitute of the coarser epidermis-immaterial whether the dissolved medicine enter the stomach or merely remain in the mouth, or be applied to a wound or other part deprived of skin.

If there be no fear of its causing any evacuation (a peculiar vital process of the living organism, which possesses a peculiar power of nullifying and destroying the dynamic efficacy of the medicines), its introduction into the rectum or application to the lining membrane of the nose, fulfils every purpose, e. g., in the case of a medicine which has the power of curing a certain pain in the stomach, a particular kind of headache, or a kind of stitch in the side, or a cramp in the calves, or any other affection occurring in some part that stands in no anatomical connexion with the place to which the medicine is applied.

It is only the thicker epidermis covering the external surface of the body that presents some, but not an insurmountable obstacle to the action of medicines on the sensitive fibres underneath it. They still act through it, though somewhat less powerfully. Dry preparations of the medicine in powder act less powerfully through it; its solution acts more powerfully, and still more so if it be applied to a large surface.
The epidermis is however thinner on some parts, and consequently the action is easier in those situations. Among these the abdominal region, especially the pit of the stomach, the inguinal regions and the inner surface of the axilla, the bend of the arm, the inner surface of the wrist, the popliteal space, andc., are the parts most sensitive to the medicine.

Rubbing-in the medicines facilitates their action chiefly on this account, that the friction of itself renders the skin more sensitive, and the fibres, rendered thereby more active and susceptible, more apt to receive the impression of the specific medicinal power, which radiates thence over the whole organism.
If the groins be rubbed with a dry cloth until their sensibility is exalted, and the ointment of the black oxyde of mercury then laid upon them, the effect is the same as though we had rubbed the same place with the mercurial ointment itself, or as though the ointment had been rubbed in, as it is usually incorrectly expressed.

The peculiar medicinal power of the remedy, however, remains the same, whether it be employed outwardly or inwardly, so as to be brought into contact with the sensitive fibers.

The black oxyde of mercury taken by the mouth cures venereal buboes at least as rapidly and certainly as the rubbing-in of Naples ointment upon the groins. A foot-bath of a weak solution of muriate of mercury cures ulcers in the mouth as rapidly and certainly as its internal administration, especially if the part that is to be bathed be previously rubbed. Finely levigated cinchona powder applied to the abdomen cures the intermittent fever which it can cure by internal use.

But as the diseased organism is altogether much more sensitive for the dynamic power of all medicines, so also is the skin of diseased persons. A moderate quantity of tincture of ipecacuanha applied to the bend of the arm effectually removes the tendency to vomit in very sick individuals (by means of its primary power to excite vomiting).

The medicinal power of heat and cold alone seems not to be so exclusively dynamic as that of other medicinal substances. Where these two agents are employed in a positive manner, the smallest possible dose of them does not suffice to produce the desired effect. When it is requisite to obtain relief rapidly they both have to be employed in greater intensity, in a larger dose (up to a certain amount). But this appearance is deceptive; their power is just as dynamically medicinal as that of other medicines, and the difference in given cases depends on the already existing habituation of our body to certain doses of these stimuli, to certain degrees of heat and cold. The heat and cold to be employed in a medicinal manner must surpass this accustomed degree by a little, in order that it may be employed in a positive manner with success (by a great deal, if it is to be used in a negative or palliative manner).

The temperature of blood-heat is for most people in our climate higher than the usual degree for the skin, and consequently a footbath of 98° to 99° Fahr. is sufficiently temperate and warm enough to remove positively heat in the head (if no other morbid symptoms are present); but in order to alleviate in a palliative manner the inflammation of a burnt hand, we require to use water considerably colder than we are accustomed to bear comfortably in healthy parts of the body, and the water should be, within certain limits, so much the colder the more severe the inflammation is.

What I have here stated respecting the somewhat greater dose of heat and cold for curative purposes applies also to all other medicinal agents to which the patient has already been accustomed. Thus for medicinal purposes we require to administer to persons hitherto accustomed to their use doses of wine, spirits, opium, coffee, andc., large in proportion to the amount they were previously accustomed to.

Heat and cold, together with electricity, belong to the most diffusible of all dynamic medicinal stimuli, their power is not diminished nor arrested by the epidermis, probably because its physical property serves as a conductor and vehicle for their medicinal power, and thus helps to distribute them. The same may be the case with regard to animalism (animal magnetism) the medicinal action of the magnet, and in general with regard to the power of the external contact of metals. The galvanic power is somewhat less capable of penetrating through the epidermis.

If we observe attentively we shall perceive that wise nature produces the greatest effects with simple, often with small means. To imitate her in this should be the highest aim of the reflecting mind. But the greater the number of means and appliances we heap together in order to attain a single object, the farther do we stray from the precepts of our great instructress, and the more miserable will be our work.

With a few simple means, used singly one after the other, more frequently however with one alone, we may restore to normal harmony the greatest derangements of the diseased body, we may change the most chronic, apparently incurable diseases (not unfrequently in the shortest space of time) into health-whereas we may, by the employment of a heap of ill-selected and composite remedies, see the most insignificant maladies degenerate into the greatest, most formidable, and most incurable diseases.

Which of these two methods will the professor of the healing art who strives after perfection, choose?
A single simple remedy is always calculated to produce the most beneficial effects, without any additional means; provided it be the best selected, the most appropriate, and in the proper dose. It is never requisite to mix two of them together. We administer a medicine in order if possible to remove the whole disease by this single substance, or if this be not completely practicable, to observe from the effect of the medicine what still remains to be cured. One, two, or at most three simple medicines are sufficient for the removal of the greatest disease, and if this result does not follow, the fault lies with us; it is not nature, nor the disease, that is to blame.

If we wish to perceive clearly what the remedy effects in a disease, and what still remains to be done, we must only give one single simple substance at a time. Every addition of a second or a third only deranges the object we have in view, and when we wish to separate the effects of the remedy from the symptoms of the morbid process (seeing that at the most we may indeed be able to know the symptoms of the action of a simple medicine, but not the powers of a mixture of drugs, that either form combinations among, or are decomposed by, one another, and these it will never be possible for us to know), we now no longer see what portion of the changes that have taken place is to be ascribed to the disease,-we are unable to distinguish which of the changes and symptoms that have occurred are derived from one, which from another ingredient of the compound remedy, and consequently we are unable to determine which of the ingredients should be retained and which discarded during the subsequent treatment,-nor what other one we should substitute for one or other or for all of them. In such a treatment none of the phenomena can be referred to its true cause. Wherever we turn, nought but uncertainty and obscurity surrounds us.

Most simple medicinal substances produce in the healthy human body not few, but on the contrary, a considerable array of absolute symptoms. The appropriate remedy can consequently frequently contain among its primary effects an antitype of most of the visible symptoms in the disease to be cured (besides many others which render it suitable for the cure of other diseases).

Now the only desirable property that we can expect a medicine to possess, is this, that it should agree with the disease-in other words, that it should be capable of exciting per se the most of the symptoms observable in the disease, consequently, when employed antagonistically as a medicine, should also be able to destroy and extinguish the same symptoms in the diseased body.

We see that a single simple medicinal substance possesses in itself this property in its full extent, if it have been carefully selected for this purpose.

It is therefore never necessary to administer more than one single simple medicinal substance at once, if it have been chosen appropriately to the case of disease.

It is also very probable, indeed certain, that of the several medicines in a mixture, each no longer acts upon the disease in its own peculiar way, nor can it, undisturbed by the other ingredients, exert its specific effect,-but one acts in opposition to the other in the body, alters and in part destroys the action of the other, so that from this combination of several powers that dynamically decompose each other during their action in the body, an intermediate action is the result, which we cannot desire, as we cannot foresee, nor even form a conjecture respecting it.

In the action of mixtures of medicines in the body, there occurs what, indeed, must occur according to the maxim of experience given above (viz.:-that a general irritation in the body removes another, or else suppresses it, according as the one irritation is analogous or antagonistic to the other, or provided the one be much more intense than the other)-the actions of several of the medicines in the compound partially destroy one another, and only the remainder of the action, which is not covered by any antagonistic irritation in the mixture, remains to oppose the disease; whether this be suitable or no, we cannot tell, as we are unable to calculate what actually will remain.

Now, as in every case, only a single simple medicinal substance is necessary; no true physician would ever think of degrading himself and his art, and defeating his own object, by giving a mixture of medicines. It will rather be a sign that he is certain of his subject if we find him prescribing only a single medicinal substance, which, if suitably chosen, cannot fail to remove the disease rapidly, gently and permanently.
If the symptoms be but slight and few in number, it is an unimportant ailment that scarcely requires any medicine, and may be removed by a mere alteration of diet or regimen.

But if – as rarely happens-only one or a couple of severe symptoms be observable, then the cure is more difficult than if many symptoms were present. In that case the medicine first prescribed may not be exactly suitable, either because the patient is incapable of describing the extent of his ailments, or because the symptoms themselves are somewhat obscure and not very observable.

In this more uncommon case we may prescribe one, or at most, two doses of the medicine that appears to be the most appropriate.

It will sometimes happen that this is the right remedy. In the event of its not being exactly suitable, which is most commonly the case, symptoms not hitherto experienced will reveal themselves, or symptoms will develop themselves more fully, that the patient has not previously noticed, or only in an indistinct manner.

From these symptoms which, though slight, now shew themselves more frequently and are more distinctly perceptible, we may now obtain a more accurate picture of the disease, whereby we may be enabled to discover with greater and even the greatest certainty the most appropriate remedy for the original disease.
The repetition of the doses of a medicine is regulated by the duration of the action of each medicine. If the remedy acts in a positive (curative) manner, the amendment is still perceptible after the duration of its action has expired, and then another dose of the suitable remedy destroys the remainder of the disease. The good work will not be interrupted if the second dose be not given before the lapse of some hours after the cessation of the action of the remedy. The portion of the disease already annihilated cannot in the mean time be renewed; and even should we leave the patient several days without medicine, the amelioration resulting from the first dose of the curative medicine will always remain manifest.

So far from the good effect being delayed by not repeating the dose until after the medicine has exhausted its action, the cure may on the contrary be frustrated by its too rapid repetition, for this reason, because a dose prescribed before the cessation of the term of action of the positive medicine is to be regarded as an augmentation of the first dose, which from ignorance of this circumstance may thereby be increased to an enormous degree, and then prove hurtful by reason of its excess.

I have already stated that the smallest possible dose of a positively acting medicine will suffice to produce its full effect. If, in the case of a medicine whose action lasts a long time, as for instance digitalis where it continues to the seventh day, the dose be repeated frequently, that is to say, three or four times in the course of a day, the actual quantity of medicine will, before the seven days have expired, have increased twenty or thirty-fold, and thereby become extremely violent and injurious; whereas the first dose (a twentieth or thirtieth part) would have amply sufficed to effect a cure without any bad consequences.
After the expiry of the term of action of the first dose of the medicine employed in a curative manner, we judge whether it will be useful to give a second dose of the same remedy. If the disease have diminished in almost its whole extent, not merely in the first half-hour after taking the medicine, but later, and during the whole duration of the action of the first dose; and if this diminution have increased all the more, the nearer the period of the action of the remedy approached its termination-or even if, as happens in very chronic diseases, or in maladies the return of whose paroxysm could not have been expected during this time, no perceptible amelioration of the disease have indeed occurred, but yet no new symptom of importance, no hitherto unfelt suffering deserving of attention have appeared, then it is in the former case almost invariably certain, and in the latter highly probable, that the medicine was the curatively helpful, the positively appropriate one, and, if requisite, ought to be followed up by a second-and finally even, after the favourable termination of the action of the second, by a third dose if it be necessary and the disease be not in the mean time completely cured,-as it often is, in the case of acute diseases, by the very first dose.

If the medicine we have chosen for the positive (curative) treatment excites almost no sufferings previously unfelt by the patient, produces no new symptom, it is the appropriate medicament and will certainly cure the original malady, even though the patient and his friends should not admit that any amendment has resulted from the commencing doses,-and so also conversely, if the amelioration of the original disease take place in its whole extent from the action of the curative medicine, the medicine cannot have excited any serious new symptoms.

Every aggravation, as it is called, of a disease that occurs during the use of a medicine (in doses repeated before or immediately after the expiry of its term of action), in the form of new symptoms not hitherto proper to the disease, is owing solely to the medicine employed (if it do not occur just a few hours before inevitable death, if there have taken place no important error of regimen, no outbreak of violent passions, no irresistible evolution of the course of nature by the occurrence or cessation of the menstrual function, by puberty, conception, or parturition); these symptoms are always the effect of the medicine, which, as an unsuitably chosen positive remedy, or as a negative (palliative) remedy, either ill-selected or given for too long a time, and in too large doses, develops them by its peculiar mode of action to the torment and destruction of the patient.

An aggravation of the disease by new, violent symptoms during the first few doses of a curative medicine is never indicative of feebleness of the dose (never requires the dose to be increased), but it proves the total unfitness and worthlessness of the medicine in this case of disease.

The aggravation just alluded to by violent, new symptoms not proper to the disease, bears no resemblance to the increase of the apparently original symptoms of the disease during the first few hours after the administration of a medicine selected in a positive (curative) manner, which I formerly spoke of. This phenomenon of the increase of what seem to be the pure symptoms of the disease, but which are actually predominant medicinal symptoms resembling those of the disease, indicates merely that the dose of the appropriately selected curative medicine has been too large-it disappears, if the dose has not been enormously large, after the lapse of two, three, or at most, four hours after its administration, and makes way for a removal of the disease that will be all the more durable, generally after the expiry of the term of the action of the first dose; so that, in the case of acute affections, a second dose is usually unnecessary.

However, there is no positive remedy, be it ever so well selected, which shall not produce one, at least one slight, unusual suffering, a slight new symptom, during its employment, in very irritable, sensitive patients,-for it is almost impossible that medicine and disease should correspond as accurately in their symptoms as two triangles of equal angles and sides resemble each other. But this unimportant difference is (in favourable cases) more than sufficiently compensated by the inherent energy of the vitality, and is not even perceived except by patients of excessive delicacy.

Should a patient of ordinary sensibility observe during the duration of the action of the first dose, an unusual sensation, and should the original disease appear at the same time to decline, we are unable to determine with precision (at least not in a chronic disease) from this first dose, whether or no the medicine selected was the most appropriate curative one. The effects of a second dose of equal strength, given after the first has exhausted its action, can alone decide this point. From the action of this, if the medicine was not perfectly or exceedingly appropriate, there will again appear a new symptom (but not often the same that was observed from the first dose, usually another one) of greater intensity (or even several symptoms of a like character), without any perceptible progress occurring in the cure of the disease in its whole extent;-if, however, it was the appropriate positive medicine, this second dose removes almost every trace of a new symptom, and health is restored with still greater rapidity, and without the supervention of any new ailment.
Should there occur from the second dose also some new symptom of considerable severity, and should it not be possible to find a more appropriate medicine (the fault of which may however lie either in a want of diligence on the part of the physician, or in the smallness of the supply of medicines, whose absolute effects are known) in the case of chronic diseases, or acute diseases that do not run a very rapid course, a diminution of the dose will cause this to disappear, and the cure will still go on, though somewhat more slowly. (In this case also the energy of the vitality aids the cure).

The choice of the medicine is not inappropriate if the chief and most severe symptoms of the disease are covered in a positive manner by the symptoms of the primary action of the medicine, while some of the more moderate and slighter morbid symptoms are so only in a negative (palliative) manner. The true curative power of the predominant positive action of the remedy takes place notwithstanding, and the organism regains full possession of health without accessory sufferings during the treatment, and without secondary ailments thereafter. It is not yet decided whether it is advantageous in such a case to increase the doses of the medicine during the continuance of its employment.

If, during the continued employment of a curative medicine without increasing the doses (in a chronic disease,) fresh symptoms not proper to the disease should, in the course of time, present themselves, whereas the first two or three doses acted almost without any disturbance, we must not seek for the cause of this impediment in the inappropriateness of the medicine, but in the regimen, or in some other powerful agency from without.
If, on the other hand, as is not unfrequently the case when there is a sufficient supply of well known medicines, a positive medicine perfectly appropriate to the accurately investigated case of disease, be selected and administered in a suitably small dose, and repeated after the expiry of its special duration of action, should none of the above alluded to great obstacles come in the way, such as unavoidable evolutions of nature, violent passions, or enormous violations of regiminal rules, and should there be no serious disorganization of important viscera, the cure of acute and chronic diseases, be they ever so threatening, ever so serious, and of ever so long continuance, takes place so rapidly, so perfectly, and so imperceptibly, that the patient seems to be transformed almost immediately into the state of true health, as if by a new creation.
The influence of regimen and diet on the cure is not to be overlooked; but the physician needs to exercise a supervision over them only in chronic diseases, according to principles which I shall develop in the special part of my work. In acute diseases, however (except in the state of complete delirium), the delicate and infallible tact of the awakened internal sense that presides over the maintenance of life, speaks so clearly, so precisely, so much in conformity with nature, that the physician needs only to impress on the friends and attendants of the patient, not to oppose in any way this voice of nature, by refusing or exceeding its demands, or by an injurious officiousness and importunity.Share this ...

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James Tyler Kent – Lecture on The second prescription


James_Tyler_KentThe second prescription – James Tyler Kent
lecture read before the International Hahnemannian Association at Niagara Falls in 1888

Editorial Note: What perplexing problems we often meet in practice! How we crave, at times, the advice of a master mind! We are so often the victims of prejudice, over-confidence or ignorance, and our patients suffer in consequence of this. Could we but understand the intricate laws governing the inner man, disease, and remedies, how much more wisely might we adjust ourselves to the far-reaching problems which endanger the life of a father, a mother, a noble son or an affectionate daughter. We would not then, as is so often done, impede or pervert the action of a carefully selected remedy by our impatience to get results, or by our impetuosity in hastening certain conditions which will not be hastened, or by our ignorance in so quickly changing remedies before one of them has had time for definite action. To help us in this noble work we reproduce below a masterly paper by Dr. J. T. Kent, read before the International Hahnemannian Association at Niagara Falls in 1888. – G. E. D.
What is more beautiful to look upon than the bud during its hourly changes to the rose in its bloom. This evolution has so often come to my mind when patiently awaiting the return of symptoms after the first prescription has exhausted its curative power. The return symptom-image unfolds the knowledge by which we know whether the first prescription was the specific or the palliative, i. e., we may know whether the remedy was deep enough to cure all the deranged vital wrong or simply a superficially acting remedy, capable of only a temporary effect. The many things learned by the action of the first remedy determine the kind of demand made upon the physician for the second prescription.

Many problems come up to be solved that must be solved, or failure may follow.

How long shall I watch and wait? Is a question frequently asked but seldom answered.

Is the remedy still acting? Is the vital reaction still affected by the impulse of the remedy?
If the symptoms are returning, how long shall they be watched before it is necessary to act or give medicine.?
Is the disease acute or chronic?
Why is the second prescription so much more difficult than the first?
Why is it that so many patients are benefited when first going to the physician and thereafter derive no benefit?

I presume that most good prescribers will say: “We have often acted too soon, but never waited too long.” Many physicians fail because of not waiting, and yet the waiting must be governed by knowledge. Knowledge must be had, but where can it be obtained? To know that this waiting is right is quite different from waiting without a fixed purpose. This knowledge cannot be found where its existence is denied; it is not found with unbelievers and agnostics.

When the first prescription has been made and the remedy has been similar enough to change the existing image, we have but to wait for results. The manner of change taking place in the totality of symptoms signifies everything, yet the manner of the return of the image, provided it has disappeared, signifies more.

First. If aggravation of symptoms follow; Second. If amelioration of symptoms follow;

1. Aggravation of existing symptoms may come on with general improvement of the patient, which means well; but-

If aggravation of the symptoms is attended with decline of the patient the cure is doubtful, and the case must be handled with extreme care, as it is seldom that such patients recover perfectly.

2. If amelioration follow the prescription, to what does the amelioration apply?
It may apply to the general state or but to the few symptoms. If the patient does not feel the elasticity of life returning, the improved symptoms are the facts upon which to doubt recovery.

The knowledge that the disease is incurable often is obtained only in this way. In such cases every remedy may palliate his sufferings, but cure does not come. The symptoms that are the expressions of the debility are there, and hence the totality of the symptoms is not removed.

After the curative impulse has entirely subsided, the symptoms will appear one by one, falling into place to arrange an image of the disease before the intelligent physician for the purpose of cure.

If the first prescription has been continuously given, there has been but little if any chance of a pure returning image of the disease, therefore this image must be very unreliable.

When the remedy has been fully exhausted, then, and only then, can we trust the symptoms constituting the picture.

If the first prescription was the similimum, the symptoms will return-and when they return-asking for the same remedy. Too often the remedy has been only similar enough to the superficial symptoms to change the totality and the image comes back altered, therefore resembling another remedy, which must always be regarded as a misfortune, by which the case is sometimes spoiled, and the hand of the master may fail to correct the wrong done.
Whenever the symptoms return the same image, calling for the same remedy, then it is that we have demonstrated, that-for a time, if the disease be chronic-we can but recommend the range of dynamics to cure this case. This rule is almost free from exceptions if the remedy is an antipsoric.

What must the physician do who has not the knowledge of dynamic medicines? He must sometimes see sick images come back without change of symptoms, though I believe it is seldom. The symptoms may call for Phosphorus as strongly as when he began, and Phosphorus 6x has served and no longer cures. What can he do but change his remedy? Can it be possible that man can be so ignorant of how to cure as to give a drug that is not indicated because the one that is indicated does not cure? These ignorant mortals condemn the system of Homoeopathy and feel that they have performed their duty to the sick, forgetting that ignorance was the culprit.

I have observed in cases where a low potency had been administered in frequently repeated doses, that some time must elapse before a perfect action will follow the higher potency; but where the dose had not been repeated after its action was first observed, the new and higher potency will act promptly. When the symptoms come back-after prudent waiting-unchanged, the selection was correct, and if the same potency fail to act a higher one will generally do so quite promptly, as did the lower one first. When the picture comes back unaltered except by the absence of some one or more symptoms, the remedy should never be changed until a still higher potency has been fully tested, as no harm can come to the case from giving a single dose of a medicine that has exhausted its curative powers. It is even negligence not to do such a thing.

Proper time to change

When the demonstration is clear that the present remedy has done all it is capable of doing-and this demonstration can not be made until much higher potencies than usually made have been tried-then the time is present for the next prescription.

To change to the next remedy becomes a ponderous problem, and what shall it be?

The last appearing symptom shall be the guide to the next remedy. This is so whenever the image has been permitted to settle by watching and waiting for the shaping of the returning symptom- picture. Long have I waited after exhausting the power of a remedy, while observing a few of the old symptoms returning; finally a new symptom appears. This latest symptom will appear in the anamnesis as best related to some medicine having it as a characteristic which most likely have all the rest of the symptoms.

It is not supposed that this later appearing symptom is an old symptom on its way to final departure, for so long as old symptoms re-appear and disappear it is granted that no medicine is to be thought of.

It is an error to think of a medicine when a symptom-image is changing. The physician must wait for permanency or firmness in the relations of the image before making a prescription.
Some say, “I must give the patient medicine or he will go and see someone else.” I have only to say that it were better had all sick folks gone somewhere else, for these doctors seldom cure but often complicate the sickness.

The acute expressions of a chronic disease have a different management from the acute disease, e. g., a child suffers from bronchitis in every change of weather. It may grow worse if treated with the remedy for the acute symptoms.

The miasm that predisposes the child to recurrent attacks must be considered.

One recently under my care had received Antimonium tart., Calcarea, Sulphur, Lycopodium, etc., in such indiscriminate confusion that the child was not cured. The waiting on Sac.-lac. through several attacks permitted the drug-effects to pass off, and the true image of the sickness was permitted to express itself through several of the exacerbations taken as a whole.

When western ague is complicated with a miasm, a single paroxysm does not fully express the totality, but several must be grouped and the true image will be discovered. If the acute disease be complicated with a miasm the indicated remedy will wipe it out “cito, tuto et jocund.”

Avoid haste

All things oppose haste in prescribing. In very grave diseases haste is a common error, more frequently with the second prescription than the first. Many doctors suppose that a diphtheria demands a medicine immediately because “something must be done.” This is an error; many a life has been saved by waiting and waiting.

For example:

A little girl was suffering from a severe attack of diphtheria and the mother had treated it four days with Mercurius 3x, and Kali bich. 3x, in alternation. She was poor, and therefore I did not refuse to take the case which was then in a very bad state: nose, mouth and larynx full of exudate.

After a long study the child received Lycopodium cm., one dose, dry, which cleared out the exudate from nose and fauces, but did not touch the larynx.

I dare not tell you how long I watched that child before I saw an indication for the second remedy which it would have needed had the Lycopodium been given when the child first took sick. I waited until the poor child was threatening dissolution when I saw a little tough yellow mucus in the mouth. Kali bich., cm., one dose, cleared the larynx in one day and there was no further medication necessary.

The first prescription is made with the entire image of the sickness formed. (People usually send for the doctor after there can be no doubt of the sickness to be treated.)
The doctor watches the improvement of the patient and the corresponding disappearance of the symptoms under the first prescription, and when the case comes to a standstill he is uneasy, and with increasing fidgetiness he awaits the coming indication for the next dose of medicine.

This fidgetiness which comes from a lack of knowledge unfits the physician as an observer and judge of symptoms; hence we see the doctor usually failing to cure his own children. He cannot wait and reason clearly over the returning symptoms.
While watching the prescriptions of beginners, I have observed very often the proper results of the first prescription. The patient has improved for a time, then ceased to respond to any remedy.

Close investigation generally reveals that this patient improved after the first dose of medicine, that the symptoms changed slightly without new symptoms, and the new “photo” seemed to call for some other remedy, when, of course, the remedy was changed and trouble began. Constant changing of remedies followed until all the antipsorics in the Chronic Diseases had been given on flitting symptom-images, and the patient is yet sick. This is the common experience of young Hahnemannians trying to find the right way. Some of experience make lesser blunders and some make few, but how many have made none? All of these blunders I have made, as I had no teacher, until I blundered upon the works of the great Master.

Wait and observe

The first prescription may not have been well chosen medicine, and then it becomes necessary to make a second effort.

As time brings about the re-examination of the patient, new facts are brought out in relation to the image of the sickness, indicating that the first medicine had not been suitable; perhaps several weeks have passed and the re-examination finds no change in the symptoms.

Shall I compare all the facts in the case to reassure myself of the correctness of the first prescription, or shall I wait longer?

Yes, to the former, of course, and if the remedy is still the most similar to all the symptoms, wait, and watch, and study the patient for a new light on his feelings to which he has become so accustomed he has not observed.

Commonly the new study of the case will reveal the reason why the first prescription has not cured: it was not appropriate.

If it still appears to be the most similar remedy the question arises: “How long shall I wait?”

At this point it should be duly appreciated that the length of time is not so important as being on the safe side, and “wait” is the only safe thing to do. It may have been many days, but that matters not, wait longer.

The finest curative action I ever observed was begun sixty days after the administration of the single dose.

The curative action may begin a slate as a long-acting drug can produce symptoms on a healthy body. This guide has never been thought of by our writers, but it is well to be considered. Why not?

It is the practice for some to go lower if a high potency has failed.

This method has but few recorded successes but should not be ignored.

The question next to be considered is the giving of a dose of medicine in water and divided doses. This has at times seemed to have favor over the single dry dose. This is open for discussion, requiring testimony of the many, not of few, to give weight. The best reports are made from both methods, and both are in harmony with correct practice.

Improper action

The next important step to be considered is when the first prescription has acted improperly, or without curative results. Then it becomes necessary to consider a second prescription. The first prescription sometimes changes the symptoms that are harmless and painless into symptoms that are dangerous and painful.

If a rheumatism of the knee goes to the heart under a remedy prescribed for the one symptom, the remedy has done harm. It is an unfortunate prescription and must be antidoted. In incurable diseases when a remedy has set up destructive symptoms, an antidote must be considered.

If the remedy changes the general symptom-image, and the general state of the patient is growing worse, the question then comes up, was the prescription only similar to a part of the image, or is the disease incurable? Knowledge of disease may settle this question. If the disease is incurable, the action of the remedy was not expected to do more than to change the sufferings into peaceful symptoms, and the second prescription is to be considered only when new sufferings demand a remedy.

But suppose such a change of suffering comes after the first prescription and the disease is undoubtedly curable, then the conclusion must be that the first prescription was not the true specific, and that the true image has not been seen.

Wait until the old image has fully returned is all there is to do. It is hazardous practice to follow up rapidly all the changing symptoms in any sickness, with remedies that simply for the moment seem similar to the symptoms present. The observing physician will know
by the symptoms and their directions, whether the patient is growing better or worse, even though he appear to the contrary to himself and his friends.

The complaints of patient or friends constitute no ground for a second prescription. The greatest sufferings may intervene in the change of symptoms during progress of permanent recovery, and if such symptoms are disturbed by a new prescription or palliated by inappropriate medicine, the patient may never be cured.

The object of the first prescription is to arrange the vital current or motion in a direction favorable to equilibrium, and when this is attained it must not be disturbed by a new interference. Ignorance in this sphere has cost millions of lives.

When will the medical world be willing to learn these principles so well that they can cure speedily, gently and permanently?

There can be no fixed time for making the second prescription; it may be many months.
The second prescription must be one that has a friendly relation to the last one or the preceding. No intelligent prescription can be made without knowing the last remedy. Concordances in Boenninghausen must not be ignored. The new remedy should sustain a complementary to the former.

Remedies suitable to follow

In managing a chronic sickness the remedy that conforms to an acute experience of the illness is worth knowing, as very often its chronic may be just the one that conforms to its symptoms.

Calcarea is the natural chronic of Belladonna and Rhus; Natrum mur. sustains the same relation to Apis and Ignatia; Silicea to Pulsatilla; Sulphur to Aconite. When Pulsatilla has been of great service in a given case and finally cures no more, while the symptoms now point to Silicea, the latter will be given with confidence as its complementary relation has long been established.

On the other hand Causticum and Phosphorus do not like to work after each other, nor will Apis do well after Rhus.

How physicians can make the second prescription without regard to the experience of nearly a century, is more than man can know.

These things are not written to instruct men of experience in the right way, but for the young men who have asked so often for the above notes of our present practice.
I am told almost daily that this kind of practice is splitting hairs, but I am convinced of the necessity of obeying every injunction.

Careful records

You should have no confidence in the experience of men who do not write out faithfully all the symptoms of the patient treated, and note carefully the remedy, and how given.

Especially is this necessary in patients likely to need a second prescription.

The physician who has in his case-book the notes of every illness of his patients has wonderful hold of any community. He has the old symptoms and the remedies noted that cured, and he can make indirect inquiry after after all the old symptoms long ago removed. The pleasure is not small found in consulting such a note-book.

Experience soon leads the close prescriber to note all the peculiar symptoms and to omit the nondescript wanderings indulged in by sick people; however. it is important to be correct in judgment.

Many physicians make a correct first prescription and the patient does well and cheers up for a while, but finally the test is made for the second and then all is lost. Homoeopathy is nothing if not true and, if true, the greatest accuracy of detail and method should be followed. It is fortunate that the physicians who repeat while the remedy is acting are such poor prescribers or their death-list would be enormous.

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The Medical Observer


HahnemannThe Medical Observer
Samuel Hahnemann

from the introduction to Materia Medica Pura

In order to be able to observe well, the medicinal practitioner requires to possess, what is not to be met with among ordinary physicians even in a moderate degree, the capacity and habit of noticing carefully and correctly the phenomena that take place in natural diseases, as well as those that occur in the morbid states artificially excited by medicines when they are tested upon the healthy body, and the ability to describe them in the most appropriate and natural expressions.

In order accurately to perceive what is to be observed in patients, we should direct all our thoughts upon the matter we have in hand, come out of ourselves, as it were, and fasten ourselves, so to speak, with all our powers of concentration upon it, in order that nothing that is actually present, that has to do with the subject, and that can be ascertained by all the senses, may escape us.

Poetic fancy, fantastic wit and speculation, must for the time be suspended, and all over- strained reasoning, forced interpretation and tendency to explain away things must be suppressed. The duty of the observer is only to take notice of the phenomena and their course; his attention should be on the watch, not only that nothing actually present escape his observation, but that also what he observes be understood exactly as it is.

This capability of observing accurately is never quite an innate faculty; it must be chiefly acquired by practice, by refining and regulating the perceptions of the senses, that is to say, by exercising a severe criticism in regard to the rapid impressions we obtain of external objects, and at the same time the necessary coolness, calmness, and firmness of judgment must be preserved, together with a constant distrust of our own powers of apprehension.

The vast importance of our subject should make us bestow the energies of our body and mind upon the observation; and great patience, supported by the power of the will, must sustain us in this direction until the completion of the observation.

To educate us for the acquirement of this faculty, an acquaintance with the best writings of the Greeks and Romans is useful, in order to enable us to attain directness in thinking and in feeling, as also appropriateness and simplicity in expressing our sensations; the art of drawing from nature is also useful, as it sharpens and practices our eye, and thereby also our other senses, teaching us to form a true conception of objects, and to represent what we observe, truly and purely, without any addition from the fancy. A knowledge of mathematics also gives us the requisite severity in forming a judgment.

Thus equipped, the medical observer cannot fail to accomplish his object, especially if he has at the same time constantly before his eyes the exalted dignity of his calling — as the representative of the all-bountiful Father and Preserver, to minister to His beloved human creatures by renovating their systems when ravaged by disease.

He knows that observations of medical subjects must be made in a sincere and holy spirit, as if under the eye of the all-seeing God, the Judge of our secret thoughts, and must be recorded so as to satisfy an upright conscience, in order that they may be communicated to the world, in the consciousness that no earthly good is more worthy of our zealous exertions than the preservation of the life and health of our fellow-creatures.

The best opportunity for exercising and perfecting our observing faculty is afforded by instituting experiments with medicines upon ourselves. Whilst avoiding all foreign medicinal influences and disturbing mental impressions in this important operation, the experimenter, after he has taken the medicine, has all his attention strained towards all the alterations of health that take place on and within him, in order to observe and correctly to record them, with ever-wakeful feelings, and his senses ever on the watch.

By persevering in this careful investigation of all the changes that occur within and upon himself, the experimenter attains the capability of observing all the sensations, be they ever so complex, that he experiences from the medicine he is testing, and all, even the finest shades of alteration of his health, and of recording in suitable and adequate expressions his distinct conception of them.

Thus only is it possible for the beginner to make pure, correct, and undisturbed observations, for he knows that he will not deceive himself, there is no one to tell him aught that is untrue, and he himself feels, sees, and notices what takes place in and upon him. He will thus acquire practice to enable him to make equally accurate observations on others also.

By means of these pure and accurate investigations we shall be made aware that all the symptomatology hitherto existing in the ordinary system of medicine was only a very superficial affair, and that nature is wont to disorder man in his health and in all his sensations and functions by disease or medicine in such infinitely various and dissimilar manners, that a single word or a general expression is totally inadequate to describe the morbid sensations and symptoms which are often of such a complex character, if we wish to portray really, truly, and perfectly the alterations in the health we meet with.

No portrait painter was ever so careless as to pay no attention to the marked peculiarities in the features of the person he wished to make a likeness of, or to consider it sufficient to make any sort of a pair of round holes below the forehead by way of eyes, between them to draw a long-shaped thing directed downwards, always of the same shape, by way of a nose, and beneath this to put a slit going across the face, that should stand for the mouth of this or of any other person; no painter, I say, ever went about delineating human faces in such a rude and slovenly manner; no naturalist ever went to work in this fashion in describing any natural production; such was never the way in which any zoologist, botanist, or mineralogist acted.

It was only the semeiology of ordinary medicine that went to work in such a manner,

when describing morbid phenomena. The sensations that differ so vastly among each other, and the innumerable varieties of the sufferings of the many different kinds of patients, were so far from being described by word or writing according to their divergences and varieties, according to their peculiarities; the complexity of the pains composed of various kinds of sensations, their degrees and shades, was so far from being accurately or completely described, that we find all these infinite varieties of sufferings huddled together under a few bare, unmeaning, general terms, such as perspiration, heat, fever, headache, sore throat, croup, asthma, cough, chest complaints, stitch in the side, bellyache, want of appetite, indigestion, dyspepsia, backache, coxalgia, haemorrhoidal sufferings, urinary disorders, pains in the limbs (called according to fancy gouty or rheumatic), skin diseases, spasms, convulsions, and c.

With such superficial expressions, the innumerable varieties of sufferings of patients were disposed of in the so-called observations, so that — with the exception of some one or other severe, striking symptom in this or that case of disease — almost every disease pretended to be described is as like another as the spots on a die, or as the various pictures of the dauber resemble one another in flatness and want of character.

The most important of all human vocations, I mean the observation of the sick, and of the infinite varieties of their disordered state of health, can only be pursued in such a superficial and careless manner by those, who despise mankind, for in this way there is no question either of distinguishing the peculiarities of the morbid states, or of selecting the only appropriate remedy for the special circumstances of the case.

The conscientious physician who earnestly endeavours to apprehend in its peculiarity the disease to be cured, in order to be able to oppose to it the appropriate remedy, will go much more carefully to work in his endeavour to distinguish what there is to be observed; language will scarcely suffice to enable him to express by appropriate words the innumerable varieties of the symptoms in the morbid state; no sensation, be it ever so peculiar, will escape him, which was occasioned in his feelings by the medicine he tested on himself; he will endeavour to convey an idea of it in language by the most appropriate expression, in order to be able in his practice to match the accurate delineation of the morbid picture with the similarly acting medicine, whereby alone, as he knows, can a cure be effected.

So true it is that the careful alone can become a true healer of diseases.

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aphorism 1


HahnemannThe physician’s high and only mission is to restore the sick to health, to cure, as it is termed.1

1 His mission is not, however, to construct so-called systems, by interweaving empty speculations and hypotheses concerning the internal essential nature of the vital processes and the mode in which diseases originate in the interior of the organism, (whereon so many physicians have hitherto ambitiously wasted their talents and their time); nor is it to attempt to give countless explanations regarding the phenomena in diseases and their proximate cause (which must ever remain concealed), wrapped in unintelligible words and an inflated abstract mode of expression, which should sound very learned in order to astonish the ignorant – whilst sick humanity sighs in vain for aid. Of such learned reveries (to which the name of theoretic medicine is given, and for which special professorships are instituted) we have had quite enough, and it is now high time that all who call themselves physicians should at length cease to deceive suffering mankind with mere talk, and begin now, instead, for once to act, that is, really to help and to cure.

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