The 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.