In the retrospect to which the commencement of a new volume of such a periodical as the Review, naturally invites us, several important considerations present themselves. Going beyond the more immediate past and looking back to the earlier years of Hahnemann's life, we notice that for a long period after the idea of the homoeopathic law and method became clear in his mind, he made frequent and very earnest efforts to commend this idea to the acceptance of his professional colleagues. Every form of argument and of demonstration was employed by him to persuade Hufeland and the profession generally, to investigate and to accept the homoeopathic law of cure.
It was not until many years had been occupied with fruitless labors of this sort, not until, in response to these efforts, he had been ridiculed and branded as an infamous impostor, that Hahnemann separated himself from the body of the medical profession, and defiantly flung to the breeze the banners of his new school of medicine.
The earnestness and long continuance of his efforts to reconcile fidelity to his convictions of truth and harmony with his professional brethren, may serve to show us how highly he prized this harmony. On the other hand, the unflinching determination with which to the end of his long life he accepted ostracism and contumely and personal suffering and poverty, when recreancy to his convictions had become the only alternative, should make us bow with reverence before a devotion to Truth and Duty which has had no parallel among physicians.
The majority of Hahnemann's immediate pupils stood by him faithfully in his entire separation from the dominant school of medicine. Some, however, who adhered to the new system, deprecated Hahnemann's apparent hostility to the old school, and sought by every means to bridge over the chasm which separated the Homoeopathist from medical men at large. That this was a very praiseworthy endeavor is not to be denied; for not less in professional than in social life is it a delightful thing for “brethren to dwell together in unity,” but it should not be forgotten that the dwelling together is possible only where “unity” is possible – where this is unattainable there should be a wide and acknowledged separation.
The attempt to smooth over the radical and inevitable differences between Homoeopathists and Allopathists led, at a very early period, to the ignoring of certain fundamental principles involved in the science of Homoeopathy. This evil steadily increased, until, fifteen years ago, the practice of the great majority of Homoeopathists bore very little resemblance indeed to that of Hahnemann and his stricter pupils, and their success was proportionably less; but little, if at all, greater in many respects than that of the best allopathic practitioners.
Hufeland declared that Homoeopathy, if it should prevail, would “be the grave of medical science.” This was the keynote of the objections made by Hahnemann's opponents. And these objections had so great influence over many of his followers that they endeavored, in every way, to accept the theories and philosophy of the old school while adhering to Hahnemann's practical method. The true and manly and safer course would have been to claim as Hahnemann did that, experience having shown the homoeopathic method to be true, a philosophy of medical science with which Homoeopathy is incompatible, must be, ipso facto, a false philosophy. We have gained nothing by our endeavors to conciliate the old school and to accommodate our doctrine to theirs. On the contrary, we have lost both the respect of the more enlightened Allopathists and what is infinitely more important, a clear understanding of our own position.
Hahnemann declared the pathology of his day to be an unsafe basis of medical treatment, and proved that Therapeutics could never be based on Pathology; for the reason that Pathology is a science of Hypothesis respecting the nature and processes of morbid action and must always be speculative and uncertain. Homoeopathists were at once charged with ignoring or neglecting Pathology, and many of their numbers have been so intimidated by this hue and cry as to resort to very painful, almost ludicrous exhibitions of a devotion to pathological science as a source of indications for treatment, which would be absolutely incompatible with true homoeopathic practice. For, a Therapeutics based on pathological indications must, of necessity, be a system of broad generalizations, while to the true homoeopathic practice the strictest individualization is an indispensable condition.
Hahnemann gave us a Materia Medica Pura, in which the slightest effects of drugs, not merely those which could be observed by a looker-on, but also modifications of sensation, thought and emotion, perceptible only to the prover, were carefully recorded in such a way as to make the effects of each drug most clearly distinguishable from those of every other. A cry went up at once from the ranks of the old school, against the puerility of these alleged provings, and the absurdity of prescribing for serious diseases on the strength of such “trivial” symptoms. It was affirmed that subjective symptoms of which the majority of each proving consists, are almost valueless to the prescriber as an indication for treatment. A great many Homoeopathists were deeply moved by these allegations and proceeded in various ways to expurgate the Materia Medica, striking out the subjective symptoms and seeking the characteristics only in the few objective symptoms which the provings contain. The injurious influence thus exerted on the practice of Homoeopathy throughout the world has been almost inexpressibly great!
Hahnemann taught the efficacy of small doses. He showed that when drugs are prescribed according to the homoeopathic law, it is indispensably necessary that the doses be small, and that infinitesimal doses are more efficacious than large ones.
Nothing has brought more opprobrium upon Hahnemann from the Allopathists, nor more ridicule upon his followers than this question of the dose. And many Homoeopathists yielding to this clamor and shrinking from this ridicule; make a merit of disclaiming any fellowship with Hahnemann on this point and loudly proclaim their willingness, in the matter of large doses to “go as far as he that goes the farthest.”
We have thus the spectacle of a large body of professed Homoeopathists denying their master in the three fundamental points of his system – the indication, the remedy and the dose! And all this, as much through lack of moral courage to brave the obloquy which attaches to the strict Hahnemannian, as from honest difference of opinion.
All profess allegiance to the homoeopathic law, “Similia similibus curantur,” but the party of which we speak denies every one of the conclusions above alluded to, and to which this law conducted Hahnemann. An inevitable consequence has been a mournful deterioration of homoeopathic practice, until now, save in the practice of the strict Hahnemannians, there is rarely seen an example of those rapid, almost magical cures which gained for Hahnemann and his pupils their worldwide fame.
It is a gratifying fact that a marked reaction began about twelve years ago, and is now going on. Greater desire to thoroughly understand the science and art as Hahnemann taught them; greater faithfulness in the study of the Materia Medica Pura; greater boldness in professing the peculiar doctrines of Homoeopathy, are manifest on every side. For much of this auspicious change we are indebted, before all, to the teaching by pen and by practical example of the lamented von Boenninghausen; for much also to the faithful labors of Wurmb in the Vienna hospital, the results of which have been given to the world by Kaspar and Eidherr; and for much to the arduous labors of Dr. Drysdale in the compilation of the British Repertory and in the various essays in which he explains the nature and merits of that work, and urges the necessity of a faithful study of the Materia Medica. The change which a faithful study of Hahnemann's writings and especially of the Materia Medica will produce in the practical views of the student, is strikingly and happily shown by a comparison of Dr. Drysdale's Essays in the first volume of the British Journal (1843), with his remarks on the Repertory, in volume eighteen of the same journal (1860).
“No one has rightly understood the Examination of the Sources, etc., nor the Spirit of the Homoeopathic Doctrine, [Hahnemann's Lesser Writings, English edition, pp. 696 and 748.] who can imagine that the time has come, or can ever come, when clinical experience can supercede the pure symptoms as the final indication for specific Therapeutics. Nevertheless, the tendency of many is to go to this extreme; for, if we look through the homoeopathic practical literature, both standard and periodical, we find that nine-tenths of the indications are merely clinical, and no pains are taken to bring out the correspondence of the pure symptoms. Whither is this tending? Let us see. Allopathy now a days is a very different thing from what it was; mainly, I think, from the indirect action of Homoeopathy upon it and also from the borrowing, directly from us, many specifics which are used often in a simple form; also the use of specifics is partly acknowledged as a desideratum, and partly adopted practically under the names of tonics and alternatives; but the indications are always purely clinical and empirical. Now, in as, far as we rely on clinical indication alone, wherein do we differ from the ordinary school? In no way, except that, being superior in numbers and having the command of more men of talent in hospitals, they will beat us with what were originally our own weapons. Our only resource, then, is to go back to the more diligent cultivation of our special field, viz.:-the Materia Medica. There we have scope enough to recover lost ground and get again far ahead; for, granting all that Pathology and clinical experience can teach us – and I would of course avail myself of it to the very fullest extent – how far does that bring us in determining the one right medicine required in a system of specifics? A very little way indeed. Very often it offers us a free choice of twenty to fifty medicines, all equally eligible – a kind of liberty and equality for which we may spare our thanks, as most likely only one or two of them can be specific. Let any practitioner seriously think over the cases that present themselves in one day's average practice, and tell us how many are well pronounced examples of pure inflammation of the large organs or other well-defined diseases whose course is definite and symptoms sufficiently fixed to enable us to fix the specific ab usu in morbis. A very small number it will be; and applying this to the practice of medicine at large, we come back to Hahnemann's proposition, that no two cases are exactly alike, a fact that strikes at the root of all attempts, to perfect a system of specifics by experience in disease.”
The same point has been discussed with great ability and in a still more practical manner by writers in the Allgemeine Homoeopathische Zeitung, and especially by its able Editor, Dr. Veit Meyer, whose published cases of diseases treated purely according to the totality of the symptoms, have given a peculiar interest to recent volumes of that periodical. D.
As regards the remedy, the reaction to which we allude is not yet so decidedly manifested among Homoeopathicians. The disposition early shown to expurgate the Materia Medica, as it was called, and to exclude from it most of the subjective symptoms, reducing each proving to a collection of objective phenomena, led to the re-provings of drugs by the Austrian Society. This labor was unquestionably undertaken for the purpose of showing Hahnemann had, been very loose and unguarded in compiling his Materia Medica, and that many symptoms therein contained were untrustworthy. By the admission of, the Austrian provers themselves, the result was a complete vindication of Hahnemann. The effect on the school at large was an increased respect for Hahnemann, and greater confidence in his teachings and provings.
The studies of Materia Medica by Dr. Roth, which are now appearing in the Vierteljahrschrift, have a similar object; they are monuments of industry, and will certainly do much good; chiefly, however, in a direction the very opposite of that in which their author intends them to operate. Dr. Hering has already exposed the inaccuracy of many of Roth's criticisms on Hahnemann's provings; but the very barrenness of the state to which he would reduce the Materia Medica, making it a mere collection of objective symptoms of results of pathological actions, deprived of all the characteristic individuality which subjective symptoms give, shows to the intelligent student, that such a Materia Medica can never meet the needs of the prescriber. A similar result attended the labors of the compilers of the so-called “American Materia Medica”, which appeared in the North American Journal, but came to an end, we believe, at the time of the secession of its chief fabricator, Dr. Peters. The revulsion from these attempts to eviscerate Hahnemann's Materia Medica has been a powerful agent in the reaction we speak of.
But the impulse towards such a reaction has been, most of all, the result of a reaction, in opinion and practice, respecting the third topic of which we have spoken, viz.: the dose. In the matter of the dose, Homoeopathicians had widely diverged from Hahnemann, a large majority holding, as some even now affirm, that the dose is a matter of no importance, provided the remedy be well selected. A marked difference was observed between the success of Hahnemannians, and of what were called Rational Homoeopathists, the difference being all in favor of the former. The most obvious and superficial difference in the respective practices of the two parties being, of course, the dose, attempts to imitate the successful practice of the Hahnemannian would naturally begin with the adoption of his doses.
But so intimately connected and mutually dependent are the Hahnemannian doctrines of dose, remedy and indication, that it is impossible to succeed with Hahnemann's doses, unless we study our remedy and fix upon our indication, in the way which he employed.
Experiments with small doses, then, have led and will always lead honest-minded and capable men, to return to the strict practice of Hahnemann and his pupils. The reaction in the matter of the dose may be said then to have led, in some measure, the reaction in other matters.
In 1850 the long-continued success of von Boenninghausen had already created a profound impression among Homoeopathicians. Dr. Meyer, of Leipsic; was an earnest student, at that time, of the whole subject we are discussing. Dr. Wurmb, at the same period, was successfully treating acute diseases in his hospital at Vienna, with the thirtieth decimal potency. He had determined to make his hospital the gathering place for facts which should aid in determining the, vexed question of the dose. He hoped that subsequent trials might show the superiority or lower dilutions; his hope was not realized. The records of the hospital show a clear superiority of the high over the low potencies, in the treatment of acute affections. Dr. Wurmb's frank publication of this result, which overthrows his own speculations regarding the dose, has exerted a marked influence throughout our school.
On every side, in every country, there are eager inquiries concerning the high potencies and the proper method of using them. Countless experiments are instituted, and in the main with favorable results.
It might prevent disappointment, however, if experimenters would bear in mind that the high potencies will not succeed unless the remedy has been selected, not upon the basis of a pathological theory, but on a similarity of its symptoms with the totality of the patients symptoms, and that, in collecting the patients symptoms, the first, rank must be accorded to those symptoms which are peculiar to the individual, and which are, therefore, characteristic of the case.
We have seen that in three fundamental doctrines the majority of Homoeopathicians set themselves in opposition to Hahnemann, influenced thereto by the clamor of the Allopaths. We have seen that thereby the practical success of the Homoeopathic school was made materially less than that of Hahnemann and his strict adherents; we have seen that, constrained by this practical result, many Homoeopathicians are seeking to regain the path which Hahnemann indicated, but from which they had strayed. But for this wandering and the failures which followed it, how much more firmly might Homoeopathy have been, at this time, established in the world. And how great a weakness, was it thus to wander! Natural laws never conflict. Truth is never inconsistent with herself. If the practical precepts of Hahnemann agreed among themselves and were confirmed by practical experiments, as they were in the treatment of the sick, what need his followers have been concerned, that they seemed inconsistent with other medical doctrines or made some medical sciences seem superfluous?
So much the worse for these sciences! It would follow, of necessity, that further investigation must reform these doctrines, and remodel these sciences into harmony with the newly-discovered truths. What if the new science were, to the Jews of that generation, “a stumbling block”, and to the medical Greeks of the day “foolishness.” How could they doubt, if they should continue in steadfast faith to develop and practise it, that it would be demonstrated, in due time, to be “the power of God and the wisdom of God!”
And now, while the majority of our school still reject Hahnemann's methods and precepts though a few are turning back to them, the Allopathists are beginning to realize Dr. Drysdale's anticipations, and are beginning to “beat us with what were originally our own weapons.”
From the standpoint of physiology and pathology, the very sciences in dread of which we have sacrificed some of our essential doctrines, Prof. Hoppe, the Allopathist, of Basle university, is demonstrating the correctness of Hahnemann's teachings, and is showing that Hahnemann's charlatanism consisted only in the fact that in pathology and in medical philosophy, as well as in practical tact and observation, he was simply two generations in advance of his contemporaries.
1. “That for every individual case of disease, the specific remedy, the individual-specific remedy must be sought for and found, and that (thus) in every individual case of disease the process of cure is a process of discovery.”
2. “The discovery of Hahnemann, that the remedy acts in small, very small doses, in smaller doses than any one has hitherto imagined, and that in these very small doses it may act more powerfully than in large doses,” – a discovery, says Dr. Hoppe, which surpasses in brilliancy all of Hahnemann's other achievements.
Prof. Hoppe proceeds to explain, on scientific physiological and pathological grounds, the necessity of the former doctrine of Hahnemann – the necessity of individualizing each case of disease, and of treating it as if the like had never before been met with. In so doing he demonstrates the impossibility of accurately prescribing upon knowledge of drugs derived ab usu in morbis. This leads him to demonstrate the necessity and advantage of drug-provings upon the healthy.
He does not hesitate to go wherever truth leads him, and to admit every conclusion that evidently follows from facts which observation has compelled him to accept. Accordingly, in a very remarkable article upon “Characteristic Symptoms,” a translation of which appeared in the last number of this Review, he demonstrates the value of trivial subjective symptoms, showing that they are, and by their nature, must be, of controlling importance in the indication of the remedy.
Far from dreading what the Mrs. Grundy of Pathology may say to this, he coolly “turns her flank,” by bringing up a very strong and plausible physiological and pathological argument to his support – a branch of that same argument by which, a year ago, he sought to account for the action of infinitesimal doses.
On the subject of the dose he is not less master of the situation. Determined to accept whatever is demonstrated, and to keep his mind free from prejudice, he admits that the question of the dose is still an open question; but he avers that it is by no means unimportant. He affirms that while the thirtieth potency is sometimes unavailing, it is often too strong, producing unnecessary accessory symptoms, even while it removes those for which it was administered. He declares that the balance of testimony is altogether in favor of those who use the potencies, that they effect a greater proportion of cures and do a less amount of mischief, and that those who refuse to use the potencies deprive themselves of a most important means of curing.
The improbability of the potencies possessing any power gives Prof. Hoppe no concern; the fact satisfies him. Nor is he at a loss to account, by a satisfactory theory, for the fact that the thirtieth potency is very often more efficient to cure than the third. It matters but little that he does not accept Hahnemann's theory of potentization, since he freely admits the facts. With one sentence of Professor Hoppe's remarkable publication we close these disjointed remarks:
“Hahnemann, as he studied the actions of remedies, could not fail to discover the aggravating effects of drugs, and to therefore diminish and diminish the dose, and thus at last to discover the efficacy of small doses and of the dilutions; but at the same time he discovered also the significance of the subjective symptoms, and through these he made it profitable for physicians, sensibly and profitably to observe the human body and to devote to it, chiefly and more than up to his day had ever been done, yes for the first time, a greater, exacter and more universal attention. Whatever, that is great, has been accomplished by the medicine of today, through material investigations, the same great results has Hahnemann attained in the way of the subjective symptoms, and both together constitute, for the first time, a whole; yet the significance of both the subjective and the objective symptoms is difficult to apprehend. Auscultation may leave matters as unclear as pain can. Whoever will only take the trouble to stand on his own feet, to observe whatever occurs, and to incorporate, as best he can, what he observes with the sum total of his knowledge, he will come into contact with subjective symptoms, and will learn to put a proper estimate upon them. It was not materialism that was the cause of subjective symptoms being neglected, but the cause was the inherent difficulty of their study, and then, until Hahnemann raised them to their proper significance, the objectlessness of such a study. It was Hahnemann who first showed what purpose subjective symptoms might subserve, and thereby gave an interest to the investigation of them. xxxi.
|The American Homoeopathic Review Vol. 05 No. 01, 1864, pages 01-07, pages 61-67
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