Principles of medicine; designed for use as a text-book in medical colleges, and for consideration by practitioners generally

Front matter

RX 81 .M15 Copy 1

Chap..'.!.; "Copyright No,

Shelf_.JiA.5

Preface

The object of this book is to show just what is the cure sought in any given practice of homoeopathy — to show that that cure cannot be intelligently attempted excepting under guidance of sitnilia similibus carantur as law, and to show that one may consistently accept homoeopathy and at the same time accept whatever else is good in medicine. Definition of the end sought in any given practice of homoeopathy is here recognized as essential to the most satisfactory exposition of homoeopathy's claim; such definition occurs and recurs throughout the book, and is never lost sight of.

Rational practice is here defined, and something is shown of wherein lies its strength, and wherein lie its limitations.

Empiricism is discussed: wherein lies its essential feebleness is shown, while at the same time

IV. PREFACE.

reason is given for believing that we can never entirely outgrow the practice of empiricism.

Numbers I, II and IX of the contents are revised from Philosophy in Homoeopathy. In that book, as in its predecessor Similia Similibus Curanturf, something was offered as positive argument in favor of Homoeopathy, but it is here omitted, because based upon premises which can not be assumed or, with propriety, discussed in the class-room of a medical college, — and as a text-book in the colleges this present book is intended. The only argument here offered in favor of homoeopathy is one by exclusion.

It is hoped that Principles of Medicine will prove of interest to practitioners as well as to undergraduates.

Contents

I. Is Homoeopathy Exclusive ? (Extract from a Letter

to a Physician), .... 9

II. Homoeopathy the Only System of Curative Medicine. (Two Lectures delivered in the Homoeopathic Medical College in the University of Michigan), . . .15

I. Is Homoeopathy Exclusive?

EXTRACT FROM A LETTER TO A PHYSICIAN.

IS HOMOEOPATHY EXCLUSIVE?

[Extract from a Letter to a Physician.]

Dr. Blank held in his paper, as I understood him, that homoeopathists should not bar out treatment which is useful though not homoeopathic. I said that I most cordially sympathized with Dr. Blank in the position which he had taken. I said, moreover, that I was equally cordial in my sympathy with those who insist that there cannot possibly be any law of cure other than si??iilia. I said, there is no inconsistency in the statement that I most cordially sympathize both with Dr. Blank and with those who lay stress on similia^s being the only law of cure. The explanation of any apparent inconsistency here would be arrived at by accurately defining the word cure. Having thus denned cure, we should, I think,

IO PRINCIPLES OF MEDICINE.

be in a position to maintain that no treatment not

homoeopathic can be curative — that as a system of

curative medicine homoeopathy is exclusive; but it

does not follow that there may not be indefinitely

many principles (concerning which similia says

nothing) upon which one can base useful, though

not curative, treatment. Upon one or another such

principle (concerning which similia says nothing)

one proceeds when he gives morphine as an anodyne;

when he gives iron or lime to supply a deficiency of

that ingredient in blood or other tissue; or when with

germicides or parasiticides he directly attacks germs

or parasites which have been introduced from without

into wounds or into the alimentary canal.

In some circumstances it may be equally feasible

and equally useful either to cure your patient homoe-

opathically or to relieve him by useful, though

non-homoeopathic and non-curative, treatment. To

illustrate,* let us suppose that he is afflicted with an

intestinal parasite, and let us suppose further that

the parasite's continued presence depends upon some

unhealthiness of the patient. If, guided by your

patient's symptoms, you administer a homoeopathic

*This is simply for the sake of illustration. I am not advocating homoeopathic treatment as efficient against intestinal parasites. We could as well draw illustration from germ diseases. See pp. 17, 18 and 113 to 116 of this book.

IS HOMOEOPATHY EXCLUSIVE r* II

remedy, and as a result of this he discharges the parasite,, you will have cured your patient. If, on the other hand, you directly attack the parasite with parasiticides and kill it, your patient, relieved of the proximate cause of his illness, may recover. In the first instance you will have treated your patient and cured him; in the second instance you will not, in the same sense, have treated your patient — you will have directly attacked the parasite, and your patient will not have been, in the same sense, cured — he will have recovered: in either instance a result is that your patient, whereas he was ill, is well. This, of course, assumes that you have not with the parasiticide harmed your patient.

Many other illustrations might be given of the fact that a patient may become well as a result of non-curative treatment. On the other hand may not the result of curative treatment be something short of health ? I may attempt to cure a patient with valvular disease of the heart, or with chronic nephritis, expecting never to see him well, but hoping to effect improvement which will in kind be cure.

All this suggests a sliding scale. Of two men who agree that similia is the only law of cure one may attempt homoepathic treatment in almost every case, while the other rarely attempts it.

II. Homceopathythe Only System Of Curative Medicine

[Two Lectures delivered in the Homoeopathic Medical College in the for November, 1889.]

II.

HOMOEOPATHY THE ONLY SYSTEM OF CURATIVE MEDICINE.

I.

We enter to-day upon a course of study in materia medica and therapeutics. Before taking up the study of individual drugs, let us map out the field in which our work is to be done; and I ask your very particular attention to these introductory remarks, for I believe that an intelligent understanding of them will be of the greatest value to you as students in the various departments of medical science, as practitioners, and as supporters of homoeopathy and whatever else is good in medical science and in the art of healing.

Similia similibus cur ant ur is the law and the only possible law of cure — as a system of curative medicine homoeopathy is exclusive; but there are various (15)

principles (concerning which similia says nothing) upon which useful, though not curative, treatment may be based. I am careful to call similia similibus curantur a law and not a rule. Men make rules, but a law of nature is not man-made and exists in the very nature of things; such a law I believe similia similibus curantur to be.

To understand this statement — that as a system of curative medicine homoeopathy is exclusive, but that there are various principles upon which useful, though not curative, treatment may be based — you must first know precisely what we mean by each of the words homoeopathy and cure.

The word homoeopathy Qo/jlolos, like, and irddos, affection or morbid condition) by implication defines itself as simply a recognition of similia similibus curantur as law. Let us note, then, that the word homoeopathy and the law which it recognizes have reference to the quality only and not to the quantity of a medicine.

We say that similia is the law and the only possible law of cure. What, then, do we mean by cure? By cure we mean such modification of the quality of vital processes and their effects that, whereas these processes and effects are abnormal, they shall become normal (or approximately so), and this as the immediate effect of the medicine used. A drug can be curative only by reason of its dynamic effect upon the patient. Curative treatment is invariably a treatment of the patient and never a direct attack upon a proximate cause of disease. We shall presently return to this subject of homoeopathy and cure. Let us now speak of some principles upon which we can base useful though non-curative treatment. In our care of patients we should observe the principles of hygiene. These are alike applicable in the care of the sick and the care of the well. In directing what exercise a patient shall take and what clothing he shall wear, we are, of course, outside the field of medicine. There are, however, certain instances in which treatment is called medical, though based upon principles identical with those of hygiene. A simple instance of this kind is where the larvae of intestinal parasites have been introduced in measly pork or other meat into the alimentary canal. It is the business of the hygienist to see that no such larvae be introduced, and that in the proper cooking of meat any larvae possibly present be killed before the meat is eaten. If, however, living larvae have been introduced, and from them develop parasites whose presence in the alimentary canal is the occasion of their victim's illness, it is proper to directly attack those parasites by putting into the patient's alimentary canal any substance which will destroy the parasites without harming the patient. This treatment we call medical, but it is based upon a principle identical with one of hygiene. In the supposed case you do not treat your patient at all; you directly attack a proximate cause of his illness, and when that cause is removed he will probably recover. This is one illustration of treatment which is useful, but not curative. It may be taken as typical of all instances in which it is feasible to directly attack parasites on the skin, in the skin or in any part of the body and destroy them without harming the patient.

After the foregoing remarks there is perhaps no occasion for making special mention, in this connection, of the germ theory of disease and practice based upon it. To immediately attack and destroy disease germs in an open wound or any place in the body without harming the patient may be useful, but is not curative, treatment. If, instead of bacteria, ptomaines becomes the direct object of our attack, we shall still be no nearer to curative treatment. Whatever progress may be made in practice on this line, it can never afford a system of curative treatment, which I think you will plainly see when we come to speak again of homoeopathy and cure.

HOMCEOPATHY THE ONLY SYSTEM. 1 9

Let us take another example of treatment which we call medical, though it is based upon a principle identical with one of hygiene. If you examine the blood of an anaemic patient, and find that it contains less iron than does the blood of a person in health, it seems reasonable to supply that deficiency by having him take into his system more iron. If you regulate his diet so that he shall take food containing an unusual amount of iron, you will not think of calling any part of his food medicine; if, however, you give him iron in a pill, that you will call medicine. The deficiency of iron in the blood of an anaemic patient is an effect of abnormality in vital processes. To simply supply that deficiency will not render those processes normal, and to render them normal is a requisite to cure. We have given here an illustration of what may be useful, though not curative, treatment. Various other substances may be given as medicine upon this same principle, i. e., to supply a deficiency resulting in tissues from abnormality in vital processes.* A use of iron distinct

* Drugs useful in some such way as this may be indefinitely many, — preparations of lime or phosphorus may be among them; quinine may be one, though it probably is not. [See H. C. Wood's Therapeutics : its Principles a?id Practice, ninth edition, p. 639.] A curative medicine in such circumstances would immediately so modify the quality of vital processes that the deficiency, which is an effect of abnormality in these processes, would not persist.

from the above may be where, by disease effects in an anaemic patient, it is indicated as homoeopathic and curative.

Some substances which are used for the sake of their physical properties may be called medicine; as demulcent drinks. Possibly you would call protective salves and also lubricants, medicine. Obviously, none of these things are curative.

Certain substances are used as medicine for the sake of their chemical properties. If, as an effect of abnormality in vital processes, the gastric juice is too acid or not acid enough, you may, by putting into the stomach after meals an alkali or an acid, partially neutralize or else render more acid the juice, and thus help your patient. In neither case is the immediate object of the treatment mentioned to modify the quality of those vital processes to whose abnormality is due the variation from normal gastric juice. The treatment, therefore, is not curative, though it may be useful.

A word here in regard to stimulants pure and simple. Stimulants, as such, affect vital processes, both as to strength and as to rate or speed, but not as to quality. When these processes are weakened and threaten to entirely fail, you may, by stimulating them, bridge a patient over some critical period.

As stimulants do not immediately modify the quality of vital processes, they cannot be curative, though they may be immensely useful.*

We have now cited a number of instances illustrative of useful non-curative treatment : in none of them does the treatment immediately modify the quality of vital processes in the patient, and that it should do so is one of the requisites to cure. Let us again take up the subject of cure and inquire how it may be effected.

Cure involves a specified modification of vital processes. As these processes are in themselves unknowable to inductive science, we cannot affect them in a specified way unless under guidance of a law which states the relation between certain facts in themselves knowable.

It seems as if the knowable facts between which

a law of cure would define the relation could not

possibly be any other than, on the one hand, effects

produced by the disease in question, and, on the

' * If I correctly understand the action of alcohol and of digitalis upon the heart, the following will illustrate what I mean by a stimulant pure and simple. The heart-beats of a patient with pneumonia or typhoid fever may be affected as to strength and rate by alcohol, but not as to quality; — under the influence of alcohol the heart's action remains in quality that of pneumonia or typhoid fever and nothing else. Digitalis while affecting the strength and rate of heart-beats in such a patient affects also their quality. I take it that alcohol is a stimulant pure and simple, but that digitalis is not.

other hand, dynamic effects producible by an indicated drug or drugs taken in health.*

The reason for thinking that a law of cure would speak of drugs as dynamic agents is, that to immediately modify the quality of vital processes is a requisite to cure. The reason for thinking that only in effects do vital processes (as modified by disease or drug) afford the knowable data of which a law of cure would speak is that, while to directly deal with a proximate .cause of disease is not curative, vital processes can be kjiown to inductive science only in proximate causes and in effects.

Let us now inquire, What is the relation between unmodified disease effects and unmodified dynamic drug effects, which marks a drug as curative? Dr. J. P. Dakef has said that only four relations are conceivable in answer to this question, viz. : " i. The Antipathic — AvTi-wa0os — where the symptoms, or conditions indicated by them, are opposites ; the relationship being one of direct antagonism.

* Dynamic properties in a drug are those by reason of which it acts immediately upon vital processes. Physical or chemical examination does not touch upon dynamic properties in a drug, any more than does such examination of an animal organ touch upon vital processes. On dynamic properties see Pereira's Materia Medica and Therapeutics, third American edition, vol. I, pp. 135 to 138.

\ Therapeutic Methods, pp. 88, 89.

HOMCEOPATHY THE ONLY SYSTEM. 23

" 2. The Allopathic — A\\os-7ra0os — where the symptoms are different, the same organs and tissues being affected in a different manner, or other organs and tissues being affected in some manner ; the relationship being one of in defin ite dh • ers it\ • .

"3. The Isopathic — lo-os-irados — where the symptoms are identical, the same organs and tissues being affected, and in exactly the same manner ; the relationship being one of sameness or identity.

"4. The Homceopathic — *OnoLos-irados — where the symptoms are similar, the same organs and tissues being affected in a like manner \ the relationship being one of similarity, and not identity.

Dr. Dake has practically included in this list of four all the possible relations, and he has included more. What he speaks of as the allopathic relation is really no relation at all. In passing, it is obvious that the law of cure cannot require simply that a drug to be curative must be capable of producing pathogenetic effects unlike the disease effects present. Xo one believes in allopathy with the definition here implied.

There is in reality no isopathic relation, for disease effects and drug effects cannot be identical ] — no two things can by any possibility be identical. It is well enough to observe in this connection not only that isopathy is impossible, but that, if it were possible, its demand would be such as we could not practically meet. Under its sanction one remedy and only that particular remedy could be indicated in any given case, for identical is not a comparable adjective. Similar, however, is a comparable adjective, and similia recognizes that various drugs may be in various degrees curative in the same circumstances.

II.

We have now advanced to a point where we can say that the law of cure must define the antipathic or else the homoeopathic relationship as that by which we may recognize a drug as curative. Let us now consider what claim contraria co7ttrariis curantur might make to being the law of cure. What is the contrariety which contraria would exact? What is an antipathic drug? There are two distinct meanings with which we use the word opposite. We may say that one symptom is the opposite of another, meaning that the two vary in diametrically opposite directions from the standard found in health ; as when we say that a too rapid heart action is the opposite of a too slow, or that the condition of a contracted capillary is the opposite to that of a dilated one, or that a temperature above normal is the opposite of a temperature below normal. Disease effects of which such opposites can obtain seem comparatively few, and probably there is no disease of which, taken as a whole, such an opposite can be predicated. What, in this sense, are the opposites of itching, nausea, headache, inflammation, fatty or other degeneration, rheumatism, pneumonia, typhoid fever? The fact seems to be that there are none. Where such opposites do obtain they seem to be opposites in a very general way only. What particular opposite would the following particulars indicate in a given case of diarrhoea?: blackish stool after which there is a griping pain in the umbilical region — associated with this diarrhoea is a pressive frontal headache with blurring of vision — the headache and blurring disappear when head is tightly bound. I do not see that any one of these particulars (simply as here stated, and without theory as to how it was brought about) could serve as an indication under contraria contrariis curantur. * Dr. Carroll Dun-

* By way of contrast note that, theoretically at least, each particular of the diarrhoea supposed might serve as an indication for a homoeopathic remedy.

ham* is right in thinking that a law of cure implies a capability of endless development in the drug science which it recognizes, and we see that there would be no such thing as a science of drug contraries capable of endless development. We conclude that contraria contrariis curantur cannot be the law of cure, if the oppositeness which it would exact be such as we have here defined and illustrated, f

We said that the word opposite is used with two distinct meanings. We find it impossible to regard contraria contrariis curantur as the law of cure, if by opposites we mean effects varying in diametrically opposite directions from the standard found in health. Using opposite with its other meaning we may say that health is the opposite of any disease, and that

* Homoeopathy the Science of Therapeutics, p. 13.

f Contraria contrariis opponenda is an entirely different thing from contraria contrariis curantur whose claim to being the law of cure we have been considering. It may at times be well to forcibly oppose or antagonize contraries with contraries {contraria contrariis opponenda), but there is no need of a law under which to do that, and I do not know that contraria contrariis opponenda purports to be a law of nature — it is simply a rule sometimes applicable in rational practice; and the result of practice with dynamic drugs under this rule is not cure, for the immediate resultant of two abnormal forces (that of disease and that of the pathogenetic properties in a drug) cannot be health. See on p. 95 of this book what is said of a pupil dilated with a mydriatic and then contracted with a myotic — also what is said in foot-note on p. 29 as to the impossibility of radically blotting out disease effects with antagonistic dynamic drugs.

in health is found the opposite of any symptom. If this latter is the meaning with which we are to use the word opposite, co7iti'aria demands that a curative drug must be one which taken in health would produce health. The reductio ad absurdum is complete.

Having first demonstrated that cure cannot be intelligently undertaken unless under guidance of a law denning the relation between unmodified disease effects and unmodified dynamic drug effects, we have now by exclusion demonstrated that no relation other than that of similarity can be the one denned by that law. We are thus obliged either to fix our belief in swiilia as the law, and the only possible law, of cure, or else to give up all attempt to intelligently cure.

Understand, please, precisely what this argument by exclusion has done for us. An argument by exclusion never proves anything unless something is assumed at the outset. We have assumed that there is such a thing as cure, and our argument has brought us to the conclusion that similia siinilibus curantur is the law of cure. One or another of you may say that our argument has been logical throughout, but that we are mistaken in the opinion that there is such a thing as cure. I think you will do well to regard this as a matter of opinion. We shall continue upon the assumption that there is such a thing as cure.*

A practical difficulty which may embarrass one in the treatment of some patients, perhaps very many patients, is that of inducing with drugs effects which resemble in any considerable degree those of many a disease. I think, though, that this difficulty need not deter one from accepting similia as law. Some patients may be incurable for aught similia says.

* Hahnemann, in arguing for homoeopathy, discussed dynamic drugs acting differently from the disease — those acting oppositely to the disease — and those acting similarly to the disease. See Vol. I, p. 10 of his Materia Medica Pura, translated by Dr. Dudgeon, with annotations by Dr. Hughes; 1880.

One who does not see that all possible relations between disease effects and unmodified dynamic drug effects are included in 1 and 4 of Dr Dake's list may be helped by the following, which is a presentation in detail of, I think, all such relations conceivable. I think that in our search for the relation which the law of cure would define, we can eliminate the relations represented by starred lines, and that the only unstarred lines represent the relation defined by similia: —

# 1. Drug capable of producing effects precisely opposite to the disease effects.

•$2. Drug capable of producing effects similar to precise opposites of the disease effects.

\k 3. Drug capable of producing the opposite, health.

4. Drug capable of producing a condition similar to the opposite, health, and having some relation to the disease effects, but affording no similarity to effects opposite to those of the disease.

& 5. Drug capable of producing effects identical with those of the disease.

6. Drug capable of producing effects similar to those of the disease.

Line 1 cannot represent the relation which the law of cure would define, because a drug capable of producing effects precisely opposite to those of disease is as impossible as is an

Little has been done in the science of drug pathogenesy compared with what is still undone: the like might be said of any science. While similia is absolute and eternally the same, our ability to practice under its guidance will be ever greater and greater, as the sciences of disease effects and drug pathogenesy are developed. One of the best things that has ever been written on the subject of homoeopathy is Dr. Carroll Dunham's essay, "Homoeopathy the Science of Therapeutics;" and in that essay Dr. Dunham, having shown that the "Therapeutic Law," by which he means the law of cure, must define the relation between unmodified disease effects and unmodified dynamic drug effects, says truly that the

isopathic drug. On isopathy see pp. 23, 24 of this book. Because precise oppositeness between disease effects and dynamic drug effects does not obtain, it is impossible to radically blot out disease effects with an antagonistic dynamic drug. See what is said on pages 96, 97, 98 upon the question of radical antagonism between dynamic drugs.

An antipathic relation which we have already considered under coyitrai'ia coyitrai'iis curantur, and eliminated (see pp. 24, 25, 26), is really that here represented by line 2.

There is no such drug as line 3 would exact, or line 5.

The relation represented by line 6 has already been considered and accepted as that which the law of cure must define.

The relation represented by line 4 is the same as that represented by line 6. It is evident that a drug capable of producing a condition similar to the opposite, health, is, if its effects bear any relation to those of the disease and are not similar to the opposites of these latter, homoeopathic; for any deviation from health in these drug effects involves, if they bear any relation to the disease effects, a similarity to these disease effects or to their opposites.

first condition of a science of therapeutics is that there be "a capability of infinite progress in each of its elements without detriment to its integrity as a whole." Let me say right here that when we speak of the science of homoeopathy we do not mean the practice of homoeopathy; the practice of homoeopathy — the practice of medicine or surgery in any of its departments; unless we except empiricism, is invariably and inevitably an art. It is the principles and scientific facts upon which practice is based that constitute medical science; just as the building of bridges is an art, while the science of civil engineering comprises those principles and facts of science upon which the scientific bridge-builder proceeds,

You now understand that a knowledge of two distinct sciences (the science of unmodified disease effects; and the science of unmodified dynamic drug effects) is absolutely essential to the practice of homoeopathy.

The following are three ways in which the development of materia medica pura, i. <?., the science of unmodified dynamic drug effects in human beings, is effected:

First. By acquisition of knowledge regarding hitherto unknown drugs.

HOMCEOPATHY THE ONLY SYSTEM. 3 1

Second. By acquisition of knowledge regarding hitherto unrecognized effects of drugs already known. Third. By the elimination of errors in the materia medica pura as handed down to us, for it is not to be for an instant supposed that no errors of observation have been committed by those who have worked at this science.

Conspicuous as means toward the development of a knowledge of materia medica pura are experiments with drugs upon the lower animals, but the results of these experiments can never be accepted unquestioned as data upon which to base the curative treatment of human beings; for the dynamic effects of a drug upon one of the lower animals are sometimes very different from its effects upon man, — moreover, as regards subjective effects, human beings alone can describe them. That some animals enjoy a partial or complete immunity from harmful effects of certain substances very poisonous to man is a fact with which you will become well acquainted. " Birds are peculiarly insusceptible to the action of opium or morphine."* "In their sensitiveness to atropine animals differ very much, and as a general rule, herbivora are less susceptible than carnivora.

*Brunton's "Pharmacology, Therapeutics and Materia Medica," adapted to the United States Pharmacopoeia by Francis H. Williams, M. D., third edition, p. 851.

Thus the rabit may be fed for days entirely upon belladonna leaves without injury, and many grains of atropine are necessary to kill him. Birds — at least pigeons — I have found will often recover after the hypodermic injection of two grains of atropine, and three grains by the mouth did not prove fatal. A very curious and at present inexplicable fact, which I have repeatedly verified, is that the pupils in pigeons cannot be dilated by the use of belladonna."* Dr. C. D. F. Phillipsf cites authority for the statement that goats eat belladonna leaves with impunity. Not only do the dynamic effects of a drug in human beings frequently differ from those in one of the lower animals, but the dynamic effects of a drug in one of the lower animals may be very different from those in another animal of a different class, order, genus or even species. Ipecacuanha is an emetic to men and to dogs, but not to rabbits; the same is true of tartarized antimony. It is probable that caffeine will produce rigor mortis markedly in frogs of one species — little, if at all, in those of another species. J Never confound drug pathogenesy with materia medica pura: by the former we mean unmodified dy-