Homœopathic medical practice: a systematic treatise on diseases of the brain and eye

Front matter

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HOMEOPATHIC MEDICAL PRACTICE:

SYSTEMATIC TREATISE

Preface

The present work, consisting of brief treatises on Diseases of the Brain and Eye, was originally designed to form the initial portion of a more general work on the Homoeopathic Practice of Medicine. But as the Author's time is now so fully occupied by professional duties as to prevent its speedy completion, and as the parts are complete in themselves, and will make a convenient Manual on Diseases of the Brain and Eye, the publisher has decided to issue them as a distinct work. The portion relating to Ophthalmology having been published separately, the following remarks, taken from the Preface to that volume, will be equally applicable to this :

Unfortunately, the science of which we treat is still regarded by many as too abstruse, and the practice of it too difficult, for the general profession, and hence it has been relegated, for the most part, to a comparatively small number of practitioners. We say unfortunately, because the vast majority of ophthalmic diseases are still treated, and of necessity always will be treated, by the ordinary medical attendant. The important question, then, is, not whether diseases of the eye

4 PREFACE.

should be turned over to the specialist for more scientific investigation and treatment — the propriety of which, in manycases, no one who has any regard for the welfare of the patient will deny — but whether the general practitioner, who, nine times out of ten, is expected to treat these cases, shall be properly qualified to discharge a duty which, whether qualified or not, he is required to perform. Besides, even if it were possible for the majority of such cases to be referred to experts, the general practitioner would still need to be as fully informed on this as on other branches of medical learning, in order to enable him to give proper and timely advice to his patients, and to secure to himself the advantages, too numerous to mention, resulting only from a well-rounded medical education. Let us not be misunderstood. We are not calling in question the propriety of referring all complicated and difficult cases to specialists, but, as nine-tenths of all diseases of the eye are either inflammatory or functional, and as only a small proportion of eye difficulties, except such as require manual dexterity in operating, will be sent to ripe specialists — of which there indeed but very few— we are simply emphasizing the need of greater competency on the part of those who are daily called upon to diagnose and treat this important class of cases. And we opine that the chief reason the general profession is, as a body, so lamentably ignorant of Ophthalmology, is not in consequence of the abstruseness of the science, for this is no greater than that of any other department of medicine and surgery ; more especially since the discovery of the ophthalmoscope — the use of which has greatly simplified the subject,

PREFACE. 5

and rendered many parts of it much more definite and easy of comprehension. But we are of the opinion that the reason of this acknowledged incompetency lies chiefly in the paucity of suitable Manuals. Not that the profession is wholly without valuable aids of this character, but that those already published are, for the most part, too concise to serve as guide-books to the student and general practitioner, or else savor too much of prolixity, in consequence of the introduction of unnecessary details, or of matter which belongs rather to the province of strictly theoretical treatises.

Whether this volume will meet the requirements above suggested, is not for the author to affirm. He can, however, truly say, that he has labored conscientiously and assiduously to bring it up to the standard of what he conceives to be requisite in a text-book of this character ; and he will feel amply compensated for his labors if the work shall be found free from any serious defects, and, at the same time, not wanting a reasonable degree of the only merit within the scope of his design, namely, that of furnishing a clear and concise description of ophthalmic diseases and their appropriate treatment, together with a correct and intelligible account of the facts, principles and discoveries furnished by the ablest of the American, English and German authorities.

We have not deemed it necessary, nor even desirable, to cite the authority for every important statement made in the text. To have done so would have greatly encumbered our pages, and increased the size and expense of the work. We have, however, in most cases, given due credit for any fact or

6 PREFACE.

discovery the authorship of which it is important the reader should know ; and would refer those who desire to consult any of the original sources of information to the admirable treatise of Stellwag, whose bibliography of every department of the literature of Ophthalmology, is sufficiently ample to satisfy the most exacting.

C. P. HART.

Wyoming, Ohio, October, 1877.

ERRATA.

Owing chiefly to the fact that some of the proof-sheets failed to reach the Author in time for revision, a number or typographical errors remain uncorrected. Fortunately, most of them are of such a character as to be readily understood by the reader, and will not, therefore, need to be pointed out. In order, however, to avoid any ambiguity, the reader will please insert, the pronoun their between "require" and "separate," on page 102, fifth line ; omit the period after the word characteristic, on page 254, second paragraph; and substitute edgeiox "eye" in note on page 122 ; epichondral for " episcleral" on page 136, twenty-first line; it for them in the tenth and twelfth lines on page 188; T for " Tn" in parenthesis on page 213 ; and Aurum for " Arum " on page 254.

GENERAL OBSERVATIONS.

Although this department, as its title indicates, is intended to be devoted strictly to the practice of medicine, yet, owing to the erroneous notions still prevalent concerning the system of practice herein inculcated, its principles are often misunderstood, perverted and misapplied. It will, therefore, not only not be out of place, so far as may be consistent with our general plan, to endeavor at the outset to correct such erroneous views, by a few preliminary observations on the true principles of our system ; but we may reasonably hope, by so doing, to make their practical application by the inexperienced more intelligible and easy, as well as to prevent, to some degree, those perversions of them which arise altogether from ignorance. Still, as Hahnemann himself observes, (Organon, §i,) "the first and sole&vXy of the physician is, to restore health to the sick," and not to spend his time in constructing and explaining, much less in contending about mere theories, whether true or false.

In pursuance of this plan, we shall first lay down a few of the more important definitions and homoeopathic aphorisms, after which we shall treat briefly of symptoms, both pathogenetic and morbid,* and then of the homoeopathic medicines, their doses, duration of action, and repetition.

DEFINITIONS AND APHORISMS.

Disease is a departure from health \ and is either local, as affecting only a part of the animal sytem or functions, or constitutional^ as embracing, to a greater or less extent, the whole system.

Diseases are either acute or chronic, the former term being applied to such derangements of the health as are speedily overcome, and produce no permanent organic changes ; and the latter to those diseases which are either slow in their development and progress, or which, from wrong treatment or otherwise, are extended far beyond the natural term of their duration.

They are also divided into primary, and secondary or consecutive, the former term being applied to the original disease, or first series

* Strictly speaking, all symptoms are morbid, since they are the result of diseased action ; but we shall use the term in its ordinary sense, to denote only those symptoms which belong to natural diseases, in contradistinction to those which are artificially excited, namely, the pathogenetic, or medicinal. 2 of derangements ; and the latter to the subsequent morbid phenomena, particularly when they grow out of, or are in any way dependent upon, or referable to, the primary disease.

The causes of disease may be either external or internal, mechanical, chemical, pathogenetic, or toxical.

Among the most prolific internal causes of disease, is a depraved state of the blood, or taint of the system, affecting to a greater or less extent nearly the whole human family — the resultant of former diseases on the human system, which, variously modified, have come down to us from our ancestors — and called by Hahnemann, psora. Whatever opinion we may entertain concerning Hahnemann's theory on this subject, or however unfortunate he may have been — if, indeed, he was unfortunate — in the selection of a term by which to designate this peculiar condition, the fact itself cannot be ignored, even by those who attempt to throw ridicule upon it. The condition does exist, and not only acts as a prolific cause of disease, but greatly modifies diseases originating from other causes. Ordinarily it exists in a dormant or latent state, producing a chronically depraved state of health, usually termed dyscrasia; but when it becomes active, as it does when other causes have disturbed the comparatively healthy balance which the vital force, aided by time, has served to produce, or when thrown into activity by the effects of remedial agents, then its presence becomes so pronounced that the most prejudiced cannot fail to see it. What matters it, then, so we clearly recognize the condition itself, whether we call it psora, dyscrasia, chronic blood disease, or any thing else? As long as no better name is found for it, we have no hesitation in calling it psora, and psora it shall be ! " Multa non sunt sicut multis videntur /"

Diseases can properly be said to be cured, only when the affected parts and functions are restored to their original state ; that is to say, when the disease is thoroughly eradicated, and its effects entirely removed from the system. On the other hand, when diseases, either through treatment or otherwise, simply disappear, or become latent, without being thoroughly eradicated, they are said to be suppressed. It is this suppression of disease, the ordinary result of allopathic treatment, which constitutes true psora, as above defined, and is the chief cause of nearly every chronic disease. Whenever it becomes active, there is generally an effort, so to speak, on the part of nature

PRACTICE OF MEDICINE. II

to eliminate it from the system by throwing it to the surface, constituting the various forms of tetter, and other itchy eruptions, whence the name by which Hahnemann designated the affection, namely, psora, a term derived originally from the Greek, and signifying to rub.

From the foregoing, it is evident that the psora, properly so called, is a very different affection, ordinarily, from that single vulgar form of it commonly called the itch, to which allopathists would fain confine it. The latter is the least significant, as it is the most superficial, of all its multiplied forms and manifestations, and generally depends upon some local cause of irritation; while the former is a profound, peculiar, compound morbific element, whose impress is so clearly stamped upon almost every form of disease, as greatly to modify its character, duration, history and treatment. It is, in fact, as before stated, the expression of the difference between the cure and the suppression of disease, which has resulted from the general non-observance in treatment, from time immemorial, of the true and only law of cure, the homoeopathic, which we will now explain.

It was a discovery of the immortal Hahnemann, that diseases can . only be cured by remedies which are capable of producing similar diseases in healthy persons. This irrefutable law of nature is expressed by the formula, " similia similibus curantur," or like is cured by like, a law as simple and beautiful in its expression, as it is universal in its application ; and which is destined to revolutionize the whole art and science of medical practice.

This great natural law of cure had suggested itself to several early physicians, especially Stahl, whose words are as follows : " The received method in medicine, of treating diseases by opposite remedies — that is to say, by medicines which are opposed to the effects they produce, (contraria contrariis) — is completely false and absurd. I am convinced, on the contrary, that diseases are subdued by agents which produce a similar affection." (Similia Similibus.) — See Introduction to Hahnemann 's Organon. But it was not until the brilliant genius of Hahnemann set it forth disclosed in all its beauty and perfection, with irrefutable reasoning and the most ample illustration, that it began to be generally recognized by the learned as the true, unerring, a?id universal law of nature ; while now, it may be truly said, there are but few so ignorant and undiscerning, as not in some way " to do it homage."

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Experience shows that, agreeably to this law, those medicines which, taken in large quantities, produce in healthy organisms symptoms similar to those of the disease, are the therapeutical agents that, in small and convenient doses, cure it in the most prompt, certain, and permanent manner. Hence it follows, that homoeopathic remedies annihilate disease, by exciting in the system a certain artificial malady, which so closely resembles the natural one, as to destroy the symptoms of the disease to which such relation is sustained.

In order, therefore, to effect a satisfactory cure of any particular disease, we have, in the first place, to select from all others that medicine whose effects, symptoms, or manner of action, upon the healthy organism, most nearly resembles the symptoms of the disease which we aim to cure ; and, secondly, to administer it in such form and manner, and with such frequency, as experience shows to be best adapted to the end in view. The first of these prerequisites we shall consider under the head of

SYMPTOMATOLOGY.

Symptoms are of two kinds or classes, namely : those belonging to natural diseases, called morbid, and those developed by medicinal agents, acting upon healthy organisms, termed pathogenetic. Their character is essentially the same, and they differ only in degree and manner of production. The former are the expression, or representation, so to speak, of natural diseases, or maladies ; the latter of analogous artificial diseases. The former are arranged in particular groups, more or less variable, according to the age, sex, temperament, and general constitution of the patient ; the latter in certain other groups, more or less similar, according to the nature of the medicine producing them, their mode of preparation and administration, and the condition and susceptibility of the provers, or those upon whom they are made to act. While there are no known medicines capable of producing groups of symptoms precisely the same as those of natural diseases, many of them furnish groups of striking similarity, whereby we are enabled to select, agreeably to the law of " similia" such as prove curative in natural diseases. These, when rightly selected and administered, never fail of effecting perfect cures ; such medicines are therefore called specifics. Hence a thorough knowledge of the Materia Medica, and especially of the pathogenetic symptoms peculiar to the several remedies, and which are termed characteristics, is essentially necessary to success in homoeopathic practice. Such knowledge can only be acquired by studying and carefully noting the effect of medicines on the healthy subject. Happily, so far as the production of a true Materia Medica is concerned, this work in the vast realm of pathogenetic investigation, has already been performed by numerous observers and provers, upon whose veracity and accuracy we can implicitly rely. Of these, Hahnemann justly stands at the head ; while the names of Stapf, Hartlaub, Hering, Franz, Nenning, and a host of others, furnish a constellation whose light pales only before that of the illustrious founder of the homoeopathic system.

Notwithstanding all this, it is not to be denied that our Materia Medica has already become encumbered with many indefinite and unreliable "symptoms " whose presence in our works renders it extremely difficult, in many cases, to make a proper selection. Hence it becomes necessary in searching for a specific, to carefully sift, compare, and weigh the several symptoms, both of the remedy and the disease, selecting that which furnishes the most striking and perfect resemblance between them, at the same time having regard to the following principles :

i. Symptoms have a relative value only ; that is to say, the pathogenetic characteristics of a medicine are of greater or less value, only as compared with those which have or have not the same characteristics ; so that those symptoms, which at one time, or in one series of comparisons, have no particular value, may at another time be of the greatest importance. Hence no pathogenetic or medicinal symptom should be disregarded, or lightly esteemed, because common to other remedies, any more than we should be justified in neglecting similar symptoms in the treatment of disease.

2. The totality of the symptoms is the only true indication in the selection of the remedy. For although, as before remarked, there are no well-recognized pathogenetic groups of symptoms precisely the same as those of natural diseases, there are those which bear such a striking resemblance to them, as plainly to indicate their remedial virtues under the law of " sitnilia." But since they are often associated with others of a diverse character, it is necessary always to have regard to the totality of the symptoms, otherwise the law could not justly be said to apply.

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3. A remedy to be perfectly homoeopathic, must be capable of producing all those symptoms which are peculiar ', extraordinary and characteristic in the natural disease. When this resemblance exists, the disease will generally yield to a single dose of the medicine, provided the remedy be properly administered, and due attention given to hygienic influences.

4. If a remedy is chosen which is not strictly homoeopathic to the disease, that is, to the totality of the symptoms, it will, especially in appreciable doses, give rise to symptoms not properly belonging to the disease, and therefore referable only to the remedy ; or it will have the effect of increasing the morbid symptoms, producing what is called homoeopathic aggravation. If, in these cases, the pathogenetic symptoms are sufficiently similar to those of the disease, to give the remedy a decidedly homoeopathic effect, the disease will, as in the former case, generally yield to a single dose of the medicine, provided sufficient time be allowed for the homoeopathic aggravation to subside.

THE HOMOEOPATHIC MATERIA MEDICA.

The homoeopathic materia medica, in its complete form, contains such a vast number of symptoms, natural, morbid and pathogenetic, that the student is apt to be overwhelmed by their multiplicity and unscientific arrangement. I have therefore made a selection, under the head of " Characteristic Materia Medica" embracing only such pathogenetic symptoms as are peculiar to the several remedies, or have been confirmed by clinical experience. Of course, this is not intended in any sense as a substitute for our more elaborate works on the subject, but simply as an aid to the student in acquiring an easy and at the same time definite knowledge of the characteristic symptoms of our principal medicines. A thorough knowledge of these symptoms, together with the analytical system of diseases and their remedies, will enable any competent person to select, without difficulty, the true specific for any group of symptoms which may present themselves in the course of any disease, either acute or chronic. These tables the student will do well to memorize, especially those pertaining to the more common and special forms of disease, as well as the characteristic indications of the remedies employed. This amount of familiarity with the homoeopathic materia medica, and the pathogenesis of medicines, is necessary in order to give the required coup d'ozil of the symptoms, so that the relation of the remedy to the disease may be readily and clearly recognized, and much time and suffering, as well as unnecessary labor and research, avoided.

THE HOMOEOPATHIC DOSE.

Owing to its extreme minuteness, the efficiency of the homoeopathic dose, whether the medicine be exhibited in the first or last attenuations, has often excited the astonishment of the inexperienced. Many ingenious attempts have been made to explain its efficiency ; some referring it solely to a dynamic power developed in its preparation, and others attributing it simply to dilution. Doubtless, both explanations are, to a certain extent, correct ; that is to say, that a direct and absolute increase of medicinal energy is produced by simple attenuation, while at the same time their peculiar virtues are exalted by atomic separation. For, on the one hand, it cannot be denied that within certain extreme and indefinite limits, bounded only by atomic separation, medicinal substances are free to act upon the living organism, only in proportion as their ultimate particles, or atoms, are in a condition to be brought into the most intimate connection with the living tissues; while, on the other hand, it is equally certain, that true atomic separation must, from the very nature of the case, set free the peculiar medicinal virtue of the substance, and that in direct proportion to the amount of atomic separation. So that, practically, it makes but little, if any, difference which explanation is received, since in both cases, the power or virtue of the medicine, whether dynamic or otherwise, is proportionate to the amount of dilution, attenuation, or atomization, to which the medicine is subject in its preparation.

For these reasons, we would, as a general rule, recommend the employment of the higher attenuations, except when used as blood aliments, as antidotes to toxic symptoms, and in specific blood diseases, when the size of the dose, or degree of attenuation, should be regulated by the object in view, and by the exigencies of the case. (See the remarks on doses and attenuations under the head of Diphtheria.) Some, on the other hand, prefer the high attenuations only in chronic diseases, and employ low ones in the acute. But, if the above reasoning be correct — and we can testify that it has been amply verified in our own experience — the practitioner has only to repeat the dose at sufficiently short intervals, to extinguish promptly and satisfactorily the most acute symptoms. Cases, it is true, sometimes occur, in which the lower preparations seem to yield the best results ; but we are satisfied, both by experience and observation, that in the vast majority of cases, if sufficient care and judgment be exercised in the selection and administration of the remedy, the greatest benefit will be derived from the exclusive use of the higher potencies, in nearly every simple or non-specific form of disease.* c. p. hart.

* The student will naturally desire some definite rule or principle by which to regulate the potency, or size of dose, in particular cases. In lieu of such information, which can only be acquired by long practice and observation, the suggestions contained in the following extract from an article of ours, entitled " Observations on the Homoeopathic Dose." published in the " Cincinnati Medical Advance" for November, 1873, may be of value :

" But a still more important consideration, affecting the question of dose, is the precise pathological condition of the patient. The symptoms, so far as casual observation goes, may be the same, and yet different cases, or the same case at different times, require either different remedies, or different attenuations of the same remedy. This is a matter of every day observation, and yet it is not sufficiently recognized in our therapeutics. To illustrate : A patient is threatened with congestion of the bowels. This presupposes a congested state of the portal system. The latter, more particularly, will determine the remedy. The former, including, of course, all the minuter elements of the case which go to make up the tout ensemble, and especially the matter of susceptibility, time and degree, will cceteris paribus, determine the potency or degree of attenuation. Thus, the state of greatest congestion short of actual effusion, necessarily calls for the higher attenuations, since the lower ones will be quite certain to precipitate the condition we wish to avoid. On the other hand, slight congestions, contrary to what, at first glance, we might suppose would be the case, generally require the lower potencies, though the higher may answer the purpose ; but the latter will require, of course, to be pushed to the point of successful reaction to be effective. The great difficulty in such cases, is, to determine the exact pathological condition in question. If the tension, so to speak, of the function, or diseased action of the part, is as great as nature will bear without a decided change of condition, then the higher potencies will be most effective in subduing the symptoms for which they are given. On the other hand, using the same term as before, if the tension is light or weak, and the diseased function or action of the part is capable of a much greater strain, without any essential change in its pathological condition other than one of degree, or range of action, then experience shows that low attenuations are equally, and in many cases, even more effective than the high. In short, the whole question seems to turn upon the facility with which, in any given case, reaction is capable of being excited.

Of course, there are some conditions which stand outside of this law, such as chemical, chemico-vital and toxical conditions, which it would be absurd in the highest degree to attempt to bring under it; such for example as anozmia, in which there is a notable deficiency of haematine in the blood. Here iron is required as a nutrient, and hence, cceteris 'paribus, the lower the form in which we administer it, the better."

REPETITION OF THE DOSE.

The repetition, no less than the volume of the dose, is a subject upon which great differences of opinion still exist among homceopathists. Some administer the medicine in a single dose, generally of a low attenuation, and if no perceptible benefit is found to result, they fly immediately to some analogous remedy, or alternate it with others of a supplementary, or supposed corroborative character, as though a curative effect were to be obtained by a direct action of the medicine. But no principle of our practice is better established, than that cures, properly so called, are never effected by the direct action of medicines, but by the reaction of the vital force excited by them. (Hahnemann, Org., §§63, 64, 68.) Hence, experience shows that, although a single dose of a well-selected remedy is often sufficient to produce a healthy reaction, and thus start a cure, which, if not interrupted by injudicious interference, mental impressions, or errors of diet, will go on to completion ; yet, if the disease be severe, so that reaction of the vital force is not easily excited, a repetition of doses, at longer or shorter intervals, according to the urgency of the case, the nature of the affection, and the age, constitution and temperament of the patient, is necessary in order to produce a salutary effect. The greatest caution, however, needs to be observed in the repetition of the dose, as well on the one hand to avoid aggravations resulting from excessive reaction, as on the other to promote it by a steady pathogenetic influence of the vital power, to the extent of a complete subdual of the morbid symptoms. Nor should we fail to remember, that a too sudden, or a too violent assault on the vital power, even to the point of successful reaction, is often attended by unpleasant effects, especially if low attenuations are employed, so as in a great measure to frustrate the end in view. When, therefore, the vital power rises in opposition to the action of the remedy, especially when new symptoms, and not simply aggravations of the old ones, are developed, we must allow sufficient time for the excitement to subside, and then, if a healthy reaction has taken place, the salutary effect should be allowed to continue uninterrupted to its close ; if not, it should be steadily but gently stimulated by such repetition of the remedy 3 as may be found necessary to accomplish it* Of course, the frequency of such repetitions will necessarily depend, as before stated, upon the nature of the disease, the urgency of the case, and the age, constitution, temperament and general condition of the patient.

As a general rule, we have obtained the best results by dissolving twenty or thirty globules of the thirtieth potency in half a tumbler of water, stirring it well, and giving a teaspoonful of the solution every hour, or oftener, in acute cases, and once or twice a day in chronic cases. If aggravations occur, either natural or pathogenetic, the medicine should be omitted until they subside, or until it is seen what effect, if any, the omission has upon the symptoms, when, if a curative action has been fully developed, the medicine already given may be found to suffice ; if not, it should be repeated, agreeably to the rules and principles already suggested. If the disease be a violent one, such as croup or cholera, the medicine should be administered every five, ten or fifteen minutes, according to the urgency of the case. In all instances, whenever an amelioration of the symptoms takes place, the administration of the medicine should be suspended ; but should they recur, or convalescence cease, the same medicine should be immediately resumed, or another appropriate one given. Should the salutary effects of the remedy be interfered with, or suspended, in consequence of errors of diet, cold, or other causes, measures should be adopted to counteract the supposed cause of the interference, and as soon as the interruption ceases, the original medicine should be at once resumed, and the disease guided to a favorable issue agreeably to the principles already explained.