THE art of medicine professes to restore the sick to health, to ward off disease from the healthy and those who have a tendency to disease, and, in cases of disease where cure is no longer possible, to palliate suffering and prolong the term of life.
Were medicine a perfect art, there should be no disease among those immediately subject to its supervision and those in other circumstances who might happen to become the subjects of disease, should be speedily and effectually restored by its means.
That medicine is not a perfect art, is evident from the melancholy fact, that those under the immediate supervision of its professors do not escape disease, and those whom disease attacks frequently die, or remain uncured. That medicine should become a perfect art, we should require to know perfectly the vital processes in health,. the causes of disease, the exact nature of the changes produced in the organism by disease, and the agents in nature capable of altering the morbid operations of the organism into health. It were also requisite that there were agent sin nature capable of producing such alternations in every case, i.e., remedies for all diseases.
But when we look to the facts of the case, we find that we possess only a partial knowledge of the vital processes in health: that we know but imperfectly the exciting causes of disease; that we know little or nothing of their proximate causes; that our knowledge of remedies is very limited; and that thee are some diseases respecting which we have no evidence that they have ever been cured either designedly or accidentally; consequently, we have not proof that thee exist in nature end remedies for them.
Such being the case, medicine must necessarily be an imperfect art, and its progress towards perfection will advance pari passu with our increasing knowledge of the vital operations in health and disease, and of the powers and modus operandi of remedial agents.
This would seem to be a controvertible statement; for it may be said, that while the sciences of physiology and pathology have advanced greatly in recent times, the therapeutics of the so- called physiological and pathological school have remained pretty much as they were in point of success some centuries back, it they have not absolutely retrograded.
Still, it is so obvious that a correct physiology and pathology must greatly assist therapeutics, that we must suspect the existence of some fallacy in the physiology and pathology as hitherto taught if they have not contributed to this desired end.
And, indeed, we shall find that, until a very recent period, the theories and hypothetical views of which these branches of medical science mainly consisted, were utterly inadequate to explain the phenomena they professed to elucidate, and were mostly mere learned verbiage and ingenious sophists; while, of late years, physiologists and pathologists, have with few exceptions, been more occupied with pursing the brilliant fields of research opened up by the scalp. The microscope, and the improved means of chemical analysis, that with cultivating he apparently hopeless barren fields of speculative pathology and physiology.
Thus it is rather physiological and pathological anatomy and histology and organic chemistry that have been cultivated, than pathology and physiology.
Though Hahnemann inveighed against the current physiological and pathological theories, he was not that enemy to theory he is represented to be. Indeed, I doubt much whether any one devoid of a highly speculative mind could discover and formalize a general law of nature; for to do so implies that the discoverer shall from a greater or smaller number of facts build up a hypothesis which shall supply all that is wanting in those facts to constitute a universality. Indeed, if we want proof that
Hahnemann was very prone, nay perhaps too prone, to theory, i.e., too ready to generalize from insufficient data, we need only look to his extraordinary attempts to explain the mode of action of homoeopathic remedies, which are almost as wild pathological theories as any of those he has ridiculed; and his doctrine of chronic diseases is an unmitigated pathological doctrines which Hahnemann was at most pains to combat and refute viz., those of John Brown (see Lesser Writing, pp. 405, 616), are those which, with the necessary modifications, in my humble opinion, along afford the explanation of the homoeopathic application of drugs to the treatment of disease, as I trust we shall presently see.
It is obvious that while, on the one hand, incorrect pathological doctrines can never be the basis of a true system of therapeutics, on the other, it does not necessarily follow that correct pathological doctrines must first be obtained before a true system of therapeutics can be discovered; because, as Dr. Scott has well pointed out in his prize essay k (Bit, Journ. of Hom., vi. 145.) a therapeutic law does not necessarily imply a theory of disease, but only a theory of cure. Still, those pathological doctrines cannot be correct which are at variance with discovered therapeutical facts; and again, a successful system of therapeutics may be used as a touchstone for enabling us to judge of the truth or falsity of various pathological doctrines, and may even be employed to assist us in framing a correct pathological hypothesis. It does not, however, necessarily follow that because we are in possession of true system of therapeutics we shall be enabled to build up correct pathological doctrines.
Thus we shall perceive that Hahnemann, applying what he believed and we believe to be his true system of therapeutics as a touchstone to test the validity of current pathological doctrines, found that they did not agree, and therefore he rightly inferred that the latter were false, and being naturally of a speculative turn of mind, he tied his hand at the invention of a pathological doctrine to suit his therapeutical views, with what indifferent success we shall thereafter see.
Believing, as I do, that it is greatly for the interest of homoeopathy that it should have a scientific pathological basis, which, it must be confessed, was not procured for it by Hahnemann, I have no hesitation in introducing an outline of general pathology as introductory to our subject, and in doing so I shall dismiss, as far as possible, all theoretical speculations on the nature of disease, except in so far as these are necessary fourth explanation and scientific foundation of the law Which I conceive to govern the curative action of drugs in all cases. I say in all ceases; for however the means used to effect a cure may apparently differ, the ultimate change that is produced, whereby the disease is cured, must, it is obvious, in all cases be the same; as the process of combustion I excite in the candle-wick is the same, whether I inflame it by means of a red-hot coal by electrical action, by the by the friction of two hard bodies, or by a lucifer match.
The living organism is made up of a collection of parts or organs, endowed with vitality or irritability, which is the cause of their performing certain functions when acted on by certain powers or stimuli. These functions are different indifferent parts, and the stricture of the part determines the function it
shall perform. Each organ, having a different structure from the rest, and performing a different action, has its peculiar stimuli, the due supply of which causes it to perform its functions normally, and their undue supply produces abnormal action or disease.
Or we may express the proposition thus: Life may be said to consist of the phenomena resulting from the action of certain powers or stimuli up a certain susceptibility, the balance of which constitutes health, and the loss of this balance, disease.
Food, the air, exercise, and the ordinary circumstances by which we are surrounded, adequately supply the stimuli to the organism requisite to preserve it in health; but as the organism is liable to disease, we must inquire into the cause of its production.
The causes of disease are twofold, predisposing and exciting. (We may for the present pass over the so-called proximate cause, that signifying the intimate structural change produced by the other two in the organism, which gives rise to the aggregate of symptoms that we term disease).
A PREDISPOSING CAUSE may be defined to be, in the words of John Fletcher, “some permanent condition of the body which, though insufficient under ordinary circumstances to produce a morbid change, still , in co-operation with an exciting cause, does so; an EXCITING CAUSE may be defined to be some accidental variation of the circumstances affecting the body which, though likewise insufficient in itself to produce a morbid change, may still co-operate with a predisposing cause in doing so.” (Fletcher’s Pathology page 1).
We can, it is true, suppose an exciting cause that shall be capable of producing a disease without the intervention of any peculiar predisposing cause; thus all are liable to a wound from external violences but where no predisposing cause exists, the wound will heal kidneys where there exists, however, a predisposing case, we may have, in one, erysipelas, in another tetanus, in a third traumatic fever, in a fourth an unhealthy ulcer, and so on. However, the definition just given is quite sufficient for all practical purpose, as the wound or other effect of external violent cannot be considered as a disease, in the proper acceptation of the term, but is, strictly speaking, only to be regarded as an exciting cause of disease.
The PREDISPOSING CAUSES of disease are numerous. As we have not time, and it is foreign to my purpose, though by no means so to my subject, to enter particularly into all the points bearing upon general pathology, I must content myself with doing little more than making a mere enumeration of human, believing that you are already adequately indoctrinated on these subjects, and that therefore a mere allusion to them will be sufficient. Among these predisposing causes, one of the most important is Age. It may be said, in a general way, that in early life there is a greater pronounces to disease of the head; in middle life to those of the chest; and in old age to disease of the abdomen. There are likewise special disease to which each age is exclusively or in a greater degree liable, and these depend manifestly on the peculiarity of structure or of function that accompanies each age. This subjects has latterly revived considerable attention, especially from the Vienna pathologists; and I would counsel those of any hearers who desire to study this subject more in detail to pursue some papers by Professor Engel, in the fourth and fifth volumes of the British Journal of Homoeopathy, on the condition of the blood at different periods of life.
Sex may be considered as another predisposing cause of disease. Independent of the different confirmation of the two sexes, rendering each liable to their proper disease, it has been ascertained that in some disease to which both are liable, they are not so equally: thus, in star omnium I may state that it has been alleged and statistically proved that males are less liable to lunacy than females. The experience of St. Luke’s Hospital is, that of 18, 754 patents treated there during the century of its existence, 11, 167 were women, 7587 men. (House hold Words. Jan. 17, 1852, p. 387.) Esquirol also makes the proportion in favour of females. Males are more liable to tubercle than females, whilst females are more prone to spasmodic and convulsive diseases, to anaemia, and some other affections. In the period of adult life, woman seems on the whole more disposed to disease whereas in old age the liability of the two sexes to disease seems to be, if anything, reversed.
Temperament is another predisposing cause, which I need not dwell on.
Idiosyncrasy, from which few, if any, are except, may be defined as the weak point in every individual, rendering him liable to inordinate impressions from certain stimuli, which may act little or not at all on the generality of mankind. Some historical examples of idiosyncrasy I may refer to. Thus Henry III of France could not bear a cat: Tycho Brahe trembled at the sight of a hare; Erasmus was always thrown into a fever when he ate fish; Wladislaus, king of Poland, ran away at the sight of an apple, and the same fruit made John de Quercito, secretary to Francis I., fall a bleeding. Garden, the philosopher, could not endure eggs; Cresses had an insurmountable dislike to bread; Scaliger was convulsed by the sight of cresses; and Cardinal Hauy de Cardonne swooned at the smell of a rose. Orfila mentions of a woman that she could not be- is a place where decoction of linseed was being made, without swelling of the face, followed by fainting. I know a lady who faints at the smell of musk, and several members of a family who immediately get a violent headache on entering a room where there is a sprig of mignonette; and I have a lady as a patient whose face and had swallow, and whose body becomes covered with blotches, if she but swallow a small quantity of any vegetable acid. In her the idiosyncrasy commenced late in life, and sees to increase from year to year; so that whereas at first it was only vinegar or lemon-juice that produced these peculiar symptoms, now the smallest quantity of any fruit, raw, baked, or preserved, has precisely the same effect.
Habit of body has been reckoned as another predisposing cause. It implies the condition of general strength or weakness, of obesity or leanness, of plethora and the reverse, these states being produced generally, in the first instance, by climate, diet, mode of life, etc.
Climate and season, as predisposing causes, need not be dwelt
on, the greater liability to certain affections in cold climates and seasons, and to certain others in the reverse circumstances being perfectly familiar to all of you.
Diet, as a predisposing cause, is also generally recognized. Thus those reared on a rich and nutritious diet are subject to quite another class of affections from those who have only a poor and perhaps insufficient diet within their reach. Individual articles of food, in themselves wholesome, may in excess be exciting causes of disease.
Regimen, habits of life, and external circumstances may obviously all constitute predisposing causes of disease.
In respect to all such predisposing causes, it is wonderful the power human beings have of adapting themselves to different circumstances of climate, diet, mode of life, etc.
Healthy specimens of the human race are met with from the pole of the tropics; in the highest mountain ranges, on the sandy plain, and in the deepest valleys; enjoying the most constant change of scene and air, and living a sedentary life in close and ill-ventilated apartments; following the chamois from rock to rock over tracts of dazzling snow, or groveling like the mole far underground in the murky mine, illumined only by the feeble glimmer of the veiled “Davy,” and inhaling an atmosphere highly impregnated with noxious gases; exposed t wet and cold like the fisherman, or half-roasted all day long before a glowing furnace like the glass blower; subsisting on vegetables and water, or washing down the richest meats with deep potations of strong wines; reclining all day long on the softest couches, with no more violent exercise than is occasioned by turning over the pages of a new novel, or toiling from morning till night like a horse, and reposing the weary limbs at night upon the hard ground.
That however all these circumstances may occasionally act as predisposing causes to disease we are well assured by the fact that a certain large proportion of persons exposed to any of these extremes are subject to certain ailments; but at the same time the above facts teach us there is a considerable range within which health may be maintain, and we know that a strict adhesion to a uniform mode of life is not the best possible mode of preserving health, and that exceeding carefulness of avoid fancied causes of disease, and with respect to trifles, is by no means rarely the indirect cause of disease , by increasing the susceptibility.
A study of predisposing causes of disease is necessary for the physician, both for enabling him to prevent the occurrence of malady, and also for the removal of disease when it does occur. It is, moreover, on a knowledge of them that he must chiefly build his system of hygiene.
The EXCITING CAUSES OF DISEASE conspire with the predisposing cause to the production of disease; they may be divided into ordinary and accidental.
The first or ordinary class comprises temperature, light, electricity, air, miasms, parasites, food, sympathy, passions, etc.; the accidental class, wounds, contusions,poisons, etc.
The effect of extremes of temperature in producing diseases is well-known; and, indeed, accepting as true the commonly-received notion that heat is direct stimulant, and cold a direct sedative, it is worth while pausing for a moment to consider the probable mode of action of these two agents upon the organism for, with some necessary modifications, the action of all other exciting cause of disease may burned under one or other of these two classes, direct stimulant and direct sedative. An inquiry into the mode of action of these two agents as far as that is possible, will give us the necessary insight into the most probable proximate causes of disease, and thus assist us in our proposed task of giving therapeutics a rational pathological basis.
In this attempt I shall not claim for myself the merit of originality, nor shall I attempt to adduce, for the purpose of refuting them, all the other opinions of learned authorities on the subject. To those who are curious upon the subject, I would recommend the writings of one who, not himself an experimental physiologist, has brought the keenest wit and the most philosophical acumen to bear upon the subject of physiology and pathology of any modern author with those works I am acquainted. I mean the works of the late John Fletcher of Edinburgh, which I would earnestly advise all homoeopathists to study.
The first effect of a direct stimulant, such as heat is, upon the capillaries, is to cause them to contract. This contraction represents increased action in the capillaries themselves The application of a red-hot iron to the skin is observed to be followed at first by a deathly paleness of the part, and the alternation in the calibre of the capillaries has been observed, microscopically, in the foot-web of the frog and the transparent omentum or other animals, by Spallanzani, Thomson, Philip, Hastings, Burdach, Wedemeyer, Koch, and many others. During this contraction the motion of the fluid in the capillaries is quickened, as noticed by the increased rapidity of the passage of the blood-globules. After a longer or shorter interval, the capillaries become dilated, sometimes to double their normal state; this dilatation indicates diminishes action in the capillaries, and is accompanied by accumulation, tardy circulation, and even stagnation in the circulation of the fluid contained in the capillaries. This constitutes inflammation; and though we are not in a position to deny that there may be some other change in the capillaries not cognizable by the senses, such as loss or alteration of some, perhaps electrical, property in the capillaries which causes the blood-globules to stick to the sides of the vessels in the marvellous way in which they have been noticed, yet so much seems to be evident, that inflammation does not consist essentially in a spasm or increased action of the capillaries, as supposed by Stahl, Van Helmont, Hoffmann, Cullen, and others, but in a dilatation or diminished action of them, as first advanced by Vacca Berlinghieri, and subsequently taught by many of the best physiologists.
We may suppose that the contraction and dilatation of he capillaries may occur within certain limits, without compromising health. The primary paleness, followed by the blush that attends certain mental emotions, is a familiar instance of this.
After the manner of John Brown, we might illustrate this subject by figures. Thus, supposing the medium or quiescent state of he capillaries to be represented by O, the range of healthy action might be said to be between 5 and -5, while that of morbid stimulation and subsequent depression ranged between 5 to _5 to 10; the consecutive depression bearing an exact proportion to the previous over-action.
Thus, consistently will health, the vessel will contract and expand thin a d cretin limited range, in obedience to the natural stimuli; but of a stimulus of too great power be applied, it will contract, first inordinately, and again expand to such a degree as that it shall be incapable of recovering its natural calibre immediately , perhaps at all, without the application of a fresh stimulus. the actual cause of this is supposed to the that the increased irritation causes a proportionate exhaustion of irritable matter and therefore of irritability, and consequently the usual stimuli (of the circulating fluids, etc.) cause less than usual irritation; hence, as we see, the vessels do not resume their healthy contraction, or do so but slowly.
The morbific effect of a direct sedative, such as cold is supposed to be, is in the end of the same as that of a direct stimulant, only the sedative acts at two removes. At first, there is dilatation beyond the healthy degree, then contraction also beyond the healthy degree, followed in its turn by more or less permanent dilation, constituting the morbid state, inflammation, etc.;-or, as this process has been explained, the direct sedative causes primarily diminished irritation in the part on which it acts, this diminished irritation from stimuli be increased), and this again is followed by a proportionate exhaustion.
It is, however, doubtful to my mind whether cold is a direct sedative. Many facts induce me to believe that it is often, if not always, a direct stimulant; at the events, extremes of cold seem to act as stimulants, though I am not prepared to deny that a minor degree of cold may act as a direct seductive. Perhaps heat acts as an irritation more on the arterial capillaries, cold on the venous, or vice versa, which would account for the different effects of their application.
In the first stage of this inflammation it will be evident, the capillaries in which the operations of secretion and excretions are performed being contracted, these functions will be diminished. when, on the contrary, the capillaries are dilated, more blood pouring into hem, these functions should be increased and we find this to be the case, as shown by the effusions (or rather secretions) of lymph, serum, etc. There are as many kinds of inflammations as there are different structure of the body; and the products of inflammation not only differ to an equal degree, but are moreover wonderfully modified by the diathesis, dyscrasias, or peculiar condition of the organism and its fluids. This has been beautifully illustrated by the observations of the Vienna pathologists, to which I have already referred.
Though we are unable to prove that all morbid actions are analogous to inflammation, it is highly probable that a very great number of them are so, and it is also highly probable that the division of diseases into structural and functional is incorrect; for we have good reason to believe that all functional diseases, so called, must depend on some change of structure somewhere; and we know that structural disease, commonly so called, are accompanied by alternation of function.
An agent that must never be lost sight of in considering morbid action is sympathy. This term implies the transmission of an irritation or stimulation from one part of the system to another. To give illustrations of it in healthy action, I may refer to the obvious connection by this agent of the skin and kidneys, of the larynx and testicles, the uterus and mammae, etc.,etc. In pathology we observe this property still more markedly displayed. I shall only cite a few instances. Orchitis in the male, and mastitis is the female, are a frequent effect of cynanche parotidea; the eyes are apt to be sympathetically inflamed in gonorrhea. It has been said that such results and the effects of poisons are owing to absorption; but the same cannot be said of such instance as the ulceration of the duodenum following extensive burns, the irritation of the nose attendant on morbid action in the rectum, etc.
That this property of sympathy plays an important part in the production and cure of disease cannot be denied. It is not, however, requisite that we should inquire into its essential nature, or ascertain precisely what is the particular organ or structure which gives rise to it. It is sufficient to know that it pervades the whole system, and is in constant operation. Sympathy, then, implies that property of the organism whereby an irritation applied to one part is propagated to another, where there is a specific susceptibility for its reception The symptomatic fever accompanying inflammation is an instance of sympathy. While inflammation may be defined as the action of a morbific irritation on a definite spot, fever may be considered as the action of an irritation on the whole capillary system of the skin. The first effect, corresponding to the contraction of the capillaries in inflammation proper is exhibited by the coldness, paleness, and shivering. The second, corresponding to the dilatation of the capillaries, is represented by the heat and redness of the skin, and this is followed by the increased secretion from the capillaries, in the form of sweat.
It is by the principle of sympathy that we explain those phenomena that occur in the course of many disease, viz., metastasis and metaschematismus. The return of the capillaries to a healthy state indicates an increase in their irritation; this irritation is propagated by sympathy to another parts and there gives risen to the morbid phenomena designated by those appellations.
The action of the passions and emotions in the production of diseases, of which they are such a frequent cause, may also be referred to the head of sympathy. The irritation in the brain is propagated to the organ more directly in sympathy with that apart which is the seat of the mental affection in question, and acting like another irritation, produces disease in a similar manner. The passions and emotions are also a common predisposing cause of disease.
Among the exciting causes of disease, miasms or specific viruses deserve especial consideration and though we shall hereafter have occasion to consider the affections produced by miasmatic causes
in general more in detail, it is necessary to allude to them in this place.
Miasms are of two sorts, which may he termed acute and chronic. Acute miasms are irritations that give rise, within a certain period after their with the organism, to a certain definite series of phenomena, terminating in complete recovery or in death. After once invading the system, they appear to destroy, for a time at least the susceptibility of the organism to be acted on by the same miasms. Their intensity seems to depend, in some degree, on the length of the period of what is called their latent stage, ie., the period from their invasion of the organism till the development of their peculiar effects, which may be considered the period during which their peculiar irritation is at work. Some of them, when inoculate, appear in a milder form than the natural disease, which is generally considered to be owing to the shorter duration of their latent stage. During the course of the disease excited by them, their specific miasms is reproduced. Such miasms are variola, vaccinia, rubeola, perhaps hydrophobia, typhus, mumps, etc.
The chronic miasms likewise, after a longer or shorter period of incubation, produce an array of morbid phenomena in the body, but seem to have little tendency to cease spontaneously, and are very apt to degenerate into different permanent morbid states. At one period of their existence they reproduce the miasms capable of propagating themselves. Such miasms are syphilis, gonorrhea, various skin diseases, much as tinea capitis, perhaps scabies, etc.
Parasitical animals are frequently stated to be an exciting cause of disease, but whilst some of them, such as the various specifies of pediculus and the acarus scabiei, seem to be always communicated from one individual to another, or to invade the body from without, others, such as hydatids and intestinal worms, seem rather to be the result of a morbid process-a renal morbid secretion in fact. The proofs that they are so are chiefly these: that similar worms are never found in other situations: that they are found in the foetus; that each is found in its won habitat, and however else; that some of them exist in parts of the body whither it seems impossible their ova could have been transported by the circulation or otherwise; that their ova have been given in vain to healthy persons. Moreover, when we consider the changes that occur in effused lymph as it becomes organized, we shall have less difficulty in conceiving how more lightly organized structures, in some cases possessing a quasi- independent existence, may be secreted by the organisms. It has been observed, namely, that in the possesses of organization of effused lymph, the blood-vessels originate in the centre of the effused mass and are not propagated into it from the blood- vessels of the system; and attention to this fact, in considering the difficulties attendant on the treatment of various normal growths, which may be supposed to possess, like parasites, a sort of independent existence will explain to us, in some measure, the difficulty of affecting them by our therapeutics appliances. We should also bear in mind that the healthy body is capable of secreting and does secrete creatures having a separate vitality. Thus the testicles develop myriads of independent animals, the spermatozoa, and the ovaries secrete the ovum, which speedily acquires a distinct vitality. A consideration of these facts
will reconcile us to the idea of other organs of the body, in a morbid state, being capable of producing structures having a quasi-independent life. Of course it cannot be denied that these parasites, however produced, do frequently become a source of irritation, and consequently it is often expedient to secure their expulsion, but we cannot hop to prevent their reproduction, unless by our specifics we are able to alter the morbid state to which they owe there being.
In ancient times all contagious diseases used to be attributed to animalculae, and this theory has recently been revised by Henle, and supported by very ingenious arguments. To this abuse Hahnemann himself attributed the invasion and propagation of cholera, in a pamphlet he wrote on the subject if that disease, published in the Lesser Writings (P. 849).
Before proceeding to he subject of therapeutics, I may briefly recapitulate what we may consider to be the essential nature of the morbid process. The organism, from one of the predisposing causes alluded to above, is rendered susceptible to the action of an irritation, such as one of the exciting causes just hinted at. The irritation seems, in the first instance, to produce an over- action of the power which regulates the admission of blood into the extreme capillaries-when they are the part acted on by the irritation; this constitutes the state of incubation, the latent stage of the malady the stage of extreme contraction of the capillaries and is followed, sooner later by a diminished action of that same power, causing dilation of the capillaries; consequently, entrance of more blood, and increased discharge of their contents-increase secretion. The return to the healthy state is indicative of a restoration of their contractile power to the capillaries, and the consequent due passage through them of the normal among of blood. Such restoration is effected in several different ways: 1st, by the gradual and slow action of the natural stimuli; 2nd, by the application of an artificial stimulus, causing the capillaries to resume their natural; contraction, and that either (a) directly to the seat of the disease, or (b) by its application to another apart, whence the irritation is communicated by sympathy to the seat, of morbid action.
This description of the morbid process is applicable to only the simplest form of morbid action, viz., simple inflammation. In the more complex morbid processes, many more and mode intricate actions come into play, but they may all, or almost all, be revolved into the following elements.