The Value of Objective Symptoms

A discussion by Lippe and other doctors, circa 1867, of the value of objective and subjective symptoms.

On June 20th, 1867, Lippe presented before the Philadelphia County Homoeopathic Medical Society the following essay, which was considered “an elaborate, forcible, and highly-interesting essay on Objective Symptoms,” which was followed by “an animated and interesting debate.” Charles H. Von Tagen[1] said that he found a great proportion of objective symptoms in Lippe’s Textbook of Materia Medica. He said that Lippe had “seen fit to avail himself of, and incorporate pathological and objective with, subjective symptoms in the light of characteristics.” For instance, he reported, “Of the two hundred and eighty symptoms credited Lycopodium, ninety-seven are objective; and of these not a few are mere pathological phrases, some of which are emphasized by the author. Under Lachesis we find of the one hundred and fifty symptoms given in the Textbook, forty-eight at least are objective, and some mere pathological phrases; of two hundred and twenty-nine symptoms of Pulsatilla, seventy-five are purely objective, purely pathological, or of a mixed character.”

Von Tagen then asked Lippe, “I should like to know from what source could we obtain such symptoms as are furnished us from Old School works on toxicology? And how could we select a remedy for hydrocephalus, particularly in an advanced stage, with any degree of accuracy, did not we avail ourselves of such resources as toxicology affords us in the shape of objective symptoms?”

Lippe answered, “All the doctor’s inquiries may be found in the paper I have just read. No person who has heard me can have possibly understood me to discard objective symptoms. I did not say so and did not mean so. Objective symptoms point only to a series of remedies. We must then individualize and be guided by the other—subjective—symptoms, forming in this totality a true picture of the diseased condition of the patient. What good does it do us to know that we have before us a case of hydrocephalus, and to know that Belladonna, Hyoscyamus, Helleborus, Stramonium, Digitalis, Opium,etc., have produced and cured that form of disease, except that the subjective symptoms will lead the individualizing physician to find the curative truly homeopathic remedy? We must individualize; get all the symptoms, and prescribe for the patient, not the disease. The subjective characteristic symptoms of the patient will indicate the remedy.”

Henry Newell Guernsey added, “We may say of Spongia, Iodium, Mercurius and some other medicines, that they produce glandular swellings, and we may agree that as far as that goes, these glandular swellings are characteristic symptoms of those remedies. But knowing this, how near are we to the point of finding the remedy that will cure a given case? What is to determine which of these remedies we are to give? We are at first all at sea, until at last we come to some peculiar subjective symptom that we know belongs to one of the remedies, though not to all the others. The patient has glandular swelling, and in connection with that many other symptoms, and besides a particular symptom, sensational and subjective. Now, in finding that, we know positively and without the slightest shadow of a doubt what is to be the remedy.

Although we know glandular swelling to be a characteristic symptom of these remedies, yet of how little value is it to us until we find the indicating, sensational, subjective symptom. I do not find it to be so necessary as is generally alleged, in order to find the homeopathic remedy, to resort to the use of the stethoscope, etc. I say to the patient, ‘How do you feel? Give me all your sensations.’ If I find myself successful in eliciting symptoms which indicate in their totality a remedy, and which the pathogenesis of no other remedy contains, he feels certain that the true curative agent has been chosen, even though he has not placed a finger on the patient or applied his ear to the chest. If the subjective symptoms that cover the sensations of the patient are thoroughly investigated and obtained, and the simillimum therefore discovered, a cure will follow its employment. This is the way that Hahnemann has taught us to investigate disease and treat patients.”

Lippe added, “The Textbook that I prepared to facilitate the study of the Materia Medica, and which I use as a foundation for my lectures, has been severely criticized [by Dr. Von Tagen] because it contains objective symptoms. But upon a closer examination my learned colleague will find that the objective symptoms and pathological names do not stand alone. For instance, he will find Gangrene under Arsenicum album and Secale cornutum, and looking over the Conditions he will further find that all the symptoms are relieved by heat under Arsenicum album, and aggravated by heat under Secale cornutum. In a case of gangrene, in which the patient is anxious to have the affected part, say the toes, well wrapped up, Secale will surely do no good, but Arsenicum album will; the pathological condition only calls the attention to some remedies, but the subjective symptoms decide the choice of the remedy. He called attention to the case of pneumonia cured by Podophyllum, and mentioned in his paper, having caused quite a stir in old England, because the pathological condition was not under the remedy, and although the patient lived, it was proclaimed that such cures would prove to be the grave of science.”

Von Tagen then asked, “What value are the subjective symptoms as compared with the objective in cases of infants. They cannot speak, and can therefore furnish us with objective symptoms only. Guernsey said, “I would give an instance that would show what might be obtained from children who could not speak. I had a case of croup, a bad case, in which the child could not speak. The symptoms were peculiar, and the ordinary remedies did not seem to be indicated. Soon, however, he observed that one cheek was red and the other pale. Several remedies were indicated by this symptom, among them Chamomilla—but at last it came out that the child could not be pacified except by being walked rapidly up and down the room by the nurse, and that it breathed more freely while thus exercised. This decided, in connection with the other symptom, that it was a case for Chamomilla. Who ever thinks of Chamomilla in croup? This medicine was given, and the child was well in a very short time, whereas he had previously quite despaired of its life.

Dr. George R. Starkey remarked, “We cannot all hit the same mark unless we all aim at it. It appears to be the case now that some of us are aiming wide. Some speak of discarding objective symptoms and being governed by the subjective alone. I don’t believe that any physician thus practices. The author of the paper just read is certainly not one of those who discard the objective phenomena. On the contrary he gives great heed to them. Dr. Lippe’s son, convalescent from the war, in whose case a remedy was prescribed by the doctor mainly from a peculiar eruption on the elbow joint, and of which a single dose produced such satisfactory action that no other remedy was given for several weeks. I can recall another illustrative case, one of apoplexy, in which there was no subjective symptom to be had. This is a very different matter from saying a patient has congestion of the liver and prescribing for that. To illustrate the necessity there is sometimes for objective symptoms, I had a case in my practice, a young lady, who after every stool experienced a violent pain in the anus. He tried to cure the complaint by selecting a remedy by the subjective symptoms alone, but unsuccessfully. Finally, I made an examination, and discovered a tumor near the anus that was evidently about to suppurate. I could not say that I discovered any symptoms of Hepar sulphur in the case, but I gave that medicine, and the patient was speedily relieved of the difficulty.”

J. H. P. Frost said, “While the homeopathic law and the common consent of homeopathic physicians require the careful consideration of all the symptoms, still I claim that the symptoms which are primary, purely sensational and absolutely subjective, are those which are of supreme importance. Such are those already referred to as determining the prescription even in infants; although objective to our apprehension they are essentially sensational and absolutely subjective in these little patients. Such are those truly subjective, sensational symptoms which determine the remedy in obscure forms of chronic disease, where pathology is entirely at fault. Such, finally, are all those supremely important, sensational and absolutely subjective conditions of time and circumstance. When we have collated all the objective symptoms of functional derangement and of structural disorganization, still the purely sensational, the absolutely subjective symptoms will be found to constitute the last appeal in the selection of the individual remedy for the individual case. This, which I believe to be in necessary accordance with the highest principles of therapeutics, is confirmed by the experience, not only of the ablest and most successful homeopathic physicians, but also by that of the great mass of the profession.”

Guernsey added, “What is health, and what is disease? There is an influx of life (subjective) which, on the one side, received in an orderly manner, results in health; and which, on the other side, received in a disorderly manner, results in disease. So the influx of subjective light and heat from the sun develops on the earth the objective forms of animate creation.

In like manner, the subjective love and will of the father becomes efficient in the generative act, is embodied, becomes objective in the seminal embryo on the one side; so also in like manner the subjective affection of the mother inspires the ovules, becomes their soul, becomes objective in them. And so, finally, from the intimate vital union of these two objective forms there results the new creation, the new human being, whose subjective constitution corresponds throughout its whole subsequent life to the combined subjectivity of both its parents. And whose objective development in life, that is in forms of health or of disease, corresponds no less accurately to the objective development of both its parents, or of that one whose influence was predominant in conception.

Thus if we interpret these things correctly, and make the proper application to the subject before us, we shall see that the sphere of the subjective symptoms and conditions corresponds to the sphere of causes, and that the sphere of objective symptoms corresponds to the sphere of results. These subjective symptoms, which are so closely allied to the cause of disease, are removed by homeopathic treatment alone, and in this manner the objective or ultimate forms of disease are prevented. The proof of this is seen in the successful treatment of hereditary disease, in its prevention, its cure, and in its final eradication from the system.

Homeopathy is as yet but fifty years old; so far we have done much; but let us have three thousand years of observation and experience in the treatment of disease, and we shall then no longer find any objective symptoms at all. The race will then have become purified from disease, and all that is disorderly in the system, indicated subjectively, will be rectified long before it can become objective.”

It is very important to note that, typically in homeopathy, objective symptoms represent what the physician and attendants and can see, hear, and observe with all their senses, whatever is changed or extraordinary in the patient.1 However in this essay, Lippe specifically addressed the value of objective symptoms according to the definition of Edwin Hale, which is “the truly pathological symptoms (objective symptoms or structural lesions),”2 and how they are valued at the exclusion of other symptoms by pathological prescribers.

Henry Madden, one of the editors of the Monthly Homoeopathic Review, had addressed the British Homoeopathic Society with a paper entitled On the (So-Called) Unity of Disease.3He wrote, “It appears to me that, in practice, there are three expositions? of our law of cure: 1. The crude simile, where purgatives are considered homeopathic to diarrhea, astringents to constipation, diuretics to diuresis, etc.; and where local irritants, as Nitrate of Silver, etc., are considered homeopathic to local inflammation and its consequences. Even this interpretation of our law will lead to very happy results; but, at best, it only merits the name given to it some years ago by Dr. Drysdale, who called it ‘precisionised allopathy.’ 2. The similius, where elective affinity is looked for, and where there is not merely the apparent similarity of action, but, over and above this, a special affinity between the drug and the diseased organ. In this case it will not be deemed sufficient to give any purgative for every kind of diarrhea; but the source of the over-activity of bowels will be traced to the colon, small intestines, etc., as the case may be; and that purgative selected which exerts its action upon the same portion of the mucous tract. In hepatic derangements, remedies will be selected which act directly on the liver, or indirectly through the portal system, according to the nature of the case ascertained by the practitioner. In short, those who practice after this fashion, determine, as far as possible, the pathological condition of the case in hand, and apply to it the drug which most nearly represents this condition in its pathogenesis. And I am perfectly willing to admit, that when pathology and pathogenesy are both fully-developed sciences, nothing more will be needed. Nay, more, I am quite content to be guided, as far as our present knowledge extends, by this rule; and I can safely affirm, that I never prescribe with more confidence, and have never felt more satisfied with my results, than in those cases where the pathological condition has been accurately detected, and a well-proved drug, capable of causing the same morbid change, has been employed for its cure. In fact, I will go one step further, and say that if, of two remedies, one was strongly indicated symptomatically, while the other presented the essential pathological picture of the case, and failed in showing any marked symptomatic relationship, I should, undoubtedly, employ the pathological simile in the first instance, and only have recourse to ‘symptom-covering’ when other indications had failed me. 3. There is the simillimum. Those who seek to apply rigidly this interpretation of our law, are, at present, reduced to the necessity of what is called ‘symptom-covering;’ and, at the very outset, I will express my conviction that this plan is often absolutely necessary.

Much, very much, may be said against it; and the force of some of the objections cannot be denied. Nevertheless, when all has been said, the fact remains, that we often do succeed in diagnosing the proper remedy in this way, when we have utterly failed in all our previous attempts. At the present stage of development of the complementary sciences of pathology and pathogenesy, there often exists no other method of tracing an exact resemblance. All recent advances in physiology tend to prove that every different series of phenomena must imply a corresponding difference in their source; but wherein these differences consist, we are, as yet, unable to say. The ‘pathological’ guide, therefore, in these instances is not yet possible, and the ‘symptomatic’ is the? only available index.”

In the discussion that followed, Richard Hughes said, “I don’t hesitate, for my own part, to give an undeviating adherence to that mode of practice which Dr. Madden had described as that of the similius. I believe, indeed, that by selecting medicines in this way we were far more likely to reach the true simillimum, than when we aimed at it by seeking to cover every little symptom which presented itself. This latter practice had, happily, few representatives in England, but there was a large school in America in which it was an article of faith. I lately met with a case reported by a disciple of this school, in which Podophyllum was given (with supposed curative results) to atroublesome case of pneumonia, merely because the alvine evacuations were characteristic of this drug, the author admitting that he had no evidence of its exerting any influence upon the lungs. If this was homeopathy, he could only echo Hufeland’s prediction, that it would be the grave of science.4 Dr. Hughes would allow that there were exceptional cases, conforming to no known type, and difficult to trace to their source, in which ‘symptom-hunting’ might be our best guide to the remedy. But he believed that, with the progress of pharmacodynamics, the resort to such practice would become less and less necessary.”

This sets the stage for Lippe’s critical analysis of pathological prescribing taught by Hughes and Hale and adopted by an entire generation of professed homeopaths. He clarified that in pure homeopathy the totality of symptoms must always be considered, despite one prominent subjective or objective symptom. This means that all the subjective and objective symptoms of the disease of the patient, which include all the organic changes, form one totality. These organic changes can call the attention of the healer to remedies associated with its cure, however, in all cases, the totality of symptoms must always be considered. He also reaffirmed that the value of cured clinical symptoms.

Lippe illustrated well in this essay how pathology, as well as all the other collateral medical sciences, must be subservient to therapeutics and not the other way around. He discussed the theory of unity in disease, which since ancient time, “is believed to embrace all, or nearly all the ills” of the living organism, as “to oneness of cause, of progress, and of result.”5 Hippocrates wrote in section II of his treatise On Winds, “The nature is the same for all diseases. They differ only in their seat. At first, they appear all different because of the diversity of their localizations, but in reality, there is only one and same essence, and only one and same cause for all diseases.”6 Galen, Rush, Lindlahr (“Transgressions of natural law”), and Tilden (“Toxemia”) have all dealt with the unity of disease. Even Hahnemann touched the unity of disease when he wrote in paragraph 80 of the Organon that it took him 12 years of research to discover that “Psora is the true underlying cause and creator of almost all the multitudinous, indeed, innumerable disease forms that are not due to syphilis and sycosis.”

However, Lippe addressed the unity of disease in the context mentioned by Madden, which is the idea that all diseases have the same origin and the same treatment. For instance, Samuel Dickson had previously proposed that “intermittent fever is the type of all diseases,” and that quinine was its cure.7 Lippe masterly illustrated the fallacy of such a proposition and reiterated that the proven guide for success in the art of healing is strict individualization.

Living as we do in an age of contentions and strife, in an age in which progress, the order of the day, meets with an actively engaged opposition to retard it, in an age in which compromises are supposed to accomplish what a strict adherence to principles seems difficult to procure, we cannot wonder that professed friends of homeopathy should again appeal to old prejudices and clamor for the most superior value of objective symptoms, and that they solemnly declare, under a poorly disguised claim to superior knowledge, that the progress and final salvation of our school depends on them. We find them imitating Dr. Richard Hughes, one of the editors of that pseudo-homeopathic journal (Monthly Homoeopathic Review),8 who in discussion inaccurately cited a cure of pneumonia by Podophyllum,* in which cure the physician in the choice of the remedy had not been guided by the objective symptoms, but solely by such as were characteristics, both of the patient and the remedy (Podophyllum),9 and said afterward, “If this was homeopathy, he could only echo Hufeland’s prediction that it would be the grave of science.” To this learned remark a plain rejoinder might be put in, which is this, “It would be far better that science were consigned to the grave before it sends the patient to that place.” If homeopathy was accepted as taught by Hahnemann and as practiced by “Podophyllum Bell,”10 and cured the patient, the object of medicine was truly accomplished, and homeopathic science was saved from perdition.11

The continuous and strenuous opposition to pure homeopathy, appealing to old prejudices and ever anxious to compromise with allopathy, is constantly changing its base; at one time they attack the theory of potentization, at another the single remedy; and either attack failing to gain the desired end, and coming as they do out of the conflict much the worse and badly beaten, they return to the contest in a new dress, and, claiming superior knowledge, affirm dictatorially the superior importance of the objective symptoms, both for ascertaining the state of the patient (the disease) and for the determination of the curative action of the medicines.

Objective symptoms form a part and portion of the patient’s condition; they belong to him, they must be noted and receive all the consideration to which they are entitled. Objective symptoms, or what is often understood by them, a changed pathological condition of the organs or structures, are not always present in all cases; and it may be as well to remark at this time that the most careful physician will so manage his cases as to prevent this pathological condition. If Skoda,12 as quoted at our March meeting,**forms his diagnosis by the objective symptoms alone,” he may be all right in his own way, but we are not obliged to accept his mode of forming a “diagnosis.” And allow me to repeat once more what has been so often said, that in this particular we differ from Skoda and the whole allopathic school, that we treat patients, and that our aim is to obtain a full, correct picture of the abnormal condition of the patient; that is our diagnosis; while Skoda & Co. must form a diagnosis by the objective symptoms alone and be guided by this diagnosis, by a mere name of a disease in their treatment. The results of these opposite modes of treatment are the only criteria of the correctness of the one or the other modes of practice, and our appeal is to the experiment.13

The followers of Hahnemann all agree that the totality of symptoms, including all the observable objective symptoms, forms the true picture of the diseased condition of the patient; and while applying the law of the similars, we also find in our materia medica, objective symptoms. And this being so, let us see, first, how we came to obtain and to incorporate into our materia medica these objective symptoms; and second, let us see what is their comparative value for the cure of the sick.

The first proposition can be well illustrated by turning to our materia medica, both old and modern; and this historical analysis is open to everybody’s inspection and criticism; and with your permission I will take up, for this purpose, Platina and Apis mellifica. In Hahnemann’s Chronic Diseases we find, under the uterine symptoms of Platina, the provings Dr. Gross made on his wife,—furnishing the subjective symptoms; and all the other uterine symptoms appear to be the results of clinical observations, and were incorporated into the materia medica by Hahnemann himself. We find symptom 286, “Painful bearing (pressing) down as if the menses would appear, at times with pressure to go to stool, drawing through the groins over the hips towards the small of the back, where the pain continues for a longer time;” and symptom 287, “Painful sensitiveness and continuous pressure on the mons veneris and in the genitals, with internal, almost continuous chilliness and external coldness, (except on the face);” symptom 289, “The painful pressure, as if the menses would appear, disappears when lying down in bed in the evening, but returns as soon as she rises in the morning.” Hahnemann now adds, evidently a clinical observation, and incorporates an objective fact in the symptom 288, “Spasms and stitches in the indurated uterus.” The subjective symptoms 286, 287 and 289, observed by Gross, no doubt induced Hahnemann to give Platina in uterine diseases, and he was now enabled to add an objective symptom, “indurated uterus;” but he takes good care not to give it alone, as then it might be misconstrued into an assertion that Platina would cure all cases of indurated uterus; he couples it with the subjective symptoms, spasms and stitches in the indurated uterus, and gives this clinical observation as a characteristic point, thereby enabling the physician to determine under what circumstances Platina will and must cure an indurated uterus. This analysis of Hahnemann’s Platina provings establishes the following two facts:

1. The subjective symptoms indicated Platina in a form of disease in which an objective symptom and a changed pathological condition predominated, which Platina had not caused on the prover.

2. The objective symptom, as the result of a clinical observation, was incorporated into the materia medica, and to it were added the guiding subjective symptoms.

In Hering’s American Provings,14 we find under Apis mellifica, symptom 685, “Pain as from a sprain in the region of the left ovary, worse when walking, in the evening at six; in a few hours the same pain on the right side,* with pressing downward and sensation of lameness in the shoulder-blades; she is compelled to bend forward when she walks, on account of a constrictive, painful sensation in the abdomen; the following morning some sensation remains on the left side;” symptom 686, “A fine cutting pain from the left side of the abdomen, (from the left ovarian region, extending over to the right side when stretching herself in bed;) it was first quite mild but became more violent every time she stretched herself, which she did five times, then it ceased, (evening of the 7th day);” symptom 687, “Drawing in the region of the right ovaries, (the 20th day).” These three symptoms are the observations of one lady, and from the 30th potency. Symptoms 689 and 690 are clinical observations, and begin to give indications for the use of Apis; symptom 689, “The numbness and dullness in the right side of the abdomen (extending from the ovary) towards the hip spreads now to the ribs and downward over the right thigh; better when lying on it;” symptom 690, “Great aggravation of the pain and sensitiveness in the ovarian region in a case of considerable induration, and in another case, where it was only beginning.”

And now come the clinical results also incorporated into the materia medica, symptom 692, “Sharp, cutting, stinging pain in the swollen ovary, with scanty urine and retarded stool;” symptom 693, “Inflammation of the ovaries;” symptom 694, “Dropsy of the ovaries;” symptom 695, “Hypertrophy of the ovaries;” symptoms 696, “Hypertrophy and induration of the ovaries, principally on the right side, with pain when stooping and when beginning to walk.” This analysis of Hering’s Apis proving establishes also some facts:

1. The subjective symptoms indicated Apis in a form of disease in which an objective symptom and a changed pathological condition predominated, which Apis had not caused on the prover.

2. The objective symptom, as the result of a clinical observation, was incorporated into the materia medica, and to it were added from the same source some guiding subjective symptoms.

Our materia medica received, as we have illustrated, the objective symptoms by means of the subjective symptoms both in the metal proved in Europe and in the animal poison proved more than thirty years later in America. And having shown how we came to incorporate objective symptoms into our materia medica, we will further see of what comparative value they are for the cure of the sick.

We are taught by Hahnemann in his Organon that we must note all the symptoms of the patient in order to obtain a full and correct picture of the case to be treated, and then select the similar remedy. All the symptoms comprise all the objective and subjective symptoms; and we have no right to set either aside, if we first can obtain them, and if the simile is known to us. As the subjective symptoms of the provers have led us to prescribe remedies of which the objective symptoms also present in the patient had never been observed by the provers, and while we thereby were enabled to cure such objective symptoms, we may with safety and confidence continue to follow these precedents. The objective symptoms, as in the above illustrations, may call our attention to Platina in an indurated uterus, and to Apis in inflammation, hypertrophy, induration, or dropsy of the ovaries; but we would meet with disappointment and certain failure in a large number of cases were these objective symptoms alone to guide us. Our attention is called to them, and if the other characteristic, often seemingly unimportant, symptoms of the patient also correspond with those of the remedy, we will not be disappointed, and success must follow. One symptom alone, let it be objective or subjective, should never determine the choice of the remedy; this one symptom only calls our attention to one or more remedies, and the other symptoms and conditions also present in the case must be well considered and the simile15 must be found.

The tendency of the present day is to go back to the objective symptoms, to set aside the subjective symptoms, and reduce our materia medica to a pathological picture book. Our English friends object most earnestly against the incorporation of objective symptoms, the results of clinical observations, into our materia medica, and we are here admonished to carry our provings to a point at which objective, pathological, structural changes are accomplished. The illustrations above given show both parties to be in error, and that error has it origin in a neglect to study analytically our materia medica. The objective symptoms obtained by involuntary provings (poisonings or allopathic treatment) have little if any value for practical purposes. And the attempt to prove medicines, until pathologically changed conditions of the organs and tissues are obtained, will prove a failure forever. Even if a possibility existed that such changes could be produced, it would still be an almost impossible task to obtain them. We return to the illustration of Platina. Would we find women willing to take that metal until the uterus became indurated, and would they be willing to be examined per speculum from time to time until such changes became apparent? Thank God for a predominant modesty of the tender sex, and I for one would beg to be excused from selecting such a strong-minded woman who would submit to these examinations for a prover; I should have very little confidence in her veracity, and must confess that my own sense of propriety, if not my modesty, would be a bar to such proceedings.

In the illustration of Apis we would meet with other difficulties, and suppose for argument’s sake that the objective symptoms enumerated under Apis could be produced on the prover, it would not be possible to ascertain the pathological structural changes with any certainty; and we all know full well what fatal mistakes are made daily by the best pathologists, and how often they find their diagnosis false when they attempt the various operations for supposed diseases of the ovary. Accepting then the objective symptoms as part of our materia medica, we accept with them all that is true and useful in pathology. We make pathology subservient to homeopathy, but not vice versa. Allow me to give a passing illustration. The pathologist might learn from us, and might have done so in the debates of his Society. When discussing scarlet fever we had certain facts laid before us.

1. Whenever the urinary secretion became scanty in the beginning of the disease, serious symptoms were to be guarded against.

2. The amelioration of very grave cases of scarlet fever manifested itself first under the action of Arum triphyllum, by an increased secretion of pale urine.

Pathologists dwell on the albuminous urine during the progressive stages of the disease, but I for one have not yet found a single remark from our very learned friends as to the necessity of carefully watching the urinary secretions at the very outset of scarlet fever, and I know they neglect this persistently. And what good could it do the pathologist or the patient, if he is not a homeopath. Pathology would demand diuretics, and surely they would not mend the case.

Again, pathological anatomy cannot give any satisfactory solution of the effects of medicine. It is proposed to ascertain by means of the chemical analysis the process of the changed organic life and with it its changed condition, which the medicine has produced; it is proposed to draw these conclusions from the changes which the medicine has made in the expectoration, urine, feces, perspiration and exhaled air, all of which is an impossibility. To give and prove medicines according to such theories is more than risky, as the chemical action constitutes the opposite of organic life. I will further show how it is practically impossible to carry out this mode of investigation. Suppose we possess the chemical analysis of all the secretions caused by a remedy, and wish ourselves to apply them under the homeopathic law of the similars. We must accordingly analyze with great accuracy and very frequently all and every secretion of the patient. The analysis must be very accurate, for a few atoms of oxygen, hydrogen, carbon, nitrogen or chlorine may change the most innocuous substance into the most noxious. If such course were to be pursued consistently and conscientiously, one physician could no well attend more than one patient a day. It is, however, evident that a physiological action does not necessarily depend on a chemical action, and vice versa; on the other side it is true that the chemical and physical processes are subservient to the organic life. Further, many animal and vegetables substances, as Opium, Moschus, Castoreum, are so changed in the organism that they have as yet not been found in the blood or structures. Still they cure. Some of the salts, Tannin, and many acids, possess the chemical property of coagulating albuminous formations in the intestines or in the blood,—they all have the same chemical effect, and yet how great the difference in their organic relations and in their effects on the organism.

An effort has been made here to illustrate the utility of pathology to the homeopathic profession. The illustration has been twice offered. It is said that some years ago a case was received into the Pennsylvania Hospital. The man spoke only the Swedish language; no thorough examination was made, and on the next night he died in the water closet, evidently of “congestive fever.” It is further claimed that a careful application of pathology, of objective symptoms, selecting the simillimum, might save life in such a case.16

Admitting, for argument’s sake, that the objective symptoms of a living mute would reveal the existence of “congestive fever,” what would be the simile, let alone the simillimum, in such a case? Chininum sulphuricum, or Gelsemium, or Baptisia, or Belladonna, or Aconitum? One of them? Or in alternation? Or in a mixture? Had a homeopath been present and known nothing else but that the patient had “congestive fever,” he would have been at a loss what to do, but he would very likely have discovered more symptoms, objective and subjective, at least as late as when the mute rose and walked to the water closet; he must have had an object in going there, and the revelation of more symptoms might have been made at that place. What did he do there? What did he deposit? And how did he do it, with or without pain? In what position? What was the character of the deposit? The secretions might have been tested with litmus and turmeric paper. Even the microscope might have revealed anomalies, and life might have been saved, but only by making pathology subservient to homeopathy.

To reject all objective symptoms or to neglect pathology would surely stamp a man as a fanatic and ignoramus in these days, and it would have been just as absurd to reject chemistry in the middle ages, because the students of that science followed it in order to “make gold” and become alchemists. Absurd as was the end they sought to accomplish, their experiments furthered the science of chemistry. And so it is in our days with pathologists; they fondly hope to find a unity of disease, and specific remedies for them; and while we keep clear of their illusions, we profit by the occasional advancements of the medical sciences which result from their researches,—thereby making pathology and all other collateral branches of medical science subservient to homeopathy.

But notwithstanding the invectives here uttered on a former occasion,17 and invectives are no arguments, I do contend, “there is no possibility of reconciling pathology with truths that Hahnemann taught.” We accept pathology for what it is worth; and making it subservient to homeopathy is far from forming a union with it, or binding the contending parties to a state of friendship. If the unity of disease were admitted, then pathology would lay in its valid claims for an equal share of consideration with homeopathy. But the unity of disease is not admitted; and the different stages of it, and the peculiarities of individuals, bring us back to the truths taught by Hahnemann and not accepted by pathology. What does it signify to a homeopathician if the objective symptom (the eruption) shows him that he has a case of scarlet fever before him? How can pathology, the scarlet fever, be “reconciled” into homeopathy, except by prescribing for the scarlet fever a remedy which causes a like eruption on the well, and setting aside all the other insignificant small, individual, trifling, subjective symptoms. Such a practice of homeopathy would be like the play of Hamlet with Hamlet left out.

We can further illustrate the true position of homeopathy and pathology. And the unity of disease not yet having been admitted, we might suppose that the greatest unity of diseased conditions might be caused by large doses of a medicine, and that one and the same antidote would serve in all cases to remove the ill results of the strong-acting remedy; and that at least on such an occasion pathology and homeopathy might be reconciled. Far from it. Let us take up Veratrum album, a well-known vegetable remedy, known to the ancients. The white hellebore was a famous remedy of Hippocrates; and, under his crude practice, evil results often followed its administration. As an antidote, Hippocrates gave sesamoides,18 also a vegetable, and Dierbach (in his remedies of Hippocrates, p. 115)19 thinks, according to Theophrastus, this remedy to be the seeds of the white hellebore, and it was also given for quartan fever and vomiting. But, says Hippocrates, in section V, it is fatal if convulsions appear after the administration of the white hellebore.—“Convulsio ab elleboro lethale.”20 The crude generalizer was satisfied to possess one antidote, and never thought of diminishing the dose, and thereby preventing fatal results from the convulsions, or even the necessity of an antidote. How differently does homeopathy treat such cases; and if the great susceptibility of a person to the effects of Veratrum album indicates the use of an antidote, that antidote cannot be the same in all and every case. Hahnemann says, in his Materia Medica Pura, 2d edit., page 329: “Sudden bad results of Veratrum album are most surely relieved by a couple of cups of strong coffee. But if there are principally present pressing headache, with coldness of the body and stupor, with unconsciousness, then camphor is the antidote. If there is present an anxious despair, with coldness of the body, or if accompanied even by a burning sensation in the brain, then Aconite is of service. The other remaining and long-lasting effects of Veratrum album, for instance, the daily fever recurring before midnight, are best removed by China officinalis, in small doses.” And since there is no unity of action of one medicine, and the diversity of its action on different individuals, under different circumstances, requires different antidotes for those various conditions; and as there is no unity of diseases, and as different individuals, under different circumstances, require different remedies, we shall ever be compelled to individualize, if we wish to be consistent and successful; and no garb of apparent learning will ever pave the way to an inconsistent generalizing practice under the assumed named of homeopathy. And for these reasons, therefore, there can be no possibility of reconciling pathology with the truths that Hahnemann taught.

The further development of our materia medica lies in the opposite direction. The proving of drugs in massive doses, frequently repeated, until objective symptoms are developed, as has been proposed, is objectionable for various reasons:

1. The objective symptoms alone give us no indications for the administration of the remedy.

2. Massive doses, frequently repeated, should they cause objective symptoms, would cause with them an incurable disease.

3. The experiment has shown that massive doses, frequently repeated, (as Thuja proved in Vienna) have revealed but few useful symptoms and caused life long sufferings.

The Vienna provings of Natrum muriaticum show clearly that the potencies have furnished us with the most valuable symptoms. And in this direction alone can we look for an advancement of our materia medica. Even the provings with the higher and highest potencies have developed such wonderful new symptoms, found reliable as guides for the cure of the sick, that it is much more advisable to prove them carefully than to go back to massive, destructive doses. And as the symptoms produced by the higher and highest potencies are all, with rare exceptions, subjective symptoms, and as they give us a better knowledge of drug-action; so do subjective symptoms, observed on the sick, give us a greater and better knowledge of his diseased condition, and facilitate the cure of the sick.

Our aim is to cure the sick, and if the pathologists desire reconciliation they must accept Hahnemann’s teachings. Guided in their diagnosis by objective symptoms alone, they fail to cure; guided by the teachings of Hahnemann, we do not fail to cure. And as opposites cannot be conciliated, so can there be no reconciliation between the followers of Skoda and those of Hahnemann. Their ways lead to the patients in different directions: Skoda’s go where he wants them, to the dissecting table, that Science may live; Hahnemann’s live, and return to health and usefulness. And there can be no other inference drawn from the imperative command to conciliate the two, but that we also should send our share of patients to the dissecting table; and against any such reconciliation I, for one, hereby respectfully protest.

@ This article was published in Hahnemannian Monthly 1866-67; 2: 529-540.

Footnotes

[1] Charles H. Von Tagen (1835-1880) graduated from the Homoeopathic Medical College of Pennsylvania in 1858. During the Civil War, he served an as a surgeon the United States Army. He wrote, “It has fallen to the lot of the writer during the past three years to tinker and patch faulty operations of this character in at least fifty instances. Let then no such charges be justly laid at the door of any homeopathic surgeon; such gross and palpable errors as these richly merit the severest rebuke and condemnation of both the public and profession. The idea that homeopaths are not surgeons is almost universal; the argument has been repeatedly advanced and urged by our opponents as one of their most potent weapons against our school. It is in the province of every true lover of the system, both in and out of the profession, to aid in building up and encouraging surgical ability wherever found in our ranks. Let not then the fair name and world-wide fame of homeopathy be tarnished, and let those who seek to make surgery their specialty, see to it that they do nothing to cause her to blush. As far as my humble self is concerned, it shall be my constant aim and effort to render myself worthy of the name of ‘homeopathic surgeon.’ ” (NAJH 1865-66; 14: 485) In Cleave’s Biographical Encyclopedia of Homoeopathic Physicians and Surgeons, we can read, “During his army career, he gained valuable surgical experience, and carefully observed the treatment of hospital gangrene, and its kindred diseases, pyemia, erysipelas, thrombus, etc., tabulating the cases to show the percentage of loss; four hundred cases were treated by him with marked success, the percentage of loss being reduced from 40 down to 3 per cent. In ‘Resections, ’ he won much success; one case, in which he saved-a mangled foot, torn by a Minie ball, was considered worthy of report in the United States Medical and Surgical Journal of Chicago, Vol. I, No. 3, p. 271.”

1 Paragraph 84 of the Organon.

2 Edwin M. Hale. Importance of pathological indications in the selection of remedies. Transactions of the Homoeopathic Medical Society of the State of New York 1865: 85-97. Hale wrote in particular in this address, “By symptoms Hahnemann understood those sensations, pains, etc., caused by the drug, and which are termed the subjective symptoms of a pathogenesis. I do not mean to imply that he ignored the objective symptoms altogether, but they certainly occupied a lower place in his estimation. Such was the uncertain condition of the science of pathology in his time, that it is not to be wondered at that Hahnemann should reject its dubious teachings; but, in so doing, he went to the other extreme, and his followers, even to this day, have imitated his example. It remains for homeopathic physicians of the present day to finish the glorious work Hahnemann begun and add their pathological pathogeneses to his excellent symptomological provings. Not until we have such provings, can we consider our materia medica to be based upon a perfect method.” Such a deviation from the teaching of Hahnemann appears quite benign but was in fact another step towards pathological prescribing. It is part of the movement Lippe called, “The continuous and strenuous opposition to pure homeopathy.”

3 Henry R. Madden. On the (so-called) unity of disease. Annals and Transactions of the British Homoeopathic Society and of the London Homoeopathic Hospital 1868; 5: 132-147.

4Christoph Wilhelm Hufeland (1862-1836) was the leader of German medicine and the champion of practical medicine. From 1795 to 1835, Hufeland published his influential Journal der practischen Arzneykunde und Wundarzneykunst (Journal of Practical Medicine). He considered Hahnemann “as one of the most distinguished intelligent and original physicians” and published many of Hahnemann’s papers including his famous 1796 Essay on a New Principle for Ascertaining the Curative Powers of Drugs. Hufeland, whom Hahnemann called the Nestor of medicine, was the physician to famous scientists, poets and philosophers, including Goethe, Herder, Schiller, and Wieland. He authored numerous works and perhaps his most famous and interesting one is entitled, Macrobiotic, The Art of Prolonging Life (1797), which still remains today a very good reading.

The fact that Hufeland, who was an earnest seeker for the ultimate in practical medicine, never adopted homeopathy despite his familiarity with Hahnemann and his work is quite puzzling. In 1830, Hufeland wrote a second essay on homeopathy in which he wrote, “Homeopathy must be utterly rejected as the universal principle of the whole art of medicine. As such, in its crude form it would be the grave of science and of humanity too.” Perhaps key to understand the difference between Hahnemann and Hufeland, two ardent and honest seekers, is that the former emphasized medicine as an art while the later emphasized it as a science. Art entails the employment of means to accomplish a desired end. To possess the art is to possess the capacity to achieve an end, or to be in the possession of a know-how. Knowledge associated with science doesn’t imply having the know-how of that science. The know-how associated with the art of a discipline is in fact greater than its science. A healing art (Heilkunst) has indeed a much farther reach than just the application of scientific knowledge (Heilkunde). The outcome of modern medicine is a very good example of a science devoid of art.

5 Henry R. Madden. On the (so-called) unity of disease. Annals and Transactions of the British Homoeopathic Society and of the London Homoeopathic Hospital 1868; 5: 133.

6 Hippocrate de Cos. De l’art médical. Paris: Librairie Générale Française, 1994, 577.

The Writings of Hippocrates and Galen. Epitomized from the Original Latin translations by John Redman Coxe. Philadelphia: Lindsay and Blakiston, 1846.

7 Samuel Dickson. The Unity of Disease, Analytically and Synthetically Proved: With Facts and Cases Subversive of the Received Practice of Physic. London: Simpkin and Marshall, 1838.

8Richard Hughes was in fact editor of the British Journal of Homoeopathy and not the Monthly Homoeopathic Review, as suggested by Lippe.

*Annals and Transactions of theBritish Homoeopathic Society 1868; 5 (26): 145.

9 Lippe is referring to two cases with pneumonia treated by James Bell in an article entitled Single Symptoms. (Hahnemannian Monthly 1865-66; 1: 181-183) This article can be found in Appendix Eof this book. This article illustrates well the principle of prescribing for the most characteristic symptoms of the disease, as compare to the name or form of the disease, or even clinical experience.

10 James Bell wrote in the introduction to his treatise on diarrhea, “Yet some affect to sneer at this method, and only a little time ago the author had the honor to acquire an enviable title [“Podophyllum Bell”], because he had observed the power of Podophyllum to cure true pneumonia when selected by some characteristic symptoms, although it has never been known to produce that condition.”

11 In other words, the art of homeopathy (curing the sick) “saved” its science from perdition.

12 Josef Skoda (1805-1881) was professor of clinical medicine in Vienna. He recognized “morbid anatomy as the sole basis for an accurate diagnosis, and endeavored to unravel the complex phenomena of disease, to reduce them to their simple elements, and per viam exclusionis to arrive at an exact diagnosis.” (Edinburgh Medical Journal 1881 (1); 27: 285.)

**Hahnemannian Monthly 1866-67; 2: 474.

13 Lippe constantly referred to experiment in the treatment of the sick or the clinical test, as the best proof of efficacy of a particular mode of treatment. Didn’t he in fact precede the modern movement of evidence-based medicine by more to 125 years?

14 Constantin Hering. Amerikanische Arzneiprüfungen. Vorarbeiten zur Arzneilehre als Naturwissenschaft. Leipzig: Winter, 1857.

* Will the British Journal please take note of this, like other similar trifling occurrences, and compare the clinical observations of “Observers?” Apis cures in the reverse direction in which the symptoms came.

15 It is interesting to note that Lippe didn’t write the simillimum.

16This suggestion was made by John C. Morgan during the March meeting of the Philadelphia County Homoeopathic Medical Society. (Hahnemannian Monthly 1866-67; 2: 474)

17Lippe is referring to the March meeting of the Philadelphia County Homoeopathic Medical Society when John C. Morgan said, “It may be contented by the fanatical or the ignorant, that there is no possibility of reconciling pathology with the truths that Hahnemann taught, and on the other hand, some who seem wise place it above and before them.” (HM 1866-67; 2: 473-474.)

18 “Sesamoides” means like sesame.

19 Johann Henirich Dierbach. Die Arzneimittel des Hippokrates, oder Versuch einer systematischen Aufzählung der in allen hippokratischen Schriften vorkommenden Medikamenten. Heidelberg: Groos, 1824.

20 Lippe is referring to the first aphorism of section V of the Aphorisms of Hippocrates.

About the author

Adolph Lippe

Adolph Lippe

Adolph Lippe - Renowned homeopathic physician and founding member of the International Hahnemannian Association, who worked in the United States. Born near Goerlitz, Prussia, 5-11-1812, died in Philadelphia 1-23 1888. His parents were Count Ludwig and Countess Auguste of Lippe-Weissenfeld.[1] After completing his legal studies, Lippe became interested in homeopathy, and emigrated to the United States in 1837. A year later he enrolled in the North American Academy of Homeopathy at Allentown, Pennsylvania, from where he graduated in 1841. He was successful treating the epidemics that then prevailed in Cumberland Valley. He then settled in Philadelphia, where from 1863 until 1868 he was professor of materia medica in the Homeopathic College of Pennsylvania. He was a colleague of James Tyler Kent, Henry Newell Guernsey, Carroll Dunham . Besides some essays and treatises from the French, German, and Italian which became standards, Lippe was the author of: Comparative Materia Medica (Philadelphia, 1854) and Text-Book of Materia Medica (1866)

2 Comments

  • v nice so many time we spoile the case as mentioned bt dr nesh in kali iod lung heapatization
    pt sympt show bell but need kali iod

  • DEAR DR,
    IT IS NOT EASY TO COMMENT ON WRITINGS OF DR ADOLPH LIPPE. BUT I THINK THAT A BUSY HOMEOPATH CONCENTRATES ON THE TROUBLE FOR WHICH A PATIENT COMES TO HIM. ONLY WHEN HE FINDS THAT THERE ARE 5 OR 6 REMEDIES FOR HIS MAIN TROUBLE, THEN ONLY WE MAY ASK MORE QUESTIONS AND SEVERAL TYPES OF MODALITIES ETC TO ELIMINATE NEAR LIKENESS REMEDIES TO FIND THE MOST EXACT REMEDY FOR CURE.
    THANKS
    DR SHEKHAR

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