philosophy

Dr. Dudley said that he had always been in doubt regarding the significance of the expression, it is the physician's duty to treat his patient and not the disease. He always though that it was his duty to treat the disease and not the patient. If a man has congestion of the brain and we treat him allopathic fashion we give him purges. That is treating the patient, we certainly are not treating the disease, as we miss it by twenty-four inches. Hahnemann intended, by everything he wrote, to impress upon us the unity of the group of symptoms. We find symptoms that appear to be widely at variance, but he contends that all symptoms constitute parts of a single whole. It is our duty to aim our remedy at the unity of the group of symptoms-the totality we call it. The symptoms probably have a similar central origin. They are all links in a continuous chain. We have to deal with symptoms, the outward expression of inward disease. We ought to leave the patient, for the time being, out of sight. 

J. Pemberton Dudley, MD
Proceedings of the Homeopathic Medical Society of Pennsylvania, 1883
(in discussions following Scheme of Provings of Picrate of Zinc)

from The Genius of Homeopathy
Lectures and Essays on Homeopathic Philosophy
Stuart M. Close
Chapter X - Indispositions and the Second Best Remedy

Not every case which presents itself to the physician requires medicine. It may only require the searching out and correcting of some evil habit, some error in the mode of living, such as faulty diet, unsanitary, surroundings, non-observance of ordinary hygienic requirements in regard to breathing, exercise, sleeping, etc.

In Par. 4 of the Organon, Hahnemann says: "He (the physician) is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health."

In Par. 5 the physician is enjoined to search out "the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease to enable him to discover its fundamental cause, which is generally due to a chronic miasm."
In making these investigations he directs our attention to "the physical constitution of the patient, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual functions, etc."

But this line of investigation is equally fruitful and necessary in dealing with the indispositions of which I am particularly speaking.

In the note to Par. 7, Hahnemann says: "As a matter of course every sensible physician will remove such causes at first, after which the indisposition will generally cease spontaneously." By way of illustration he goes on to say: "He will remove from the room strong smelling flowers, which have a tendency to cause syncope and hysterical sufferings;" (and I may add that he will order hysterical and neurotic "lady patients" to abandon the use' of the strong perfumes and sachet bags with which they render the air of their rooms unfit to breathe, aggravate their complaints and make themselves a nuisance to everyone who comes near them); "extract from the cornea the foreign body that excites inflammation of the eye; loosen the over-tight bandage on a wounded limb, ligature the wounded artery, promote the expulsion of poisonous ingesta by vomiting extract foreign substances from the orifices of the body, crush or remove vesical calculi, open the imperforate anus of the new born infant, etc."

In short, Hahnemann has done his best to make it clear that the use of common sense is not incompatible with homœopathic practice, his enemies and some of his overzealous followers to the contrary notwithstanding.

The young homeopathic doctor, fresh from the halls of materia medica, with his brand new case of medicines, is apt to be like the small boy with his first jack-knife who wants to carve and whittle everything within reach-a simile, by the way, quite as applicable to the young surgeon! Both of them leave a trail which to follow does not require the sagacity of a Sherlock Holmes.

Consider for a few moments, then, that class of cases which require for their use only the correction of faulty habits and the removal of exciting causes. Consider also that it often requires the exhibition of as much wisdom, skill, good judgment and tact to perform this function as it does to prescribe medicine; indeed, it often requires more. It is much easier to deal out medicine and dismiss the patient, than it is to make a-careful investigation of the habits and circumstances of a patient who probably does not need medicine at all, but only wise and kindly advice on how to live.
Great is the power and value of homœopathic medicine, but, like all other good things, it can be abused. Even high potencies can be abused and cause mischief, as I saw illustrated very strikingly when I was sent for in haste to see a patient for whom I had prescribed a few days before. I relate the case because it not only illustrates the particular point I am discussing now, but also the subject (if posology which I shall take up subsequently.The patient was an old gentleman who was in a state of mild senile dementia, with enfeebled power of thought, loss of memory, tendency to involuntary urination and defæcation, rather persistent sleeplessness, and becoming careless in his personal habits. But lie had been perfectly tractable arid mild in his demeanor, and had made no trouble for his family.The symptoms led me to prescribe a remedy, which I gave in the two hundredth potency, with directions to take two doses daily.Three days later I was sent for in haste to see him. I found him in a highly excited state of mind, with flushed face, widely dilated pupils, staring expression and suspicious of being poisoned. He excitedly and harshly accused me of giving him "another man's medicine" which had "filled his bowels up;" he had removed all his clothes, refused to put them on again, and was going about the house nude before the women, without shame, and had tried to go out of doors in that state.

I recognized the symptoms immediately, as I hope you have done. Probably most of you will be able to name the remedy. It was Hyosciamus, of course.

On making inquiries I found that instead of taking the remedy twice a day as directed, owing to a misunderstanding, he had been taking it every two hours. Of course he was making 1 proving-of the two hundredth potency! A single dose of Belladonna, two hundredth, removed the whole trouble in a few hours, and he resumed his ordinary placid course of life.

An experience of that kind has a strong tendency to remove any scepticism one may have as to the power of high potencies. It also conveys an impressive warning against too frequent repetition of doses. Moreover, it upsets the theory that high potencies do not act upon the aged. Incidentally it shows the possibility, sometimes denied, of making provings with highly potentiated medicines and substantiates the claims of those who hold that no remedy can be considered as well proved until it has been proved in the potencies as well as in crude form.

It is well known that the most valuable, e part of a drug action, the finer shadings of symptomatology, are almost never brought out under the use of the tinctures and low potencies.These appear usually under the action of a medium or high potency, or toward the close of a proving of a low potency, long after the first effects of the drug have passed away; so that it has come to be a maxim among experienced provers that the last appearing Symptoms in a proving are the most valuable and characteristic. In the same way, the last appearing symptoms in a disease, especially chronic disease, are of the highest rank in selecting the remedy-a practical point it is well to remember.We should never neglect to inquire of a patient whether any new symptoms have appeared since the last visit or prescription and value any such highly.

Returning to the subject of indisposition: Having discovered such a case and determined that it does not require medication, the question arises, how is such a case to be managed? At first sight it would seem to be a very simple matter; merely to tell the patient bluntly that he does not need medicine, but only to mend his life and correct his habits according to the advice and instruction which you have given or will give.This view of the matter does not take into consideration the peculiarities of human nature as formed by ages and generations of habit and custom. Only occasionally do we meet a patient to whom we can give ideal advice and treatment. In spite of the rapid growth of the no-drug idea as promulgated by the various modern cults, the average patient who goes to the doctor, expects to get medicine. If he is so far advanced in his ideas as to believe in the no-drug theory he will probably not go to the doctor at all, but will seek out the osteopath or the Christian science healer.The patient who believes in drugs and goes to a doctor for treatment will be very likely to listen incredulously to your well-meant advice and will depart to tell his friends in anything but a respectful manner, that he thought you were a doctor, but he found that you were only a half-baked Christian scientist after all, or something to that effect.To direct his attention to his errors of living and order him to correct them is to apparently put the burden of cure upon him, and that is not what he wants at all. He expects us to bear that burden.That is what he comes to us for. Besides that, he often resents the assertion that his trouble is due to his own ignorance or willfulness.There is a large class of people today-selfish, pleasure-seeking, luxury-loving, dissipating creatures, male and female-who demand of the physician relief from the pains and penalties of their hygienic sins, but are not willing to do their necessary part toward bringing this about.They want to "eat their cake and have it too."

We cannot afford to antagonize this class, either for their sakes or our own.We owe them a duty as well as ourselves, and few of us can afford to pick our patients.We must take them as they come and adjust ourselves to their individual needs and peculiarities.These in general are some of the cases which require tact in management. "You can catch more flies with molasses than with vinegar." We can gradually lead some of these people into better ways of life and thought and cure them of both their sickness and their sins, if we are patient and wise and tactful; while at the same time we are increasing the extent and influence of our practice.The physician who aims to be something more than a mere dispenser of palliatives, pills, and piffle, will never lack opportunities to magnify his profession and become a power for righteousness in his community, as well as 'a healer -of its diseases. It is in dealing with such cases-the indispositions and habit disorders-that the "second best remedy in the materia medica" so often comes into use. Of course you all know what the second best remedy is. No? I am surprised that your education. has been so neglected! But I am glad it is to be my privilege to teach you something you do not know.There are so few things that the average young doctor does not know!

In order to fully appreciate the value of the second best remedy, we must first clearly understand what is the best remedy in the materia medica.There cannot be any doubt in your minds as to that, I am sure. It is the indicated remedy.You also know that having once been found, the best remedy must be given time to act, and that its action must not be interfered with by other drugs or influences until it has accomplished all of which it is capable.You also know, or, if you do not, you will learn (if you keep your eyes open and your wits about you) that too many doses of the best remedy may spoil the case.

One of the distinguishing characteristics of a great painter is that he knows when to stop. Many a painting which would have been great, if the artist had known when to stop, has been weakened and spoiled by over-finishing. In his anxiety to perfect a few insignificant details he robs his work of, its vitality-kills it. It is the same in treating a case.The problem is to give just enough medicine and not too much.Too many doses may spoil the case. I have referred to the class of people who expect and demand medicine, and are not satisfied unless they get it, until they have been taught better.
Now just here comes in the second best remedy without which no good homœopathist could long practice medicine. Its technical name is saccharum lactis officinalis; abbreviated sac. lac. or s. I.; just plain sugar of milk! The young homœopath's best friend, the old doctor's reliance and a "very present help in time of trouble!"

The doctrine of placebo, from the Latin placere, to please-, future, placebo "I shall please," is as old as medicine itself. Its psychological value is commensurate with the frailties and peculiarities of human nature.The traditional "breadpill" of our medical ancestors has given place, in the march of scientific progress, to the more elegant powder of virginal white, pure sugar of milk; or to the seductive little vial of sugar pills or tablets, artistically labeled and bestowed with impressive directions as to the exact number of pills for a dose and the precise hours of taking, with confident assurances of the happy effects to be expected, if directions are faithfully followed!

Marvelous are the results witnessed from the resort to this remedy in cases where it is indicated. I have seen it bring sleep to the "insomniac," when even morphine had failed. I ha e heard patients declare that it was the most effective cathartic the had ever taken and beg for a generous supply for future use which supply I have usually refused on the ground that it was too powerful a remedy to be entrusted to the hands of the unskilled. It is indeed too powerful and too useful a remedy to be held 'lightly, or to be lightly used.The knowledge of its use is too dangerous to be disseminated among the laity. It should be as jealously guarded as a "trade- secret" worth millions. Never admit its use to any but the initiated, if you value your influence and reputation, but never fail to use it when your judgment dictates it.

Let us glance at a few of the practical uses of the placebo.You are called to a new case.You see the patient and make your examination.You decide that it is a case for medication.You have written down your symptom-findings and glanced over the record.The case is difficult and you are not able to decide offhand what remedy is indicated.You must have time and opportunity to study it up.The patient and friends want something done at once. Rapidly you run over the case in your mind.This patient is seriously ill.To make a mistake in the first prescription might be fatal, or it might prejudice the case by confusing it so that a quick and satisfactory cure would be impossible.Your reputation in the new family will depend upon your success.You must retain the confidence of the patient but you must have time and make no mistake.

This is where your knowledge of the second best remedy comes into use. Calmly and confidently you prepare and administer a generous "s. l." powder, leave explicit directions for the use of as many subsequent doses as you deem judicious, make an appointment to see the patient again in an hour or two, or three, and then hie you to the seclusion of your library, where you proceed to apply your knowledge of how to study the case and find the remedy according to the principles of the Organon.
When you have worked out your case and found the remedy, you return.Then you enter the patient's presence as master of the situation-unless the Master of Destiny has ordained otherwise.
Does anybody consider that lost time? It is a pity that more time is not lost in that way! Thousands of cases might have been saved and many a professional reputation, by following such a course, instead of yielding to the silly panic-impulse to "do something quick," which almost invariably results in doing the wrong thing.

Patients do not usually die in a minute.There is always plenty of time to do the right thing, always, at the right time. If you know what the right thing is without reflection and study, do it at once. Give your remedy at once if you are sure of it, but not otherwise. If you are not sure, give sac. lac.
If the case is really pressing and demands immediate medication, retire to another room with your repertory then and there.

The very greatest of our prescribers-men like Bœnninghausen, Hering, Lippe,Wells, Biegler, of those who are gone, and almost all our expert prescribers of today, do not fail to carry their repertory with them to all cases, nor hesitate to use it in the presence of the patient if necessary. Instead of arousing distrust on the part of the patients, as you might think, it awakens confidence.To see -a physician making a thorough examination, studying, "taking pains," showing a real interest in the case and a determination to do his best at the "psychological moment" (which is always the present moment with the man who is suffering), is calculated to inspire confidence at all times-except with fools, whom no physician wants for patients and who ought to be permitted to get off the earth as soon as possible for the benefit of posterity anyway.

Another use for the second best remedy is as a supplement to the indicated remedy. Experience shows that Hahnemann was right when he advised that the remedy should be stopped as soon as signs of improvement appear, and the curative reaction be allowed to go on without further repetition of doses as long as it will.This, of course, refers to the cases where repeated doses are given from the beginning.When improvement begins and you desire to cease medication, you will simply substitute sac. lac. for the remedy and watch your case.

The same course is pursued when treatment is begun with the single dose, by which method many of the most brilliant cures are made.

We may give enough sac. lac. powders to last during the interval between visits, or a vial of blank tablets or pellets; but be sure to moisten the tablets and pellets with alcohol, or put some unmedicated pellets in the sac. lac. powders. Patients have a way of investigating powders sometimes and counting the pellets. If they find no pellets they may become suspicious.

The medicine case should always contain a vial of blank pellets properly labeled for such use. One friend of mine always carries a duplicate case of vials containing blank pellets, but labeled as medicines to disarm suspicion.

These are some of the ways to use the second best remedy. If you follow the right course you will find more and more use teaching and thinking on therapeutic subjects.The use of placebo is simply one form, and a very powerful form of therapeutic suggestion; or, to use the still more recent term, psycho-therapy. In the habitual, systematic and judicious use of the harmless little powder of sac. lac. the homœopathist antedated all the modern cults of drugless healing, and even they have devised no more powerful nor efficient measure.

We are not under the necessity of sending our patients away, as Dr.Win. Gilman Thompson, of Cornell University Medical College, had to do. He was holding a medical clinic before the senior class,To this clinic came a woman whose case was diagnosed as neurasthenia.Among the multitude of complaints she poured forth, she laid most stress upon constipation; but declared that she could and would not take any more cathartics.

Dr.Thompson pondered over the problem a few moments and then turned to the class and said: "Gentlemen, there is but one thing to do for this patient.We will send her to Boston. There, they will give her a subconscious pill, and she will get an Immanuel Movement!"

Many who are not susceptible to the "subconscious pill" will respond to the somewhat more tangible but none the less efficient sac. lac. powder, even among those who live in Boston!

Objection has been made to this mode of dealing with cases, by certain individuals with very delicate consciences, on the ground that it was not strictly honest! To practice even such a mild deception upon patients would violate their fine sense of honor! Besides, it tended to engender in patients a habit of dependence upon sac. lac., and to demoralize the physician who followed the practice!
Recall the words of Him who said: "Woe unto you, Scribes and Pharisees, hypocrites! for ye pay tithes of mint and anise and cummin, and have omitted the weightier matters of the law, judgment, mercy and faith; these ought ye to have done, and not to leave the other undone.Ye blind guides which strain at gnat and swallow a camel!"

He who said that, anointed the eyes of a blind man with "clay mixed with spittle," bade him go and wash in the pool of Siloam, and he recovered his sight-healed by faith; awakened by the therapeutic suggestion of a clay placebo and an order to take a bath!

Any harmless measure which tends to arouse the curative reaction of the organism through the awakening of faith and confident expectation, is not only right but legitimate and sometimes indispensable.

But what shall we say of the men who have been so pained at the thought of using the placebo, when we find them violating every fundamental law and principle of the art whose name they profess before the world, by using powerful drugs in such a manner in their treatment of the sick, in both public and private practice, as to do irreparable injury?

Or what shall we say of men prominently before the public as official representatives of homœopathy in college and hospital, who herd patients in a Metropolitan Hospital ward, arbitrarily denominate them a "class," without regard to their individual symptoms, and give them all, indiscriminately, hypodermic injections of "a preparation of digitalis" for their hearts?

This is indeed neglecting "the weightier matters of the law." It is the irony of fate that makes it possible to say such a thing of men who conduct a great hospital which was specifically founded and financed for the purpose of dispensing the blessings of homœopathy to the poor of the great city.
And what about the young men who have come from far and wide to the colleges connected with such hospitals, and pay their money in good faith for such instruction in the methods and principles of homœopathy, who are called upon to witness such perversions of all true therapeutic principles, to say nothing of homœopathy? Should they not be considered?

President Cleveland immortalized himself by declaring that "Public Office Is a Public Trust."
President Roosevelt endeared himself to the people, and will go down in history as the great exponent of "The Square Deal."

These two great leaders, each in his own way, have thus voiced the principles of common honesty in the conduct of public and private affairs.The people have listened and responded.The world is waking up, for, as President Lincoln said: "You can fool some of the people all of the time; you can fool all of the people some of the time, but you cannot fool all the people all of the time."

When homœopathic colleges teach homœopathy in every appropriate chair; when homœopathic hospitals and homœopathic clinics are conducted on homœopathic principles; and when homœopathic physicians make at least a sincere attempt to prescribe homœopathic remedies for their patients; then, and not before, will the/principles of common honesty find their application in the homœopathic medical profession.

It is a breach of trust to do otherwise.The moral obligation is upon every man who is affiliated with a homœopathic institution, and upon every physician who professes the name of homœopathy, to be true to homœopathic principles.'

It is not many years since the late Judge Barrett, of the Supreme Court, in a decision which he handed down in a certain case, declared that the legal obligation rested upon every professedly homœopathic physician to practice according to homœopathic principles; and that he was liable at law if he did not do so.The people who give their money to found and sustain homœopathic institutions have some right in this matter which should be respected.

We have now a "pure food law" which requires that all goods shall be "true to label." The time may come, and perhaps is not far distant, when we shall have a "pure practice law," which will require that a man who represents himself as a graduate of a homœopathic school and a practitioner of homœopathy, shall be required to practice in accordance with the principles of that school or suffer the penalty of his misrepresentation-in other words, that he shall be "true to label." He will not be able in that day, as he is now, to advertise, "57 varieties!" There is but one variety of homœopathy, and that is the homœopathy of Hahnemann, the principles of which are plainly laid down in the Organon. All other varieties are fraudulent, concocted of impure materials and injurious to health, like the inferior canned goods of the manufacturers, which they try to preserve with antiseptics. If some of the fraudulent homœopaths were compelled, like the food manufacturers, to state on their labels the names and percentages of the foreign ingredients in their wares, it might be better for the people, but they would have to enlarge either their labels or their packages in order to make room for the list.

With all this there is no need to be pessimistic. The leaders of the homœopathic profession are awake to the true state of affairs. They are demanding of their colleges and teachers that homœopathic principles shall be taught, and the colleges are responding as rapidly as they can, hampered as they are by the presence of some men in their faculties who are antagonistic to everything homœopathic. They recognize that the future of homœopathy depends upon the young men who are coming up; upon the classes now within college halls; that the long neglected principles and methods of homœopathy must be restored to their true place in the college curriculum and taught by men who love the art of healing and are imbued with the spirit of homœopathy and the love of it! We may know the principles-the science of homœopathy-but unless we love the art, and practice it, we will fail in the highest department of our calling. Never was there such need as there is today for pure homœopathy, nor such opportunities for young men of enthusiasm and earnest purpose, who are thoroughly trained in homœopathic methods. The colleges need them as teachers.The hospitals need them as internes and visitors, and in other official positions.The people need them as practical healers. Prepared for that work, "The world is our oyster."

What is Similar
Constantine Hering     

The Homeopathic Recorder, Vol XLVII No 1; January 1932
translated & reprinted from Stapf’s Archives, Vol. 22, 1845;
 translation by Calvin B. Knerr, M.D.

One might think Hahnemann must have been inspired when one reflects and considers the many details upon which he built his new doctrine; the particulars being as astounding as the whole.

Take the word homoionpath, from the Greek, familiar as it has become through long usage, is yet so happy a choice, so strikingly to the point, that the more we think about it the more we marvel at its aptitude and feel gratified.

One need but hark back to the time when the word was not yet chosen and Hahnemann himself not yet able to see clearly. He did not say harmonious, agreeing, corresponding, adequate, analogous or identical; not congruous, nor covering, although he did make use of "cover" (decken) in other places; he purposely did not use the word like or ison, although he insisted upon the greatest possible likeness of symptoms, and surely never discarded a remedy by reason of its too great similarity or complete likeness. But he said homoios and translated it by similar before he could know that the word, in later scientific development, would come to stand as the one correct and approved term. Pathy, and the word allos or alloios, besides enantion (enantiopathy) were chosen later to favor homoion. The word homoion, the more we examine it, expresses the fundamental idea of the new doctrine better and more clearly than any that could have been chosen. It is the one true and right word, which has served, and will continue to serve through all time.

Our short history has already furnished several examples of the enemys attempts to substitute another name and hoist another flag, but our banner still proudly streams and is mightiest. Short as is our history, that of the other side is still more brief. All oppositions trying to hook on, were, if not exactly stillborn, yet so weazen as soon to fade, or at most to hover about like spectres in dark corners. We are still alive. So it was and ever will be; for it is not the word but the spirit that abides in the word, the spirit of truth which keeps us alive. It is in the nature of the truth to endure forever. All other power is scattered by it like dust.

The Greeks made a distinction between ison and homoion, but none between homon and homoion. I am not speaking of grammarians, but of Greeks. They use the word ison where things equal, totally alike, are compounded; equal measure, angles or leg of an angle, sides, equal values, weight, equal parts, import, also equality of birth, standing, rank. On the other hand homoion is employed for equality of character, manner of living, feeling, opinion and disposition; the same with color, form and tone; in short, where we use the word similar. In this difference of usage we recognize a vital difference. In the New Testament ison is only used in a sense of perfect likeness, for example, "he deemed himself like unto God", etc. Not homos. On the other hand homoion is used in the parables; for instance "the kingdom of heaven is like a grain of mustard seed"; and again, "like a merchant", etc.; also in Revelations where corresponding imagery is concerned. Also in the parallel passage in Matthew 22, 39, "and the second is like unto it", which Luther quite correctly translated by like.

Later I will again refer to these passages by which my remaining doubts of the true meaning of similar were dispelled. Homoios in all of these means likeness in difference of kind, in different domains, always in cases where together with likeness there must be the thought of a difference.

We surely know that Hahnemann did not borrow the word from the New Testament. Not even should he have read the passage in Acts 14, 15, where Paul rends his garments and cried out, "We are homoeopaths, (sufferers alike) and will not sacrifice oxen." Nor would this have deterred him from adopting the name. It was not Hahnemanns way to long hesitate over a choice of words. In choosing the remedy for a particular case he took all the more time because it was his aim and purpose to cure. Moreover there was no authority to influence him in the least in his dietetics; yet when he had gradually perfected this he had come up with Moses without suspecting it. He had the desire to heal, for which reason Nature revealed herself to him and through him to us. In this sense we may say he was inspired.

I make particular mention of this because I was always puzzled to understand the reasons which guided Hahnemann in making choice of drugs for his provings. Certain it is used that he always took the biggest catch away from the rest of us when it came to fishing for important drugs to prove. This, to say the least, is remarkable. He never appeared willing to talk about, or make answer to this; and I know that what is being written in the present would not have induced him to give reasons for making his selections, thereby giving us guidance in our work for the future. Reflect upon the large domain of the vegetable kingdom alone and make a survey of the materia medica of his time and observe how, in making his selections, he was always sure to light upon the best.

If, with Belladonna and Nux vomica, his choice was influenced by the poisoning cases, there were hundreds of other drugs equally poisonous. If he chose Chamomilla on account of its general use in the home, there were innumerable other home remedies he might have chosen; and later very little of importance came from this source.

 Hahnemann lost no time in selecting the obsolete Aconite, the Pulsatilla which had been overlooked, and the forgotten Arnica. I am putting the question to everyone: What would Hahnemann and young homoeopathy have done without these remedies?.

The provings of Ignatia and Angustura, with a few others, were undertaken casually; the choice of Oleander was a mere fancy. He made several almost purposeless provings with Leontodon, Cyclamen, Verbascum, Chelidonium and some others. At least none of these, so far, (1845) has found its way into daily practice. In spite of all he found the more important remedies and gave them prominence. Later provings, made by other physicians, were still left far behind. Gross, with Platina, surpassed Aurum; Helbig gave us Nux moschata, which, if not more important, takes equal rank with Nux vomica. Stapf, by placing Tartar emetic in our hands, gave us a remedy of like applicability with Aconite and Bryonia, put Coffea on a par with Opium, surpassed Thuja with Sabina, and Crocus with Drosera, etc.; Seidel went beyond Ledum with his Rhododendron, beyond Capsicum with Senega, and G.F. Muller opened up a remedy in Hypericum of equal importance to Arnica. While skipping many other valuable contributions to materia medica, mention might be made of Lachesis which though not exactly on a level with those mentioned, still outstripped Moschus in symptomatology and its frequent use in practice. But what does it amount to compared to the masterly work of Hahnemann? As surely as Lachesis far surpasses all other animal medicines, how poor and incomplete it stands beside the Sepia of Hahnemann!.

Strangest of all is how Hahnemann, with his antipsoric theory, and after his discovery of potentization found also the more important antipsoric remedies. They seemed to fairly snow in upon him. Not the ones he took up later and classed with the antipsorics but the ones with which he began.

Who, at the time, would have placed the least confidence in the action of any of these drugs, several of which have since become our most important remedies? Many will remember the time when charcoal was jeered at as being thoroughly inert, and we were told to select poisons only, and powerful ones at that.

It was evident that Sulphur and Phosphorus would prove important medicines, but who was not surprised to find in Silicea, Lycopodium, and Sepia, and then in Natrum muriaticum, remedies of such enormous value? Was this chance? Then why was the lucky hit so often repeated? Proof by the mathematical law of probabilities fortunately is at hand, as was the case with the Pleiades and the old English astronomer. Repetition eliminates chance. Was there a scientific reason? Which? If we but knew, so that we could follow in the same course, the way by which Hahnemann won the heights through all three natural kingdoms the world over! He concealed nothing, yet nowhere mentions reasons for his choice. What then remains but inspiration?.

It is not our purpose to add to or to subtract from Hahnemann. His greatness is sufficiently attested by the quality of his researches. His purpose was to heal, and to give freely to all of what seemed to him of greatest importance. For this reason he put out all of his remedies in the form of monographs. It did not seem to trouble him whence the remedies came; he simply alluded to their origin that others might know from what source they were obtainable. Possibly he did not give it a thought that Pulsatilla and Aconite were both Ranunculaceae, or that Staphisagria and Hellebore belong to the same family. And what good would it have been to him? What good to his patients?.

Materia medica assumes a different aspect to him who approaches it from without, intent upon taking the fortress. The study of natural history occupied me from my earliest years, and having learned the importance of signs and characteristics, the desire grew within me to see the whole brought into an orderly system. It was therefore quite natural that my first private undertaking in homoeopathy (in the fall of 1821) was the making of a synopsis of proved remedies in tabular form showing their classification according to natural orders and indicating the important gaps and omissions. To fill some of these gaps I introduced new remedies, collected symptoms from poisonings, and began to make provings. The aim of my society of provers was to contribute original material, and preference was given to such remedies as were intended for publication; three in each issue, one from each of the kingdoms. The Cryptogamia, of which we had none, were chosen, also the animal products, Moschus, at that time, being the sole example; this being done to make the series more complete. It was not so much the effects from individual drugs that I was after, but a knowledge of the different kingdoms, classes and families. This course I have pursued hitherto, as my contributions to the Archives will show.

All provings were particularly intended to place our materia medica on a level with the natural sciences; to furnish a new side to minerals, plants and animals, a matter which belongs to natural history as much as do form, color, habits, etc. For this reason I desired always, and with all remedies, to have an eye to their origin, and to where they belong. Of course many others have done the same; in other ways I merely make mention of this for the benefit of those who have not followed the same course, that they may understand this departure.

It naturally follows that one who devoted more time to study than to general practice, aimed to get a grasp on materia medica in a diagnostic way. In natural history all is done by comparison of similarities and differences, the purpose being to become acquainted with peculiarities. Like minerals are arranged in steps for comparison, plants laid side by side to ascertain their genus and their species by comparing their greater or lesser features. So we can, and must do, with remedies, which of course is far more difficult, at least now, but the hard work must be done to make it easier in the future.

I remember with great satisfaction the time when I saw Hartlaubs comparative study of Nux vomica, Ignatia and Pulsatilla in manuscript, and remarked: "If Nux and Ignatia are similar in action this is quite natural because they belong to the Strychniae, but if both resemble Pulsatilla, which belongs to the Ranunculaceae, to which the other two do not bear the least resemblance, is this then unnatural?" It would appear that I then picked up a rough stone, without, at the time, attempting to polish it. But I kept it in my pocket. Years passed before I reached the conclusion that it must be that in the first two the differences are of most importance, and in the latter the agreement. Years passed before I placed myself before the grindstone to polish my stone.

Let us concentrate upon the law of sequences as it is to be observed in practice. If remedies follow better the more similar they are, not only to the case, but among one another, we should not hesitate to prescribe such, if at all suitable to the case. Under like circumstances I promptly, and with a light heart, prescribed one mineral acid, one base, one metal, and one of the Solanaceae after the other; the same with the Ranunculaceae, Colchicum, Veratrum and Sabadilla were found to make splendid following, likewise Nux vomica and Ignatia; for all their similarity these often seemed indicated in the same case, of course to be prescribed only when symptoms fully corresponded. In a large number of cases, for all my painstaking, I had poor success and had to look lively for other remedies. In nearly all instances the symptoms were decidedly aggravated, or the case spoiled. This, to say the least, was annoying. It put one in mind of one, who trying to start a fire by heaping wet leaves upon a bed of live coals, blows and blows until the biting smoke fill his eyes and lungs, coughs, chokes and he has to run for fresh air.

I had made a collection of real antidotes for my own use. Camphor and Spiritus nitri dulcis I did not consider to be proper antidotes. I also made a list of such remedies as were known to follow well. I then saw that but very few remedies that bore a close resemblance were to be found contiguous in nature (natural order). On the contrary the most general antidotes and the best following remedies came from sources far apart. I was in the position of one camping out, who, turning to his fire and finding the little flames crackling and leaping from between dry leaves and fagots quickly makes preparation for roasting his potatoes for which the keen mountain air has sharpened his appetite.

The discovery, with the best of intentions, was promptly communicated, but totally disregarded or misunderstood, and by some contradicted. It might have been that my potatoes were underdone, burned on the outside, since no one wished to partake of them. Believing the fault to have been mine, I, for several years, zealously continued my experiments, to find the rule to be true and constant, without an exception. All depends upon how the rule is conceived and applied. I could not possibly have overlooked the fact that, often antidotes are found in close natural relation, as for instance with Belladonna and Hyoscyamus which also follow well, also Mercurius and Aurum, and some others.

Some years ago, attention was called (in the Archives) to the nearness (closeness) of antidotes, the plant acting against the poison obtained from its fruit or leaves, bile against saliva, etc. It was this antidotal variation running through all nature that gave the impulse to my investigations and led to the discovery of the law by which medicinal forces in nature are distributed.

The best antidotes stand widely apart in the natural order of things, which experience will readily teach, even from a superficial examination of a table of antidotes. Some few antidotes stand very close, close as possible. This, to some, might have the appearance of a contradiction. Should we, on this account, no longer believe in rues? That would be stupidity. The problem must be solved. I am not surprised when practitioners become hopeless in the face of such obstacles and express themselves in favor of selecting remedies according to the old plan, taking what seems most similar to them while believing that subtleties are confusing and that the future of homoeopathy will be assured when we have grown sufficiently in age, wisdom and experience - that it has always been the same with all new doctrines, etc., etc. It would be absurd to regard some close antidotes as exceptions and others as coming under the rule. It is a poor rule that swarms and creeps with exceptions, as we all know.

There are experiences cited where there is a similarity between remedies called antidotes, and another similarity by which they are not antidotes, where the similar remedy causes an aggravation. If, however, there exists a two fold similarity, one in which the remedies mutually wipe out one another, and another in which they do not efface, but strengthen one another, the case might, indeed must, be that the same thing can happen between symptoms of the drug and symptoms of the disease. Hence there may be a similarity by which the remedy for the disease is wrongly chosen and will aggravate instead of relieve. Such cases every practitioner has known; I confess to having met many in former years, and it was but poor comfort to say that the remedy was wrongly chosen. Wherein lay the mistake?.

It is to be hoped that everyone will clearly see that all attempts to raise homoeopathy to the ranks of a real science must depend upon the manner by which the fundamental principle similia similibus is defined. That this principle is lacking in scientific accuracy can readily be seen. Our learned opponents, to be sure, did not make mention of this, nor did anyone else as far as I know; and if they had they would not have put it to practical use. Anyhow they were blinded, and like poor finches kept whistling the same tune over and over, for it was still night for them in the forest. The only exception, one Comfort by name, dilated somewhat upon the subject, but to cover his speculation he denied having read the Archives, reminding one of the poor fellow who confessed to having taken money, but declared upon his honour that he had not removed any from the middle drawer of the till.

Before proceeding any further with our research we must finish with those who dubbed it "mere dealing in words while trying to define what is similar". These, to be sure, must have held a quite different opinion of science, if any at all. The point in question amounts to no less than the foundation of all therapeutics. I am, of course, well aware that we practising physicians have found, do find, and, it is to be hoped, will find the right remedy many times more in the future, each in his own way of looking for the similimum. All of which, however, does not satisfy science, which deals with sound reasons only. Should we not then apply a bit more of printers ink, by way of a lubricant, to our creaky door hinges to make them work smoother?.

"Comparisons and propositions concerning similarities," says a celebrated empiric investigator (Berzelius, Part 4, P. 13) "depend upon the individuality of things to be compared; the comparison which best corresponds with the individuality of most of the things to be compared, is naturally the one to be followed". In our art, homoeopathy, where everything depends upon similarity, shall we rest content with this much and stop at individualities? We might, then, as well admit that any old woman knows as much of what is alike. Old women often do know, as in the case of a newly born infant, one declaring it to be like the father, another like the mother, and a third that it resembles no one in particular, thus leaving the matter open for gossip. Consult any portrait painter and hear what he has to say about peoples opinion of what is, or is not, a likeness. I myself, know of a woman who positively refused to see a likeness to her husband in his daguerrotype, because anyone could see the wart on his face was on the wrong side! Another person, looking wise, gave assurance that the matter could not be otherwise, because "optically the rays of light," etc., etc. And yet the woman was in the right. Again I know of a man who sanctioned the mending his wifes teakettle with her daguerrotype because, In the first place, he said, "she looks as dark as a mulatto in the picture, and secondly, it shows a hand not unlike a ham, thirdly, she looks made enough to bite me; while everyone knows my wife has a beautiful, fair complexion, a neat little hand, and is always sweet and kind!".

Maybe the matter rests with instinct; a mysterious coming to light of the creative artistic genius; the born physician sprung ready made from the hand of his Maker, like a bee from its cell, always ready to do the trick. Is it mechanical instinct or mysterious divination that gives the experienced practitioner that nice sense of perception by which he practically smells out the suitable remedy? It is not my purpose to interfere with the practitioner who appeals to instinctive selection for I have a strong leaning to that way myself. Anyhow there are many things under the sun, likewise the moon, not dreamt of by our philosophers; all I ask is that such like talk should be kept out of science. If such an evil were allowed to spread it would soon put an end to all system and order, since everyone has his pet opinion, his own instinct, and marks time in his particular way. Who then is to know who is right?.

For an answer let us first turn to the mathematicians, to whom first rank is conceded, and next to the philosophers who pretend to a kind of superiority; next to good common sense, to balance things, to the naturalists, who, in a way, share our difficulties, and finally make appeal to our own experience as to what is meant by similar.

What is called similar, like all else in mathematics, is sufficiently definite but can be of little use to us unless it is raised to universality. Mathematically speaking like means that which is the same in respect to size; sometimes also when differing in size, but congruous where both are in accord and two figures cover each other. Although, at first sight, it may seem of little use to us, it yet appears that the doctrine of congruence might be here applied. Since we call like all that which is alike in substance, and similar what is alike in respect to form, it must follow that the similar, which is conditioned by form, must include a likeness of that which determines form. By the rule of like proportions we may reach conclusions as to unknown quantities. Mathematicians have found the law of analogy of the very greatest use; likewise pathologists and other natural scientists. We should be able to do the same in materia medica and in therapy, a matter which needs further elucidation.

The definition of similarity as "likeness of that which is essential, important, intrinsic, determinative", after all, would fit into other provinces of mathematics. Like relations are always similar. For the same reason I never could become interested in the quarrels over theories concerning parallels, because obviously a higher conception of similarity, applied to lines, explains the parallels, be they straight or crooked, thereby making superfluous both straight as well as crooked proofs.

In conclusion I must make mention of the controversy between philosophers in reference to analogy and deductions by analogy. Reasoning by analogy I have always claimed to be the only correct method. It is the golden theory of Pythagoras, by which heaven and earth are unlocked. Nevertheless, like the law of quadrature of triangles, it has been dubbed Pons asinorum by dunces. The statement that deductions by analogy are untrustworthy is ridiculous. If the result is wrong, the fault is not in the method of reasoning but because it is misapplied, which holds good in all things. It strikes me in a manner as if one should not use ones eyes, because, as it is foolishly expressed,our senses deceive us, when all the while our mistakes happen because we draw faulty conclusions through our sense impressions; or again as if one would say we should discard the rule of three because schoolboys sometimes fail to get right results when doing their examples. Obviously analogous is the same as that which mathematicians call similar, meaning intrinsically alike. If our angles and corresponding sides are properly placed we will be able to take measurements into distance with the same accuracy as does the geometer. It come to the same as with the simple rule of three. As surely as anyone having three lines can find the proportional fourth, or so to speak, the fourth term, just as surely must it come our right in our reasonings by analogy if the premises are right.

This brings us to Part Second, namely, the question addressed to philosophers: What is similar?.

If I begin my task with a sign I must beg that this be put down to my ignorance of the subject. After all manner of research among philosophies I have found nothing but nothings. Every now and then I came across a something which turned out to be nothing, and then again a nothing which claimed to be something. Hollow spectres arose on all sides to dishearten me. Is it any wonder I lost my temper with the old dame? No doubt there are many learned men to whom I should do reverence, cap in hand; several more who command admiration in more ways than one, to whom I pay my modest tribute, for after all it is not my purpose to throw everything into the same pot promiscuously, but I cannot be expected to spare the entire party for the sake of a few notables. It cannot be helped, for they not give us the truth as we physicians need it. This without exception.

Now, in 1840, with the goal in sight, after a period of twelve years of research in which the daily question has been, "What is the true meaning of similar?" without claiming to have read all, I find myself shuddering at the things I have read. I have followed many a circuitous route, mostly leading nowhere, through all manner of sciences and their encyclopaedias, studying dictionaries, conversation and other lexicons trying to find out what is similar, what like, and what contrary, looking first for explanations, then for corroboration of my own conjectures. I gathered much, but least of all from philosophers; from them in fact nothing, unless it were how NOT to do the thing. As far as I know, no philosopher ever took the trouble to explain these simple concepts. At any rate these learned gentlemen seem to have cared more for words than their meanings. Philosophies hang upon the tree of science very much like nests of tailor-birds, artfully constructed form fibres and threads of bark; only the birds have no technical terms. Examine such a nest carefully, as I have often done; you will find it ingeniously hanging together and firmly fastened to the tree, but either empty or containing a few eggshells, or possibly a couple of timidly peeping, naked, little objects, sorry representatives of the grand ideas of nature. Over premises which philosophers should take for granted, as do mathematicians by their axioms, they vex themselves in their efforts to prove; and that which we desire to have explained they dismiss with an hypothesis. From this nothing sensible can come.

If I am be permitted to refer to the fruits of my earnest labors so often published in a humorous way, I can give assurance that my fun is to be taken seriously.

THE MEDICINE OF EXPERIENCE.
Samuel Hahnemann, 1805

Man, regarded as an animal, has been created more helpless than all other animals. He has no congenital weapons for his defense like the bull, no speed to enable him to flee from his enemies like the deer, no wings, no webbed feet, no fins, no armour impenetrable to violence like the tortoise, no place of refuge provided by nature as is possessed by thousands of insects and worms for their safety, no physical provision to keep the enemy at bay such as render the hedgehog and torpedo formidable, no sting like the gadfly, nor poison-fang like the viperto all the attacks of hostile animals he is exposed defenceless. He has, moreover, nothing to oppose to the violence of the elements and meteors. He is not protected from the action of water by the shining hair of the seal, nor by the close oily feathers of the duck, nor by the smooth shield of the water beetle his body, but a slight degree lighter than the water, floats more helplessly in that medium than that of any quadruped, and is in danger of instant death. He is not protected like the polar-bear or eider-duck by a covering impenetrable to the northern blast. At its birth the lamb knows where to seek its mother's udder, but the helpless babe would perish if its mother's breast were not presented to it. Where he is born nature nowhere furnishes his food ready made, as she provides ants for the armadillo, caterpillars for the ichneumon-fly, or the open petals of flowers for the bee. Man is subject to a far larger number of diseases than animals, who are born with a secret knowledge of the remedial means for these invisible enemies of life, instinct, which man possesses not. Man alone painfully escapes from his mother's womb, soft, tender, naked, defenceless, helpless, and destitute of all that can render his existence supportable, destitute of all wherewith nature richly endows the worm of the dust, to render its life happy.

Where is the benevolence of the Creator, that could have disinherited man, and him alone of all the animals of the earth, of the bare necessities of life ?

Behold, the Eternal Source of all love only disinherited man of the animal nature in order to endow him all the more richly with that spark of divinitya mind which enables man to elicit from himself the satisfaction of all his requirements, and a full measure of all conceivable benefits, and to develop from himself the innumerable advantages that exalt the children of this earth far above every other living thing mind that, indestructible itself, is capable of creating for its tenement, its frail animal nature, more powerful means for its sustenance, protection, defense and comfort, than any of the most favoured creatures can boast of having derived directly from nature.

The Father of mankind has chiefly reckoned on this faculty of the human mind to discover remedial agents, for his protection from the maladies and accidents to which the delicate organism of man is exposed.

The help that the body can afford itself for the removal of diseases is but small and very limited, so that the human mind is so much the more compelled to employ, for the cure of the diseases of the body, remedial powers of a more efficient kind than it has seemed good to the Creator to implant in the organic tissues alone.

What crude nature presents to us should not form the limit for the relief of our necessities no, our mind should be able to enlarge her resources to an unlimited degree for our perfect well-being.

Thus the Creator presents to us ears of corn from the bosom of the earth, not to be chewed and swallowed in a crude and unwholesome state, but in order that we should render them useful as nutriment by freeing them from the husk, grinding and depriving them of everything of an injurious and medicinal nature, by fermentation and the heat of the oven, and partaking of them in the form of bread a preparation of an innocuous and nutritious character, ennobled by the perfecting power of our mind. Since the creation of the world the lightning's flash has destroyed animals and human beings but the Author of the universe intended that the mind of man should invent something, as has actually been done in these latter days, whereby the fire of heaven should be prevented from touching his dwellings that by means of metallic rods boldly reared aloft he should conduct it harmless to the ground. The waves of the angry ocean reared mountains high threaten to overwhelm his frail bark, and he calms them by pouring oil upon them.

So he permits the other powers of nature to act unhindered to our harm, until we discover something that can secure us from their destructive force, and harmlessly avert from us their impressions.

So he allows the innumerable array of diseases to assail and seize upon the delicate corporeal frame, threatening it with death and destruction, well knowing that the animal part of our organism is incapable, in most cases, of victoriously routing the enemy, without itself suffering much loss or even succumbing in the struggle the remedial resources of the organism, abandoned to itself, are weak, limited and insufficient for the dispersion of diseases, in order that our mind may employ its ennobling faculty in this case also, where the question concerns the most inestimable of all earth's goods, health and life.

The great Instructor of mankind did not intend that -we should go to work in the same manner as nature we should do more than organic nature, but not in the same manner, not with the same means as she. He did not permit us to create a horse j but we are allowed to construct machines, each of which possesses more power than a hundred horses, and is much more obedient to our will. He permitted us to build ships, in which, secure from the monsters of the deep and the fury of the tempest, and furnished with all the comforts of the mainland, we might circumnavigate the world, which no fish could do, and therefore he denied to our body the piscine fins, branchiae and float, that were inadequate to perform this feat. He denied to our body the rustling wings of the mighty condor, but on the other hand, he allows us to invent machines filled with light gas, that with silent power lift us into far higher regions of the atmosphere than are accessible to any of the feathered tenants of the air.

So also he suffers us not to employ the process of sphacelus, as the human corporeal organism does for itself, in order to remove a shattered limb, but he placed in our hand the sharp, quickly-dividing knife, which Faust moistened with oil, that is capable of performing the operation with less pain, less fever, and much less danger to life. He permits us not to make use of the so-called crises, like nature, for the cure of a number of fevers we cannot imitate her critical sweat, her critical diuresis, her critical abscesses of the parotid and inguinal glands, her critical epistaxis, but he enables the investigator to discover remedies wherewith he may cure the fever more rapidly than the corporeal organism is capable of producing crises, and to cure them more certainly, more easily, and with, less suffering, with less danger to life and fewer after-sufferings, than unassisted nature can do by means of crises.

I am therefore astonished that the art of medicine has so seldom raised itself above a servile imitation of these crude processes, and that it has at almost all periods been believed that hardly anything better could be done for the cure of diseases than to copy these crises, and to produce evacuations in the form of sweat, diarrhoea, vomiting, diuresis, venesections, blisters, or artificial sores. (This was and remained the most favourite method of treatment from the earliest times till now, and it was always fallen back upon when other modes of treatment, founded on ingenious speculations, disappointed the hopes they had raised.) Just as if these imperfect and forced imitations were the same thing as what nature effects in the hidden recesses of vitality, by her own spontaneous efforts, in the form of crises ! Or as if such crises were the best possible method for overcoming the disease, and were not rather proofs of the (designed) imperfection and therapeutical powerlessness of our unaided nature ! Never, never was it possible to compel these spontaneous endeavours of the organism by artificial means (the very notion implies a contradiction), never was it the Creator's will that we should do so. His design was that we should bring to unlimited perfection our whole being, as also our corporeal frame and the cure of its diseases.

This design has hitherto been in part fulfilled by pure surgery alone. Instead of acting like unassisted nature, which can often only throw off a splinter of bone in the leg by inducing a fever attended by danger to life, and a suppuration that destroys almost all the limb, the surgeon is able, by a judicious division of the irritable integuments, to extract it in a few minutes by means of his fingers, without occasioning any great suffering, without any considerable bad consequences, and almost without any diminution of the strength. A debilitating slow fever, accompanied by intolerable pains and uninterrupted torturing to death, is almost the sole means the organism can oppose to a large stone in the bladder whereas an incision made by a practised hand frees the sufferer from it often in a quarter of an hour, spares him many years of torment, and rescues him from a miserable death. Or ought1 we to attempt to relieve a strangulated hernia by an imitation of the mortification and suppuration, which are the only means, besides death, that nature possesses against it ? Would it suffice for the rescue and preservation of life, did we not know of any other mode of stopping the hemorrhage from a wound in a large artery than by causing a syncope of half-an-hour's duration, as nature docs ? Could the tourniquet, bandage and compress be thereby dispensed with ?

It has always been a matter worthy of the greatest admiration to see how nature, without having recourse to any surgical operation, without having access to any remedy from without, does often, when left quite unassisted, develop from itself invisible operations whereby it is able often, it is true, in a very tedious, painful, and dangerous manner but still really to remove diseases and affections of many kinds. But she does not do these for our imitation! we cannot imitate them, we ought not to imitate them for there are infinitely easier, quicker, and surer remedial means which the inventive faculty implanted in our mind is destined to discover, in order to subserve the ends of medicine, that most essential and most honourable of all earthly sciences.

Medicine is a science of experience: its object is to eradicate diseases by means of remedies.

The knowledge of diseases, the knowledge of remedies, and the knowledge of their employment, constitute medicine.

As the wise and beneficent Creator has permitted those innumerable states of the human body differing from health, which we term diseases, he must at the same time have revealed to us a distinct mode whereby we may obtain a knowledge of diseases, that shall suffice to enable us to employ the remedies capable of subduing them he must have shewn to us an equally distinct mode whereby we inay discover in medicines those properties that render them suitable for the cure of diseases, if he did not mean to leave his children helpless, or to require of them what was beyond their power.

This art, so indispensable to suffering humanity, cannot therefore remain concealed in the unfathomable depths of obscure speculation, or be diffused throughout the boundless void of conjecture it must be accessible, readily accessible to us, within the sphere of vision of our external and internal perceptive faculties.

Two thousand years were wasted by physicians in endeavouring to discover the invisible internal changes that take place in the organism in diseases, and in searching for their proximate causes and a priori nature, because they imagined that they could not cure before they had attained to this impossible knowledge.

If the fruitlessness of these long-continued endeavours cannot be regarded as a proof of the impossibility of this undertaking, the maxim of experience that they were unnecessary for the cure, might suffice to shew its impossibility. For the great Spirit of the Universe, the most consistent of all beings, has made that only possible which is necessary.

Although we never can attain to a knowledge of the internal corporeal changes on which diseases depend, yet the observation of their external exciting causes has its uses.

No alteration occurs without a cause. Diseases must have their exciting causes, concealed though they may be from us in the greater number of cases.

We observe a few diseases that always arise from one and the same cause, e. g., the miasmatic maladies hydrophobia, the venereal disease, the plague of the Levant, yellow fever, small-pox, cow-pox, the measles and some others, which bear upon them the distinctive mark of always remaining diseases of a peculiar character and, because they arise from a contagious principle that always remains the same, they also always retain the same character and pursue the same course, excepting as regards some accidental concomitant circumstances, which, however, do not alter their essential character.

Probably some other diseases, which we cannot shew to depend on a peculiar miasm, as gout, marsh-ague, and several other diseases that occur here and there endemically, besides a few others, also arise either from a single unvarying cause, or from the confluence of several definite causes that are liable to be associated, and that are always the same, otherwise they would not produce diseases of such a specific kind, and would not occur so frequently.

These few diseases at all events, those first mentioned (the miasmatic), we may therefore term specific, and when necessary, bestow on them distinctive appellations.

If a remedy have been discovered for one of these, it will always be able to cure it, for such a disease always remains essentially identical, both in its manifestations (the representatives of its internal nature), and in its cause.

All the other innumerable diseases exhibit such a difference in their phenomena, that we may safely assert that they arise from a combination of several dissimilar causes (varying in number and differing in nature and intensity).

The number of words that may be constructed from an alphabet of twenty-four letters may be calculated, great though that number be but who can calculate the number of those dissimilar diseases, since our bodies can be affected by innumerable, and still, for the most part, unknown influences of external agencies, and by almost as many forces from within.

All things that are capable of exercising any action (and their number is incalculable), are able to act upon and to produce changes in our organism which is intimately connected with and in conflict with all parts of the universe and all may produce different effects as they differ among themselves.

How various must be the effects of the action of these agencies, when several of them at once, and in varied order and intensity, exercise their influence on our bodies, seeing that the latter are also so variously organized and present such diversities in the various conditions of their life, that no one human being exactly resembles another in any conceivable respect!

Hence it happens that, with the exception of those few diseases that are always the same, all others are dissimilar and innumerable, and so different that each of them occurs scarcely more than once in the world, and each case of disease that presents itself must be regarded (and treated) as an individual malady that never before occurred in the same manner, and under the same circumstances as in the case before us, and will never again happen precisely in the same way!

The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for the purpose of curing it, expresses itself by the symptoms, as they present themselves to the investigations of the true observer in their whole extent, connexion and succession.

When the physician has discovered all the observable symptoms of the disease that exist, he has discovered the disease itself he has attained the complete conception of it requisite to enable him to effect a cure.

In order to be able to perform a cure, it is requisite to have a faithful picture of the disease with all its manifestations, and in addition, when this can be discovered, a knowledge of its predisposing and exciting causes, in order, after effecting the cure by means of medicines, to enable us to remove these also by means of an improved regimen and so prevent a relapse.

In order to trace the picture of the disease, the physician requires to proceed in a very simple manner. All that he needs is carefulness in observing, and fidelity in copying. He should entirely avoid all conjectures, leading questions, and suggestions.

The patient relates the history of his ailments, those about him describe what they have observed in him, the physician sees, hears, feels, &c., all that there is of an altered or unusual character about him, and notes down each particular in its order, so that he may form an accurate picture of the disease.

The chief signs are those symptoms that are most constant, most striking, and most annoying to the patient. The physician marks them down as the strongest, the principal features of the picture. The most singular, most uncommon signs furnish the characteristic, the distinctive, the peculiar features.

He allows the patient and his attendants to relate all they have to say without interrupting them, and he notes down everything attentively he then again enquires what were and still are the most constant, frequent, strongest, and most troublesome of the symptoms he requests the patient to describe again his exact sensations, the exact course of the symptoms, the exact seat of his sufferings and bids the attendants once more detail, in as accurate terms as they are able, the changes they have observed in the patient, and which they had previously mentioned.

The physician thus hears a second time what he had formerly noted down. If the expressions correspond with what was already related, they may be considered as true, as the voice of internal conviction j if they do not correspond, the discrepancy must be pointed out to the

patient, or those about him, in order that they may explain which of the two descriptions was nearest the truth, and thus what required confirmation is confirmed, and what required alteration is altered.

If the picture be not yet complete if there be parts or functions of the body regarding whose state neither the patient nor his attendants have said anything, the physician then asks what they can remember respecting these parts or functions, but he should frame his questions in general terms, so as to cause his informant to give the special details in his own words.

When the patient (for, except in cases of feigned diseases, most reliance is to be placed on him as regards his sensations) has, by these spontaneous or almost unprompted details, put the physician in possession of a tolerably complete picture of the disease, it is allowable for the latter to institute more particular enquiries.

The answers to these last more special questions, however, which have somewhat the character of suggestions, should not be accepted by the physician at the first response as perfectly true, but after making a note of them on the margin he should make fresh enquiries respecting them, in a different manner and in another order, and he should warn the patient and his attendants in their answers to make accurate replies, and to make no additions, but merely to tell the exact circumstances of the case.

But an intelligent patient will often spare the physician the trouble of making these particular enquiries, and in his account of the history of his disease will usually have made voluntary mention of these circumstances.

When the physician has completed this examination, he notes down what he has silently observed in the patient during his visit, and he corrects this by what the attendants tell him how much of this was or was not usual with the patient in his days of health.

He then enquires what medicines, domestic remedies, or other modes of treatment have been employed in former times, and what have recently been used, and especially the state of the symptoms before the use or after the discontinuance of all medicine. The former form he regards as the original state the latter is in fact an artificial form of the disease, which, however, he must sometimes accept and treat as it is, if there is any pressing emergency in the case that will not admit of any delay. But if the disease is of a chronic character, he lets the patient continue some days without taking any medicine, to allow it to resume its original form, until which time he defers his more particular examination of the morbid symptoms, in order that he may direct his treatment towards the persistent and unsophisticated symptoms of the chronic malady, but not towards the evanescent, ungenuine, accidental symptoms, produced by the medicines last used as it will be necessary to do in acute diseases where the danger is urgent.

Finally, the physician makes general enquiries as to any exciting causes of the disease that may be known. In ten cases we shall not find one where the patient or his friends can assign a certain cause. If, however, there have happened one respecting which there can exist no dubiety, it generally occurs that it has been voluntarily mentioned by them at the commencement of their account of the disease. If it is necessary to make enquiries respecting it, it usually happens that very uncertain information is elicited on this head.

I except those causes of a disgraceful character, which the patient or his friends are not likely to mention at all events, not of their own accord, and which, consequently, the doctor should endeavour to find out by dexterously framing his questions, or by private enquiries. With these exceptions, it is a hurtful, or, at all events, a useless task to endeavour to ferret out other exciting causes, by means of suggestions, especially as the medical art knows very few of these (I shall mention them in their proper places) on which we can base a trustworthy mode of  treatment, regardless of the particular signs of the disease they have induced.

By exercising all this zealous care, the physician will succeed in depicting the pure picture of the disease he will have before him the disease itself, as it is revealed by signs, without which, man, who knows nothing save through the medium of his senses, could never discover the hidden nature of any thing, and just as little could he discover a disease.

When we have found out the disease, our next step is to search for the remedy.

Every disease is owing to some abnormal irritation of a peculiar character, which deranges the functions and well- being of our organs.

But the unity of the life of our organs and their concurrence to one common end does not permit two effects produced by abnormal general irritation to exist side by side and simultaneously in the human body. Hence our

First maxim of experience.

When two abnormal general irritations act simultaneously on the body, if the two be dissimilar, then the action of the one (the weaker) irritation will be suppressed and suspended for some time by the other (the stronger) and, on the other hand, our

Second maxim of experience.

When the two irritations greatly resemble each other, then the one (the weaker) irritation, together with its effects, will be completely extinguished and annihilated by the analogous power of the other (the stronger).

(Illustration of the first maxim.) If a person be infected at the same time by, for instance, the miasmata of measles and small-pox (two dissimilar irritations), and if the measles have appeared first, it immediately disappears on the day of the eruption of the small-pox, and it is only after the latter is completely gone that the measles again returns and completes its natural course. The red rash that had already commenced to shew itself disappeared, as I have frequently observed, on the eruption of the smallpox, and only completed its course when the small-pox was dried up. According to Larrey, the plague of the Levant immediately remains stationary whenever the small-pox begins to prevail, but again returns when the latter ceases.

These two corporeal irritations are of a heterogeneous and dissimilar character, and the one is therefore suspended by the other but only for a short time.

(Illustration of the second maxim.') If the two abnormal corporeal irritations be of a similar nature, then the weaker will be entirely removed by the stronger, so that only one (the stronger) completes its action, whilst the weaker was quite annihilated and extinguished. Thus the small-pox becomes an eradicator of the cow-pox the latter is immediately interrupted in its course whenever the miasm of the small-pox that was previously latent in the system breaks out, and after the small-pox has run its course the cow-pox does not again appear.

The cow-pox miasm, which in addition to its well-known effect of developing the cow-pock with its course of two weeks' duration, has also the property of giving rise to a secondary eruption of small red pimples with red borders, particularly in the face and forearms (and under certain unknown circumstances it produces this effect usually soon after the desiccation of the pocks), permanently cures other cutaneous eruptions wherewith the inoculated person was already, though ever so long before, affected, if this cutaneous disease was only tolerably similar to that cow-pox exanthema.

These two abnormal irritations cannot exist simultaneously in the same body, and thus the morbific irritation that appears last removes that which previously existed, not merely for a short time, but permanently, in consequence of being analogous to the latter it extinguishes, annihilates, and cures it completely.

It is the same thing in the treatment of diseases by means of medicines.

If the itch of workers in wool be treated by strong purgatives, such as jalap, it gradually yields almost completely, as long as the purgatives are continued, as the action of these two abnormal irritations cannot co-exist in the body but as soon as the effect of the artificially- excited irritation ceases that is to say, whenever the purgatives are discontinued, the suspended itch returns to its former state, because a dissimilar irritation does not remove and destroy the other, but only suppresses and suspends it for a time.

But if we introduce into a body affected by this itch a new irritant of a different nature, it is true, but still of a very similar mode of action as, for example, the calcareous liver of sulphur, from which others besides myself have observed an eruption produced very similar in character to this itch, then, as two general abnormal irritations cannot co-exist in the body, the former yields to the latter, not for a short time merely, but permanently, as that last introduced was an irritation very analogous to the first that is to say, the itch of the wool-workers is really cured by the employment of the calcareous liver of sulphur (and for the same reason by the use of sulphur powder and sulphureous baths).

Those diseases, also, which the casual observer considers as merely local, are either suppressed for some time by a fresh irritation applied to this part, where the two irritations are of dissimilar or opposite tendency, as, for example, the pain of a burnt hand is instantly suppressed and suspended by dipping it in cold water, as long as the immersion is continued, but it immediately recurs with renewed violence on withdrawing the hand from the water or the first is entirely and permanently destroyed that is to say, completely cured, when the last irritation is very analogous to the first. Thus, when the action of the remedy, e. g., the artificial irritation applied to the burnt hand, is of a different nature, it is true, from the burning irritation of the fire, but of a very similar tendency, as is the case with highly concentrated alcohol, which when applied to the lips produces almost the same sensation as that caused by a fiamc approached to them, then the burnt skin, if it be constantly kept moistened with the spirit, is in bad cases in the course of a few hours, in slighter ones much sooner completely restored and permanently cured of the pain of the burn. So true is it that two irritations, even when they are local, cannot co-exist in the body without the one suspending the other, if they are dissimilar, or the one removing the other, if the added one hare a very similar mode of action and tendency.

In order, therefore, to be able to cure, we shall only require to oppose to the existing abnormal irritation of the disease an appropriate medicine that is to say, another morbific power whose effect is very similar to that the disease displays.

As food is requisite for the healthy body, so medicines have been found efficacious in diseases medicines, however, are never in themselves and unconditionally wholesome, but only relatively so.

The pure aliments of food and drink taken until hunger and thirst abate, support our strength, by replacing the parts lost in the vital processes, without disturbing the functions of our organs or impairing the health.

Those substances, however, which we term medicines are of a completely opposite nature. They afford no nourishment. They are abnormal irritants, only fitted for altering our healthy body, disturbing the vitality and the functions of the organs, and exciting disagreeable sensations in one word, making the healthy ill.

There is no medicinal substance whatsoever that does not possess this tendency, and no substance is medicinal which does not possess it.

It is only by this property of producing in the healthy body a seines of specific morbid symptoms, that medicines can cure diseases that is to say, remove and extinguish the morbid irritation by a suitable counter-irritation.

Every simple medicinal substance, like the specific morbific miasmata (small-pox, measles, the venom of vipers, the saliva of rabid animals, &c.) causes a peculiar specific diseasea series of determinate symptoms, which is not produced precisely in the same way by any other medicine in the world.

As every species of plant differs in its external form, in its peculiar mode of existence, in its taste, smell, &c., from every other species and genus of plants every mineral substance, every salt differs from all others in both its external and internal physical qualities, so do they all differ among themselves in their medicinal properties that is to say, in their morbific powers each of these substances effects an alteration in our state of health in a peculiar, determinate manner.

Most substances belonging to the animal and vegetable kingdoms are medicinal in their raw state. Those belonging to the mineral kingdom are so both in their crude and prepared state.

Medicinal substances manifest the nature of their patho-genetic power, and their absolute true action on the healthy human body, in the purest manner, when each is given singly and uncombined.

Many of the most active medicines have already occasionally found their way into the human body, and the accidents they have given rise to have been recorded.

In order to follow still farther this natural guide, and to penetrate more profoundly into this source of knowledge, we administer these medicines experimentally, the weaker as well as the stronger, each singly and uncombined, to healthy individuals, with caution, and carefully removing all accessory circumstances capable of exercising an. influence. We note down the symptoms they occasion precisely in the order in which they occur, and thus we obtain the pure result of the form of disease that each of these medicinal substances is capable of producing, absolutely and by itself, in the human body.

In this way we must obtain a knowledge of a sufficient supply of artificial morbific agents (medicines) for curative implements, so that we may be able to make a selection from among them. Now, after we have accurately examined the disease to be cured that is to say, noted down all its appreciable phenomena historically and in the order in which they occur, marking particularly the more severe and troublesome chief symptoms, we have only to oppose to this disease another disease as like it as possible, or in other words, a medicinal irritation analogous to the existing irritation of the disease, by the employment of a medicine which possesses the power of exciting as nearly as possible all these symptoms, or at all events, the greater number and severest, or most peculiar of them, and in the same order, in order to cure the disease we wish to remove, certainly, quickly, and permanently.

The result of a treatment so conformable to nature may be confidently depended on, it is so perfectly, without exception, certain, so rapid beyond all expectation, that no method of treating diseases can shew anything at all like it.

But here it is necessary to take into consideration the immense difference, that can never be sufficiently estimated, betwixt the positive and negative, or as they are sometimes termed, the radical (curative), and the palliative modes of treatment.

In the action of simple medicines on the healthy human body there occur, in the first place, phenomena and symptoms, which may be termed the positive disease, to be expected from the specific action of the medicinal substance, or its positive primary (first and principal) effect.

When this is past there ensues, in hardly appreciable transitions, the exact opposite of the first process (especially in the case of vegetable medicines), there occur the exact opposite (negative) symptoms constituting the secondary action.

Now, if in the treatment of a disease we administer those medicines whose primary symptoms, or those of its positive action, present the greatest similarity to the phenomena of the disease, this is a positive or curative mode of treatment that is to say, there occurs what must take place according to my second maxim of experience, rapid, permanent amelioration, for the completion of which the remedy must be given in smaller and smaller doses repeated at longer intervals, to prevent the occurrence of a relapse, if the first or first few doses have not already sufficed to effect a cure.

Thus, to the abnormal irritation present in the body, another morbid irritation, as similar to it as possible (by means of the medicine that acts in this case positively with its primary symptoms) is opposed in such a degree that the latter preponderates over the former, and (as two abnormal irritations cannot exist beside each other in the human body, and these are two irritations of the same kind) the complete extinction and annihilation of the former is effected by the latter.

Here a new disease is certainly introduced (by the medicine) into the system, but with this difference in the result that the original one is extinguished by the artificially-excited one but the course of the artificially- excited one (the course of the medicinal symptoms), that has thus overcome the other, expires in a shorter time than any natural disease, be it ever so short.

It is astonishing that, when the positive (curative) medicine employed corresponds very exactly in its primary symptoms with those of the disease to be cured, not a trace of the secondary symptoms of the medicine is observable, but its whole action ceases just at the time when we might expect the commencement of the negative medicinal symptoms. The disease disappears, if it belong to acute diseases, in the first few hours, which are the duration allotted by nature to the primary medicinal symptoms, and the only visible result is, recover real dynamic mutual extinction.

In the best cases the strength returns immediately, and the lingering period of convalescence usual under other modes of treatment is not met with.

Equally astonishing is the truth that there is no medicinal substance which, when employed in a curative manner, is weaker than the disease for which it is adapted no morbid irritation for which the medicinal irritation of a positive and extremely analogous nature is not more than a match.

If we have not only selected the right (positive) remedy, but have also hit upon the proper dose (and for a curative purpose incredibly small doses suffice), the remedy produces within the first few hours after the first dose has been taken a kind of slight aggravation (this seldom lasts so long as three hours), which the patient imagines to be an increase of his disease, but which is nothing more than the primary symptoms of the medicine, which are somewhat superior in intensity to the disease, and which ought to resemble the original malady so closely as to deceive the patient himself in the first hour, until the recovery that ensues after a few hours teaches him his mistake.

In this case the cure of an acute disease is generally accomplished by the first dose.

If, however, the first dose of the perfectly adapted curative medicine was not somewhat superior to the disease, and if that peculiar aggravation did not occur in the first hour, the disease is, notwithstanding, in a great measure extinguished, and it only requires a few and always smaller doses to annihilate it completely.

If, under these circumstances, in place of smaller doses, as large or larger ones are administered, there arise (after the disappearance of the original disease) pure medicinal symptoms, a kind of unnecessary artificial disease.

But the case is quite different with palliative treatment, where a medicine is employed whose positive, primary action is the opposite of the disease.

Almost immediately after the administration of such a medicine there occurs a kind of alleviation, an almost instantaneous suppression of the morbid irritation for a short time, as in the case cited above of the cold water applied to the burnt skin. These are called palliative remedies.

They prevent the impression of the morbid irritation on the organism only as long as their primary symptoms last, because they present to the body an irritation that is the reverse of the irritation of the disease thereafter their secondary action commences, and as it is the opposite of their primary action, it coincides with the original morbid irritation and aggravates it.

During the secondary action of the palliative, and when it has been left off, the disease becomes aggravated. The pain of the burn becomes worse when the hand is withdrawn from the cold water than before it was immersed.

As in the (positive) curative mode of treatment in the first hour a slight aggravation usually ensues, followed by an amelioration and recovery all the more durable, so in the palliative method there occurs in the first hour indeed, almost instant aneouslya (deceptive) amelioration, which, however, diminishes from hour to hour, until the period of the primary, and in this case palliative, action expires, and not only allows the disease to reappear as it was before the use of the remedy, but somewhat of the secondary action of the medicine is added, which, because the primary action of the remedy was the opposite of the disease, now becomes the very reverse that is to say, a state analogous to the disease. This state is an increase, an aggravation of the disease.

If it is wished to repeat the palliative aid, the former dose will now no longer suffice it must be increased, and always still further increased, until the medicine no longer produces relief, or until the accessory effects, whatever these may be, of the medicine continued in ever-increased doses, arc productive of bad consequences, that forbid its further employment bad consequences which, when they have attained a considerable height, suppress the original malady that has hitherto been treated (in conformity with the first maxim of experience), and, in place thereof, another new and at least as troublesome disease appears.

Thus, for instance, a chronic sleeplessness may be frequently suppressed for a considerable time by means of daily doses of opium given at night, because its (in this case palliative) primary action is soporific, but (in consequence of its secondary action being sleeplessness, accordingly an addition to the original disease) that only by means of ever increasing doses, until an intolerable constipation, an anasarca, an asthma, or other malady from the secondary action of opium, prohibits its further employment.

If, however, but a few doses of the palliative medicine be employed for a habitual malady, and then discontinued before it can excite an important accessory affection, it is then speedily and clearly apparent, that it is not only impotent against the original malady, but that it moreover aggravated the latter by its secondary effects. This is truly but negative relief. If, for instance, in the case of chronic agrypnia sought to be cured, the patient only obtained too little sleep, in that case the evening dose of opium will certainly immediately cause a kind of sleep, but when this remedy, which here acts only in a palliative manner, is discontinued after a few days, the patient will then not be able to sleep at all.

The palliative employment of medicines is only useful and necessary in but few cases chiefly in such as have arisen suddenly and threaten almost immediate danger.

Thus, for example, in apparent death from freezing (after friction to the skin and the gradual elevation of the temperature) nothing removes more quickly the want of irritability in the muscular fibre, and the insensibility of the nerves, than a strong infusion of coffee, which in its primary action increases the mobility of the fibre and the sensibility of all the sensitive parts of the system and is consequently palliative as regards the case before us. But in this case there is danger in delay, and yet there is no persistent morbid state to be overcome, but whenever sensation and irritability are again excited and brought into action even by a palliative, the uninjured organism resumes its functions, and the free play of the vital processes maintains itself again, without the aid of any further medication.

In like manner, cases of chronic diseases may occur, for example, hysterical convulsions or asphyxias, where the temporary assistance of palliatives (as eau de luce, burnt feathers, &c.), may be urgently demanded, in order to restore the patient to his usual undangcrous morbid state, for the cure of which, the totally different durable aid of curative medicines is required.

But where all that is capable of being effected by a palliative is not accomplished in a few hours, the bad consequences spoken of above commence to make their appearance.

In acute diseases, even such as run their course in the shortest time, we would better consult the dignity of medicine and the welfare of our patients, by treating them with curative (positive) medicines. They will thereby be overcome more certainly, and on the whole, more rapidly, and without after-complaints.

However, the bad consequences of the palliative in slight cases of acute diseases are not very striking, not very considerable. The chief symptoms disappear in a great measure after each dose of the palliative, until the natural course of the disease comes to an end, and then the organism, which has not been very seriously deranged during the short time by the secondary effects of the palliative, again resumes its sway, and gradually overcomes the consequences of the disease itself, together with the after-sufferings caused by the medicine.

If, however, the patient recover under the use of the palliative, he would also have recovered equally well and in the same space of time, without any medicine (for palliatives never shorten the natural courses of acute diseases), and would thereafter more readily regain his strength for the reasons just given. The only circumstance that can in some measure recommend the physician who practices in this way, namely, that the troublesome symptoms are occasionally subdued by his palliatives, offers to the eyes of the patient and his friends some apparent, but no real advantage over the spontaneous recovery without the use of medicine.

Hence the curative and positive treatment possesses, even in diseases of a rapid course, a decided advantage over all palliative alleviations, because it abridges even the natural periods of acute diseases, really heals them before the time for completing their course has expired, and leaves behind no after-sufferings, provided the perfectly suitable curative agent has been selected.

It might be objected to this mode of treatment, " that physicians from the earliest periods of the existence of the medical art, have (to their knowledge) never employed it, and yet have cured patients."

This objection is only apparent for ever since the existence of the art of medicine, there have been patients who have really been cured quickly, permanently, and manifestly by medicines, not by the spontaneous termination of the course of acute diseases, not in the course of time, not by the gradual preponderance of the energy of the system, but have been restored in the same manner as I have here described, by the curative action of a medicinal agent, although this was unknown to the physician.

Occasionally, however, physicians suspected that it was that property of medicines (now confirmed by innumerable observations) of exciting (positive) symptoms analogous to the disease, by virtue of a tendency inherent in them which enabled them to effect real cures. But this ray of truth, I confess, seldom penetrated the spirit of our schools, enshrouded as they were in a cloud of systems.

When the remedy has been discovered by this mode of procedure, so conformable to nature, there still remains an important point, namely, the determination of the dose.

A medicine of a positive and curative character may, without any fault on its part, do just the opposite to what it ought, if given in too large a dose in that case it produces a greater disease than that already present.

If we keep a healthy hand in cold water for some minutes, we experience in it a diminution of temperature, cold the veins become invisible, the fleshy parts become shrunken, their size is diminished, the skin is paler, duller, motion is more difficult. These are some of the primary effects of cold water on the healthy body. If we now withdraw the hand from the cold water and dry it, no long time will elapse before the opposite state ensues. The hand becomes warmer than the other (that had not been immersed), we notice considerable turgescence of the soft parts, the veins swell, the skin becomes redder, the movements more free and powerful than in the other kind of exalted vitality. This is the secondary or consecutive action of the cold water on the healthy body.

This is, moreover, almost the greatest dose in which cold water can be employed with a permanent good result, as a positive (curative) medicinal agent in a state of (pure) debility analogous to its above described primary effects on the healthy body. I repeat, the " greatest dose " for if the whole body should be exposed to the action of this agent, and if the cold of the water be very considerable, the duration of its application must at least be very much shortened, to a few seconds only, in order to reduce the dose sufficiently.

But if the dose of this remedy be in all respects much increased above the normal amount, the morbid symptoms peculiar to the primary action of the cold water increase to a state of actual disease, which the weak part it was intended to cure by its means cannot or can scarcely remove again. If the dose be increased still more, if the water be very cold, if the surface exposed to the water be larger and the duration of its application much longer than it ought to be for an ordinary curative dose of this agent, there then ensue numbness of the whole limb, cramp of the muscles, often even paralysis and if the whole body have been immersed in this cold water for an hour or longer, death ensues, or at least the apparent death from freezing in healthy individuals, but much more speedily when it is applied to feeble individuals.

The same is the case with all medicines, even with internal ones.

The reaper (unaccustomed to the use of spirits) exhausted by heat, exertion, and thirst, who, as I have said above, is restored in the course of an hour by a small dose, a single mouthful of brandy (whose primary action shews a state very similar to that sought to be combated in the present instance), would fall into a state of (probably fatal) synochus, if under these circumstances he were to drink, in place of a single mouthful, a couple of pints at once the same positive remedial agent, only in an excessive, injurious dose.

Let it not be supposed that this injurious effect of excessively large doses appertains only to medicinal agents applied in a positive (curative) manner. Equally bad results ensue from excessive doses of palliatives, for medicines are substances in themselves hurtful, that only become remedial agents by the adaptation of their natural pathogenetic power to the disease (positively or negatively) analogous to them, in the appropriate dose.

Thus, to give an example of negative (palliative) medicines, a hand very much benumbed by cold will soon be restored in the atmosphere of a warm room. This moderate degree of warmth is efficacious in this case as an agent of antagonistic tendency to the numbness from cold that is to say, as a palliative but its employment is not attended with any particular bad effects, because the dose is not too strong, and the remedy need only be used for a short time, in order to remove the moderate and rapidly produced morbid state it is wished to cure.

But let the hand which has become completely benumbed and quite insensible from the cold (frost-bitten), be quickly immersed for an hour in water of 120 Fahr., which is not too great for a healthy hand, and the part will inevitably die the hand mortifies and falls off.

A robust man, much overheated, will soon recover in a moderately cool atmosphere (about 65 Fahr.) without experiencing any appreciable disadvantage from this palliative but if immediately after being so overheated he has to stand for an hour in a cold river (wherein he might probably have remained without any bad result when not in a state of heat), he will either fall down dead, or be affected by the most dangerous typhus.

A burnt part will be alleviated in a palliative manner by cool water, but will become sphacelated if ice be applied to it.

And the same is the case with internal remedies also. If a girl, excessively overheated by dancing, swallow a quantity of ice, every one knows what usually ensues, and yet a small tablespoonful of cold water, or a minute quantity of ice would not do her any harm, although it is the same palliative, only in a smaller dose. But she would be certainly and permanently cured, even though excessively overheated, if she were to choose a small, appropriate dose of a remedy whose primary effect is analogous (curative) to the state she is in for instance, if she should drink a little very warm tea mixed with a small portion of heating spirituous liquor (rum, arrack, or the like), in a moderately heated room, walking quietly about but a large glass of alcoholic liquor would, on the other hand, throw her into a high fever.

None but the careful observer can have any idea of the height to which the sensitiveness of the body to medicinal irritations is increased in a state of disease. It exceeds all belief, when the disease has attained a great intensity. An insensible, prostrated, comatose typhus patient, unroused by any shaking, deaf to all calling, will be rapidly restored to consciousness by the smallest dose of opium, were it a million times smaller than any mortal ever yet prescribed.

The sensitiveness of the highly diseased body to medicinal irritations increases in many cases to such a degree, that powers commence to act on and to excite him, whose very existence has been denied, because they manifest no action on healthy robust bodies, nor in many diseases for which they are not suited. As an example of this, I may mention the heroic power of animalism (animal magnetism), or that immaterial influence of one living body upon another produced by certain kinds of touching or approximation, which displays such an energetic action on very sensitive, delicately-formed persons of both sexes, who are disposed either to violent mental emotions or to great irritability of the muscular fibres. This animal power does not manifest itself at all between two robust healthy persons, not because it does not exist, but because, according to the wise purposes of God, it is much too weak to shew itself betwixt healthy persons, whereas the same influence (quite imperceptible when applied by one healthy person to another) often acts with more than excessive violence in those states of morbid sensibility and irritability, just as very small doses of other curative medicines also do in very diseased bodies.

It is analogous to the medicinal powers of the application of the magnet in disease and the contact of a morbid part with the other metals, to which the healthy body is quite insensible.

On the other hand, it is as true as it is wonderful, that even the most robust individuals, when affected by a chronic disease, notwithstanding their corporeal strength, and notwithstanding that they can bear with impunity even noxious irritants in great quantity (excesses in food and alcoholic liquors, purgatives, &c.)yet as soon as the medicinal substance positively appropriate to their chronic disease is administered to them, they experience from the smallest possible dose as great an impression as if they were infants at the breast.

There are some few substances employed in medicine which act almost solely in a chemical manner some which condense the dead fibres as well as the living (as the tannin of plants), or loosen them and diminish their cohesion or their tension (as the fatty substances)some which form a chemical combination with hurtful substances in the body, at least in the prima vise (as chalk, or the alkalies which combine with some deleterious metallic oxydes, or some acrid acid in the stomachsulphuretted hydrogen water with the most dangerous metals and their oxydes) others which decompose them (as alkalies or liver of sulphur do the noxious metallic salts) others which chemically destroy parts of the body (as the actual cautery). With the exception of these few things, and the almost purely mechanical operations of surgery on the body, amputation, which merely shortens the limb, and blood-letting, which merely diminishes the amount of that fluid, together with some mechanically injurious and insoluble substances that may be introduced into the body all other medicinal substances act in a purely dynamic manner, and cure without causing evacuations, without producing any violent or even perceptible revolutions.

This dynamic action of medicines, like the vitality itself, by means of which it is reflected upon the organism, is almost purely spiritual in its nature that of medicines used in a positive (curative) manner is so most strikingly with this singular peculiarity, that while too strong doses do harm and produce considerable disturbance in the system, a small dose, and even the smallest possible dose, cannot be inefficacious, if the remedy be only otherwise indicated.

Almost the sole condition necessary for the full and helpful action is that the appropriate remedy should come in contact with the susceptible living fibre but it is of little, almost of no importance how small the dose is which, for this purpose, is brought to act on the sensitive parts of the living body.

If a certain small dose of a diluted tincture of opium is capable of removing a certain degree of unnatural sleepiness, the hundredth or even the thousandth part of the same dose of such a solution of opium suffices almost equally well for the same end, and in this way the diminution of the dose may be carried much farther without the excessively minute dose ceasing to produce the same curative result as the first of which more will be said in the special part.

I have said that the contact of the medicinal substance with the living, sensitive fibre, is almost the only condition for its action. This dynamic property is so pervading, that it is quite immaterial what sensitive part of the body is touched by the medicine in order to develop its whole action, provided the part be but destitute of the coarser epidermisimmaterial whether the dissolved medicine enter the stomach or merely remain in the mouth, or be applied to a wound or other part deprived of skin.

If there be no fear of its causing any evacuation (a peculiar vital process of the living organism, which possesses a peculiar power of nullifying and destroying the dynamic efficacy of the medicines), its introduction into the rectum or application to the lining membrane of the nose, fulfils every purpose, e. g., in the case of a medicine which has the power of curing a certain pain in the stomach, a particular kind of headache, or a kind of stitch in the side, or a cramp in the calves, or any other affection occurring in some part that stands in no anatomical connexion with the place to which the medicine is applied.

It is only the thicker epidermis covering the external surface of the body that presents some, but not an insurmountable obstacle to the action of medicines on the sensitive fibres underneath it. They still act through it, though somewhat less powerfully. Dry preparations of the medicine in powder act less powerfully through it its solution acts more powerfully and still more so if it be applied to a large surface.

The epidermis is, however, thinner on some parts, and consequently the action is easier in those situations. Among these the abdominal region, especially the pit of the stomach, the inguinal regions and the inner surface of the axilla, the bend of the arm, the inner surface of the wrist, the popliteal space, &c., are the parts most sensitive to the medicine.

Kubbing-in the medicines facilitates their action chiefly on this account, that the friction of itself renders the skin more sensitive, and the fibres, rendered thereby more active and susceptible, more apt to receive the impression of the specific medicinal power, which radiates thence over the whole organism.

If the groins be rubbed with a dry cloth until their sensibility is exalted, and the ointment of the black oxyde of mercury then laid upon them, the effect is the same as though we had rubbed the same place with the mercurial ointment itself, or as though the ointment had been rubbed in, as it is usually incorrectly expressed.

The peculiar medicinal power of the remedy, however, remains the same, whether it be employed outwardly or inwardly, so as to be brought into contact with the sensitive fibres.

The black oxyde of mercury taken by the mouth cures venereal buboes at least as rapidly and certainly as the rubbing-in of Naples ointment upon the groins. A footbath of a weak solution of muriate of mercury cures ulcers in the mouth as rapidly and certainly as its internal administration, especially if the part that is to be bathed be previously rubbed. Finely levigated cinchona powder applied to the abdomen cures the intermittent fever, which it can cure by internal use.

But as the diseased organism is altogether much more sensitive for the dynamic power of all medicines, so also is the skin of diseased persons. A moderate quantity of tincture of ipecacuanha applied to the bend of the arm effectually removes the tendency to vomit in very sick individuals (by means of its primary power to excite vomiting).

The medicinal power of heat and cold alone seems not to be so exclusively dynamic as that of other medicinal substances. Where these two agents are employed in a positive manner, the smallest possible dose of them does not suffice to produce the desired effect. When it is requisite to obtain relief rapidly, they both have to be employed in greater intensity, in a larger dose (up to a certain amount). But this appearance is deceptive their power is just as dynamically medicinal as that of other medicines, and the difference in given cases depends on the already existing habituation of our body to certain doses of these stimuli, to certain degrees of heat and cold. The heat and cold to be employed in a medicinal manner must surpass this accustomed degree by a little, in order that it may be employed in a positive manner with success (by a great deal, if it is to be used in a negative or palliative manner).

The temperature of blood-heat is for most people in our climate higher than the usual degree for the skin, and consequently a footbath of 98 to 99 Fahr. is sufficiently temperate and warm enough to remove positively heat in the head (if no other morbid symptoms are present) but in order to alleviate in a palliative manner the inflammation of a burnt hand, we require to use water considerably colder than we are accustomed to bear comfortably in healthy parts of the body, and the water should be, within certain limits, so much the colder the more severe the inflammation is.

What I have here stated respecting the somewhat greater dose of heat and cold for curative purposes, applies also to all other medicinal agents to which the patient has already been accustomed. Thus for medicinal purposes we require to administer to persons hitherto accustomed to their use doses of wine, spirits, opium, coffee, &c., large in proportion to the amount they were previously accustomed to.

Heat and cold, together with electricity, belong to the most diffusible of all dynamic medicinal stimuli their power is not diminished nor arrested by the epidermis, probably because its physical property serves as a conductor and vehicle for their medicinal power, and thus helps to distribute them. The same may be the case with regard to animalism (animal magnetism), the medicinal action of the magnet, and in general with regard to the power of the external contact of metals. The galvanic power is somewhat less capable of penetrating through the epidermis.

If we observe attentively we shall perceive that wise nature produces the greatest effects with simple, often with small means. To imitate her in this should be the highest aim of the reflecting mind. But the greater the number of means and appliances we heap together in order to attain a single object, the farther do we stray from the precepts of our great instructress, and the more miserable will be our work.

With a few simple means, used singly one after the other, more frequently, however, with one alone, we may restore to normal harmony the greatest derangements of the diseased body we may change the most chronic, apparently incurable diseases (not infrequently in the shortest space of time) into health whereas we may, by the employment of a heap of ill-selected and composite remedies, see the most insignificant maladies degenerate into the greatest, most formidable, and most incurable diseases.

Which of these two methods will the professor of the healing art who strives after perfection, choose ?

A single simple remedy is always calculated to produce the most beneficial effects, without any additional means provided it be the best selected, the most appropriate, and in the proper dose. It is never requisite to mix two of them together.

We administer a medicine in order, if possible, to remove the whole disease by this single substance or if this be not completely practicable, to observe from the effect of the medicine what still remains to be cured. One, two, or at most, three simple medicines are sufficient for the removal of the greatest disease, and if this result does not follow, the fault lies with us it is not nature, nor the disease, that is to blame.

If we wish to perceive clearly what the remedy effects in a disease, and what still remains to be done, we must only give one single simple substance at a time. Every addition of a second or a third only deranges the object we have in view, and when we wish to separate the effects of the remedy from the symptoms of the morbid process (seeing that at the most we may indeed be able to know the symptoms of the action of a simple medicine, but not the powers of a mixture of drugs, that either form combinations among, or are decomposed by, one another, and these it will never be possible for us to know), we now no longer see what portion of the changes that have taken place is to be ascribed to the disease, we are unable to distinguish which of the changes and symptoms that have occurred are derived from one, which from another ingredient of the compound remedy, and consequently we are unable to determine which of the ingredients should be retained and which discarded during the subsequent treatment, nor what other one we should substitute for one or other, or for all of them. In such a treatment none of the phenomena can be referred to its true cause. Wherever we turn, naught but uncertainty and obscurity surrounds us.

Most simple medicinal substances produce in the healthy human body not few, but on the contrary, a considerable array of absolute symptoms. The appropriate remedy can consequently frequently contain among its primary effects an antitype of most of the visible symptoms in the disease to be cured (besides many others which render it suitable for the cure of other diseases).

Now the only desirable property that we can expect a medicine to possess, is this that it should agree with the disease in other words, that it should be capable of exciting per se the most of the symptoms observable in the disease, consequently, when employed antagonistically as a medicine, should also be able to destroy and extinguish the same symptoms in. the diseased body.

We see that a single simple medicinal substance possesses in itself this property in its full extent, if it hare been carefully selected for this purpose.

It is therefore never necessary to administer more than one single simple medicinal substance at once, if it have been chosen appropriately to the case of disease.

It is also very probable, indeed, certain, that of the several medicines in a mixture, each no longer acts upon the disease in its own peculiar way, nor can it, undisturbed by the other ingredients, exert its specific effect but one acts in opposition to the other in the body, alters and in part destroys the action of the other, so that from this combination of several powers that dynamically decompose each other during their action in the body, an intermediate action is the result, which we cannot desire, as we cannot foresee, nor even form a conjecture respecting it.

In the action of mixtures of medicines in the body, there occurs what, indeed, must occur according to the maxim of experience given above (viz., that a general irritation in the body removes another, or else suppresses it, according as the one irritation is analogous or antagonistic to the other, or provided the one be much more intense than the other)the actions of several of the medicines in the compound partially destroy one another, and only the remainder of the action, which is not covered by any antagonistic irritation in the mixture, remains to oppose the disease. Whether this be suitable or no, we cannot tell, as we are unable to calculate what actually will remain.

Now, as in every case, only a single simple medicinal substance is necessary no true physician would ever think of degrading himself and his art, and defeating his own object, by giving a mixture of medicines. It will rather be a sign that he is certain of his subject if we find him prescribing only a single medicinal substance, which, if suitably chosen, cannot fail to remove the disease rapidly, gently, and permanently.

If the symptoms be but slight and few in number, it is an unimportant ailment that scarcely requires any medicine, and may be removed by a mere alteration of diet or regimen.

But if as rarely happens only one or a couple of severe symptoms be observable, then the cure is more difficult than if many symptoms were present. In that case the medicine first prescribed may not be exactly suitable, either because the patient is incapable of describing the extent of his ailments, or because the symptoms themselves are somewhat obscure and not very observable.

In this more uncommon case we may prescribe one, or at most, two doses of the medicine that appears to be the most appropriate.

It will sometimes happen that this is the right remedy. In the event of its not being exactly suitable, which is most commonly the case, symptoms not hitherto experienced will reveal themselves, or symptoms will develop themselves more fully, that the patient has not previously noticed, or only in an indistinct manner.

From these symptoms which, though slight, now show themselves more frequently, and are more distinctly perceptible, we may now obtain a more accurate picture of the disease, whereby we may be enabled to discover with greater, and even the greatest certainty, the most appropriate remedy for the original disease.

The repetition of the doses of a medicine is regulated by the duration, of the action of each medicine. If the remedy acts in a positive (curative) manner, the amendment is still perceptible after the duration of its action has expired, and then another dose of the suitable remedy destroys the remainder of the disease. The good work will not be interrupted if the second dose be not given before the lapse of some hours after the cessation of the action of the remedy. The portion of the disease already annihilated cannot in the meantime be renewed and even should we leave the patient several days without medicine, the amelioration resulting from the first dose of the curative medicine will always remain manifest.

So far from the good effect being delayed by not repeating the dose until after the medicine has exhausted its action, the cure may, on the contrary, be frustrated by its too rapid repetition, for this reason, because a dose prescribed before the cessation of the term of action of the positive medicine is to be regarded as an augmentation of the first dose, which from ignorance of this circumstance may thereby be increased to an enormous degree, and then prove hurtful by reason of its excess.

I have already stated that the smallest possible dose of a positively acting medicine will suffice to produce its full effect. If, in the case of a medicine whose action lasts a long times for instance, digitalis, where it continues to the seventh day, the dose be repeated frequently, that is to say, three or four times in the course of a day, the actual quantity of medicine will, before the seven days have expired, have increased twenty or thirty-fold, and thereby become extremely violent and injurious whereas the first dose (a twentieth or thirtieth part) would have amply sufficed to effect a cure without any bad consequences.

After the expiry of the term of action of the first dose of the medicine employed in a curative manner, we judge whether it will be useful to give a second dose of the same remedy. If the disease have diminished in almost its whole extent, not merely in the first half-hour after taking the medicine, but later, and during the whole duration of the action of the first dose and if this diminution have increased all the more, the nearer the period of the action of the remedy approached its termination or even if, as happens in very chronic diseases, or in maladies the return of whose paroxysm could not have been expected during this time, no perceptible amelioration of the disease have indeed occurred, but yet no new symptom of importance, no hitherto unfelt suffering deserving of attention have appeared, then it is in the former case almost invariably certain, and in the latter highly probable, that the medicine was the curatively helpful, the positively appropriate one, and, if requisite, ought to be followed up by a second and finally even, after the favorable termination of the action of the second, by a third dose if it be necessary, and the disease be not in the meantime completely cured as it often is, in the case of acute diseases, by the very first dose.

If the medicine we have chosen for the positive (curative) treatment excites almost no sufferings previously unfelt by the patient, produces no new symptom, it is the appropriate medicament, and will certainly cure the original malady, even though the patient and his friends should not admit that any amendment has resulted from the commencing doses, and so also conversely, if the amelioration of the original disease take place in its whole extent from the action of the curative medicine, the medicine cannot have excited any serious new symptoms.

Every aggravation, as it is called, of a disease that occurs during the use of a medicine (in doses repeated before or immediately after the expiry of its term of action), in the form of new symptoms not hitherto proper to the disease, is owing solely to the medicine employed (if it do not occur just a few hours before inevitable death, if there have taken place no important error of regimen, no outbreak of violent passions, no irresistible evolution of the course of nature by the occurrence or cessation of the menstrual function, by puberty, conception, or parturition) these symptoms are always the effect of the medicine, which, as an unsuitably-chosen positive remedy, or as a negative (palliative) remedy, either ill-selected or given for too long a time, and in too large doses, develops them by its peculiar mode of action to the torment and destruction of the patient.

An aggravation of the disease by new, violent symptoms during the first few doses of a curative medicine is never indicative of feebleness of the dose (never requires the dose to be increased), but it proves the total unfitness and worthlessness of the medicine in this case of disease.

The aggravation just alluded to by violent, new symptoms not proper to the disease, bears no resemblance to the increase of the apparently original symptoms of the disease during the first few hours after the administration of a medicine selected in a positive (curative) manner, which I formerly spoke of. This phenomenon of the increase of what seem to be the pure symptoms of the disease, but which are actually predominant medicinal symptoms resembling those of the disease, indicates merely that the dose of the appropriately selected curative medicine has been too large it disappears, if the dose has not been enormously large, after the lapse of two, three, or at most, four hours after its administration, and makes way for a removal of the disease that will be all the more durable, generally after the expiry of the term of the action of the first dose so that, in the case of acute affections, a second dose is usually unnecessary.

However, there is no positive remedy, be it ever so well selected, which shall not produce one, at least one slight, unusual suffering, a slight new symptom, during its employment, in very irritable, sensitive patients, for it is almost impossible that medicine and disease should correspond as accurately in their symptoms as two triangles of equal angles and sides resemble each other. But this unimportant difference is (in favourable cases) more than sufficiently compensated by the inherent energy of the vitality, and is not even perceived except by patients of excessive delicacy.

Should a patient of ordinary sensibility observe during the duration of the action of the first dose, an unusual sensation, and should the original disease appear at the same time to decline, we are unable to determine with precision (at least not in a chronic disease) from this first dose, whether or no the medicine selected was the most appropriate curative one. The effects of a second dose of equal strength, given after the first has exhausted its action, can alone decide this point. From the action of this, if the medicine was not perfectly or exceedingly appropriate, there will again appear a new symptom (but not often the same that was observed from the first dose, usually another one) of greater intensity (or even several symptoms of a like character), without any perceptible progress occurring in the cure of the disease in its whole extent if, however, it was the appropriate positive medicine, this second dose removes almost every trace of a new symptom, and health is restored with still greater rapidity, and without the supervention of any new ailment. Should there occur from the second dose also some new symptom of considerable severity, and should it not be possible to find a more appropriate medicine (the fault of which may, however, lie either in a want of diligence on the part of the physician, or in the smallness of the supply of medicines, whose absolute effects are known) in the case of chronic diseases, or acute diseases that do not run a very rapid course, a diminution of the dose will cause this to disappear, and the cure will still go on, though somewhat more slowly. (In this case also the energy of the vitality aids the cure.)

The choice of the medicine is not inappropriate if the chief and most severe symptoms of the disease are covered in a positive manner by the symptoms of the primary action of the medicine, while some of the more moderate and slighter morbid symptoms are so only in a negative (palliative) manner. The true curative power of the predominant positive action of the remedy takes place notwithstanding, and the organism regains full possession of health without accessory sufferings during the treatment, and without secondary ailments thereafter. It is not yet decided whether it is advantageous in such a case to increase the doses of the medicine during the continuance of its employment.

If, during the continued employment of a curative medicine without increasing the doses (in a chronic disease), fresh symptoms not proper to the disease should, in the course of time, present themselves, whereas the first two or three doses acted almost without any disturbance, we must not seek for the cause of this impediment in the in- appropriateness of the medicine, but in the regimen, or in some other powerful agency from without.

If, on the other hand, as is not infrequently the case when there is a sufficient supply of well known medicines, a positive medicine perfectly appropriate to the accurately investigated case of disease, be selected and administered in a suitably small dose, and repeated after the expiry of its special duration of action, should none of the above alluded to great obstacles come in the way, such as unavoidable evolutions of nature, violent passions, or enormous violations of regimental rules and should there be no serious disorganisation of important viscera, the cure of acute and chronic diseases, be they ever so threatening, ever so serious, and of ever so long continuance, takes place so rapidly, so perfectly, and so imperceptibly, that the patient seems to be transformed almost immediately into the state of true health, as if by a new creation.

The influence of regimen and diet on the cure is not to be overlooked but the physician needs to exercise a supervision over them only in chronic diseases, according to principles which I shall develop in the special part of my work. In acute diseases, however (except in the state of complete delirium), the delicate and infallible tact of the awakened internal sense that presides over the maintenance of life, speaks so clearly, so precisely, so much in conformity with nature, that the physician needs only to impress on the friends and attendants of the patient not to oppose in any way this voice of nature, by refusing or exceeding its demands, or by an injurious officiousness and importunity.

from Stuart Close, The Genius of Homeopathy, chapter XI, Symptomatology:

Totality of the Symptoms.-"Totality of the Symptoms" is an expression peculiar to homoeopathy which requires special attention. It is highly important to understand exactly what it means and involves, because the totality of the symptoms is the true and only basis for every homoeopathic prescription.

Hahnemann (Org., Par. 6) says:-"The ensemble or totality of these available signs or symptoms, represents in its full extent the disease itself; that is, they constitute the true and only form of which the mind is capable of conceiving." The expression has a two-fold meaning. It represents the disease and it also represents the remedy, as language represents thought.

1. The Totality of the Symptoms means, first, the totality of each individual symptom.
A single symptom is more than a single fact; it is a fact, with its history, its origin, its location, its progress or direction, and its conditions.
...
2. The Totality of the Symptoms means all the symptoms of the case which are capable of being logically combined into a harmonious and consistent whole, having form, coherency and individuality. Technically, the totality is more (and may be less) than the mere numerical totality of the symptoms. It includes the "concomitance" or form in which symptoms are grouped.
Hahnemann (Org., Par. 7) calls the totality, "this image (or picture) reflecting outwardly the internal essence of the disease, i. e., of the suffering life force."

The word used is significant and suggestive. A picture is a work of art, which appeals to our esthetic sense as well as to our intellect. Its elements are form, color, light, shade, tone, harmony, and perspective. As a composition it expresses an idea, it may be of sentiment or fact; but it does this by the harmonious combination of its elements into a whole-a totality. In a well balanced picture each element is given its full value and its right relation to all the other elements.

So it is in the symptom picture which is technically called the Totality. The totality must express an idea. When studying a case from the diagnostic standpoint, for example, certain symptoms are selected as having a known pathological relation to each other, and upon these is based the diagnosis. The classification of symptoms thus made represents the diagnostic idea. Just so the "totality of the symptoms," considered as the basis of a homoeopathic prescription, represents the therapeutic idea. These two groups may be and often are different. The elements which go to make up the therapeutic totality must be as definitely and logically related and consistent as are the elements which go to make up the diagnostic totality.

The "totality" is not, therefore, a mere haphazard, fortuitous jumble of symptoms thrown together without rhyme or reason, any more than a similar haphazard collection of pathogenetic symptoms in a proving constitutes Materia Medica.

The Totality means the sum of the aggregate of the symptoms: Not merely the numerical aggregate-the entire number of the symptoms as particulars or single symptoms-but their sum total, their organic whole as an individuality. As a machine set up complete and in perfect working order is more than a numerical aggregate of its single dissociated parts, so the Totality is more than the mere aggregate of its constituent symptoms. It is the numerical aggregate plus the idea or plan which unites them in a special manner to give them its characteristic form. As the parts of a machine cannot be thrown together in any haphazard manner, but each part must be fitted to each other part in a certain definite relation according to the preconceived plan or design-"assembled," as the mechanics say-so the symptoms of a case must be "assembled" in such a manner that they constitute an identity, an individuality, which may be seen and recognized as we recognize the personality of a friend.

...

The true Totality, therefore, is a Work of Art, formed by the mind of the artist from the crude materials at his command, which are derived from a proving or from a clinical examination of the patient.

It is important that these points should be understood, because, otherwise, there is liability to err in several directions.

1. Error may arise in placing too much emphasis upon a single symptom, or perhaps actually prescribing on a single symptom as many thoughtlessly do.

2. Error may arise in attempting to fit a remedy to a mass of indefinite, unrelated or fragmentary symptoms by a mechanical comparison of symptom with symptom, by which the prescriber becomes a mere superficial "symptom coverer."

3. Failing in both these ways the prescriber may fall to the level of the so-called "pathological prescribers," who empirically base their treatment upon a theoretical pathological diagnosis and end in prescribing unnecessary and injurious sedatives, stimulants, combination tablets, and other crude mixtures of common practice.

The physician who knows what a symptom is from the homoeopathic standpoint and how to elicit it; who knows what the totality of the symptoms means and how to construct it, and who has the intelligence, the patience and the honesty to study his case until he finds it will not be guilty of such practice.

Samuel Hahnemann, The Medical Observer -
a preface to his Materia Medica Pura

In order to be able to observe well, the medicinal practitioner requires to possess, what is not to be met with among ordinary physicians even in a moderate degree, the capacity and habit of noticing carefully and correctly the phenomena that take place in natural diseases, as well as those that occur in the morbid states artificially excited by medicines when they are tested upon the healthy body, and the ability to describe them in the most appropriate and natural expressions.

In order accurately to perceive what is to be observed in patients, we should direct all our thoughts upon the matter we have in hand, come out of ourselves, as it were, and fasten ourselves, so to speak, with all our powers of concentration upon it, in order that nothing that is actually present, that has to do with the subject, and that can be ascertained by all the senses, may escape us.

Poetic fancy, fantastic wit and speculation, must for the time be suspended, and all over-strained reasoning, forced interpretation and tendency to explain away things must be suppressed. The duty of the observer is only to take notice of the phenomena and their course; his attention should be on the watch, not only that nothing actually present escape his observation, but that also what he observes be understood exactly as it is.

This capability of observing accurately is never quite an innate faculty; it must be chiefly acquired by practice, by refining and regulating the perceptions of the senses, that is to say, by exercising a severe criticism in regard to the rapid impressions we obtain of external objects, and at the same time the necessary coolness, calmness, and firmness of judgment must be preserved, together with a constant distrust of our own powers of apprehension.

The vast importance of our subject should make us bestow the energies of our body and mind upon the observation; and great patience, supported by the power of the will, must sustain us in this direction until the completion of the observation.

To educate us for the acquirement of this faculty, an acquaintance with the best writings of the Greeks and Romans is useful, in order to enable us to attain directness in thinking and in feeling, as also appropriateness and simplicity in expressing our sensations; the art of drawing from nature is also useful, as it sharpens and practices our eye, and thereby also our other senses, teaching us to form a true conception of objects, and to represent what we observe, truly and purely, without any addition from the fancy. A knowledge of mathematics also gives us the requisite severity in forming a judgment.

Thus equipped, the medical observer cannot fail to accomplish his object, especially if he has at the same time constantly before his eyes the exalted dignity of his calling — as the representative of the all-bountiful Father and Preserver, to minister to His beloved human creatures by renovating their systems when ravaged by disease.

He knows that observations of medical subjects must be made in a sincere and holy spirit, as if under the eye of the all-seeing God, the Judge of our secret thoughts, and must be recorded so as to satisfy an upright conscience, in order that they may be communicated to the world, in the consciousness that no earthly good is more worthy of our zealous exertions than the preservation of the life and health of our fellow-creatures.

The best opportunity for exercising and perfecting our observing faculty is afforded by instituting experiments with medicines upon ourselves. Whilst avoiding all foreign medicinal influences and disturbing mental impressions in this important operation, the experimenter, after he has taken the medicine, has all his attention strained towards all the alterations of health that take place on and within him, in order to observe and correctly to record them, with ever-wakeful feelings, and his senses ever on the watch.

By persevering in this careful investigation of all the changes that occur within and upon himself, the experimenter attains the capability of observing all the sensations, be they ever so complex, that he experiences from the medicine he is testing, and all, even the finest shades of alteration of his health, and of recording in suitable and adequate expressions his distinct conception of them.

Thus only is it possible for the beginner to make pure, correct, and undisturbed observations, for he knows that he will not deceive himself, there is no one to tell him aught that is untrue, and he himself feels, sees, and notices what takes place in and upon him. He will thus acquire practice to enable him to make equally accurate observations on others also.

By means of these pure and accurate investigations we shall be made aware that all the symptomatology hitherto existing in the ordinary system of medicine was only a very superficial affair, and that nature is wont to disorder man in his health and in all his sensations and functions by disease or medicine in such infinitely various and dissimilar manners, that a single word or a general expression is totally inadequate to describe the morbid sensations and symptoms which are often of such a complex character, if we wish to portray really, truly, and perfectly the alterations in the health we meet with.

No portrait painter was ever so careless as to pay no attention to the marked peculiarities in the features of the person he wished to make a likeness of, or to consider it sufficient to make any sort of a pair of round holes below the forehead by way of eyes, between them to draw a long-shaped thing directed downwards, always of the same shape, by way of a nose, and beneath this to put a slit going across the face, that should stand for the mouth of this or of any other person; no painter, I say, ever went about delineating human faces in such a rude and slovenly manner; no naturalist ever went to work in this fashion in describing any natural production; such was never the way in which any zoologist, botanist, or mineralogist acted.

It was only the semeiology of ordinary medicine that went to work in such a manner, when describing morbid phenomena. The sensations that differ so vastly among each other, and the innumerable varieties of the sufferings of the many different kinds of patients, were so far from being described by word or writing according to their divergences and varieties, according to their peculiarities; the complexity of the pains composed of various kinds of sensations, their degrees and shades, was so far from being accurately or completely described, that we find all these infinite varieties of sufferings huddled together under a few bare, unmeaning, general terms, such as perspiration, heat, fever, headache, sore throat, croup, asthma, cough, chest complaints, stitch in the side, bellyache, want of appetite, indigestion, dyspepsia, backache, coxalgia, haemorrhoidal sufferings, urinary disorders, pains in the limbs (called according to fancy gouty or rheumatic), skin diseases, spasms, convulsions, and c.

With such superficial expressions, the innumerable varieties of sufferings of patients were disposed of in the so-called observations, so that — with the exception of some one or other severe, striking symptom in this or that case of disease — almost every disease pretended to be described is as like another as the spots on a die, or as the various pictures of the dauber resemble one another in flatness and want of character.

The most important of all human vocations, I mean the observation of the sick, and of the infinite varieties of their disordered state of health, can only be pursued in such a superficial and careless manner by those, who despise mankind, for in this way there is no question either of distinguishing the peculiarities of the morbid states, or of selecting the only appropriate remedy for the special circumstances of the case.

The conscientious physician who earnestly endeavours to apprehend in its peculiarity the disease to be cured, in order to be able to oppose to it the appropriate remedy, will go much more carefully to work in his endeavour to distinguish what there is to be observed; language will scarcely suffice to enable him to express by appropriate words the innumerable varieties of the symptoms in the morbid state; no sensation, be it ever so peculiar, will escape him, which was occasioned in his feelings by the medicine he tested on himself; he will endeavour to convey an idea of it in language by the most appropriate expression, in order to be able in his practice to match the accurate delineation of the morbid picture with the similarly acting medicine, whereby alone, as he knows, can a cure be effected.

So true it is that the careful alone can become a true healer of diseases.