by Samuel Hahnemann
Review of the therapeutics, allopathy and palliative treatment
that have hitherto been practiced in the old school of medicine
As long as men have existed they have been liable, individually or collectively, to diseases from physical or moral causes. In a rude state of nature but few remedial agents were required, as the simple mode of living admitted of but few diseases; with the civilization of mankind in the state, on the contrary, the occasions of diseases and the necessity for medical aid increased, in equal proportion. But ever since that time (soon after Hippocrates, therefore, for 2500 years) men have occupied themselves with the treatment of the ever increasing multiplicity of diseases, who, led astray by their vanity, sought by reasoning and guessing to excogitate the mode of furnishing this aid. Innumerable and dissimilar ideas respecting the nature of diseases and their remedies sprang from so many dissimilar brains, and the theoretical views these gave rise to the so-called systems, each of which was at variance with the rest and self-contradictory. Each of these subtile expositions at first threw the readers into stupefied amazement at the incomprehensible wisdom contained in it, and attracted to the system-monger a number of followers, who re-echoed his unnatural sophistry, to none of whom, however, was it of the slightest use in enabling them to cure better, until a new system, often diametrically opposed to the first, thrust that aside, and in its turn gained a short-lived renown. None of them, however. was in consonance with nature and experience; they were mere theoretical webs, woven by cunning intellects out of pretended consequences, which could not be made use of in practice, in the treatment at the sick-bed, on account of their excessive subtilty and repugnance to nature, and only served for empty disputations.
Simultaneously, but quite independent of all these theories, there sprung up a mode of treatment with mixtures of unknown medicinal substances for forms of disease arbitrarily set up, and directed towards some material object completely at variance with nature and experience, hence, as may be supposed, with a bad result – such is old medicine, allopathy as it is termed.
Without disparaging the services which many physicians have rendered to the sciences auxiliary to medicine, to natural philosophy and chemistry, to natural history in its various branches, and to that of man in particular, to anthropology, physiology and anatomy, etc., I shall occupy myself here with the practical part of medicine only, with the healing art itself, in order to show how it is that diseases have hitherto been so imperfectly treated. Far beneath my notice is that mechanical routine of treating precious human life according to the prescription manuals, the continual publication of which shows, alas! how frequently they are still used. I pass it by unnoticed, as a despicable practice of the lowest class of ordinary practitioners. I speak merely of the medical art as hitherto practiced, which, pluming itself on its antiquity, imagines itself to possess a scientific character.
The partisans of the old school of medicine flattered themselves that they could justly claim for it alone the title of ‘rational medicine’, because they alone sought for and strove to remove the cause of disease, and followed the method employed by nature in diseases.
Tolle causam! they cried incessantly. But they went no further than this empty exclamation. They only fancied that they could discover the cause of disease; they did not discover it, however, as it is not perceptible and not discoverable. For as far the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses; so they exerted themselves to imagine one, and from a survey of the parts of the normal, inanimate human body (anatomy), compared with the visible changes of the same internal parts in persons who had died of diseases (pathological anatomy), as also from what they could deduce from a comparison of the phenomena and functions in healthy life (physiology) with their endless alterations in the innumerable morbid states (pathology, semeiotics), to draw conclusions relative to the invisible process whereby the changes which take place in the inwardbeing of man in diseases are affected – a dim picture of the imagination, which theoretical medicine regarded as its prima causa morbi;1 and thus it was at one and the same time the proximate cause of the disease, and the internal essence of the disease, the disease itself – although, as sound human reason teaches us, the cause of a thing or of an event, can never be at the same time the thing or the event itself. How could they then, without deceiving themselves, consider this imperceptible internal essence as the object to be treated, and prescribe for it medicines whose curative powers were likewise generally unknown to them, and even give several such unknown medicines mixed together in what are termed prescriptions?
1. It would have been much more consonant with sound human reason and with the nature of things, had they, in order to be able to cure a disease, regarded the originating cause as the causa morbi, and endeavored to discover that, and thus been enabled successfully to employ the mode of treatment which had shown itself useful in maladies having the same exciting cause, in those also of a similar origin, as, for example, the same mercury is efficacious in an ulcer of the glans after impure coitus, as in all previous venereal chancres – if, I say, they had discovered the exciting cause of all other (non-venereal) chronic diseases to be an infection at one period or another with the itch miasm (psora), and had found for all these a common method of treatment, regard being had for the peculiarities of each individual case, whereby all and each of these chronic diseases might have been cured, then might they with justice have boasted that in the treatment of chronic diseases they had in view the only available and useful causa morborum chronicorum (non venereorum), and with this as a basis they might have treated such diseases with the best results. But during these many centuries they were unable to cure the millions of chronic diseases, because they knew not their origin in the psoric miasm (which was first discovered and afterwards provided with a suitable plan of treatment by homÃopatby), and yet they vaunted that they alone kept in view the prima causa of these diseases in their treatment, and that they alone treated rationally, although they had not the slightest conception of the only useful knowledge of their psoric origin and consequently they bungled the treatment of all chronic diseases!
But this sublime problem, the discovery, namely, a priori, of an internal invisible cause of disease, resolved itself, at least with the more astute physicians of the old school, into a search, under the guidance of the symptoms it is true, for what might be supposed to be the probable general character of the case of disease before them;2 whether it was spasm, or debility, or paralysis, or fever, or inflammation, or induration, or obstruction of this or that part, or excess of blood (plethora), deficiency or excess of oxygen, carbon, hydrogen or nitrogen in the juices, exaltation or depression of the functions of the arterial, venous or capillary system, change in the relative proportion of the factors of sensibility, irritability or reproduction., – conjectures that have been dignified by the followers of the old school with the title of causal indication, and considered to be the only possible rationality in medicine; but which were assumptions, too fallacious and hypothetical to prove of any practical utility – incapable, even had they been well grounded, of indicating the most appropriate remedy for a case of disease; flattering indeed, to the vanity of the learned theorist, but usually leading astray when used as guides to practice, and wherein there was evidenced more of ostentation than of an earnest search for the curative indication.
2. Every physician who treats disease according to such general character however he may affect to claim the name of homÃopathist, is and ever will remain in fact a generalising allopath, for without the most minute individualisation, homÃopathy is not conceivable.
And how often has it happened that, for example, spasm or paralysis seemed to be in one part of the organism, while in another part inflammation was apparently present!
Or, on the other hand, whence are the certain remedies for each of these pretended general characters to be derived? Those that would certainly be of benefit could be none other than the specific medicines, that is, those whose action is homogeneous3 to the morbid irritation; whose employment, however, is denounced and forbidden4 by the old school as highly injurious, because observation has shown that in consequence of the receptivity for homogeneous irritation being so highly increased in diseases, such medicines in the usual large doses are dangerous to life. The old school never dreamt of smaller, and of extremely small doses. Accordingly no attempt was made to cure, in the direct (the most natural) way, by means of homogeneous, specific medicines; nor could it be done, as the effects of most of medicines were, and continued to remain, unknown, and even had they been known it would have been impossible to hit on the right medicine with such generalizing views as were entertained.
3. Now termed HomÃopathic.
4. “Where experience showed the curative power of homÃopathically acting remedies, whose mode of action could not be explained, the difficulty was avoided by calling them specific, and further investigation was stifled by this actually unmeaning word. The homogeneous excitant remedies, the specific (homÃopathic), medicines, however, had long previously been prohibited as of very injurious influence”. – Rau, On the Value of the homÃopathic Method of Treatment, Heidelberg, 1824, pp. 101, 102.
However, perceiving that it was more consistent with reason to seek for another path, a straight one if possible, rather than to take circuitous courses, the old school of medicine believed it might cure diseases in a direct manner by the removal of the (imaginary) material cause of disease – for to physicians of the ordinary school, while investigating and forming a judgment upon a disease, and not less while seeking for the curative indication, it was next to impossible to divest themselves of these materialistic ideas, and to regard the nature of the spiritual-corporeal organism as such a highly potentialized entity, that its sensational and functional vital
changes, which are called diseases, must be produced and effected chiefly, if not solely, by dynamic (spiritual) influences, and could not be effected in any other way.
The old school regarded all those matters which were altered by the disease, those abnormal matters that occurred in congestions, as well as those that were excreted, as disease-producers, or at least on account of their supposed reacting power, as disease maintainers, and this latter notion prevails to this day.
Hence they dreamed of effecting causal cures by endeavoring to remove these imaginary and presumed material causes of the disease.
Hence their assiduous evacuation of the bile by vomiting in bilious fevers;5 their emetics in cases of so-called stomach derangenments;6 their diligent purging away of the mucus, the lumbrici and the ascarides in children who are pale-faced and who suffer from ravenous appetite, bellyache, and enlarged abdomen7; their venesections in cases of haemorrhage;8and more especially all their varieties of blood-lettings,9 their main remedy in inflammations, which they now, following the example of a well-known bloodthirsty Parisian physician (as a flock of sheep follow the bellwether even into the butcher’s slaughter-house), imagine to encounter in almost every morbidly affected part of the body, and feel themselves, bound to remove by the application of often a fatal number of leeches. They believe that by so doing they obey the true casual indications, and treat disease in a rational manner. The adherents of the old school, moreover, believe that by putting a ligature on polypi, by cutting out, or artificially exciting suppuration by means of local irritants in indolent glandular swellings, by enucleating encysted tumors (steatoma and meliceria) by their operations for aneurysm and lacrymal and anal fistula, by removing with the knife scirrhous tumors of the breast, by amputating a limb affected with necrosis, etc., they cure the patient radically, and that their treatment is directed against the cause of the disease; and they also think, when they employ their repellent remedies, dry up old running ulcers in the legs with astringent applications of oxide of lead copper or zinc (aided always by the simultaneous administration of purgatives, which merely debilitate, but have no effect on the fundamental dyscrasia), cauterize chancres, destroy condylomata locally, drive off itch from the skin with ointments of sulphur, oxide of lead, mercury or zinc, suppress ophthalmiae with solutions of lead or zinc, and drive away tearing pains from the limbs by means of opodeldoc, hartshorn liniment or fumigations with cinnabar or amber; in every case they think they have removed the affection, conquered the disease, and pursued a rational treatment directed towards the cause. But what is the result! The metastatic affections that sooner or later, but inevitably appear, caused by this mode of treatment (but which they pretend are entirely new diseases), which are always worse than the original malady, sufficiently prove their error, and might and should open their eyes to the deeper-seated, immaterial nature of the disease, and its dynamic (spirit-like) origin, which can only be removed by dynamic means.
5. The estimable Hofrath Dr. Fau (loc. cit., p.176) at a time when not properly conversant with homowopathy, by firmly convince the dynamic cause of these fevers, cured them without employing ayn evacuation remedy, by means of one or two small doses of homoeopathic remedies, two very remarkable cases of wich he relates in his book.*
*[This foot note is entirely omitted in the Sixth Edition.]
6. In a case of sudden derangement of the stomach, with constant disgusting eructations with the taste of the vitiated food, generally accompanied by depression of spirits, cold hands and feet, etc., the ordinary physician has hitherto been in the habit of attacking only the degenerated contents of the stomach; a powerful emetic should clean it out completely. This object was generally attained by tartar emetic, with or without ipecacuanha. Does the patient, however, immediately after this become well, brisk and cheerful? Oh, no! Such a derangement of the stomach is usually of dynamic origin, caused by mental disturbance (grief, fright, vexation), a chill, over-exertion of the mund or body immediately after eating, often after even a moderate meal. Those two remedies are not suitable for removing this dynamic derangement, and just as little is the revolutionary vomiting they produce. Moreover, tartar emetic and ipecacuanha, from their other peculiar pathogenetic powers, prove of further injury to the patientÃs health, and derange the biliary secretion; so that if the patient be not very robust, he must feel ill for several days from the effects of this pretended causal treatment, notwithstanding all this violent expulsion of the whole contents of the stomach. If the patient, however, in place of taking such violent and always (a) hurtful evacuant drugs, smell only a single time at a globule the size of a mustard seed, moistened with highly diluted pulsatillajuice, whereby the derangement of his health in general and of his stomach in particular will certainly be removed, in two hours he is quite well; and if the eructation recur once more, it consists of tasteless and inodorous air; the contents of the stomach cease to be vitiated, and at the next meal he has regained his full usual appetite; he is quite well and lively. This is true causal medication; the former is only an imaginary one and has an injurious efect on the patient.
Even a stomach overloaded with indigestible food never requires a medicinal emetic. In such a case nature is competent to rid herself of the excess in the best way through the oesophagus, by means of nausea, sickness and spontaneous vomiting, assisted, it may be, by mechanical irritation of the palate and fauces, and by this means the accessory medicinal effects of the emetic drugs are avoided; a small quantity of coffee expedites the passage downwards of what remains in the stomach.
But if, after excessive overloading of the stomach, the irritability of the stomach is not sufficient to promote spontaneous vomiting, or is lost altogether, so that the tendency thereto is extinguished, while there are at the same time great pains in the epigastrium, in such a paralyzed state of the stomach, an emetic medicine would only have the effect of producing a dangerous or fatal inflammation of the intestines; where a small quantity of strong infusion of coffee, frequently administered, would dynamically exalt the sunken irritability of the stomach, and put it in a condition to expel its contents, be they ever so great, either upwards or downwards. So here also the pretended causal treatment is out of place.
Even the acrid gastric acid, to eructations of which patients with chronic diseases are not infrequently subject, may be today violently evacuated by means of an emetic, with great suffering, and yet all in vain, for tomorrow or some days later it is replaced by similar acrid gastric acid, and then usually in larger quantities; whereas it goes away by itself when its dynamic cause is removed by a very small dose of a high dilution of sulphuric acid, or still better, if it is of frequent recurrence, by the employment of minutest doses of antipsoric remedies corresponding in similarity to the rest of the symptoms also. And of a similar character are many of the pretended causal cures of the old-school physicians, whose main effort it is, by means of tedious operations, troublesome to themselves and injurious to their patients, to clear away the material product of the dynamic derangement; whereas if they perceived the dynamic source of the affection, and annihilated it and its products homÃopathically, they would thereby effect a rational cure.
7. Conditions dependent solely on a psoric taint, and easily curable by mild (dynamic) antipsoric remedies without emetics or purgatives.
8. Notwithstanding that almost all morbid haemorrhages depend on a dynamic derangement of the vital force (state of health), yet the old-school physicians consider their cause to be excess of blood, and cannot refrain from bleeding in order to draw off the supposed superabundance of this vital fluid; the palpable evil consequences of which procedure, however, such as prostration of the strength, and the tendeny or actual transition, to the typhoid state they ascribe to the malignancy of the disease, which they are then often unable to overcome – in fine, they imagine, even when the patient does not recover, that their treatment has been in conformity with their axiom, causam tolle, and that, according to their mode of speaking, they have done everything in their power for the patient, let the result be what it may.
9. Although there probably never was a drop of blood too much in the living human body, yet the old-school practitioners consider an imaginary excess of blood as the main material cause of all haemorrhages and inflammations, which they must remove and drain off by venesections, cupping and leeches. This they hold to be a rational mode of treatment, causal medication. In general inflammatory fevers, in acute pleurisy, they even regard the coagulable lymph in the blood – the buffy coat, as it is termed – as the materia peccans, which they endeavor to get rid of, if possible, by repeated venesections, notwithstanding that this coat often becomes more consistent and thicker at every repetition of the bloodletting. They thus often bleed the patient nearly to death, when the inflammatory fever will not subside, in order to remove this buffy coat or the imaginary plethora, without suspecting tbat the inflammatory blood is only the product of the acute fever, of the morbid, immaterial (dynamic) inflammatory irritation, and that the latter is the sole cause of the great disturbance in the vascular systan, and may be removed by the smallest dose of a homogeneous (homÃopathic) medicine, as, for instance, by a small globule of the decillion-fold dilution of aconite juice, with abstinence from vegetable acids, so that the most violent pleuritic fever, with all its alarming concomitants, is changed into health and cured, without the least abstraction of blood and without any antiphlogistic remedy, in a few – at the most in twenty-four – hours (a small quantity of blood drawn from a vein by the way of experiment then shows no traces of buffy coat); whereas another patient similarly affected, and treated on the rational principles of the old school, if, after repeated bleedings, with great difficulty and unspeakable sufferings he escape for the nonce with life, he often has still many months to drag through before he can support his emaciated body on his legs, if in the mean time (as often happens from such maltreatment) he be not carried off by typhoid fever, leucophlegmasia or pulmonary phthisis.
Anyone who has felt the tranquil pulse of a man an hour before the occurrence of the rigor that always precedes an attack of acute pleurisy, will not be able to restrain his amazement if told two hours later, after the hot stage has commenced, that the enormous plethora present urgently requires repeated venesections, and will naturally inquire by what magic power could the pounds of blood that must now be drawn off have been conjured into the blood-vessels of this man within these two hours, which but two hours previously he had felt beating in such a tranquil manner. Not a single drachm more of blood can now be circulating in those vessels than existed when he was in good health, not yet two hours ago!
Accordingly the allopathic physician with his venesections draws from the patient laboring under acute fever no oppressive superabundance of blood, as that cannot possibly be present; he only robs him of what is indispensable to life and recovery, the normal quantity of blood and consequently of strength – a great loss which no physician’s power can replacel – and yet he vainly imagines that he has conducted the treatment in conformity to his (misunderstood) axiom, causam tolle; whereas it is impossible that the causa morbi in this case can be an excess of blood, which is not present; but the sole true causa morbi was a morbid, dynamical, inflammatory irritation of the circulatory system, as is proved by the rapid and permanent cure of this and every similar case of general inflammatory fever by one or two inconceivably minute doses of aconite juice, which removes such an irritation homÃopathically.
The old school errs equally in the treatment of local inflammations with its topical bloodlettings, more especially with the quantities of leeches which are now applied according to the maniacal principles of Broussais. The palliative amelioration that at first ensues from the treatment is far from being crowned by a rapid and perfect cure; on the contrary, the weak and ailing state of the parts thus treated (frequently also of the whole body), which always remains, sufficiently shows the error that is committed in attributing the local inflammation to a local plethora, and how sad are the consequences of such abstractions of blood; whereas this purely dynamic, apparently local, inflammatory irritation, can be rapidly and permanently removed by an equally small dose of aconite, or, according to circumstances, of belladonna, and the whole disease annihilated and cured, without such unjustifiable shedding of blood.
A favorite idea of the ordinary school of medicine, until recent (would that I could not say the most recent) times, was that of morbific matters (and acridities) in diseases, excessively subtile though they might be thought to be, which must be expelled from the blood-vessels and lymphathics, through the exhalents, skin, urinary apparatus or salivary glands, through the tracheal and bronchial glands in the form of expectoration, from the stomach and bowels by vomiting and purging, in order that the body might be freed from the material cause that produced the disease, and a radical causal treatment be thus carried out.