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Boenninghausen

It is now over three years since the great Homoeopathic Congress was held in Brussels, Germany being, I am sorry to say, but little represented. In the last session of this meeting after several propositions had been read, my resolution was adopted and a prize-question was proposed, to answer which a period of two years was granted. This prize essay, as the Homoeopathic journals have also made known, was intended to call out a "Treatise concerning the greater or lesser (characteristic) value of the symptoms occurring in a disease, to aid as a norm or basis in the therapeutical selection of the remedy." The answer to this question was not limited to Belgium or to France, but it was handed over to the competition of the whole medical world, and it was thus unanimously acknowledged to be a subject of the greatest importance. Nevertheless, this question, in spite of the daily increase of the homoeopathic literature, has thus far remained unsolved. This silence extending far over the time set, which was computed liberally enough, seems to justify the assumption that the solution of the question has met with considerable difficulties, though every homoeopath must every moment find himself in the position to ask himself this question, and to have to answer it. It might not appear altogether proper for me, the author of the question, to also now enter among the competition for this prize. But the old practitioner will be pardoned for furnishing at least some contribution to the solution, and thereby again calling attention to the question.

The teaching of the Organon in this matter really contains the proper, true kernel of the answer, and this, of course, deserves to be first premised. It is found in the great Paragraph No. 153 (5th Ed.) and is as follows:

"In seeking for the specific homoeopathic remedy, i.e., in this juxtaposition of the phenomena of the natural disease and the list of symptoms of the medicines, in order to discover a morbid potency corresponding in similitude to the evil to be cured, the more striking, particular, unusual and peculiar (characteristic) signs and symptoms of the case should especially and almost solely be kept in view; for there must especially be some symptoms in the list of the medicine sought for corresponding to this, if the remedy should be the one most suitable to effect the cure. The more general and indefinite symptoms, such as lack of appetite, headache, weariness, disturbed sleep, uncomfortableness, etc., in their generalness and undefinedness deserve but little attention, unless they are more especially pronounced, as something of such a general nature is seen in almost every disease and in almost every medicine."

It is seen, however, that it is here left to the physician to judge what is understood by the "more striking, particular, unusual and peculiar" symptoms, and it might, indeed, be difficult to furnish a commentary to this definition, which would not be too diffuse and, therefore, easily understood, and on the other hand would be complete enough to be properly applied to all these cases. Whence is it that we are unable to show any such definition in our literature? Even what Hahnemann adduces in ยง86, and those that follow, only contains some examples which are given without any systematic order, and are therefore but little suited to impress themselves on the memory, a requirement which in all such matters must appear to be of very great importance.

After looking about in the whole of the medical writings, allopathic as well as homoeopathic, for an aid, I remembered that in the middle ages they were accustomed to bring all such matters into the form of verses, in order that the memory might thus be assisted. The modern learned world knows, e.g., the diet of the Schola salernitana, dating from the beginning of the twelfth century, drawn up in leonine verses, as is supposed, by a certain John of Milan, from which some parts are quoted even to this day. But though I did not find here anything for the present purpose, I yet found something which, as it seemed, might prove useful with writers of quite a different doctrine. There is, namely, a hexameter dating from this same period but from the theologic scholastics; this is, indeed, of a somewhat jolting construction, nevertheless it contains briefly and completely the various momenta according to which a moral disease is to be judged as to its peculiarity and grievousness. The verse is the following:

"Quis? quid? ubi? quibus auxiliis? cur? quomodo? quando?"

The seven rubrics designated in this maxim seem to contain all the essential momenta which are required in the list of the complete image of a disease. May I be allowed, therefore, to attach my remarks to this scheme, with the desire that this hexameter, which was formerly used only by theologians, may now be also impressed on the memory of homeopaths and be put to use by them.

1. Quis?

As a matter of course the personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it.

To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both, if possible, separated, according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice.

The greatest and most important variations are here found mostly in the states of the mind and spirit, which must by scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies. In all such cases we have all the more cause to fathom these states with all possible exactness, as in them frequently the bodily ailments recede to the background, and for this very reason offer but few points for our grasp, so that we may be able to make a sure selection among the remedies which compete.

Paragraph 104 of the Organon makes it a duty of the homoeopath to make a written scheme of the image of the disease, and whoever has once acquired a certain facility in this will easily know how to satisfy this requirement and gradually acquire a certain specializing penetration, which will prove to him of ever increasing usefulness. For as every man presents an individual nature different from every other one, and as every medicine must be exactly adapted to this individuality, in agreement with the symptoms, which it is able to produce in the total man, so, an once, at this first investigation as to the Quis? A great number of medicines are thrust aside, just because they do not correspond to the personality of the patient.

The spiritual and dispositional individuality of the patient here gives the most important, often almost the only deciding points for the selection of the remedy, where the disease involved is one of the mind or spirit, and generally the two disturbances present themselves so conjoined into one that the signs of the one only receive their full and definite character from the other. Hahnemann, indeed, recognized the importance of this two momenta from the beginning, but the necessity of weighting the two in their connection with one another he only recognized later on it its full measure; and he then placed the symptoms proper to the two, which in the first provings had been separated, one making the beginning and the other the end, in the "Chronic Diseases" immediately one after the other, an improved arrangement, which we also find in the best works on Materia Medica Pura of later times.

Many other things belonging to this rubric, but concerning the bodily individuality and presenting, as it were, the chief features in the portrait of the patient, are contained in those books under the heading of "general." It would be desirable and would greatly facilitate the use if everything not pertaining thereto should be excluded, and the former be brought under a particular rubric denominated either "Individual" or "Personal," in such a way that the corporeal would present a separate picture, as has been done with respect to the spiritual and mental.

2. Quid?

Of course this question refers to the disease, i.e., to its nature and peculiarity.

It may be unquestionably received as an axiom that we must first know an evil accurately before we are able to give any effectual aid against it. That occasionally relief may be given, without having first recognized the nature of the evil, as little refutes this axiom as the fact that an unexpected event occurs frequently which lies outside of our computation, and which either leads to good or evil, while neither the good will, nor the knowledge of the physician have the least to do with it.

But this axiom must be associated with another, which is no less true and no less important, namely this: That we must also know and possess the means which are able to relieve the evil when it is recognized. Where these are lacking, the former are of course of no avail.

Since the times of Hippocrates, thus since more than two thousand years, very much has been done with respect to the first point, and we have especially enjoyed a great progress and enlightenment within the last century and up to modern times. The path of pure observation and experience, which for a time had been pretty much forsaken, and on which that ancient Father of the healing art had gathered his valuable material, has again been entered upon. At the same time our contemporaries possess and use the great advantage enuring to them from the fact that they stand on the shoulders of their predecessors, and can thus view a greater circle of vision and, more especially, that astonishing progress has been made in all the subsidiary sciences, especially in chemistry and anatomy; so also they have had the advantage offered them by many physical instruments, which it must be confessed they have used with industry and care. By these means the modern physiological school, and, at the same time, the diagnostics of diseases, have reached an excellence not attained in earlier times.

The only thing of which every Homoeopath has to complain in this matter, is that things are conducted in too general a manner for his doctrine, and that almost universally diseases are described and treated of under the same name, which differ essentially in their nature, and require for their cure very different medicines.

An immediate result of this failing is, that Homoeopaths can make only a very limited use of the great advance made by the dominant school in diagnostics, since their generality excludes every special direction as to the suitable remedy.

Now since the modern Materia Medica of allopathy, as well as the older one, moves in the same generality, the conclusion follows almost inevitably that even the most cultivated allopath often stands undecided when he is to make a choice of remedies, so that almost every one of them will order something different, and that he is usually compelled to mix many thins together in order to cover the various indications.

More about this will be found in the course of this short treatise in a more suitable place, where the other questions are also discussed. Here I can only say so much about it.
a. That the most penetrating and most indubitable diagnostic as offered by the best allopathic manuals is rarely of ever sufficient for the Homoeopath, so as to enable him to make a sure selection of the remedy, and that
b. Such a diagnostic at most, and even then not always, may serve to exclude all those remedies from the competition which do not correspond with the common genius of the disease, but seem to act chiefly on other parts of the organism.

3. Ubi?

The seat of the disease really makes a part of the former question, but it nevertheless deserves to be more particularly emphasized, as it frequently furnishes a characteristic symptom, since almost every medicine acts more and also more decidedly on certain particular parts of the living organism.

These differences not only enter into consideration in certain so-called local diseases, but also in those diseases which are called by more general names, as affecting the whole body, e.g., gout and rheumatism. For it is probably never or very rarely the case that all parts of the body are affected in the same degree; even if it should be merely the case that the right side is more affected than the left or the reverse. But the examination of the parts affected is most necessary and most required when the whole to which they belong is larger, and is described merely in that general way which allopaths seem to delight in. Such names as headache, eyeache, toothache, colic and the like can in no way contribute to a rational choice of a remedy, not even when also the kind of pain is indicated.

Of course, the exact individualization of the ubi is most necessary in local ailments. Every Homoeopath knows from experience how necessary it is, e.g., in treating toothache, to select a remedy which in accordance with its provings on healthy persons has shown its action on the especial tooth to be treated. Among the most striking and decisive phenomena in this respect we should especially number the sores on the upper side of the joints of fingers and toes, which under allopathic treatment frequently prove very obstinate, and not infrequently become malignant, and necessitate an amputation, and, as I had an opportunity of witnessing here in two cases, may even have a fatal result. Every Homoeopath knows the efficacy of Sepia in these ulcers of the joints, which have no otherwise distinguishable features when this remedy is taken internally; without any external medication it will have a sure effect. Medicines which correspond to similar ulcers on other parts of the body in such cases are utterly useless.

If the practice of auscultation and percussion, as well as the use of the stethoscope, the plessimeter, etc., had been as well known to Hahnemann and his pupils as to our young physicians, they would no doubt have made the most extended use of the same for gaining a more exact knowledge and delimitation of interior ailments. They would have found out in lung troubles, e.g., definite local signs pointing to the use of certain remedies, and would have indicated them more accurately, and would not have limited themselves to defining them as being on the left or on the right side or at the top or below. To bring up to date and to specify more closely might be one of the chief duties for those who make additional provings at the present time, and might serve to an important and essential enrichment and completion of our Materia Medica more than a whole mass of confirmations of older symptoms or the finding out of new ones, which mostly have a lack of individuality.

At the same time it will be conceded from the allopathic side that the closer delimitation of the part affected, even though it may be of moment in the completion of the diagnosis, will be of no use to allopathic therapy, because this school is unacquainted with the peculiarities of the various medicines. No allopathic Materia Medica gives any information that the one remedy, e.g., corresponds more to the anterior or the posterior lobe of the liver, more to the upper or the lower part of the lungs, on the right or the left side, according to which the choice of the remedy may be made. Even if we Homoeopaths do not as yet know this as to all remedies, we do know it with respect to many of them, and for what is lacking we find a substitute in other signs, since, as is well known, all of these correspond to the remedy to be selected, at least they must not be opposed to it. Thence it may be seen that these new inventions, the value of which I am not in any way inclined to undervalue, have far less value in a therapeutic direction than in prognosis, where they show the extent and the dangerous nature of the malady.

Finally, we must yet consider in this question that neither the internal changes, which can be determined by these instruments, nor the material external changes, which manifest themselves openly to our notice, never present the dynamic disease itself, but are only its products, and are only developed in the course of the disease. When, therefore, these first beginnings are checked by the suitable remedy before those disorganizations take place, then these latter would not come to be developed, and it would be an inexcusable procedure to allow these sufferings to advance to a point where these material changes can be recognized in an artificial manner. It was necessary to mention this, in passing, in order that it may be shown how Homoeopathy proceeds, and to deny most decidedly the objection sometimes made that Homoeopathy is merely an expectative method, which allows the disease to develop without hindrance until it is too late to help. On the contrary, Homoeopathy knows and uses in infections diseases sure prophylactic remedies, which are always and exclusively such as have the power to heal the disease itself, and they never omit their use for the protection of those around the patient.

Next (Part Two)

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