By Dr. G. H. G. Jahr.
(Translated from the Journal de la Societe Gallicane,)
By E. E. Marcy, M. D., New York.
GENERAL REMARKS: — The clinical observations which we propose to publish in successive numbers of this REVIEW, and which will be, for the most part, extracts from German publications, are designed chiefly as studies of the therapeutic character of medicines, as well as a collection of clinical facts derived from French practitioners. But in order that our readers may understand the arrangement of these facts, with reference to the study of characteristic symptoms, we find it necessary to precede these studies by a few general remarks which have already appeared, in part, in our last work on the practice of homoeopathy, but which require a little more explanation.
As a general rule, there is nothing more erroneous than to suppose that we can comprehend the therapeutic character of drugs, by a presentation of clinical facts. In the first place, those facts which, by chance, have been published, do not form perhaps the thousandth part of the cases which homoeopathic physicians treat every day, without publishing them; consequently, if we had all of them before our eyes, the conclusions which would result from them respecting the curative sphere of a medicine would perhaps be quite different from those which are now obtained from the study of facts we already possess. The true character of medicines cannot then be obtained except from pathogenetic symptoms derived from pure experimentation. But clinical observation may serve to complete and elucidate these studies. But in order to accomplish this last point, it is necessary that they should be arranged with discernment and a knowledge of cases, that is to say, we should not retain all of the symptoms which furnish these facts, but confine ourselves exclusively to those which are in a condition to furnish indications. It is in this way that beginners usually commit a grave error, in supposing that, above all, they ought to collect the symptoms which have constituted the principal malady of the clinical cases given; that is to say the pathognomonic symptoms, and to eliminate from them carefully those which appear to be purely accidental or accessory. But in order to arrive at the truth an opposite course must be pursued. For, indeed, all pathognomonic symptoms are necessary symptoms, in all cases which appertain to a malady of the same name, and they ought consequently to be found in the most diverse cases of this same disease, for if the phenomena of medicines are unknown, we shall miss their most valuable indication in all special cases of this same malady. To know the particular circumstances which causes one medicine rather than another to cure a given case, it is necessary to seek it, not in those invariable symptoms which occur in all cases of the same malady, but, on the contrary, in these accidental symptoms which may be joined to a case, and without which the disease would change its name. Besides this, nothing is more uncertain than the pathognomonic symptoms of clinical cases, because that all ought necessarily to disappear together, when the principal lesion upon which they depend is cured; for it would be very wrong to insert them among the curative effects of a medicine, if the pathogenetic study of their substance has not already revealed them as actually appertaining to the sphere of action of the drug. This is even so much the more important, as it is not sure to see a malady cured by means of a medicine whose pathogenesis does not contain in a striking manner, any pathognomonic symptom, but whose characteristic symptoms respond in a most marked manner to the accidental symptoms of a given case. The same thing obtains in other cases where a medicine whose pathogenesis contains positively all of the pathognomonic symptoms of the disease in name, but does not produce any good effect, in consequence of the single fact that it does not possess at the same time the characteristic symptoms or indicators which distinguish the given case as a special one.
In order to profit by a knowledge of the true therapeutic character of medicines, the study of clinical cases ought to be undertaken in such a manner as to combine, in each case, symptoms which are particularly indicators; that is to say, accessory symptoms which, in diseases the most diverse relative to their name, might indicate the efficacious and salutory use of this medicine.
Made from this point of view, this study, absolutely inadmissible as it is, when it comprehends only pathognomonic symptoms, becomes not only more useful, but actually indispensible, in throwing a more vivid light upon the character of pathogenetic effects, especially when facts of the most diverse nature combine to confirm the salutary influence of a medicine as such or such accessory symptoms always characterize a given case. This rule is so general, that all symptoms confirmed in this manner, may be boldly regarded as perfectly equivalent to the pathogenetic symptoms, even when these experimentations have not yet demonstrated any simile. The same rule holds good up to a certain point, with all morbid symptoms which disappear in a manner isolated under the influence of a medicine, and while the principal malady is not materially ameliorated: as, for example, vomiting which, in consequence of a dose of Ipecacuanha, alone ceases in a case of cholera; as the rapid pulse and the intense febrile heat which alone disappear after a dose of Aconite, in the treatment of an inflammatory disease, and so on. All symptoms thus cured may be included in the symptomatology as equivalent to the pathogenetic symptoms, even when they have not yet been observed as such, provided only that we take the precaution to distinguish them, by some sign, from the latter. Hahnemann in his treatise on Chronic Maladies has included some of these, among other symptoms, at the end of the preface upon medicines called antipsorics, and which have been very erroneously confounded with characteristic symptoms. This confusion, which still exists in many writings, is so much the more deplorable, as Hahnemann himself has, in the most formal manner, protested against everything which tends to contribute to it. Already, in the last edition of his Organon, he says positively that it is not necessary to regard those clinical symptoms, collected by him, as indicators (or characteristic symptoms) for the choice of the medicine, because that they are only signs ab usu in morbis, incapable of furnishing any definite indication: and, in the second edition of his Chronic Maladies, page 150 of the German edition, he reverts to the subject as follows: We translate.
"This shameful indolence, in a work which requires so much accuracy, is often applicable to pretended homoeopathists who only select medicines according to clinical signs (ab usu in morbis) such as they find enumerated in the preface of medicines, and is a mode of procedure absolutely false, and very similar to that adopted by allopathists. For these clinical signs only express isolated symptoms capable of confirming to a certain extent the choice which should be made, according to the characteristic pathogenetic symptoms, but which ought never to be taken as a guide in the choice itself, especially as they are only problematical. Notwithstanding, there are authors who advise this empirical mode of procedure."
To this passage, imperfectly rendered in the French translation of Jourdan, we may add that the "authors" of whom Hahnemann speaks are homoeopathic authors whose names we could cite, as we were at that time writing under the dictation of the master. We claim the right therefore of deciding what Hahnemann regarded as characteristic symptoms capable of serving as indicators for the absolute choice of remedies. Indeed these clinical symptoms, placed by him at the head of the pathogeneses of his antipsoric medicines, are, as he himself observes, nothing less than special indicators, simply THERAPEUTIC signs, which, like pathognomonic symptoms of pathogeneses, declare in a general manner in what affection a medicine may do good, when it will be specially indicated, but which in themselves do not declare when, or by the presence of what particular symptom, this medicine will be specially indicated against one or the other of these clinical signs included at the head of the pathogeneses. This does not imply that there may not be characteristic signs or special indicators among these clinical symptoms; but those which have this quality do not possess it in virtue of their character of clinical symptoms, but in virtue of the special role which they play, besides this, in the general therapeutic physiognomy of the medicine.
Clinical and characteristic symptoms of a medicine are not identical, unfortunately for those who confound them in practice. The first, when well selected, are signs that the medicine can cure, particularly if it is specially indicated. Characteristic symptoms are those which indicate the medicine, and which can be selected as well by the study of its pathogenesis alone as by that of clinical cases. Thus most of the characteristic symptoms which Hahnemann has pointed out to us, especially of Pulsatilla, Ignatia, Nux vomica, and other substances of his Materia Medica, have been recognized by him, not in practice, but from comparative studies which he has made of pathogenetic symptoms among themselves, and according to which he employs medicines with perfect tact, without knowing a single clinical symptom. These characteristic symptoms even now fail us with regard to all antipsoric medicines, notwithstanding the great number of clinical signs with which Hahnemann has accompanied their pathogeneses; and if we had remained with him a longer time, during the last years of his sojourn in Germany, he would perhaps have done for them what he has done for many medicines of his Materia Medica; for indeed, we had commenced, with him, a very extensive preparatory work for the comparative study of all the symptoms of many antipsoric drugs. Later, we have continued this work alone, according to the indications and views of Hahnemann, with the intention of thus filling one of the most essential defects of his works. But, as clinical observations, although incapable of furnishing all of the characteristic symptoms, may however, contribute much to the confirmation of those which pathogenetic studies have included as such, we have prefered to join the results of both, which we have constantly done to retard the publication of our works of this kind.
The series of publications which we have commenced today is designed to place before our readers the first part of our work, that is to say, the clinical elements. We expect to dispose of these elements in such a manner that they shall be associated with the characteristic symptoms which constitute the pathogenesis of each medicine. To this end, we shall first give, in the most precise manner, the chief symptoms of all cases which any given medicine has cured. Then, after having reviewed all these cases, we shall arrange the symptoms which, both from clinical observations and from the pathogenetic character of the medicine, appear to have the most general application to the most diverse cases of disease. In this work we shall follow precisely the method indicated by Hahnemann, when we worked under his supervision, and according to the same method by which we together achieved the study of the character of many medicines, especially of Aconite, Sulphur, Silicea, and Arnica. We hope that two things will result from this work, viz, to know:
1st. That the symptoms which Hahnemann himself regarded as characteristic for the choice of medicine are not identical with the clinical signs which he has placed at the head of the pathogeneses of his antipsorics.
2d. That the works and opinions which Hahnemann has published in this sense, in order to make known the character and symptoms indicative of Pulsatilla, Bryonia, Quinia, etc., do not include all the signs which he regards as characteristic for the choice of these substances; and which he would have given, if he had intended to publish thereupon a complete work. This remark applies with still greater force, to all medicines respecting whose therapeutical character we possess only a few notes made by him; that is to say, incidentally, as for example, upon Aconite, Camphor, etc.
We commence our work to day with Aconite, where our readers may see how we intend to satisfy both the exigencies of a clinical bulletin, by the publication of practical facts, and those of a work upon the character of medicines. In a word, we expect in future, to publish alternately a series of new observations, and a series of observations made with a single medicine, both, for the benefit of the practice.
VERTIGO. — 1. A man forty years of age, with light hair, red face, healthy, but accustomed to sanguineous discharges until four years since, was taken with an attack of general heat, with sweat, redness of the face, violent vertigo forcing him to sit down, and the paroxysm continuing about two hours. Four weeks afterwards he had two new attacks, the last of which was accompanied with vomiting, great weakness, and slow and uncertain step. After the use of six doses of Aconite 3d, one drop morning and evening, the attacks disappeared. — Gazette Homoeopathique of Leipzig, vol. XXXII page 228, Lembka.
2. A young man of an apoplectic constitution, and suffering from repeated attacks of vertigo, forcing him to support himself — with buzzing in the head, and difficulty in collecting his ideas, was cured of his complaint with a drop of Aconite 3d, daily. — Hygea, vol. V, page 102, Schroen.
3. A woman forty-three years old, after a fright, had attacks of vertigo whenever she attempted to rise, and forcing her to remain in bed — with great anguish, as if she was about to die. Immediately after the fright she had felt a whirling sensation in the stomach, which soon ascended to the head, with trembling, and a sensation of faintness and vertigo. Aconite 15th, followed by two doses of Opium 9th, sufficed to cure the malady. — Annales de Hartlaub et Trinks, vol. I, page 72, Bethmann.
4. Aconite decidedly produces vertigo, faintness, weakness, apoplexy, and singing in the ears, and its curative power against these affections is very positive as experience has already demonstrated. — Hahnemann, Studies respecting a new principle for the discovery of the curative virtues of medicines. — Journal of Hufeland, vol. II, sheet 3.
5. Aconite produces all the morbid phenomena which we observe in persons who have had a fright accompanied with vexation, and it is the most efficacious remedy in these cases. — Hahnemann, Materia Medica, preface to Aconite.
6. General indications.—Vertigo which forces the patient to sit down, to support himself, to lie down; apoplectic constitution; fright as the cause.
7. Vertigo as if he would have to fall down, or with tottering, not much when seated, but strongest when rising from his seat. — Materia Medica, symptoms 2, 3, 5.
APOPLEXY. — 8. A young girl twenty years old, in full health, of an apoplectic constitution and very plethoric, menstruating profusely, was attacked with apoplexy, after a fright with vexation. She fell suddenly as if stricken with lightning. Respiration slow and rattling, face and body like a corpse, marbled with violet; pulse imperceptible, beatings of the heart slow and trembling, pupils insensible to light; involuntary emission of urine; limbs cold and rigid. After five doses of Aconite 1st, at intervals of a quarter of an hour, and the simultaneous application of cold compresses to the head, and of warm napkins to the limbs, the first signs of a return to life manifested themselves. At the end of eight hours, after a few new doses of Aconite at intervals of sixty to ninety minutes, life and consciousness completely returned, but the entire left side was paralysed, the arms and feet of this side being cold and incapable of any movement; speech stammering, tongue drawn to the left side, left ear deaf, ringing in the whole head, the left side of the lips elevated in a sensible manner during respiration; the breast is cold to the touch, and leaves the impress of the finger. At the expiration of thirty hours, after a drop of Aconite 3d every two hours, the entire condition was ameliorated, with the exception of the congestion of the head, the buzzings, the stammering, and the paralysis of the tongue and limbs, which were cured with Opium.—Sturm, Gazette Homoeopathique de Leipzig, vol. I, page 66.
9. A man sixty-four years old, having a short neck, large shoulders, addicted to spirituous drinks and sexual pleasure, had an attack of sanguineous apoplexy, with all signs of life upon the point of being extinguished. At the end of four hours, after drop doses of Aconite 1st. every hour, life returned. At the expiration of twelve hours, after a dose of Aconite 3d every three hours, consciousness, vital heat and complete mobility of the upper extremities were restored. Nothing remained except paralysis of the lower limbs, of the bladder and rectum, and strong pains in the back and lumbar region, which were cured with Nux vomica. — Sturm, loco cit., page 67.
10. Aconite appears to correspond especially to sanguineous apoplexy, and is particularly adapted to persons of an apoplectic constitution, or to those who have suffered from maladies in the sphere of the circulatory system, as well as to apoplexy caused by a suppression of habitual haemorrhages. In general it is indicated when the head is hot to the touch, with violent pulsation of the carotids, skin rather hot than cold to the touch, pulse full, strong and hard, or nearly suppressed, but not intermittent. — Dose: 15th to the 18th dilutions. — Kreussler Therapeutique des Maladies aigues et chroniques, page 126.
11. Aconite is particularly capable of producing transient apoplectic and paralytic affections, partial or general, and its curative efficacy is the same in maladies of this kind. — Hahnemann, Etudes sur un nouveau principe, etc., Journal de Hufeland, vol. 1, sheet 3, 1796.
12. Symptoms which are particularly indicators. Sanguine temperament, plethoric constitution, pulsation of the carotids, face hot and red, or cold and pale; paralysis of the left side.
(To be Continued.)