Homeopathy - for Life
Study of the Materia Medica (Excerpt from the Science of Therapeutics)
by Carroll Dunham
The method by which any subject may be most successfully studied must depend on the use which is to be made of the knowledge thus gained. It is proper, then, to inquire at the outset in what way the knowledge of Materia Medica is to be made subservient to the treatment of disease.
In accordance with the homoeopathic law, we select for the cure of each individual case of disease that remedy of which the pathogenetic effects are most similar to the symptoms of the case. In the process of making this selection we must pass in mental review the various drugs which compose the Materia Medica, take a comprehensive view of the pure effects of each, and institute a comparison between each in turn, and the case for which we are prescribing. This is the theory of the process.
Now, it is evident that, in order to select from a number of candidates one which most nearly resembles a given standard, we must be familiar, not merely with the general properties of all the candidates or of certain classes into which they may be divided, but also with certain properties more or less peculiar to each one of the candidates, and which shall serve to distinguish each of them from all the others.
In fact our method requires the strictest individualization of both disease and remedy. We are so to study Materia Medica as, above all, to bring into strong relief and fix firmly in memory those peculiarities of each drug which are not met with in any other, and which therefore serve to individualize and give character to the drug that produces them and which are called its "characteristic symptoms." This term having been much and loosely used of late, it may not be unprofitable to devote a few words to the subject of characteristic symptoms.
By some writers the leading and most obvious and most frequently recurring symptoms are called characteristic. Thus Bennett calls fever a characteristic of the Exanthemata. By others the pathognomonic symptoms of a class of diseases are called characteristic, by others the pathologico-anatomical.
Now, the signification of such a word as characteristic is not absolute. It depends on the connection in which you please to use it, and which is determined by the question, "Characteristic of what?" In the instances just adduced, the varieties of symptoms cited may indeed be called characteristics, but-characteristic of what? Of classes (the Exanthemata), of groups (nosological)-but not of individuals. But the only sense in which Homoeopathists can use the term is in its application to individuals.
Hence a characteristic symptom must mean one which is possessed by none other than the individual drug of which it is predicated, and to which therefore it gives character as an individual. In this sense it corresponds precisely to those features of a man by which his friends are enabled to distinguish him from other persons and to recognize him at a glance.
It is obvious that these characteristic symptoms so precious to the Therapeutist may seem to be of little or no pathological value, may even seem accidental to those who forget that there are no accidents in Nature. They would be valueless if we did not need to individualize, but could be content with grouping our diseases and remedies.
To the Naturalist whose object it is to group his specimens, it is sufficient to know that John Doe has a vertebral column, is a mammal, has two hands, and is a Caucasian because this enables him at once to place John Doe in the variety Caucasian of the species man, and his analysis goes no farther. From this his whole physiological status follows.
But these items of general knowledge would hardly enable the sheriff to recognize John Doe in Broadway. It is of no importance to the Naturalist that he has such "accidental" peculiarities as an aquiline nose, black eyes and hair, and a brown mole on the left ala nasi; but these very peculiarities are all important to the sheriff, for they give him the means of detecting the object of his search upon the crowded street.
It must not be forgotten, however, that the points on which the Naturalist laid stress are equally important to the sheriff, for if the latter should bear in mind only the individual peculiarities of the object of his quest and should forget that he is a Caucasian, he might find the former in the person of an Indian, or, if he should forget that he is a bimanous creature, he might arrest a monkey.
To drop the figure, then, it is evident that we must seek to discover among the symptoms of every drug certain ones that are produced by no other drug, and which shall serve to distinguish it from all other drugs similar in other respects; that these symptoms will often be unimportant and trivial in a physiological point of view; furthermore, that we must, for convenience sake, when the number of drugs in our Materia Medica has become considerable, endeavor so to group them, on the basis of certain clearly defined symptoms or collections of symptoms, that for the purpose of preliminary examination and comparison, these groups may be regarded and compared as though they were individual drugs.
Let us suppose a case of uterine hemorrhage. As many as forty drugs probably produce uterine hemorrhage. On the basis of this symptom, they form a group isolated from the three hundred and forty remaining drugs of the Materia Medica. We select this group from the Materia Medica, and now we must select a remedy from the group. It is a tedious task to consider and compare them one by one. But we group them again; ten of them produce dark-colored and ten florid hemorrhage; ten a limpid and ten a clotted discharge. Our case has a dark-colored discharge. Our choice is now restricted to ten drugs. But of the ten which produce a dark discharge, only five produce simultaneously a congestive headache. Thus we are limited to five drugs.
Thus far, the distinctions on which our grouping has been based (or which have been characteristic of the groups) have had a pathological significance and importance. We can find no such basis for any further subdivision into groups. But we observe in the case a peculiar subjective symptom. The patient complains "as though a living body were moving through the abdomen."
This may seem trivial. It is equally, however, a symptom produced by Crocus, which is one of the five remedies to which our choice had been restricted, and it is produced by no other drug in the Materia Medica. It is, then, a characteristic symptom of Crocus, enabling us to individualize Crocus, and to distinguish it from all the other drugs which in many other respects agree with it.
It will be observed that dark-colored uterine hemorrhage, though produced by Crocus, cannot be said to be characteristic of it. It is a characteristic symptom of a group to which Crocus belongs, but not of Crocus, for it is produced by the other members of this group as well as by Crocus.
Characteristic symptoms must of necessity be for the most part subjective and seemingly trivial phenomena. A list of them alone, if presented as the pathogenesis of a drug, would be as meaningless, and at first sight as ridiculous, as a list of the colors and marks and angles and curves by which friends recognize each other would be, if presented alone as the sum total of the properties of certain genera and species of the animate creation.
As a background to the latter, there must be a series of phenomena capable of morphological and organic arrangement, and as the basis of the former we must have a series of objective and organic symptoms capable of physiological and pathological arrangement and of approximate explanation. But it must never be forgotten that without the characteristics, as we have described them, there can be no individualization, and without this there can be no accurate homoeopathic prescription.
The truth of this is made apparent by a glance at the history of Homoeopathy. Certain of Hahnemann's followers discarded the apparently trivial subjective phenomena from the provings of drugs, retaining only the objective, organic symptoms. They thus lost the means of distinguishing between the individual members of the groups of remedies. It was thenceforward useless for them to discriminate closely between individual cases of any one type of disease.
Hence, inevitably, arose the fashion of prescribing a specific remedy for a disease, as the phrase went, putting the leading members of respective groups of drugs and diseases to represent the whole groups. These were the so-called "specifikers," who had one or two remedies for dysentery, one for whooping-cough, one or two for scarlatina, etc., "of whom the world is weary."
But the characteristic is not always a definite symptom. Sometimes it is so, as in the case of Crocus, and as in the peculiar diplopia of Stramonium. But sometimes it resides in a peculiar condition which attaches to some symptom common to two or more drugs. This condition may be of time, or circumstance, or concomitance.
Thus, if two drugs have the symptom "dry cough from tickling in the suprasternal fossa," but to one is added the condition "occurring only in the evening," this condition of time is the characteristic of that drug in so far as the dry cough is concerned; or if one have this condition of circumstance, that "the cough is aggravated by inspiring cold air," this condition is the characteristic; or if one have the concomitant that the cough is attended by retching, this condition of concomitance is the characteristic.
Sometimes the characteristic resides in the conditions collectively. We borrow examples from Dr. Drysdale's admirable Introduction to The British Repertory:
"Pain in the stomach with nausea occurs under twenty-eight medicines.
"Pain in the stomach in the morning under thirty-seven.
"Pain in the stomach with nausea in the morning under four only."
Or it may reside in a concomitant.
"Dry retching occurs under forty-five drugs.
"Dry retching in the morning under five.
"Dry retching with eructation under one only - Ledum."
Every drug-proving, then, is to be studied in a two-fold way: On the one-hand, so as to enable us to attach it in our memory to certain groups of drugs to which it shows marked general resemblances; and, on the other hand, so as to bring out clearly into view those characteristics which distinguish it from all the other drugs of these groups in particular and of the Materia Medica in general. Our study will be at once synthetic and analytic.
Such a study is of necessity comparative in its nature. Each positive step in the study of a drug involves a question of the correspondence or difference of other drugs in respect of that step. An isolated study of all the remedies would not give us an available knowledge of the Materia Medica.
It is not enough to know that Pulsatilla, Nux vomica and Chamomilla each produce diarrhoea of a certain kind. We must also know and fix in our minds the similarities and differences of each of these diarrhoeas to those of the two others and of all other drugs.
The study of one drug is, in fact, then, the study of the whole Materia Medica. One is never so competent to thoroughly master a proving as when he has already mastered all other provings. The first effort must necessarily be the least satisfactory, the most imperfect.
This is the task to which the student of Materia Medica is invited and at which his predecessors have been laboring for fifty years. Why, he may ask, has not this been wrought out and systematized by those who have gone before? Why is the Materia Medica left in the same state in which Hahnemann placed it fifty years ago?
Our Materia Medica consists of the provings of drugs upon the healthy, made by Hahnemann and his disciples. These provings, as we have them, are, for the most part, a formal arrangement of the symptoms subjective and objective observed by the prover or his friends.
No attempt is made, with but few exceptions, to trace any pathological connection between symptoms, or to give any physiological explanations, or to distinguish between characteristic and generic symptoms. The symptoms alone are given, just as the symptoms of a case of disease would be given by an intelligent but uninstructed patient who unfolds his case to us in as plain untechnical words as he can, leaving to us the task of tracing connections and contriving explanations. There they stand, records of facts made in the plain vernacular, intelligible so long as the language shall endure.
But Hahnemann had a much higher idea of the kind of knowledge of Materia Medica which a physician requires than this statement would imply. In an essay on "The Power of Small Doses," in Hufeland's Journal, he describes this knowledge as follows:
"What organs it (the drug) deranges functionally, what it modifies in other ways, what nerves it principally benumbs or excites, what alterations it effects in the circulation and digestive operations, how it affects the mind, how the disposition, what influence it exerts over some secretions, what modification the muscular fiber receives from it, how long its action lasts, and by what means it is rendered powerless, etc., etc."
Why, then, did he not construct his Materia Medica on this model? Unquestionably because, with a wonderful sagacity which together with his brilliant genius and his prodigious learning made him the "double-headed prodigy," which Jean Paul Richter called him, Hahnemann clearly perceived the following truths:
- That the positive facts with which a physician has to deal in constructing a Materia Medica are the observations of the prover recorded in plain, unfigurative, non-hypothetical language.
- That the construction which he saw to be so desirable must be the result of the application of the sciences of Physiology and Pathology to these facts.
- That the facts of the proving being of the nature of positive observation are enduring and unchangeable.
- But that the sciences of Physiology and Pathology, being incomplete and progressive, are continually undergoing change, and that their terms must therefore be ever varying in significance as the theories on which the sciences are based vary.
- That, consequently, a Materia Medica constructed by him out of these two elements, one constant and the other variable, would of necessity be transient, could not be enduring, would soon grow obsolete and in its decline would carry out of sight the constant element also, and thus the labor of the provers would soon be lost to the world.
Such a structure would have involved an intermingling of the current physiological theories with the facts derived from observation. The precise point and extent of the intermingling would soon become undistinguishable and thus a vitiated record would be transmitted to posterity such as the advance of science would soon render useless.
A comparison of the present state of Physiology with that of 1800, of which the very terms are almost obsolete, makes the great wisdom of this view apparent. On the other hand, the pure records of observed facts, untainted by theoretical speculations, come to us from the Master's hand as pure, as intelligible, as available as when first recorded.
We have the same material for the construction of a physiological theory of the drug-action that Hahnemann had, and we can construct it with the advantage in our favor of the great advances which Physiology and Pathology have made since Hahnemann's day. This is the work which each of us must do for himself. No other can do it for him.
The result of his labor may and will differ somewhat from that of every other student, for with the light of the auxiliary sciences he forms a judgment concerning observed facts, and the significance of a fact is measured by the capacity of the observer.
The student should seek his knowledge of Materia Medica at the fountain head, in the original publications of Hahnemann's Materia Medica Pura and Chronic Diseases in the provings in Stapf's Archiv. and in the Austrian and other journals
The Manuals, however convenient for reference in the hurry of practice, are not suitable for systematic study. In some of them, the phraseology of the prover has been altered. In others, the symptoms, as reported by the prover, have been arbitrarily sundered into fragments and these fragments are scattered throughout the record. Or symptoms ex usu in morbis have been introduced and the names of diseases supposed to have been cured by the drug are incorporated with the pure symptoms.
In all of them the arrangement is somewhat altered. In many, attempts at abbreviation have been made, and with no better success than if one should squeeze one's lemons to lessen the bulk of one's luggage and yet hope to have good lemonade at the end of one's journey; for it always happens, and must from the nature of the case, that the skins are the part retained while the juice is thrown away.
If a Manual must be employed, that of Noack and Trinks seems preferable; for it preserves the phraseology of the prover and does not to any great extent sunder groups of symptoms, while it places under distinct headings the pure symptoms, and the clinical effects of the drugs and the theoretical speculations of the compilers, so that the student is in no danger of mistaking the one for the other, a danger to which Jahr's Manual does certainly expose him, and for which reason Jahr's work is less desirable than that of Noack and Trinks.
We have dwelt at some length on the sources from which the student should seek his knowledge of Materia Medica, and with good reason! "For, can a bitter fountain send forth sweet waters?" "Do grapes grow on thorns, or figs on thistles?" If the student should fall among false or incompetent teachers, could the doctrine and practice he learns be true and successful?
Having selected a remedy on which to commence his studies, the student should gather together all the reports of provers, whether in the form of their daily records (in which form our dear and lamented colleague Dr. Joslin published his admirable proving of Rumex crispus, as did also the Austrian provers), or in the Hahnemannian anatomical scheme, and should carefully peruse them.
We will assume that he has selected Pulsatilla, and will use this remedy to illustrate what we have further to say. We have no other proving of this drug than the very perfect one of Hahnemann in Vol. 1. of Materia Medica Pura.
During the first perusal, and several may be necessary for the purpose, the student should endeavor to make a general analysis of the proving. This analysis would enable him to place the drug along with several others in one or other of certain groups into which he will find, as he advances in his studies, the Materia Medica arranges itself. Among the chief points of this general analysis will be the following:
I. Sphere of action in the drug.
It will be seen that every drug affects some organs or systems of organs or tissues more decidedly than others. Pulsatilla, for example, acts pre-eminently upon the vegetative system, upon the organs of reproduction and their appendages, and upon the composition of the blood, depressing the action of the former systems and producing in the latter a condition similar to that of one form of chlorosis.
We learn these facts by bringing a knowledge of Physiology to bear upon and interpret the symptoms of the intestinal tract and of the urino-genital organs, those of the vascular system and the symptoms of the head and disposition. For in these we have retarded digestion, vertigo, audible pulsation of the carotids, momentary loss of sight and hearing on sudden exertion, palpitation, paleness, retarded and scanty menstruation with syncope and exhaustion; depressed melancholic disposition.
On the other hand, the student will notice that Pulsatilla exerts but little action upon the bones, skin and glands, and this will be another important step toward grouping.
II. The extent to which the organic substance is affected.
From some provings it must be gathered, Spigelia, for example-that the organic substance is but slightly affected or only in isolated localities, while in other provings the effect is profound and general, Carbo vegetabilis and Lachesis.
In others, again the affection of the organic substance and the irritation of the nervous system are equal in degree and both are great, Arsenicum. Conclusions on this head are drawn from the following symptoms: those of the complexion and of the skin generally, as regards color and temperature, which enlighten us respecting congestions, if there be any, and the color and character of the congesting fluid; those of the evacuations from the bowels, bladder, uterus and all secreting glands and surfaces; those of the cutaneous eruptions and ulcers; finally, those which denote the existence of dyscrasias of whatever variety, e. g., dropsies, phthisis, cancer, gout, rheumatism, etc.
Under this head we find in the proving of Pulsatilla no evidence of any further action than that above mentioned, a hydremic dyscrasia and which is further corroborated by the abundant serous or thin mucous discharges from secreting glands and surfaces.
III. The action of the drug on the vital power,
...correlative of the above, and shown in the symptoms of the nervous system as they are given conjointly with the symptoms of the various organs to which the different parts of the nervous system are distributed. He may consider the nervous system under five heads:
The sensorium, of which the symptoms are found chiefly under the rubrics Head and Disposition.
The general sensibility .
The general mobility. Data respecting these heads are found in the symptoms of the tissues to which the nerves of sense and motion are distributed.
The special sensibility, as exhibited in the symptoms of the organs of special sense-the eye, ear, nose and tongue.
The sympathetic system-as exhibited in the symptoms or organs containing involuntary muscles, in the intestinal tract and in all the sphincters.
In forming conclusions on any one of these points, regard must be had to the entire remaining action of the drug. We should otherwise reach a very false judgment. Pulsatilla, for example, produces blindness and deafness.
We might regard these as very important affections of the special senses, did we not learn also that these phenomena occur simultaneously with scanty and difficult menstruation, and with palpitation and throbbing of the carotids, and conjointly with great pallor and frequent syncope. These concurrences compel us to regard the blindness and deafness as sympathetic symptoms occurring in a chlorotic patient, and connected perhaps with a hydremia produced by Pulsatilla.
These three sections of a general analysis having been elaborated during a first perusal, the student will already be in a position to arrange many drugs in groups by their similarities and differences in these respects. He will note, for example, that in their sphere of action Pulsatilla and Nux vomica are closely allied, while again they differ widely in their mode of action both on the organic substance and on the vital power, etc.
The practical use of such an analysis is this that when such fundamental facts are known of two or more drugs, it is enough to have clearly in mind, in any case of disease, what are the effects of the disease in these three fundamental respects. If, then, the action, for example, on the organic substance be similar to what we have seen to be the effect of Pulsatilla, there can be no possibility of Nux vomica being applicable in the case and no need, therefore, of studying that drug further for the case.
This process of elimination by means of a general analysis may be relied on wherever we have good and complete provings of drugs, and where the case of disease presents clear and definite symptoms. When we are dealing with fragmentary provings and obscure cases it is of course not practicable.
As further examples, we may adduce the following: Spigelia and Silicea both affect the special senses remarkably and similarly; yet they are extremely different in their action on the organic substance. Hyoscyamus and Carbo vegetabilis affect the sphincters similarly, though in other respects so unlike.
After thus generalizing in a comprehensive way, the student will observe certain phenomena of a more special character; for example, that among the variety of sensations recorded as having been produced by the drug, there is a certain uniformity in general character throughout most of the organs affected.
But here he meets difficulties arising from inaccuracy of provers, or rather from the fact that, all descriptions of sensations being clothed in figurative language, the imaginations of different provers suggest to them different modes of expression. The wealth of the German language in synonyms has not diminished this difficulty. An approximate analysis of sensations such as has been made by Dr. Dudgeon would be of service in this regard.
The individuality of some drugs is much more strongly marked than that of others by this feature of their effects, and pro tanto, it serves as their characteristic. Thus Bryonia and Squilla are distinguished by sticking, and Arsenicum by burning, pains.
Another point to be noted, and which may serve still further to individualize the drug, is periodicity, which in many drugs is well marked and of a definite type; e. g., arsenicum, Ipecacuanha, Natrum muriaticum, Nux vomica. In Pulsatilla it is very marked, but the type is not constant.
But, perhaps, the most important of all the considerations in which resides the individuality of a drug are the conditions and concomitants of the symptoms. The conditions are the phenomena of time, place, and circumstance on which the symptoms depend.
For example, Pulsatilla produces tearing pain in the hip. So do several drugs, but that of Pulsatilla occurs in the afternoon, condition of time; it occurs and is aggravated in a warm room, condition of place; occurs during and is aggravated by repose, condition of circumstance.
A concurrence of this phenomenon and these conditions is found only under Pulsatilla. Here these conditions are the characteristic. The concomitants are those phenomena, whether we call them sympathetic or secondary, which always accompany any symptom or group of symptoms. Absence of thirst is a concomitant of many groups of symptoms under Pulsatilla. So likewise are chilliness, cold feet, wakefulness in the evening and sleepiness in the morning, etc. Nux vomica has the reverse. So is cold sweat of the forehead under Veratrum.
Having thus made a general analysis of the proving, obtaining, first, a general view of the action of the drug on the great divisions of the organism and of the pathological conditions which it produces; and, second, a general view of the characteristics of its action, the student may proceed to a special analysis, which will involve a similar study of the action of the drug on each organ and anatomical region of the body. In this he cannot do better than follow the Hahnemannian scheme.
The points to be considered in each region and under each rubric are the following: The organic changes; the sensations, their nature, locality and direction; the conditions of time, place and circumstance, and the concomitants. Thus, for example, in studying the Head, he may consider:
The SENSORIUM, under which the subdivisions may be:
Vertigo, its nature, conditions of time, place and circumstance, and its concomitants.
Thus, the vertigo of Pulsatilla is a staggering; it occurs after eating, in a warm room, and during repose (there is a rare alternate effect); the concomitants are heaviness in head on stooping, paleness and internal heat in the head.
Intelligence, with conditions and concomitants as above.
Memory, with conditions and concomitants as above.
Illusions of the imagination, and concomitants as above.
Headache, under which the points to be noted are:
Character of the pain.
Its course if it moves.
Conditions and concomitants as above.
THE ORGANIC CHANGES, which are to be studied in the same way. These comprise all objective and material phenomena.
In this manner, the student will examine the effect of the drug upon each organ and tissue of the body, as will be more clearly shown by a scheme for the study of the Materia Medica which will be appended to this essay.
The result will be an accurate knowledge of the action of the drug, in so far as the proving is complete, upon the whole organism in general and in detail. The special analysis will serve to correct certain errors into which the general analysis might lead the practitioner. Conditions are not always uniform for all the organs.
Thus, although the general conditions of Pulsatilla are occurrence and aggravation in the afternoon and evening, during repose and by heat, with relief by motion and cold, and must be so stated in a general analysis, yet there are a few special symptoms to which the opposite conditions attach, and this fact is brought out by the special analysis.
The study of a proving to be practically available must be comparative. After ascertaining the properties of each drug by positive investigation and analysis in the manner detailed, the next step is to ascertain what drugs resemble it, and in what features they are like and how they differ.
To make such a comparison as this in studying the Materia Medica, a repertory is indispensable, and this need alone, if a repertory were not equally indispensable in daily practice, would be a sufficient reply to those who idly talk about such a work being superfluous or mischievous.
Such is a method of studying the Materia Medica which, after much reflection and trial of various plans, I venture with unfeigned diffidence to unfold. It is elaborate and requires a wearying application which those alone can appreciate who have engaged in similar tasks. To complete such a systematic study, even in comparative leisure, might require seven years of unremitting labor, just the period for which a lad is apprenticed to learn his trade.
Should we shrink from devoting so long a time to the mastery of the most complex and difficult, and the noblest science and art which are possible to man on earth? I desire to add a few words of a practical nature. Prescribers are liable to two errors of an opposite kind; the possibility of which will be apparent from what has been written.
The one consists in prescribing from a general analysis of drugs without regard to the characteristics which individualize them. This is equivalent to prescribing any member indifferently of a whole group of drugs, and necessitates a corresponding generalizing view of disease. It is the method of the Old School which seeks to arrange drugs and diseases in groups and which ignores characteristics and individuals.
The other error consists in prescribing on the strength of one or two characteristics which may be detected, without however examining whether the general effects of the drug correspond to the general features of the disease. Now, characteristics, for the most part, as we have seen, derive their value from their association as concomitants or conditions with some symptom which is not in itself a characteristic. Disconnected from this, they are as void of significance as a man's nose would be if cut off from his face, though while on his face it might have been the chief feature by which his friends recognize him.
I will not deny that by this method, great successes, "lucky hits" I would call them, are sometimes made. But I do stoutly affirm that atrocious and inexcusable blunders are much more frequently the result.
I admit, too, that in certain cases of disease there is no possibility of making such an analysis as we have advised, and that certain drugs are so incompletely proved that we know of them only one or two characteristic symptoms and cannot study them as recommended. All that can be said of such cases is that they are incomplete and come under no rule.
We must do the best we can and adopt a defective method, which is nevertheless sometimes successful rather than make no attempt to cure. Better cure by a "lucky hit" than not at all. But let not this lead us astray where we might do better.
If one had to traverse a wilderness he would desire first of all a compass. If this were not to be had he might "steer by the stars." If these were obscured he might judge from the direction of vegetation and of hills and rivers. Failing these, he might even "guess" and his guess might lead him right. Nevertheless, few travelers of sound mind would be led by such a success to prefer a "guess" to a "compass."