[Read before the Hom. Med. Society of Oneida County, N. Y., June 21st, 1864.]
Hahnemann, throughout his works, takes every opportunity to urge the insufficiency of a pathological theory of the nature of a disease as the basis of the treatment. He everywhere urges that the only sure indication for every case is to be found in the totality of the symptoms which the case presents. One would think that nothing could be more clear and convincing than his arguments on this subject.
His opponents declared that his method ignored medical science, left no scope for pathology and diagnosis, and reduced therapeutics to a degrading mechanical comparison of symptoms.
Very many homoeopathists have so far deviated from Hahnemann's method as to endeavor to blend with the use of his doses and remedies, an application of pathology as a basis of treatment.
This endeavor can never be successful, inasmuch as the function of pathology is to furnish, not an indication for medical treatment, but simply a means of elucidating and collating the symptoms. The result has been a sad falling off from the standard of success in practice Which was established by Hahnemann and his pupils.
The points at issue are illustrated by the following case :
Willie M., four years old, was brought to me December 3, 1863.
He had been healthy since February, 1863, when he is reported to have had a long attack of gastric fever, from which he finally recovered with the affection about to be described.
This was a dyspnea and wheezing, distinctly perceptible at all times when the child was awake, and I which, on making any exertion, were very much aggravated, and resulted in an attack of convulsive cough with difficult inhalation, the whole paroxysm resembling precisely what is described as Millar's asthma or Laryngismus stridulus.
It was remarked that the child seemed to be free from dyspnea when sleeping soundly, but at no other time. On waking in the morning he had always a hard fit of coughing, during which he sometimes raised a little tenacious mucus.
His appetite was good, though somewhat capricious. He was considerably emaciated ; his spirits were good, and he often attempted to join in the sports of other children, but was obliged soon to desist, because of the dyspnea, and cough which every physical exertion caused and which greatly fatigued. him. On percussion and auscultation the lungs were found resonant ; the respiratory murmur was, of course, masked by the loud wheezing.
The child had been taken, in September, to Professor A. Clark, of New-York, who, after careful and repeated examinations, had given a written diagnosis — "Chronic Laryngismus."
He gave a very unfavorable prognosis and the advice to avoid all medication, save only a dose of some antispasmodic during the violent attacks of dyspnea. This advice had not been followed. The child had been, throughout his illness, under what I regard as very skillful homoeopathic treatment. I had once seen him in consultation, but had not been able to suggest anything that proved of service to him.
When now placed under my sole care, I well knew that the child had already taken, without benefit, every remedy which has symptoms at all resembling Millar's asthma or any spasmodic affection of the respiratory organs.
And it was also evident, on even a cursory examination, that no one of these remedies was clearly indicated by the symptoms of the case.
I therefore resolved to follow, as implicitly as I could, the advice given by Hahnemann for the examination of the patient and the selection of the remedy. Dismissing from my mind, then, every notion concerning the seat and probable pathological nature of the disease, I examined the patient and made the following record of the symptoms which he presented.
1/ Child emaciated, flesh soft, skin inclined to be yellow (naturally fair — a blonde) and dry.
2/ Appetite very good; always calls for food as soon as a coughing fit begins in the morning or forenoon.
3/ The right hypochondrium hard, distended, tender to the touch, painful on exertion and when he coughs.
The right shoulder is elevated and the spinal column laterally curved ; dullness on percussion on the right side, extending three fingers breadth below the margin of the ribs.
4/ Distension of the epigastrium which is tympanitic on percussion, and tender to the touch.
5/ Much rumbling of flatus in the abdomen.
6/ Frequent ineffectual desire for stool; stool scanty and ,dry, occurring once daily or once in two days.
7/ Cough dry ; sometimes in the morning a very little tenacious sputa; always a coughing fit in the morning on waking ; he has to sit up to cough ; cough excited by eating and drinking, by rapid motion, by exertion, by crying or talking. The cough hurts his right side.
8/ Constant wheezing and dyspnea aggravated by exertion and by lying down, relieved during sleep.
The tender age of the patient rendered it impossible to obtain many subjective symptoms, such as usually facilitate the individualization of cases, and the determination of the appropriate remedy.
Before proceeding further in the narration of the case, I desire to say a word upon its pathology.
The symptoms are before us : what shall our diagnosis be ?
Is the case one of spasmodic laryngeal disease, complicated by certain gastro-enteric and hepatic affections ?
Or, is it a chronic hepatitis, complicated by laryngismus ?
Which affection is primary, and which secondary ?
What relation do the groups of symptoms bear to each other ?
Professor Clark seems to have adopted the former view, regarding the gastro hepatic troubles as secondary, if indeed he paid any attention whatever to this complication.
The homoeopathic physicians who preceded the probably adopted the same view and based their treatment upon it. Now if in so doing they had happened to take a correct pathological view, the result might have been favorable ; or if they had adopted and acted upon the second hypothesis, and this had chanced to be the correct view, the result might have been favorable.
But is it not obvious to every candid mind, that, in either case, success in the treatment based upon a pathological consideration of the case must depend on the correctness of the pathological hypothesis — a matter in which certainty can never be attained.
On the other hand, if we throw aside, as irrelevant, the entire series of questions as to which is the primary disease and which the secondary — which the original malady and which the complication — if we say to ourselves :
"Here is a sick child ; let us examine and record those points in which he differs from a healthy child," we get the series of symptoms above recited, which are facts, indisputable, unmistakable, the results of pure observation.
If now, without hypothesis or speculation, we seek to find and do find a remedy which presents a series of symptoms corresponding closely to those of the patient, experience justifies us in believing that we shall have reached the utmost possible certainty of correctly selecting the remedy.
Comparing the symptoms with the Materia Medica, we perceive at once that the remedies whose names are usually associated with Millar's Asthma, Laryngismus, etc., viz.: Sambucus, Spongia, Cina, Lachesis, Hepar, Stannum, Chlorine, etc., etc., do not cover the case, having but little correspondence with groups 1, 2, 3, 4, 5, 6.
Nux vomica, on the other hand, covers these groups very well, as will be seen by comparing Materia Medica.
In addition, it has violent paroxysms of cough in the morning very early (676 and 677), excited by motion and exertion (670, 671, 672), producing pain in the epigastric zone (689), and accompanied by a desire to eat (my own observation). It has also a well-marked dyspnea.
The correspondence was so close that I had no hesitation in giving Nux vomica.
Dec. 9, four powders of the 200th were given, one to be taken every night, and the patient to report in ten days.
Dec. 21, the report was brought to me, that the child had to more wheezing nor dyspnea ; had been free from cough for five days, can play long and vigorously without inconvenience, is regular in his bowels, complains no longer of pain or tenderness in the hypochondrium — in fact seems to be perfectly well.
He deranged the digestion by eating candy at Christmas, and had a slight return of pain in the hypochondrium, which a dose of Sulphur relieved. He has ever since been entirely free from dyspnea and laryngeal spasm, and is in the enjoyment of robust and perfect health.
If such a mode of practice as this be, as is charged, unscientific — if it ignore the sciences of pathology and diagnosis as bases of treatment — thus much at least may be said in its favor, that it far surpasses every other method in the facilities it affords for the fulfillment of one not unimportant object of the physician — the cure of the patient.
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