Clarence Bartlett, M.D., Philadelphia. (Read Before the Homoeopathic Medical Society of the state of New.
Jersey, May 14, 1925. You will pardon me, I trust, if my remarks are prefaced by a few platitudes. You have all heard them, but ever do they bear being kept in mind.
It is the duty of the physician to cure the sick and to relieve human suffering. This is called the art of healing.
The physician must have a knowledge of what is curable in disease in general, and of that which is curable in his patient in particular.
Both of these saying constituted a part of Hahnemanns teachings.
To the above I may add from Broussais: The medical man who does not take into consideration the human element in his clinical work, who confines his activities to the purely scientific aspects of an illness, who does not study the patient per se is a mere naturalist; he certainly is not a physician.
Homoeopathy is the school of therapeutic optimism as opposed to the therapeutic pessimism of medical orthodoxy. It is a school of constructive aims.
My remarks this afternoon will take historical data as their foundation. An effort will be made to place Hahnemann where he belongs, i.e., in a group of medical reformers, to whom humanity to today and tomorrow owes much. Indeed I am not sure that his activities and originalities of therapeutic thought may not have played the most important part in bringing about the renaissance of the nineteenth centuries. Or to put it differently, Hahnemanns activities did much to kill empiricism and to introduce logical methods in the investigation of disease.
Hahnemann was a big man before he announced his therapeutic law. He had previously established a reputation as a chemist. His method for the detection of arsenic and his wine test stand today almost unmodified. Of him the great Berzelius said: “He would have been a great chemist had he not turned out to be a great quack”.
In 1792, Hahnemann published his celebrated essay advocating the benevolent treatment of the insane, thus antedating Pinels unchaining of the lunatics in the Bicetre by six months.
Although numerous names may be placed on the roll of honor of the medicine of the period, this essay will speak only of Auenbrugger, Hahnemann, Jenner and Laennec. Reference will also be made to the experiences of Harvey, and later of Semmelweiss. Auenbrugger published his discovery of percussion as a means of diagnosing disease within the thorax in 1761 in an essay entitled: “Inventum novum ex percussione thoracis humani ut signo, abstrusos interni pectoris morbos detegendi.” This essay received by but little serious consideration. The authoritative works of the day, as those of Van Sweeten and De Haen ignored it entirely, and yet as one of the commentators of medicine of the period remarks: “Their writings are merely of historical interest today, while Auenbruggers volume of ninety-five pages is a classic.
What can be the explanation for the omission of so great a discovery from even a passing notice by these great arbiters of medical thought in Germany?” Auenbruggers discovery was not considered seriously until 1808 when Corvisart translated the “inventum novum” and “yielded unstinted praise to its discoverer.” And this after a lapse of forty-six years. Auenbrugger died in 1809 at the age of eighty nine years. Incidentally it may here by interpolated that he was an accomplished musician and wrote an opera entitled the “Chimney Sweep” which found favor at Court. It is interesting to note that Corvisarts chief fame rests upon his revival of Auenbruggers original work.
In 1796 Hahnemann published his first homoeopathic essay entitled: “On a New Principle for the Selection of a Remedy in the Treatment of the Sick.” In the beginning Hahnemann held that the homoeopathic law was of universal application. To him it was supreme and infallible. Herein he was not different from other originators either in medicine or in other sciences. Jenner contended that vaccination performed but the once, protected against smallpox for all times and we who come after him and who believe in vaccination, do not detract one iota from his fame because of this error.
To come down to recent time less than two decades ago in fact, Ehrlich when introducing the arsenicals as the remedy for syphilis contended that but one administration of salvarsan was necessary to bring about a complete cure, and exposure anew to syphilitic infection would bring about a second attack of the disease. But such is the way of discoverers, and it is right that it should be so. Confidence in the value of their work gives them an enthusiasm that spurs them on to still greater efforts. It was ever thus, and probably it ever will be.
All of these three great men subsequently modified their teaching as experience and facts taught them to do. Hahnemann had no hesitation in specifying types of illness to which the law of similars was not applicable. While deprecating palliation, he admitted its occasional necessity. His contention that palliative treatment masked symptoms-which after all are the sole clinical evidence we have of disturbed function-depriving us of an invaluable guide to treatment, is universally conceded in all modern up-to-date medical practice.
Hahnemann repudiated the pathology of his day as useless because it was inaccurate and therefore misleading. As the same time he announced himself as ready to accept pathology as a basis for diagnosis and treatment when pathology should attain the status of an exact science. In this attitude against the pathological teaching of the late eighteenth and the early nineteenth centuries, he has received the hearty support of all physicians of today. The primitive state of that alleged science in Hahnemanns time is appalling to us of the twentieth century. Should any of you care to read for yourselves permit me to refer you to the histories of Radcliffe, Mead and Pitcairn in McMichaels fascinating brochure “The Gold-headed Cane” and “Nosography in Internal Medicine” by Karl Faber.
As students of homoeopathy, it is not necessary for me to take your time with a recounting of the opposition and ostracism Hahnemann encountered. So I proceed to Jenner.
It was on the fourteenth of May, 1796, the same year that Hahnemann published his memorable essay, that Jenner performed his first Vaccination. His experiments were carried on with every attention to scientific accuracy, and his conclusion incontestable.
As his biographer remarked, be converted “a local country tradition into a viable prophylactic principle” how viable did not become fully appreciated until the present century. But Jenner as did others, encountered prejudice. In 1798 the president of the Royal Society (London) advised him that he (Jenner) “should be cautious and prudent, that he had already gained some credit by his reputation by presenting to the learned body anything which appeared to be so at variance with established knowledge and withal so incredible.”
Later he was told that if he persisted in bringing forward his views concerning smallpox he would be asked to resign. Numerous additional statements may be presented illustrative of the persecution to which Jenner was subjected but time forbids. They are matters of history; and Jenner, like Hahnemann lives. Their adversaries are dead in name and fact. Hahnemann became an ardent advocate of vaccination, and considered the new principles a confirmation of his own teachings. This is an important fact that anti-vaccinationists of the homoeopathic school should remember.
The principal stand against homoeopathy today is not its value; it is not that is had not contributed much to health and longevity of humanity, but rather that it is sectarian; that it fosters a schism in the medical profession. Now that it absurd. Sectarianism is not a crime unless it is accompanied by bigotry and intolerance. An Episcopalian can be a Christian: a Republican or Democracy, a loyal American; and a homoeopath a physician in the broadest sense of the term. If I am forced still further to give example of sectarians, I might call Americanism sectarianism, and you smile. But recall that the Bolshevists and extreme internationalists so regard it.
Sectarianism has been of inestimable worth in the world. It has fostered principles, often false, but nevertheless they have been principles sincerely held by their devotees. The spirit of sectarianism held by all of us fosters improvements not only constructively but also by competition. I am rather inclined to think that the definition of sectarianism is much like that of orthodoxy. If you agree with me you are non-sectarian, liberal and orthodox. If you agree with me you are non-sectarian, liberal and orthodox. If your ideas are in disagreement with mine, you are sectarian, bigoted, and heterodox.
One of the unfortunate positions in which homoeopathy has been placed is the tacit consent of the school to permit its competitors to state its platform. Was ever such a peculiar state of affairs noted elsewhere? Some of our members accept the platform forced upon us with all its silliness, while others not sufficiently militant for defence or aggression blush. Let us maintain as part of our aggression that homoeopathy is scientific, that its important principles are recognized as correct by the scientific medicine of the day.
No one will accuse Dr. Morris Fishbein of being friendly to homoeopathy, and yet in his recently published work dealing with medical cults, he remarks that we must not hold against Hahnemann the vagaries and exaggerations into which some of his disciples drifted. Also it is probably true that any criticism which might be brought against Hahnemann in the light of later and better knowledge, apply equally well against a large part of the other medicine of his time. Dr.Fishbeins criticism of the times is well taken.
The speaker has shown that Jenner whose sole crime was the discovery of a benefaction of the human race was subjected to persecution hardly less than that meted out to Hahnemann, and that Auenbrugger was completely ignored for sixty years. We must be aggressive in repudiating all who attempt to foist inanities on our school. Of such individuals it might almost be said that they believe that if a thing belongs to scientific modern medicine, it cannot be homoeopathic. Fortunately these men are very few in number, but as they are militant and aggressive, we hear of then., Let the School be progressive and aggressive.
In assuming that homoeopathy is progressive and scientific, let us place it along with other sciences few if any of which have seen their maximum of efficiency and achievement. General principles are the important factors, and details come later.
the smallest dose that will cure! Who denies it?.
Increased activity of drugs through fine subdivision! We all admit it.
The influence of the infinitesimal !. A subject concerning which we are to learn much.
Admitting the increased activity of drugs because of extreme subdivision let us ask ourselves we the best method known to science to produce such subdivision? Hahnemann method of dilution and trituration was certainly the most efficient of his time; and remember that Hahnemann advocated trituration and dilution the represented detailed work.
His method of potentization was not based upon “bottle washing.” For a number of years now medicine has been interested in the colloids, which class of substances represent the finest practical subdivisions of matter known to physicists. As in line with increased activity with increased and worthy of serious recognition by us? Undoubtedly like everything, the colloids cannot be made to represent the finest subdivision of all matter; but they do represent fine subdivision of some matter; and the best possible fine subdivision of other matter. Hence they are good for us and if we are on an aggressive or constrictive platform of our own building, we must accept them for study.
Next let us consider the question of the infinitesimal; have any if you ever thought of the advancements in modern science that have made Munchausen a god of truth and Jules Verne a prophet? Science has liberated forces unknown. It will liberate others. Munchausen and Verne are in danger of defecation. Is there a greater romance than the development of the radio?
One many now rest in his library and listen to a broadcasting from Alaska with a ten-watt station. with suitable apparatus he may receive waves from London or San Francisco. A turn of the lever but one millimeter will make the difference between reception from New York or Philadelphia. Gentlemen, I am even prepared to admit that some inventive genius may arise to develop or create or discover a ray that carried in an aeroplane over the caravansaries of a metropolis will convert the grape juice or malt extracts on the tables of the diners into delicious wine and beer.
There is a plant called the Budleia variabilis magnifica. Its common name is the butterfly bush or summer lilac. As I see this plant in my dark garden and compare it with the common lilac (Syringa vulgaris) there is nothing in their characteristics appealing to me to show a most remarkable feature of the Budleia. The Syringa is the one possessed of the greatest fragrance by far. With its first blooms to late autumn it is the haven of innumerable butterflies. And yet! Were you to place a Budleia far from the garden and the field in the midst of a great city, conditions for growth of the plant only being demanded for the experiment, you may rest assured that butterflies will find it and swarm about it.
When a member of a Mayo clinic, the apothesis of scientific medicine, the Mecca of surgeons, announces boldly that a dilution of iodine amounting to the part in 80,000,000 (our 8x potency) is sufficient as a preventive of goiter. Shall we ask “Why did not a homoeopath discover that fact?” None of us was sufficiently knowledge; we used iodine in goiter successfully; but we did not have the initiative to bring modern methods to our aid. Still we have the satisfaction of permitting intensive investigation, confirm clinical findings or impressions, which goes to show that clinical impressions are not such bad things after all. The proof of all things medical is efficiency in the clinic.
Now we come to our Materia Medica wherein our progressiveness and aggressiveness are lacking. Improvement does not consist in efforts designed to prove its worthlessness, but rather to determine just what there is within that is good; that which is worthless; and that which requires to be modernized. As it stands, there is a vast amount of material testimony the value of which may be had from many practitioners.
Let us start criticism. Let us say that it consists of a mass of symptoms virtually all subjective not confirmed by objective manifestations. Now for the mass of subjective symptoms, and let us call them irrelevant and incapable of explanation. Permit me now to quote you not from the Materia Medica, but from the American Journal of the medical Sciences the following.
1.Slight queer feeling but food went down all right.
2.A feeling of nervousness on starting to swallow; after. starting food went down without any trouble.
3.A feeling o nervousness in the neck.
4.Vague sensation about the neck, as of something wrong.
5. A feeling of cramp around the neck.
6.A feeling as if my swallow was not working right, but. nothing seemed to stick there until lately.
7.Food sticking in the throat while eating in a hurry; but. it went down of itself all right,and I had no trouble for. months afterwards, though I did not hurry any more.
8.A feeling as of a lump arising in my throat. This latter symptom our author remarks occurred in many cases. In some patients it had no relation to eating: in other patients it occurred at sight of food or thoughts of eating; in other words at the beginning of a meal but disappearing after a new mouthfuls had been swallowed.
Our author is the Nestor of bronchoscopy, Chevalier Jackson, and he was telling his readers the first clinical manifestations, the early subjective symptoms of carcinoma of the esophagus. Incidentally he tells us that many of the poor victims were cast aside by their physicians as uninteresting neurotics, and in consequence were sagely advised “to forget it.” It was not until obstructive objective features appeared that a serious examination was made, but by that time, anatomical changes had advanced to the stage of incurability and the secondary invaders were swarming everywhere.
The late Sir James Mackenzie has for a number of years past been preaching the value of the subjective symptom in the clinic. He tells us that they constitute the first evidence of disturbance that we may interpret them accurately. Furthermore he contends that to wait until objective manifestations appear is to wait until anatomical changes have advanced to the stage of the incurable. To study the value of symptoms, Sir James and a few of his colleagues organized St.Andrews Institute for Clinical Research. Two small volumes emanating therefrom have been published. The beginning is small but the product should be great.
The trend of the times is all in favor of Hahnemanns original proposition, namely that drugs can be used on the sick only when we know their action on the healthy human being, and that the nicest distinctions in clinical symptomatology relate to subjective symptoms; that objective findings are anatomical as opposed to physiologic, and in the main are terminal and of themselves give no clue whatever as to what had gone before.
The study of symptomatology in its broadest sense is the study of the patient himself as the problem the solution of which is the duty of the physician. “It is the duty of the physician to cure the sick; this is the art of healing.” Early diagnosis is demanded. Sufferings must be interpreted. And now comes the relative value of symptoms in the study of the sick. All of us have admitted that a clinical picture is made up of symptoms arranged in clinical perspective. The artist with true sense of proportion arranges them for distance, center and foreground. The physician must treat; he must diagnose. With true artistic sense, he recognizes the value of symptoms for diagnosis and of others for treatment only; for be it generally admitted that symptoms which are valuable for diagnosis are by no means always the ones of most value to us in guiding our treatment.
As a corollary may I remind you of a well-known fact which you have no hesitancy in admitting: Many good diagnosticians are poor therapeutists and vice versa.
Returning to the immense mass of material in our materia medica what can be done with it? Progressiveness and advancement demands that it shall be properly placed. The clinic of a hundred years has done much to solve the problem. Permit me to use your honored president as an example. He is well and widely known ad a firm believer and practitioner of homoeopathy. He is a most fascinating teacher and expander of the sciences in which he so firmly believes. It has been by good fortune to hear him speak on many occasions.
He deals with general principles, and he speaks of special application of remedies, and with it all, I note with approval that he uses but few remedies, and makes practical use of comparatively few symptoms of those remedies. His clinical experience has enabled him to draw unto himself and for the use of his patients a certain reliable symptomatology. And what the finished artist is doing is but the practice of he rank and file. Thus there has come to us a practical line of symptoms in which we all have more or less faith-and from the clinic. Unfortunately the demands of modern medicine seem to be oblivious of the fact that most of the great discoveries in our art had been presaged by the clinic before confirmation by the laboratory.
Now this brings up the important question “can the laboratory aid therapeutic advancement and purify the materia medica?” Yes, it can do so, but mainly by observation of drug effects on human being. Studies on animals are all right within their sphere. but must be properly evaluated for the lower animals are not possessed of the same physiology as human being. The value of animal experimentation lies in the elimination of psychic influences and our ability to push drug effects to an extreme not permissible on man. Its limitations are made very impressive when we recall that some animals cannot vomit; some cannot sweat; and some exhibit peculiarities of function, thus the cat sweats only on the parts of its feet not covered by hair. And probably each and every species has its peculiarities which demand a complete study before we can transfer observations made on them to their proper place in the clinic.
Animal experimentation is all right in its way, but as conducted, indeed I might almost say as it possibly can be conducted, it can afford us information as to terminal phenomena or anatomical changes only.
There are great opportunities for modernization. We admit without hesitation that we have a cumbersome materia medica; but we also know that the real clinician is able to use it successfully. It is to be modernized first by literary research and analysis. The value is there, but we must subject the mass to modern methods to develop that which is of value. With that work completed, we are ready to begin with the laboratory, and by laboratory we mean the work shop, including the hospital bed and college laboratories as well. For the practical physician, these are inseparable.
Above all let us avoid polemics. True science does not recognize abuse as opposed to logic. Abuse may be aggressive, but it is not a good thing with which to make converts. If we cannot prosper by plain statement of facts and logic,then we are not fit to exist. The old adage says: “If you have no case, abuse the plaintiffs attorney.” Departure from fundamental principles displays weakness.
Homoeopathy needs no such defence. As evidence of this we note the active interest taken in it by many clinicians and scientists of modern times. What is more, this interest seems to be of a fair character. One of our most loyal homoeopaths has been so impressed with the value of their work and the sincerity as to motive, that he has become a tentative advocate of letting them do the work which we should do for ourselves, mainly, however, because of their greater facilities. And yet he is a strong organization man.
Gentlemen, in closing, permit me to say that there is every reason for maintaining an allegiance to out school of medicine, and doing our individual work to keep it up with the times. Hahnemann was progressive and aggressive, and why not we?.
Nor can I see how it can be utilized in any way excepting to confirm or interpret the findings in the observations on human beings. Even with this restriction, it is invaluable, but the results must be interpreted with judgment, and must not be accepted as the entire knowledge of drug action. Homoeopathy must be aggressive in assuming a proper attitude towards laboratory investigation.
Our aggressiveness must be directed to the protection of our institutions, which at one time represented the investment of probably dollar 75,000,000 over the entire country, but through lapses has dwindled to some extent. This money was contributed by the charitable for a definite subject. The wishes of the contributors must be respected as far as our initiative, ability, and industry will permit.
All evidence demonstrates that Hahnemann was a great medical reformer, and as such to be respected. To drop his name from an institution is catering to prejudice which is worse than that which in bygone years led to the persecution of Hahnemann, Hunter, Harvey, Semmelweiss and Jenner, and the ignoring of Auenbrugger and many others. I say worse, because we are living in an enlightened age which is teaching us liberality and tolerance, and which is fraught with many new things which confirm and enlarge the teachings of bygone eras. Please remember that there is much truth in many “discards”, The “junk heaps” of the scientific world are worth the labor of the scientific scavenger. Many of them contain material waiting only to be rediscovered. Let us be liberal.