in the course of such a history as that which I have only faintly sketched, that some terrible catastrophe has occurred? Do we not see minds gradually breaking down while we say there is no organic change in the brain? hearts suddenly ceasing to do their work, when after careful auscultation we have said there was nought to fear? Suicide or sudden death sometimes disturbs the calm surface of our scientific prognosis of no evil: we may be startled, and may then see all that we ought to have seen before. But when the ripples that such unforeseen events have occasioned on that smooth surface have subsided, we go on as we have already done, and still pay but little attention to what the patient feels, and delight ourselves in the precision of our knowledge with regard to physical conditions of which he may know nothing and may care still less. No one can appreciate more highly than I do the value of precise observation, but I do not believe that minute, delicate, and precise observation is limited to a class of facts which can be counted, measured, or weighed. No one can see more distinctly than I do the wrong conclusions at which a physician may arrive by accepting as true the interpretations which fanciful patients may offer of their symptoms; but I am sure that if we pay no heed to these mistaken notions of a suffering man, we lose our clue to the comprehension of the real nature of his malady. Morbid sensations and wrong notions are integral parts of the disease we have to study as a whole, and we are bound to interpret their value for ourselves; but we can ill afford to set them aside, when we are as yet but in the dawn of scientific pathology, and are endeavouring to clear away the obstacles that hide the truths we hope hereafter to see more clearly about the mystery of disordered life. The value of such symptoms may be slight in some kinds of disease, when compared with that of those phenomena which may be directly observed; but we are bound to remember that there are many affections of which they furnish the earliest indication, and there are not a few of which they are throughout the only signs."

In the light of this, which is but one among the many advantages of Hahnemann's mode of observing disease, I think we may make claim for it as being, not only the one safe thing for his own time, but also a mode of procedure most important in itself, and never to be left behind. It needs especially to be emphasized at the present day. It is with us as before the Reformation, when the Bible was used by the Church as a rule of faith only—a source whence were to be inferred the doctrines and practices obligatory on her children. What Luther and his followers did was-as Dr. Robertson Smith has well shown to recover the Book itself, in the totality of its thoughts

and words, as a means of grace to each individual soul. The fruitful results thus achieved in the spiritual sphere will be paralleled in the medical as the clinical study of disease is allowed its due preponderance, and is made the direct road to therapeutics. Of this reformation Hahnemann was the preacher in his day; and his voice must ever be echoed by his disciples when they see the profession straying into the alluring, but less practical, paths of pathological speculation.

In support of thus acting, they could cite the words of another acknowledged leader in English medicine, also now deceased,-Sir Andrew Clark. In his Presidential Address at the Clinical Society of London in 1883, this distinguished physician said :—°

"Another great work of our Society has been, and continues to be, the unfolding of the exact relations which morbid anatomy and, incidentally, experimental pathology should hold to clinical medicine. These two chief servants of our art, excited and carried away by their marvellous successes, and assuming a joint sovereignty over our art, look down with condescending superiority upon clinical medicine, ridicule her claims to supremacy, scoff at her empirical distinctions, reproach her with being unscientific, and strive to torture her into a slavish subjection to their theories. But the true relation is not this; it is, indeed, the converse of it. For the structural change is not disease, it is not co-extensive with disease; and even in those cases where the alliance appears the closest, the statical or anatomical alteration is but one of other effects of physiological forces, which, acting under unphysiological conditions, constitute by this new departure the essential and true disease. For disease in its primary condition and intimate nature is in strict language dynamic; it precedes, underlies, evolves, determines, embraces, transcends, and rules the anatomical state. It may consist of mere changes in the relations of parts, of re-arrangements of atomic groupings, of recurring cycles of vicious chemical substitutions and exchanges, of new conditions in the evolution and distribution of nerve-force; and any or all of them may be invisible to the eye, inseparable from life, and undiscernible in death. Undoubtedly the appearance of a structural alteration in the course of disease introduces a new order of events, sets in action new combinations of forces, and creates disturbances which must be reckoned with, even as mechanical accidents of the pathological processes. But always behind the statical lies the dynamic condition; underneath the structural forms are the active changes which give them birth, and stretching far beyond the limits of pathological anatomy, and pervaded by the actions *Lancet, Feb, 3, 1883.

and interactions of multitudinous forces, there is a region teeming with manifold forms of disease unconnected with structural change and demanding the investigation which it would abundantly reward. It is in this mysterious and fertile region of dynamic pathogenesis that we come face to face with the primitive manifestations of disease, and learn how much knowledge from all sources is needed to understand it aright; it is here that we see how, without help from physics, chemistry, and biology, collecting, converging, and meeting in a common light, no single problem in disease can be completely solved; it is here that we are made to comprehend how the nature of a pathological product cannot be determined by its structural character, but by the life-history of the processes of which it is only a partial expression; it is here that we observe how, in therapeutic experiments, the laws of the race are conditioned and even traversed by the laws of the individual; and it is here that we discover how clinical medicine is to become a science, and how she is already, beyond all question, at once the mother and the mistress of all the medical arts."

*It is pleasant to find Dr. Clifford Allbutt followng in this direction his eminent predecessor. "Mere observation of disease," he said in his inaugural lecture at the Middlesex Hospital School in 1900, "and morbid anatomy have taken us almost as far as these means can do.

We must

track our morbid processes in their earliest dynamic initiation, so as to arrest them at these stages." (Brit. Med. Journ., Oct. 6, 1900).

LECTURE V.

THE KNOWLEDGE OF MEDICINES.

At our last meeting we spoke of the knowledge of disease required for the practice of homœopathy. We saw that the phenomena we call "clinical"-the symptoms of maladies, subjective and objective, rational and physical, in their connection, conditions, and order of evolution-form for this purpose the main object of our study. They do more than enable nosology to classify their sum and pathology to diagnose their seat; they directly avail, under the guidance of the method of Hahnemann, for the choice of their remedies. Nosology aids in this, by grouping drugs around definite morbid species, and pathology by utilising their local affinities; but both need completing by symptomatology to determine finally the one medicine which shall be the simillimum of the disorder we have to treat. We heard some of the ripest medical thinkers of our time bearing witness indirectly to the validity of this mode of procedure, recognising the dynamic origin of disease, the importance of subjective symptoms as indicating its beginnings, and the necessity of taking all symptoms into account if we are to arrive at a true conception of a case. The inference is that to the clinical study of disease the homoeopathic student and practitioner should devote his chief attention. He should learn, indeed, all that pathology, which is the science of disease, can tell him about it in its various forms; but should use the light of such knowledge, not so much to gaze upon in scientific interest, as to illumine his perception of the actual features of that with which he has to do.

Our subject to-day is the knowledge of medicines, which are the tools of the healing art, as disease is the material on which it works. What are medicines? I do not know that any better definition of them can be given than that which was put forth by Hahnemann in 1805, in the preface to his "Fragmenta de Viribus Medicamentorum positivis":"Quæ corpus mere nutriunt, Alimenta, quæ vero sanum hominis statum (vel parvâ quantitate ingestâ) in ægrotum-ideoque et ægrotum in sanum —mutare valent, Medicamenta appellantur." My only difference with him would be that I should place the corollary foremost,

and define a medicine as a substance which has the power of changing sickness into health, and therefore-on the principle nil prodest quod non lædit idem-of altering health to sickness.

Now on what ground is any substance to be reckoned a medicine? and how is it to be ascertained what are the morbid conditions and processes it can favourably modify? There are but two ways by which to arrive at such conclusions, the empirical and the rational.

1. Many, perhaps most, of the ordinary remedial uses of drugs have been stumbled upon by chance. It has generally been the "common man" (as Hahnemann calls him), sometimes even the still lower brute, that has discovered them; and the professional healer has taken the hint and adopted the practice. After this manner has been gained bark as a remedy for ague, burnt sponge for goitre, arnica for the effects of falls and strains, graphites for tetters, sulphur for the itch. Not less empirically, though among the practitioners of medicine, has arisen the use of mercury and iodide of potassium in syphilis, of bismuth in gastralgia, of arsenic in psoriasis. Theories of the modus operandi of such remedies have often been subsequently framed; but it is certain that their original adoption grew out of no such theories, but was an accidental discovery.

Now it would be the height of unwisdom to neglect information from this source. A remedy is a remedy, however come at, and whether conforming or not to any laws of action we may suppose to prevail. Experience is the test even of medicines rationally ascertained to be such: it is but beginning the process a little lower down when experience itself discovers them. But on the other hand it is obvious that the empirical method is a very uncertain one, and affords no guarantee of further additions to our remedial wealth. Indeed, it is no method at all, but mere guess-work and chance pickingup. It is only hopelessness as to rational therapeutics which has led such writers as Wilks and Druitt in the past to make empiricism a matter for satisfaction and a standard of advance; and it is with regret that we see it rampant in the highest ranks of the medicine of to-day. Sir William Gowers has for some time been regarded as one of the leading authorities upon nervous diseases, and as a neurological specialist is in great request for consultative purposes. In an address published in the Lancet of 1895 (Nov. 23rd) he has shewn us what is in this case the "scientific medicine" on the possession of which that periodical so often felicitates the profession. "It has not been my privilege," he says, "to add much to our therapeutical resources, but the few agents I have recommended have been based on pure empiricism." He gives as examples his employ