should have to keep silence about it, and at the best wait for a brighter day. But it has been very far otherwise. The early battles over it in this country were fought (at least on our side) largely on the ground of statistics. I do not propose to renew the combat in detail; but this gage I must throw down, prepared to maintain it à outrance, that never has the method of Hahnemann had fair opportunity of pitting itself against its rival that it has not come off victorious in the contest. It was so when Tessier had half the beds in the Hôpital St. Marguerite at Paris; it was so when Fleischmann handled his cholera patients at Vienna with such comparative success as to win from the Government the long-withheld toleration of the practice; it was so when similar results obtained in this disease in the London Homeopathic Hospital (then in Golden Square) had the honour of being stifled by the official reporters, lest they should reflect upon the less favourable statistics of other institutions. It has been so since, when the Michigan and Illinois State Prisons were served by the two systems in successive terms of years; when the mortality of the one Orphan Asylum of New York which has homoeopathic treatment was set against that of the six others during the same time; when the homœopathic portion of the Cook County Hospital at Chicago recently compared notes with the other wards of the charity. To come nearer home, when the National Temperance Hospital was able to show better results than the metropolitan hospitals generally, it was obliged to except the London Homœopathic. It could only account for so surprising a fact by the supposition (which was, of course, entirely unfounded, and was promptly contradicted) that we did not admit acute cases! Is there any failure to set against these triumphs? There is none; and yet, on the assumption of the nullity of homeopathy, every such trial ought to have ended in discomfiture—that is, if the ordinary treatment were itself of any value. If the same assumption be persisted in, in face of the facts, then the higher mortality which the figures show for ordinary treatment means simply that it is to this extent positively murderous. I do not myself draw this conclusion; but then I do not believe that the rival method is merely expectancy.

The conclusion arrived at is that homeopathic remedies are, from their nature, from their negative advantages, and from the comparative results obtained with them, the best that can be employed, and such as should always be resorted to when practicable. I could enlarge more fully, did time allow, on the argument from their nature. I could show that they are constitutional substitutives, acting by elective affinities instead of topical application, and so of much more penetrating influence

and grasp of disease as a whole.* I could exhibit them as alteratives, having all the merits of the drugs so called-silently and peacefully, without evacuation or other intermediate action, extinguishing the morbid process at the seat of mischief; the only trace of their working being that where there was a storm there is calm, where there was pain there is ease, where there was weakness there is strength. But I must pause. I have said enough, I think, to vindicate Hahnemann's choice of the homœopathic, as distinguished from the antipathic and allœopathic methods of utilising drug-action in therapeutics. We have yet to study the mode of selecting the similar remedy; and this will occupy us at our next meeting.

* Dr. George Wood, in his "Pharmacology and Therapeutics," maintains that this is the modus operandi of quinine in intermittent fever-the standing type, as I have shown and have yet to show of a homoeopathic specific.

G

LECTURE VII.

THE SELECTION OF THE SIMILAR REMEDY.

That likes should-wherever practicable-be treated by likes, and that the elements of the comparison should ordinarily be the clinical features of disease and the symptoms produced by drugs in the healthy,-these points have now been established. Can we as it would seem we could-proceed at once to select our remedies?

It might have appeared to Hahnemann at first that the problem was thus simple. But in the fourth edition of the Organon (1829) he introduced a paragraph which recognised the necessity for wider considerations. It is that numbered § 5 in the fifth edition, which is the one we have in our hands as translated by Dr. Dudgeon. Let me read it to you :—

"Useful to the physician in assisting him to cure, are the particulars of the most probable exciting cause of an acute disease, as also the most significant points in the whole history of a chronic disease, to enable him to discover its fundamental cause, which generally depends on a chronic miasm. In these investigations, the apparent physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual functions, etc., are to be taken into consideration."

There are, you will observe, two distinct points made in this aphorism. The first is that the causes of disease, predisposing and exciting, are to be taken into account, not merely that they may be removed where possible, but as guides to the selection of the remedy. Thus, in choosing between nux vomica and pulsatilla in a case of dyspepsia, the sex, temperament and disposition of the patient, as also the kind of food which most disagrees, go for something in inclining the balance; in prescribing for rheumatic pains, we think of aconite or bryonia if dry cold, of rhus or dulcamara if damp, has been the exciting cause. If a morbid condition is traceable to a fit of anger, we are thereby inclined to give chamomilla for it; if to a fright, aconite or opium; if to long-continued depressing emotions, phosphoric acid. For complaints having origin in an injury, arnica is always useful, not only immediately upon its reception, but long afterwards.

Dr. Drysdale is the only writer-as far as I am aware-who has enquired into the reasonableness of this practice, upon homœopathic principles. He suggests that any similarity to the effects of definite exciting causes discoverable in the symptoms of a drug indicates that the latter has acted as a predisposing cause, making the system more susceptible to the morbific agency in question. Dulcamara is homoeopathic to catarrhal diarrhoea, not because it is a purgative, but because patients under its influence are more liable to have diarrhoea induced by cold and damp than they are without it. It thus goes deeper than the immediate attack, and not only removes this, but renders the patient less apt to its recurrence. The whole action is just another instance of the use of the totality of the symptoms in selecting the similar remedy.

But Hahnemann speaks further of ascertaining the "fundamental cause" of chronic disease, which (he says) is generally a "chronic miasm"-referring to his doctrine of the origin of a large proportion of such disease in syphilis, sycosis or psora. This we have discussed already, as one of Hahnemann's theories. The question now is, why is it useful to have this causation known? Hahnemann again shall speak for himself. In a note to § 80 of the fifth edition of the Organon, he writes concerning "psoric diseases":"I spent twelve years in investigating the source of this incredibly large number of chronic affections, in ascertaining and collecting certain proofs of this great truth, . . . and in discovering at the same time the principal (antipsoric) remedies, which collectively are nearly a match for this thousand-headed monster of disease, in all its different developments and forms. . . . Before I had obtained this knowledge, I could only teach how to treat the whole number of chronic diseases as isolated, individual maladies, with the medicinal substances whose pure effects had been tested on healthy persons up to that period; so that every case of chronic disease was treated by my disciples according to the group of symptoms it presented, just like an idiopathic disease, and it was often so far cured that sick mankind rejoiced at the extensive remedial treasures already amassed by the new healing art. How much greater cause is there now for rejoicing that the desired goal has been so much more nearly attained, inasmuch as the recently discovered and far more specific homeopathic remedies for chronic affections resulting from psora (properly termed antipsoric remedies), and the special instructions for their preparation and employment, have been published; and from among them the true physician can now select for his curative agents those whose medicinal * B. J. H., xxvi., 275.

symptoms correspond in the most similar (homœopathic) manner to the chronic disease he has to cure; and thus, from the employment of (antipsoric) medicines more suitable to this miasm, he is enabled to render more essential service, and almost invariably to effect perfect cures."

The object of seeking the "fundamental cause" now appears. It is that medicines suitable, not only to the existing symptomgroup, but to the "miasm," may be taken into account in the selection of the remedy. Translate the dubious “psoric" into "syphilitic," and you have the conception free from prejudice. We know that to trace a malady to a syphilitic origin is of the utmost importance as regards treatment. It guides us to a class of remedies of which otherwise we might not have thought. It is so no less so, Hahnemann teaches, in homoeopathic practice. He considered it a positive gain when morbid states, hitherto regarded as individuals, could be referred to a common type and treated by remedies chosen from a definite group, instead of being made the subject of an indiscriminate search through the Materia Medica.

Now this is obviously bringing pathology to the aid of symptomatology, and supplies another instance of its usefulness. Nor does it stand alone in Hahnemann's writings. He ever recognised that there were a certain number of diseases of fixed type, acquiring this by origination from a specific cause; and to these he appropriated one or more specific remedies, as always applicable and usually indispensable.

Let me give a few citations and references in support of this statement.

"We

Hahnemann's earliest and fullest utterance on the subject may be read in his 'Medicine of Experience' (1806).* observe," he there writes, "a few diseases that always arise from one and the same cause" (the italics are his), "e.g., the miasmatic maladies-hydrophobia, the venereal disease, the plague of the Levant, yellow-fever, smallpox, cowpox, the measles, and some others, which bear upon them the distinctive mark of always remaining diseases of a peculiar character; and, because they arise from a contagious principle that always remains the same, they also always retain the same character and pursue the same course, excepting as regards some accidental concomitant circumstances, which however do not alter their essential character" (here the italics are mine).

"Probably some other diseases, which we cannot show to depend on a peculiar miasm, as gout, marsh-ague, and several other diseases that occur here and there endemically, besides a few others, also arise either from a single unvarying cause or * P. 502 of Dudgeon's translation of the Lesser Writings of Hahnemann.