matic correspondence will give us this identity also; but in lack thereof it may often be obtained by analogy. It was, for instance, a long time before we had adequate provings by women; and in the absence of these we had little sure knowledge of the action of drugs on their sexual apparatus. But it was justly argued (as by Dr. Leadam *) that substances which inflamed mucous membrane or provoked hæmorrhage elsewhere should be homoeopathic to endo-metritis and metrorrhagia; and so they proved to be.

Another mode of securing what may be called "tissue-remedies" was initiated by Dr. von Grauvogl, and has been elaborated by Dr. Schüssler. As each part selects from the blood the elements it requires for its nutriment, so does it behave with the drugs brought to it by the circulatory current. But there must be a difference according as such drug is or is not an actual constituent of the part, still more if it be altogether foreign to the body. In the two latter cases the drug must be classed as a "function-remedy," ie. it exalts, depresses, or otherwise modifies vital activity without effecting substantive change. It is different when the part for which it has affinity normally contains the substance in question. If this can act elsewhere as poison in health, as medicine in disease, here it would seem to supply pabulum only,-to be a food; and such it doubtless is as long as the supply is proportioned to the demand. But what occurs when it is in excess? The reason why each part selects from the blood its proper pabulum seems to be that such nutritive elements act as specific stimuli thereto, evoking its assimilative activity. Excess of such stimulation must cause, either morbid hypertrophy, or-by exhaustion-deficient nutrition in respect of this very element; and the latter seems the more frequent occurrence. On the other hand, in such malnutrition idiopathically induced, the best remedy will consist in small doses of these very substances,-not as aliment (which proper food best supplies) but as specific stimuli, raising the depressed vital activity to its normal lines.

This was von Grauvogl's argument; and he called such substances "nutrition-remedies," instancing their usefulness by the employment of calcarea phosphorica in defective ossification of the cranium, leading to chronic hydrocephalus, and of silicea in enchondroma of the fingers. Dr. Schüssler was so enamoured of medicines of this kind, that he would have had us abandon the whole Materia Medica in favour of a dozen of them,-the fluoride, phosphate and sulphate of calcium, the phosphate of iron, the chloride, phosphate and sulphate of potassium, the phosphate of magnesium, the chloride, phosphate and sulphate See B. J. H., x. 59.

of sodium, and silica. I need hardly say that he has found no followers (among the profession) in his exclusiveness; but a large measure of success has been obtained with the new remedies of the kind he has proposed for adoption, and by generally following out the indications he has urged on our notice.*

2. Seat of action is of such value in the endeavour after specific similarity; but kind of action is of no less importance. By this I mean something more than was spoken of among the elements of generic similarity, viz.: that the pathological process shall be the same-fever, inflammation, ulceration, and so forth. I am thinking of the quality which such processes receive from the diathesis or general disease of which they are the outcome. Sydenham long ago pointed to this as an essential element in specificity. "In overcoming a chronic disease," he wrote, "he has the best and truest claim to the name of physician who is in possession of the medicine that shall destroy the species of the disease; not he who merely substitutes one primary or secondary quality for another. This he can do without extinguishing the species at all; i.e., a gouty patient may be cooled or heated, as the case may be, and his gout continue unconquered." In like manner we may say, that a medicine may be homœopathic to simple inflammation of an organ, but not to that peculiar modification impressed upon the process by its occurrence as a result of scrofula or of syphilis. Intestinal ulceration, again, is a simple thing in itself; but it varies in character according as it is a part of a typhoid fever, the ultimate issue of a dysentery, or the consequence of tuberculous deposition in the course of phthisis. To these differences and variations our medicines must correspond so far as is possible. To reach the most suitable remedies for the qualities of morbid processes is no easy task. It requires symptomatic comparison, pathological inference, analogy, and clinical experience; but when obtained it is worth all the trouble. The superiority of colchicum in gouty inflammation to the bryonia or pulsatilla the arthritis would otherwise demand is an instance in point.

3. Of another feature of specific similarity I have already spoken. It is that modification of disease which its originating

* See "The Twelve Tissue Remedies of Schüssler," by Drs. Boericke and Dewey. Dr. Schüssler evolved his theories out of homeopathy, carried them out for many years in fellowship with our body, and gave them to the last in homoeopathic form and dose. Latterly he (rather ungratefully) withdrew himself from our ranks, and took up an independent position. It is amusing to notice that in the last edition of his book on the subject, issued just before his death in 1898, he omits one of his twelve medicines, on the ground of the doubtfulness of its presence as a constituent of the organism. Yet this sodium sulphate has been in use by Schüsslerites for many years, and has not been found less active than its associates.

cause impresses upon it. It differs according as it is of physical or mental origin, and these classes have to be further subdivided. A rheumatism arising from dry cold is one thing, from damp cold another: a neuralgia induced by injury to a nerve is different from one brought on by malaria or by gout. Jaundice from mental emotion is not the same disorder as that arising from heat or from a too stimulating diet. I might multiply examples; but these are sufficient to show my meaning. Now to these modifications also our remedies must correspond; and here again the correspondence may be arrived at in various ways. Dulcamara supplies a good illustration. Carrére, who published in 1789 a treatise on its virtues, states that he had several times noticed in patients under its influence some twitching of the eyelids, lips and hands on exposure to cold damp weather, which readily subsided under the application of dry warmth. The homeopathic inference therefrom was that dulcamara would be suitable as a medicine to affections thus caused, and so it has proved to be in numerous instances. However arrived at, such causal homeopathicity (if I may so express it) is of the utmost value, and many a time leads as no other guide would to the specific remedy.

4. Another useful point of comparison between disease and drug-action is the character of the pains and other sensations present. There is a reason why one should complain of burning pain, another of tearing, another of gnawing, and so forth; we may not be able to explain it, but the kind of sensation present characterises the suffering, and on being found in pathogenesy establishes the specific similarity of the drug which causes it. The burning pain of arsenic is a good example,—the more so because it is at present inexplicable. It has been thought to depend on mucous membrane being the seat of its action; but this cannot hold good of its neuralgia, where it no less obtains.

5. Lastly, I would speak of concomitance, that is, the coincidence of two or more marked symptoms in the pathogenesis of a drug and in the phenomena of a disease. Its value rests on the mathematical law of combinations, or-as it is technically called-permutations. The number of the possible rearrangements of the figures of a series increases in proportion to their number, but by leaps and bounds exceeding not merely arithmetical but even geometrical progression, so that while for five figures it is 120, for seven it is 5040. In the same ratio increase the probabilities against any one combination occurring by chance. You will see, then, that if three distinctive symptoms of a case can be found to have been excited by a medicine, there is already considerable likelihood of its acting on the

same parts and in the same manner; and that the odds in its favour increase rapidly as the points of analogy are multiplied. If you have three legs to your stool, Constantine Hering used to say, you may well sit down upon it; but a four-legged chair is better still. He, however, judging from the shape in which he published most of his provings, did not appreciate the full value of this mode of proceeding. It is a small matter that symptoms should be present, compared with their being present in a certain connexion and sequence; and this it is as impossible to discover in the schema of Hering as in that of Hahnemann. Now, with the detailed provings in our hands, we can ascertain order as well as occurrence, and thus enhance many-fold our probability of arriving at genuine results.

Dr. Woodward, of Chicago, and Dr. Ord, of Bournemouth, have of late years urged on us the importance of chronological sequence in respect of organs or tissues affected, and have shewn that many a success may be scored by securing homœopathicity in this matter between disease and drug-action.*

Seat of action, then, in organ or tissue; kind of action, in diathesis or other quality, in causative modification, in character of sensations, and in concomitance and sequence of symptoms, these are the main elements of specific similarity. The more you can secure of them the better your prospect of reaching the "pathological simile," as Drysdale called it, which is the aim of all your endeavours and the best hope for your patient.

* See Transactions of International Hom. Congresses of 1881 and 1896.

LECTURE VIII.

THE SELECTION OF THE SIMILAR REMEDY (continued).

III. Similarity of drug-action to disease is to be generic, specific, and individual. We have considered some of the elements which go to make up generic and specific likeness, and have now to see what can further be done by way of making the similarity individual. That it should so be, if possible, must be evident. Even the essential, typical diseases affect each subject in his own way, so that he presents a variety of the species; and that which is distinctive in him must be taken into account. Individualisation is as important in therapeutics as it confessedly is in education. Still more decisive are such indications for the choice of the remedy in those anomalous morbid conditions, coming under no definite category, which constantly come before us. I cannot quite go with the saying "il n'y a pas des maladies, il n'y a que des malades ;" but here it is certainly applicable, and we may go with Dr. Clifford Allbutt in viewing as "wholesome" the "tendency to the fall of diseases, as abstract names, and to the rise of the patient."* Of the mode of dealing with such cases I shall speak farther on at present let us consider individual as complementary to specific similarity.

In pursuit hereof must be taken into account the patient's constitution and temperament, his mental and emotional state, the conditions of aggravation and amelioration presented by his sufferings, the side of the body affected, and the time of day or night at which his symptoms are most pronounced.

I. To almost every medicine of importance in homœopathic practice has been assigned, as it has become well known, a type of patient to whom it is suited. Bryonia corresponds to brunettes of bilious tendencies and choleric temper, with firm flesh; arsenicum to worn and exhausted constitutions s; nux vomica to vigorous persons of dry habit and tense fibre, addicted, it may be to "high thinking," but not to "plain living"; pulsatilla to the lymphatic, and ignatia to the nervous temperament, in women and children; and so forth. These adaptations have mostly been reached by clinical experience, but sometimes the physiological effects of drugs will lead to them; and Teste has suggested that we may often get useful hints from the results of experimentation on animals,-poisons which have most effect on carnivora or herbivora respectively finding * British Med. Journ., Oct. 6, 1900.