A bird's eye view of Hahnemann's Organon of Medicine
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Hippocrates and Hahnemann
There are two books in the literature of medicine, and two only, which stand out in absolute pre-eminence over all other medical writings, however excellent these may be. With the Aphorisms of Hippocrates medical history had its beginning, and with the Organon of Hahnemann medical history begins anew. The Father of Medicine sums up in eight books of aphorisms, numbering 422 in all (supposing them all to be authentic), the practical wisdom of his day in the art and science of medicine; and so true is his estimate of hat he observed, and so sound his judgement, that his descriptions of diseases and their gravity, and his general rules of treatment have scarcely been bettered by writers who have come after. Hahnemann, in his Organon, has likewise chosen the aphoristic form as the vehicle for his teaching. In a series of 294 aphorisms he sets forth the whole duty of the medical man. Hippocrates is more the artist of medicine, who saw clearly and described truly what he saw. Hahnemann is philosopher as well as artist : no less practical than Hippocrates he goes down into the reasons of things in a way it was not possible for Hippocrates to do.
Let me quote, almost at random, a few of the sayings of the Father of Medicine, to illustrate my meaning :-
- "When the disease exists in all its vigour, it is necessary to use the most sparing diet" (i. 8).
- "Old men are best able to bear fasting, middle-age persons bear it less easily, youths with still less ease, and children least of all. Of the last, those especially who are of a lively and active disposition" (i. 13).
- "Those diseases which are undergoing, or have already undergone, the crisis should neither be disturbed nor altered by medicines, or anything else that may cause excitement, but should be suffered to take their course" (i. 20).
- "Too much sleep and too much watching are equally injurious" (ii. 3).
- "Spontaneous lassitude is the forerunner of disease" (ii. 5).
- "Diseases arising from repletion are cured by evacuation; and those which proceed from evacuation are cured by repletion; an so in other cases diseases are removed by means which are exactly contrary to the causes" (ii. 22).
- Here, I may remark, is the genuine sphere of an allopathic principle, which is sound enough provided it is confined to the cases in which it is fairly applicable.
- "Acute diseases come to the crisis in fourteen days" (ii. 23).
- "the fourth day is the indicator of the seventh; the eighth is the commencement of the second week. The eleventh day should likewise be attended to, for it is the fourth of the second week; we should also remark the seventeenth day, for it is the fourth from the fourteenth and the seventh from the eleventh" (ii. 23).
- "It is better that a fever should happen after a convulsion than a convulsion after a fever" (ii. 26).
- "A convulsion caused by a sorrow is mortal" (v. 2).
These are sufficient to remind you of the character of this monument of antiquity. The celebrated passage in which the homeopathic idea is stated doses not occur in the book of Aphorisms, but in another work attributed to Hippocrates-"p??? " and, whether really his or not, the book is of undoubted antiquity. Hahnemann quotes it in his Introduction. The following is the passage :-
("Through likes disease arises, and through like being made us of diseases are healed in the sick-through vomiting sickness ceases")
The difference in the tone and the scope of the two works will be apparent if we place side by side the first of the aphorism of Hippocrates and the first two of those by Hahnemann. There is no more hackneyed quotation in the whole of medical literature than the
"Ars longa, vita brevis'", which opens the Hippocratic book :
"Life is short; the art is long; the occasion is sudden, experience deceptive, and judgement difficult. Nor is it enough that the physician do hi duty; he should also see that the patient and his attendants do theirs, and that external things be well managed."
Compare with this-true enough, but not very inspiriting-estimate of the doctor's difficulties and duties the tone and confidence of Hahnemann's exordium :-
"The physician's high and only mission is to restore the sick to health - to cure, as it is termed".
This is his first aphorism, and here is his second :-
"The highest ideal of a cure is rapid, gentle and permanent restoration of the health, or removal and annihilation of the disease in its whole extent, in the shortest, safest, most reliable, and most harmless way, on easily comprehensible principles".
Between Hippocrates and Hahnemann there is the difference between dim twilight and broad daylight. The difficulties of the doctor's position remain much as Hippocrates described them, but Hahnemann has brought the fullness of light to bear upon the difficult places and has shown him a way through some of them. He has brought a new life, hope, and confidence into the practice of the medical art.
To sum up : Hippocrates's Aphorisms may be described as a well-ordered collection of excellent tips; Hahnemann's constitute an organic philosophy of medicine. Hippocrates's work reminds us of isolated fragments of some wonderful statue, whilst Hahnemann's is like the living human organism itself.
It is astonishing how little is known by homeopaths generally about the Organon. It is seldom the fits book that is given to a student. I believed there is a notion that it is chiefly concerned with the theory of homeopathics and everybody is so "practical" nowadays! Besides, Hahnemann's pathology, we are told, was so crude and so different from modern pathology! And we know so much more about homeopathy and drug action than he did, that if we take his drug-provings and make use of them we may look upon the rest of his works as entertaining and interesting but scarcely practical and useful!
Now this is as far as possible from the actual truth. If there is one distinguishing feature more tan another about the Organon it is that it is practical. It contains theory, no doubt; but theory is the most practical of all things-we cannot make progress without it. A theory is "something to see by"; the better and truer the theory the more intelligent the practice. Homoeopathy is based on certain theories of disease and drug-action which experience in practice has proved to be sound. But leaving aside all that is theoretical, the bulk of the Organon deals with matters of fact and rule of practice.
Before going into details I will just rapidly sketch for you the contents of the volume. My remarks must all be understood to refer to Dr. Dudgeon's translation of Hahnemann's fifth edition, which is the best English translation we have. The fifth edition was published in 1833, Dr. Dudgeon's translation in 1849, the revised translation, from which I quote, in 1893.
Analysis of the organon
The work consists of an Introduction of about fifty pages and a text of more than twice that amount.
The Introduction comprises :-
1. A survey of the medical treatment of the time.
2. Examples of homoeopathic cures from previous writers.
3. The testimony of physicians of earlier times as to the superiority of the homeopathic principle.
The next may be divided into two parts; the first (comprising the first two aphorisms quoted already) sets forth what the physician ought to be, and what he ought to do. The remaining 292 deal with what he ought to know, and how he ought to set about achieving his object.
But I will summarise it a little more particularly.
The doctor's raison d'être and the nature of disease and medicinal action
- Aphorism i. and ii. And deal with the doctor's aim and mission.
- Nos. iii. and iv. Tell what he must investigate.
- No. v. bespeaks attention to exciting and fundamental causes.
- Aphorism vi.-viii. Set forth the importance of the totality of the symptoms in any case as constituting the disease-the thing to be dealt with and done away with. This, in opposition to those who search for the hypothetical hidden cause of disease, and aim at getting rid of that.
- Nos. ix.-xv. maintain that disease is of a spirit-like "dynamic" nature, consisting in a derangement of the vital force which can only make itself known through symptoms.
- Nos. xvi.-xxi. show that medicines, in order to meet this condition, must be themselves dynamic.
- Nos. xxii. and xxiii. discuss the antipathic use of drugs.
- Nos. xxiv. and xxv. explain their homoeopathic action.
- In Nos. xxvi. and xxvii. Hahnemann enunciates the law of homoeopathic action; and in the two following (xxviii., xxix.) he attempts to explain the operation of medicines in accordance with the law. As I shall point out presently, Hahnemann, whilst attaching no vital importance to his explanation of the law, is perfectly decided importance to his explanation of the law, is perfectly decided as to the law itself.
Susceptibility of the organism to disease action and to medicinal action
Hahnemann next (xxx.-xxxiii.) compares the susceptibility of the human body to drug diseases with its susceptibility to natural diseases; and then (xxxiv.-xlix.) he describes the behaviour of different diseases co-existing in the body at the same time, and show (l.-liii.) that the diseases which cure others are like them-in that is, are homeopathic to them. He goes on to show (liv.-lxxi) that of all methods of using drugs (which he compares elaborately) as in the case of natural diseases, it is only the homeopathic method which really effects cures.
Acute and chronic diseases; homeopathic aggravation; regimen and diet; pharmacy; animal magnetism
We now come (lxxii.-lxxxviii.) to a new branch of his subject-a survey of diseases, and his distinction between acute diseases and chronic; then (lxxxiv-civ.) to the investigation of diseases for which he gives the most precise instructions; then (cv.-cxlvii) to the investigation of the actions of drugs, rule for proving medicines, and rules for selecting the most like in every case. In exlviii. he gain explains how a cure is probably effected. After an account (exlix.) of the difference of time required for the cure of acute and chronic diseases, and further rules for selecting and administering the homeopathic remedy (cl.-clvi.), we come to the explanation of the homeopathic aggravation of disease (clvii.-clxi.). Rule for using remedies in various types of diseases take up clxii.-ccli. In cclii-celvi. he gives the signs of commencing improvement. The two following (cclvii., cclviii.) utter warning against drug favouritism. Regimen and diet occupy cclix. to cclxiii. In cclxiv. to cclxxi. he deals with the selection of plants and other substances, and the preparation of medicines therefrom for homeopathic use; in cclxxii.-cclxxiv. he urges the necessity of using only one simple single medicine for a patient at one time. The subject of dose and dynamisation is dealt within cclxxv.-cclxxxvii. The next four (cclxxxviii.-ccxcii.) tell which parts of the body are more or less susceptible to the influence of drugs, with a note on administration by olfaction. Lastly (ccxciii., ccxciv.), he defines the place of animal magnetism;
From this rapid sketch of the contents of the volume you will be able to see that for scope, profundity, originality, and practicability, the world has never seen the like. And I am not going to make any qualification in this estimate and say "compared with all that had gone before"; for it is equally true as compared with all that has come after. There is absolutely nothing to compare with it. The little systems of other men have had their day, and ceased to be : Hahnemann's is built on eternal foundations.
We sill now proceed to look more particularly at a few passages. First, we will turn to the Introduction. In a previous lecture * I have referred to the essay on a New Principle, which contained, as I endeavoured to show, the germ of the Organon and Materia Medica both. In this essay Hahnemann formulates the homeopathic principle thus :-
Every powerful medicinal substance produces in the human body a kind of peculiar disease; the more powerful the medicine the more peculiar, marked, and violent the disease.
"We should imitate nature, which sometimes cures a chronic disease by superadding another and employ in the disease we wish to cure that medicine which is able to produce another very similar artificial disease, and the former will be cured, similia similibus.
We might imagine from this that Hahnemann was a great stickler for the ris medicatrix nature, and for blindly following the efforts of the organism to rid itself of diseases. But Hahnemann was no blind follower of anything or anybody. He followed nature with his eyes open.
Illustrative extracts from the work
From the introduction
I will now quote a few passage from the Introduction which will show you Hahnemann's estimate of certain doctrines and methods which are not by any means extinct to-day, and also his estimate of the Vis medicatrix nature. In these as in all my quotations from Hahnemann I give his own italics, of which he made liberal use.
"A favourite idea of the ordinary school of medicine until recent (would that I could not say the most recent!) times, was that of morbific matters (and acridities) in diseases, excessively subtle though they might be thought to be, which must be expelled from the blood-vessels and lymphatics through the exhalants, skin, urinary apparatus, or salivary glands, through the tracheal and bronchial glands in the form of expectoration, from the stomach and bowels by vomiting and purging, in order that the body might be freed from the material cause that produced the disease, and a radical causal treatment be thus carried out.
"By cutting holes in the diseased body, which were converted into chronic ulcers kept up for years by the the introduction of foreign substances (issues, setons) they sought to draw off the materia peccans from the the (always only dynamically) diseased body, just as one lets a dirty fluid run out of a barrel through a tap-hole. By means also of perpetual fly-blisters and the the application of meze'aum they thought to draw away the bad humours and to cleanse the diseased body from all morbific matters-but they only weakened it, so as generally to render it incurable by all these senseless unnatural processes.
"I admit that it was more convenient for the weakness of humanity to assume that in the diseases they were called on to cure there existed some morbific material of what the min might form a conception (more particularly as the patients readily lent themselves to such a notion), because in that case the practitioner had nothing further to care about than to procure a good supply of remedies for purifying the blood and the humours, exciting diuresis and diaphoresis, promoting expectoration and scouring out the stomach and bowels.
Hence in all the works on Materia Medica, from Discorides down to the latest books on the subject, there is almost nothing said about the special peculiar action of individual medicines; but besides an account of their supposed utility in various nosological records of diseases, it is merely stated whether they are diuretic, diaphoretic, expectorant, or emmenogogue, and more particularly whether they produce evacuation by the stomach and bowels, upwards or downwards; because all the aspirations of the practitioner have ever been chiefly directed to cause the expulsion of a natural morbific matter, and of sundry (fictitious) acridities, which it was imagined were the cause of diseases" (pp. 10, 11).
"But the essential nature of diseases and their cure will not adapt themselves to such fantasies, nor to the convenience of medical men; to humour such stupid, baseless hypotheses, diseases will not cease to be (spiritual) dynamic derangements of our spirit-like vital principle in sensations and functions, that is to say, immaterial derangements of our state of health". (P. 11).
"Are, then, the foul, often disgusting, excretions which occur in diseases the actual matter that produces and keeps them up? Are they not rather always excretory products of the disease itself, that is, of the life, which is only dynamically deranged and disordered" (p. 14)
Further on Hahnemann exposes the doctrine of "derivation", which in his day was the favourite excuse for the employment of violent measures. But the ore modern adherents of the old school do not wish it to be supposed that in their treatment they aim at the expulsion of material morbific substances. They allege that their multifarious evacuant processes are a mode of treatment by derivation, wherein they follow the example of Nature, which, in her efforts to assist the diseased organism, resolves fever by perspiration and diuresis, pleurisy by epistaxis, sweat and mucous expectoration-other diseases by vomiting, diarrhoea and bleeding from the anus, articular pains by suppurating ulcers on the legs, cynanche tonsillaris by salivation, etc., or metastases and abscesses which she develops in parts at a distance from the seat of the disease.
"Hence they though the best thing was to imitate nature by also going to work in the treatment of most diseases in a circuitous manner, like the diseased vital force when left to itself, and thus in an indirect manner, by means of stronger heterogeneous irritants applied to organs remote from the seat of the disease, and totally dissimilar to the affected tissues, they produced evacuations and generally kept them up, in order to draw, as it were, the disease thither".
"This derivation, as it is called, was, and continues to be, one of the principal modes of treatment of the old school of medicine" (pp. 16, 17)."
On this principle all sorts of severe measures, such as blood-letting, mercurial salivation, counter-irritants, and cauteries of all kinds were employed. Hahnemann goes on to show that mere imitation of nature is not a thing to be aimed at. Nature may be imitated in her method of cure; but not the vain efforts of the organism to rid itself of a disease.
"When the old-school practitioners thoughtlessly imitating the crude, senseless, automatic vital energy, with their counter-irritant and derivative methods of treatment, attack innocent parts and organs of the body, either inflicting on them excruciating pains, or, as is most frequently done, compelling them to perform evacuations, whereby strength and fluids are wasted, their object is to direct the morbid vital action in the primarily affected parts away to those artificially attacked, and thus to effect the cure of the natural disease indirectly, by the production of a disease much greater in intensity and of quite a different kind, in the healthy parts of the body, consequently by a circuitous way, at the cost of much loss of strength, and usually of great sufferings to the patient" (p. 21).
Here is his summary of the whole matter : -
"No! that exquisite power innate in the human being, designed to direct in the most perfect manner the operations of life, while it is in health, equally present in all parts of the organism, in the fibres of sensibility as well as in those of irritability, the unwearying spring of all the normal, natural functions of the body, was not created for the purpose of affording itself aid in diseases, not for the purpose of exercising a healing art worthy of imitation. No! the true healing art is that reflective work, the attribute of the higher powers of human intellect, of unfettered judgement, and of reason selecting and determining on principle in order to effect an alteration in the instinctive, irrational and unintelligent, but energetic, automatic vital force, when it has been diverted by disease into abnormal action, and by means of a similar affection developed by a homoeopathically-chosen remedy, to excite in it a medicinal disease somewhat greater in degree, so that the natural morbid affection can no longer act upon the vital force, which thus, freed from the natural disease, has now only the similar, somewhat stronger, medicinal morbid affection to contend with, against which it now directs its whole energy, and which it soon overpowers, whereby the vital force is liberated and enabled to return to the normal standard of health and to its proper function, 'the maintenance of the life and health of the organism', without having suffered, during the change, any painful or debilitating attacks. Homeopathy teaches us how to effect this" (p. 28).
Extracts from the organon
I will now quote some of the paragraphs of the Organon itself, and will begin with the first.
The physician's high and only mission is to restore the sick to health-to cure, as it is termed.
The highest ideal of a cure is rapid, gentle, and permanent restoration of the health, or removal an annihilation of the disease in its whole extent, in the shortest, most reliable, and most harmless way, on easily comprehensible principles.
If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medicinal powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that recovery must ensue-to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated), as also in respect to the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose;-if, finally, he knows the obstacles to recovery in each case, and is aware how to removed them, so that the restoration may be permanent; then he understands how to treat judiciously and rationally, and he is a true practitioner of the heading art.
He is likewise a preserver of health if he knows the things that damage health and cause disease, and how to removed them from persons in health.
Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable 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 function, etc., are to be taken into consideration.
The unprejudiced observer-well aware of the futility of transcendental speculations which can receive no confirmation from experience-be his powers of penetration ever so great, takes not of nothing in every individual disease except the changes in the health of the body and of the mind (morbid phenomena, accidents, symptoms) which can be perceived externally by means of the senses; that is to say, he notices only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by those around him, and observed by the physician. Al these perceptible signs represent the disease in its whole extent, that is together they form the true and only conceivable portrait of the disease.
Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm, and attention paid to the accessory circumstances, § 5) be the symptoms alone by which the disease demands and points to the remedy suited to relieve it-and, moreover, the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force must be the principal, or the sole means whereby the disease can make from known what remedy it requires-the only thing that can determine the choice of the most appropriate remedy-and thus, in a word, the totality of the symptoms must be the principal, indeed the only, thing the physician has to take note of in every case of disease, and to remove by means of his art, in order that it shall be cured and transformed into health.
Now, however, in all careful trials, pure experiment, the sole and infallible oracle of the healing art, teaches us that actually that medicine which, in its action on the healthy human body, has demonstrated its power of producing the greatest number of symptoms similar to those observable in the case of disease under treatment, does also in doses of suitable potency and attenuation, rapidly, radically, and permanently remove the totality of the symptoms of the morbid state, that is to say, the whole disease present, and change it into health; and that all medicines cure, without exception, those diseases whose symptoms most nearly resemble their won and leave none of them uncured.
This depends on the following homeopathic law of nature which was sometimes, indeed, vaguely surmised but not hitherto fully recognised, and to which is due every real cure that has ever taken place :-
A weaker dynamic affection is permanently extinguished in the living organism by a stronger one if the latter (whilst differing in kind) is very similar to the former in its manifestations.
The curative power of medicines, therefore, depends on their symptoms, similar to the disease, but superior to it in strength, so that each individual case of disease is most surely, radically, rapidly and permanently annihilated and removed only by a medicine capable of producing (in the human system) in the most similar and complete manner the totality of its symptoms, which at the same time are stronger than the disease.
Acute and chronic diseases § 72.
"...The diseases to which man is liable are either rapid morbid processes of the abnormally deranged vital force, which have a tendency to finish their course more or less quickly, but always in a moderate time-these are termed acute diseases;-or they are diseases of such a character that, with small, often imperceptible beginnings, dynamically derange the living organism, each in its own peculiar manner, and cause it to deviate from the healthy condition in such a way that the automatic life energy, called vital force, whose office it is to preserve the health, only opposes to them at the commencement and during their progress imperfect, unsuitable, useless resistance, but is unable of itself to extinguish them, but must helplessly suffer (them to spread and) itself to be over more and more abnormality deranged, until at length the organism is destroyed; these are termed chronic diseases. They are caused by infection from a chronic miasm."
The above quotations must suffice for the present as examples of the matter and style of this monumental work, though many other points of interests might have been brought out. Hahnemann, for instance, was not among the vulgar crowd who reviled mesmerism when it first came out, and left to their lineal descendants in another generation to accept it under another name. He recognised the good of it, and assigned it its place. And Hahnemann would not have been surprised by the Tuberculin treatment of consumption. In a footnote to Aphorism lvi., he says : "A fourth mode of employing medicines in diseases has been attempted to be created by means of Isopathy, as it is called-that it to say, a method of curing a given disease by the same contagious principle that produces it. But even granting this could be done, which would certainly be a most valuable discovery, yet, after all, seeing that the miasm is given to the patient highly dynamised, and thereby, consequently, to a certain degree in an altered condition the cure is effected only by opposing a simillimum to a simillimum." In concluding this brief and necessarily very inadequate account of Hahnemann's wonderful book, I cannot do better than quote the words of its English translator.
In the preface to the 1849 edition Dr. Dudgeon thus fitly sums up his estimate of the Organon : "Perfect and complete in itself, it leaves no point to doctrine unexplained, no technical detail untouched, no adverse argument unanswered".
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