301 MISCELLANEOUS. The Revision of the Materia Medica. By Dr. HUGHES.* AT a meeting of the British Homœopathic Society, held March 2nd, 1882, the following resolutions were unanimously adopted: “1. That, in view of the considerations as to the state of our Materia Medica, lately adduced by Drs. Yeldham and Black in this country, and Dr. J. P. Dake in America, the British Homœopathic Society feels that the time has come for its reconstruction, and is prepared to undertake the task. "2. That, for this purpose, a Committee of seven of its members, including the President and Secretary, be appointed. "3. That this Committee be instructed to take for the basis of its work the Encyclopædia of Dr. Allen, in the light of the criticisms upon it made by its editor in the North American, and by Dr. Hughes in the British Journal of Homœopathy. "4. That the translation of Hahnemann's Materia Medica Pura, recently issued with the aid of the Society, be regarded as the first instalment of its work; and that the symptoms furnished thereto by Hahnemann and his fellow-provers be not again presented under the medicines to which they belong. "5. That the aim of the Committee shall be to expunge all untrustworthy and irrelevant matter, and to present what remains in the most accurate, concise, and intelligible form-all repetitions being avoided, and all provings being given, where possible, in consecutive order, as related by the experimenters." The Committee appointed in pursuance of these resolutions was desired to furnish specimen medicines for consideration by * The following paper was contributed to the North American Journal of Homeopathy for February. It is thought that its perusal may interest readers on this side of the water also. the Society. Aloes and Aconitine have been presented and discussed (the latter appearing as an appendix to the October number of the British Journal of Homœopathy); and the Committee are now at work on the acids employed in our practice. These, when completed, will be printed in the February number of the Annals of the Society, a special copy of which will be sent to every editor of a journal and every teacher of Materia Medica throughout the homoeopathic world, with a view of eliciting their opinions on the plan adopted. I have thought that a few words in the leading organ of our system in the United States might conduce to a better understanding of our aims and methods; and have therefore asked the favour of the insertion of the following remarks. In the preface to his Reine Arzneimittellehre, Hahnemann defines what the Materia Medica of Homœopathy must be: "If a work on Materia Medica can reveal the precise qualities of medicines, it must be one from which all mere assumption and empty speculation about the reputed qualities of drugs are excluded, and which only records what medicines express concerning their true mode of action in the symptoms they produce in the human body" (Dudgeon's Transl. I, 3). Whatever remarks, therefore, such a work may contain in prefaces and notesremarks historical, critical, interpretative, applicatory, its body must consist of a series of pathogeneses. Strictly speaking, nothing else is needed; for, given the effects of a substance in health, we have only to apply them to disease on the principle similia similibus, to elicit its medicinal powers. The great aim of Hahnemann and his school has accordingly been to ascertain and exhibit the pathogenetic effects of drugs. The object is beyond all criticism, and the labour and suffering incurred have been above all praise; and had it not been for two unfortunate circumstances, the task performed would long ago have compelled the admiration of the profession, and might have made homœopathic practice in some measure universal. The features which have ruined it as regards general acceptance, and continue to keep it the property of a small minority alone, are, 1st, the untrustworthiness of much of its material; and, 2nd, the unintelligible manner of its presentation. 1. With the symptoms which Hahnemann and the fellowprovers he gathered around him while at Leipsic have con tributed to the first two editions of his Materia Medica Pura, no candid critic can find fault. The precautions taken, as related in his preface and elsewhere, to secure healthy subjects, freedom from extraneous disturbance, good faith and accurate observation, leave nothing to be desired. That the minute deviations from ideal health incident to every one at all times should be mixed up with true medicinal effects, is almost inseparable from provings on the human subject, and scarcely detracts from their value. Hahnemann, at all events, did his best to eliminate them; and his work is pure gold, with only such alloy as the necessities of human currency compel. Already, however, one element in the six volumes of the Reine Arzneimittellehre must have a different verdict passed upon it. The symptoms cited from authors (some 4000 in all, or about 12 per cent. of the whole) are of very various quality. So far as they are observations of poisoning, they are mostly valid. But very many of them are phenomena occurring in sick persons taking the drugs, and referred by Hahnemann (not by the physicians administering them) to the remedy rather than the malady. When these symptoms have been examined in their original records, they have nearly always had to be rejectedthe evidence for their being medicinal being quite insufficient. To these (and to their later congeners) belong pretty well all the strange and incredible effects ascribed to certain drugs-the "green stools" of Belladonna, the " rage and "tenacious leucorrhoea " of Aconite, the " purulent expectoration" of Conium, the "hernia" of Antimonium crudum, the "dropsy," "jaundice," "phthisis" of China, the "gonorrhoea" of Chelidonium, &c. Now when Hahnemann retired from Leipsic to Coethen, he had no source but observations on patients taking his medicines on which he could draw for pathogenetic purposes. All symptoms warranted by him at this epoch-his additions to the later issues of the first two volumes of the Reine Arzneimittellehre (1830-3), and his copious contributions to the Chronischen Krankheiten (1st ed., 1828-30; 2nd ed., 1835-9)-are of this nature. Of the discrimination he exercised in separating between medicinal and morbid phenomena, we may judge from what we have seen him do with the observations of others; and it must be remembered that all his remedies were now given in infinitesimal doses. The example he set was also followed by some of his later disciples, among whom Wahle and Hering may be named as prominent. Patients, moreover, afforded another opportunity for supplying the Materia Medica with symptoms. Aggravations of their existing troubles occurred from time to time during treatment; and the exaggerated notions which Hahnemann entertained of the power of drugs, especially when highly attenuated, led him to set these down as, in most instances, the effect of the medicine they were taking.* Here, too, he has not wanted imitators. But by these he has been quite outdone as regards the utilisation of the sick for enriching the Symptomen-Codex. When in a prover some existing deviation from health disappeared during the action of a drug, Hahnemann records it, adding "Heilwirkung" (curative effect). Only in the case of Iodium has he done this with definite maladies (as goitre and enlarged glands) treated with the medicine. But his disciples have seized upon the proceeding and carried it to lengths from which he would have shrunk aghast. They have freely admitted" clinical symptoms into our pathogenetic lists, cutting up the cases which have recovered under the action of a remedy into their component parts, and sowing these in the appropriate divisions of the schema. They at first denoted such symptoms by a sign (or *); but soon grew careless about affixing it, and at last (as in Lippe's Text-Book and Hering's Condensed Materia Medica and Guiding Symptoms) avowedly omitted it altogether. To these deliberate vitiations (as I must call them) are to be added those incidental to time and use-the havoc wrought by translation and re-translation, the errors of repeated copying, and such like. The result is that our Materia Medica is an Augean stable, almost as foul as was the common one when Hahnemann exposed its condition, and set to work at its purification. There are, indeed (to employ another figure), far more numerous grains of wheat now scattered through the mass, and to winnow these from the chaff is not so difficult. How far this has been done, or yet remains to be done, I shall inquire immediately. Let me first speak of the other repellent feature of the Materia Medica-the mode of presenting its constituent parts. *The evidence for these statements as regards Hahnemann's mode of proceeding has been given in my little tractate on The Sources of the Homœopathic Materia Medica. 2. It does not admit of dispute, that to convey to the student the action of a medicine as elicited by proving, the record of the experiments should be given in detail. He must know the subjects on whom the drug is tried, the doses taken and their repetition, and the connection and sequence of the results. On the other hand, the practitioner of homoeopathy frequently needs simply to know what drug has produced such and such symptoms present in his patient; and for his purposes an index to the proving, or an arrangement of its produce in some orderly form, is necessary. Now, Hahnemann seems unfortunately to have had in view only the practitioner's requirements; and has withheld (it is said, destroyed) his provers' day-books, giving us their symptoms only arranged in an anatomical schema. In this he was followed by all his disciples, until, in 1844, the Austrian Society began to publish their provings and reprovings in the Oesterreichische Zeitschrift. The immense superiority of the detailed records here given must have impressed every candid mind, and it has only been the old Hahnemannians and certain modern retrogressionists* who have since ventured primarily to present fresh provings in schema form. The mischief, however, had been done; and a great mass of our pathogenetic material is only available in the disjecta membra of an anatomical catalogue of symptoms. Of the lamentations which this deplorable state of things has elicited from all quarters, space would fail to give an account. I shall content myself with citing Dr. Dudgeon's caustic description of the schema. "It is," he says, 66 as unnatural and artificial an arrangement of the features of many allied morbid portraits as though an artist should paint a family group, arranging all the eyes of all the members of the family in one part of the picture, all the noses in another, the ears all together, the mouths all together, and so on. From such a picture, correct though each feature might be, it would be a difficult matter for us to build up each separate portrait, and it is equally difficult for us to ascertain the various morbid portraits from the tableaux Hahnemann has presented us with in his Materia Medica" (Lectures, p. 233). If homeopathists can thus speak of it, what impres * See the Report of the Materia Medica Bureau of the 1881 Session of the American Institute, justly stigmatised by Dr. Allen. VOL. XLI, NO. CLXV.-JULY, 1883. U |