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did not long remain to assist me with his valuable support, as he soon afterwards went abroad with a noble Russian family, which I greatly regretted, as the other colleagues with whom I came in contact had no confidence in my recommendation of the Cyanuret of Mercury. I must, however, confess that they obtained a considerable success in the treatment of the disease by their employment of Apis, Mercurius biniodatus, Nitric acid, &c., and swabbing the throat with alcohol, though the duration of the disease under this treatment was longer.
I allowed five years to elapse before I ventured to publish the results of my treatment, and I was only induced to do so by the request of my friend and colleague Dr. Beck, the fortunate introducer of this successful treatment. He had the intention to read a paper on diphtheria and its specific remedy at the International Congress of Paris in 1877, and for this purpose he begged me to send him a report of my clinical experience, which I did. But unfortunately he could not obtain the necessary leave from his employers. A colleague to whom the reading of the paper was confided was unable to obtain a hearing.* This circumstance no doubt served to delay the knowledge of the treatment among homoeopathic practitioners until quite recently.
The above may serve as a historical introduction to the followings remarks.
The first clinical trial of Cyanuret of Mercury was suggested by an accidental or designed poisoning. At the commencement of this essay, I asserted that besides a pathological knowledge of the thing to be cured, it was necessary to have correct therapeutics. From the above recorded pathologico-anatomical account we could not have drawn any conclusion referring to the therapeutics of the special case described had we not been in possession of a long series of methodically conducted pharmacodynamic experiments of an anterior date, together with a maxim deduced from them. Such are the pathogenetic drugprovings which led their, initiator, Samuel Hahnemann, to
* Dr. Beet published in 1868, in Paris, a small pamphlet of twenty-four pages in French, On the Use of Cyanide of Mercury in Diphtheria.
his chief therapeutic principle. He called this the principle of similarity; with what right will be shown further on.
But first I must show how clinical trials, in case such should be prompted by this essay, should be successful; and this indeed is my sole object in writing it.
For the sake of greater clearness I resort once more to the historical domain.
Two years after the first announcement of the specific curative power of Cyanuret of Mercury in diphtheria, I had an opportunity of meeting several German colleagues, who, in the course of conversation, told me that in consequence of my recommendation they had employed the Cyanuret of Mercury in the treatment of diphtheria, but had not obtained the same clinical success. In spite of employing the Cyanuret of Mercury for eight days in their cases, they had observed the occurrence of diphtheric ulcerations which required Hydrochloric acid for their cure; I do not remember if some of these cases ended fatally, but this is of no consequence. This important difference from my own clinical results led me to inquire what doses they had used. I found that they had employed the 2nd decimal dilution (1 to 9), and had given this in grain doses repeated every two hours. I then made this calculation: one grain of the 2nd decimal dilution contains ~th part of a grain of the medicine. This repeated every two hours makes, if we deduct some hours for sleep, on an average ten such doses per diem, consequently ^05th = Tgth of a grain, and in eight days T~th or |th of a grain. Now, looking at the great intensity of the toxic action of this drug, from this quantity distributed over eight days, only poisonous effects, or at least a protraction instead of an involution of the morbid process, could be expected. I concluded that from these large doses they obtained the positive effect of the drug in place of the negative which is essentially the curative effect.
To this category belongs the observation made by the non-homoeopathic Petersburg physician, Dr. Erichsen, which was recorded some years ago in the St. Petersburg Medical Journal. The author there recommends, as though it were his own idea, the Cyanuret of Mercury as the most potent anti-diphthericum. He dissolved a very small quantity of the drug in a relatively large quantity of distilled water. The solution was equal to about the 3rd decimal dilution. Of this solution he prescribed a tablespoonful in rapid repetition. Under this treatment, as the author tells us, the disease had a very long duration, and the mortality, though very favourable compared with that of the ordinary treatment, was very considerable compared with my treatment, viz. 7 out of 25 = 28 per cent., so that it was not likely to induce others to adopt it. Erichsen's observations were published in 1880 in one of the principal medical periodicals of Germauy (Medicinische Central Zeitung), which opened its pages to a reply by a homoeopathic practitioner (Dr. Ohrt, of Essen). Although the writer expressly assures us it was not his intention to vindicate my claim to the priority of the recommendation of Cyanuret of Mercury as a specific remedy for diphtheria, still the reader of the short article could not be ignorant that I had felt it my duty to disclaim the credit of priority, and to give it to the person to whom it properly belonged, to wit, Dr. Alphonse Beck, at present residing in Monthey, Canton Valois. In connection with this I protested against the employment of ponderable doses, and endeavoured to lay down rational grounds for the administration of minimal doses. The editor to whom I sent my little manuscript refused to admit it into his journal.
A comparison of the clinical results of both kinds of treatment, the macrodoses and the microdoses, shows distinctly which method is the best. The microdosal treatment is shown by experience to be the most successful as far as regards diphtheria. But to one inclined to make clinical trials with Cyanuret of Mercury it might be difficult to accept the saying of Tertullian, "credo quia absurdum." Therefore I feel myself bound to show the esteemed reader the necessity a priori of minimal doses of medicine for curative purposes.
In order to do this it is first of all requisite to enter on experimental investigations relative to the causes of diphtheria. But first I make a few remarks concerning the causes of disease in general.
If we cast a glance at the totality of the universally distributed atmospherical-telluric causes (not to mention the psychical, which play but a minor part in the production of diphtheria), together with the various reactions on the part of the human organism which they induce, there are two things which occur to us: 1st, that of individuals exposed to one and the same morbific cause, some show no reaction at all; 2nd, that the modes of reaction of the others differ from one another. To the first of these propositions belong the epidemic maladies, which only affect a minority of those exposed to the same injurious influence. The second is seen when of ten individuals exposed to some accidental and transient injurious influence, such as being wet through by a pouring rain and experiencing a rude contrast of temperature, one gets a sore throat, another an attack of articular rheumatism, a third a sciatica, a fourth an intestinal catarrh, &c., whilst some escape without damage; whence we see that in addition to the exciting cause the peculiarity of the ailment is determined by some constitutional predisposition, or, to speak more accurately, a specific capability on the part of the organism of being morbidly affected. Hence the influence of one factor, the exciting cause, does not suffice to produce the morbid affection, nor to determine its specific character, so we can only attribute to it a relative power of causing disease.
We have therefore to distinguish relative causes of disease, which are almost innumerable.
On the other hand there are other, not so numerous, empirical circumstances. These are substances derived from the atmospheric-tell uric sphere which display a power of causing disease, that bear the character of irresistibility. These we term poisons. Every substance belonging to this class of morbific causes excites the organism, provided always it is constitutionally disposed, to phenomena of reaction, belonging to the class of disease, each of which in its main features corresponds to the specific characters of action of the poisonous substance, which is not determined by the individual specific disposition to disease inherent in the affected organism, or is only modified thereby quantitatively, not otherwise. To these substances we ascribe an absolute disease-producing power, and no second factor, such as predisposition, is required for the determination of the disease, which in this case is poisoning or intoxication. We call these absolute in contradiction to the relative causes of disease. Hence the idea "poison" is defined • as an absolute cause of disease. I will give an example to illustrate this: on an autumn evening a sudden cooling of the atmosphere, which is laden with moisture, in conjunction with the ingestion of a quantity of fruit, causes many persons to be taken ill with symptoms constituting the disease we term dysentery, whilst a much larger number of the people more or less exposed to the same influences remain free from these symptoms, or are affected in a different way. If in a population of 50,000, in a limited time 2000 are attacked with frequent, slimy, bloody, non-faecal evacuations, accompanied by violent colic and painful tenesmus, we recognise the prevalence of an epidemic of dysentery. On the other hand, if all the individuals in the population took a sufficient quantity of Corrosive sublimate, then not 2000, but 50,000, would be affected at the same moment and in the same manner with the above described characteristic phenomena, single cases among whom would present varieties in the degree of intensity of the malady.
The Perchloride of Mercury is the absolute cause of dysentery in contradistinction to the relative cause displayed in the autumn-weather constitution mentioned above, and this drug administered in a minute dose will, ctsteris paribus, be the infallible remedy for the disease.
In a similar relation to one another stand the micrococcus diphthericus and the Cyanuret of Mercury, and it should be borne in mind that the latter, as the absolute cause of diphtheria, was known before the former, which in consideration of the numerical proportion of epidemic diphtherial cases is to be regarded as the relative cause of the disease.
But how shall a poisonous substance furnish the remedy