This constituent, existing in such proportion, has features peculiar to itself. The symptoms it comprises are the effect, not merely of appreciable, but of large, of poisonous doses. So far they would be, in the estimation of many, of greater value than most of their surroundings. But comparison of Hahnemann's citations with the originals has disclosed such laxity as regards both the materials used, and the manner in which they have been transferred to his pages, that, until verified, all symptoms so obtained are under a cloud. I have good reason to know that such verification, with the necessary accompanying correction, will be ere long completed for all Hahnemann's medicines. In the mean time they must remain in their own special dubiousness.

The facts about the pathogenesies of the Chronic Diseases are now before us. I offer no opinion here upon the bearing they have on the value of the collection: I only desire that they shall be known as they are. One practical conclusion, however, seems to be plain. Whatever value may be ascribed to provings with infinitesimal quantities, at least they are facts of a different order from those elicited when appreciable doses are given; and we ought to

be able to distinguish between them. In Dr. Hempel's translation of the Chronic Diseases, which is the nearest approach the English reader can make to the original, there are no means of making such distinction: the whole list of symptoms stands unnumbered and unmarked. It would be an inestimable boon if some one, knowing German and having leisure, would go through the symptoms for us, and publish lists of (1) those which come from the Mat. Med. Pura, and (2) those which are in the 1st edition of the Chronic Diseases. We should know that the residue were in the 2nd edition only; and, from Dr. Allen's forthcoming Encyclopædia, where the sources are given, should see which of these were Hahnemann's (and therefore observed in patients) and which those of his fellowobservers (possibly provings). As the same collection is to give us the cited symptoms verified and corrected, we should then for the first time be in a position to gauge the worth of any symptom of the Chronic Diseases to which a repertory might direct us. At present these pathogenesies are in such a mist that they are little used. Re-provingssuch as we have had of Sulphur and Natrum muriaticum, and as the American Institute promises us of Sepia-are most welcome. But for these we must wait; and in the mean time we want to know what it is we have in our hands.

DR. RUSSELL REYNOLDS BEFORE THE BRITISH MEDICAL ASSOCIATION.

THE perusal of the thoughtful and eloquent "Address in Medicine" delivered by Dr. Russell Reynolds at this year's Annual Meeting of the British Medical Association has aroused certain considerations in our minds, which we submit in this place to him and to all whom they may

concern.

The definition of homoeopathy is that it is a therapeutic method, choosing its remedies by the rule "let likes be treated by likes ;" and the only necessary corollaries from this rule are the proved medicine, the single remedy, and the small (not necessarily infinitesimal) dose. But man was not made to dwell in the empirical region; and the conclusions of experience inevitably bring suggestions and modify thoughts as to that which is beyond experience, as to theory. We have found that the relation of similarity between drug-effects and disease is available for therapeutic purposes only when these drug-effects are dynamic, i. e. neither mechanical nor chemical. Then the existence of a purely dynamic sphere of action in medicines inevitably suggests to us, and makes us adherents of, vitalism in physiology and pathology. Again, our endeavour after perfect similarity between the two series of phenomena with which we are concerned has led to several important points of doctrine among us. Pushing our provings into minutest detail, we have found subjective symptoms vastly more abundant than objective, and not less significant and characteristic; and, our attention being thus directed, have found the like to occur in disease. We have, moreover, observed that each individual reacts in his own peculiar way to drug-influence; and have hence been led to insist on individualisation in therapeutics, on treating the patient and not merely the disease. The same observation has taught us to think much of the difference between man and the lower animals, to attach but qualified importance to experiments with drugs on the latter, to urge human provings as the only foundation for human therapeutics. Lastly, as our rule of selection leads us to use medicines which act only on the diseased parts, the light has shown us the contrasting darkness; and we have learnt to abhor and to protest against the disturbing and exhausting medication of healthy parts, which constitutes so large a part of the ordinary practice.

These have been common-places in homœopathic literature for the last forty years and more. They have gone dead against the stream of current medical thought; but we

have not greatly cared for that. It is impossible, however, to be indifferent when we hear them proclaimed by such a man as Dr. Russell Reynolds, and before such a body as the British Medical Association. That they form the substance of his Address in Medicine is evident from his own résumé of it.

"In recapitulation, let me remind you-1. That by losing sight of, or underrating the primary fact of life, we deprive ourselves (a) of the information to be gained from a study of subjective symptoms;* (b) we often misdirect our therapeutic

* "With regard to the former-' subjective symptoms '-is it not coming to this, that but little attention is often paid to the accounts. which patients give us of themselves, their ideas, emotions, feelings, and physical sensations? These are things which we cannot weigh in our most guarded balances; measure by our finest scales; split up in our crucibles; or describe in any terms save those which are peculiar to themselves, and which we cannot decompose. These symptoms are often disregarded and set aside; and the patient, whose story of disease is made up of them, is thought fanciful, hypochondriacal, hysterical, nervous, or unreal; because, forsooth, we have physically examined thorax, abdomen, limbs, and excretions, and have found in them nothing wrong; because we have looked at the retinæ, examined the limbs electrically, traced on paper the beatings of the pulse, weighed the patient, and have not found him wanting. Still he is miserable, in spite of placebo and assurance that there is 'nothing organically wrong.' There may be in him the consciousness of a deep unrest; or of a failing power, which he feels, but which we cannot see; or of a something worse than pain, a sense of 'impending evil,' that he is conscious of, in brain or heart; a want of the feeling of intellectual grasp, which he may call failure of memory,' but which memory, when we test it, seems free from fault; a want of the sense of capacity for physical exertion,' which seems, when we see him walk or run, to be a mere delusive notion, for he can do either well and easily to our eyes and those of others; and so he is called 'nervous,' and is told to do this or that, and disregard these warnings that come to him from the very centre of his life. And let me ask whether or no it has not again and again happened in the course of such a history as that which I have only faintly sketched, that some terrible catastrophe has occurred? Do we not see minds gradually breaking down while we say there is no evidence of organic change in the brain? hearts suddenly ceasing to do their work, when after careful auscultation we have said there was nought to fear? Suicide or sudden death sometimes disturbs the calm surface of our scientific prognosis of no evil; we may be startled, and may then see all that we ought to have seen before. But when the ripples that such unforeseen events have occasioned on that smooth surface have subsided, we go on as we have already done, and still pay but little attention to what the patient feels, and delight ourselves in the precision of

efforts, by eliciting vital action, rather than conserving vital force; and (c) lose sight of many of the most important causes of disease. 2. That by failing to see the speciality of the nature of man, we underrate or ignore (a) much of the etiology of human suffering; (b) are often misled by the results of observations upon animals; and (c) are in danger of misinterpreting the facts of the most serious maladies that may afflict our fellow-creatures. 3. That by disregarding the individuality of man we are in danger (a) of again and in another way losing a due appreciation of the causation of disease; and (b) of overrating the value of statistics, and of being led astray by their apparent precision, which exists only with regard to masses; and, 4. That by an unsound application of the idea of the specificity of disease, we may on the one hand (a) sweep away distinctions which are facts of pathology, and, on the other, (b) raise up or lay down lines of demarcation which are unreal."

There are some points raised here which do not concern us at present. But that vitality is a property per se; that subjective symptoms are to be earnestly regarded; that we misdirect our therapeutic efforts if we "elicit vital action," i. e., stimulate healthy parts; that we "are often misled by

our knowledge with regard to physical conditions of which he may know nothing and may care still less. No one can appreciate more highly than I do the value of precise observation, but I do not believe that minute, delicate, and precise observation is limited to a class of facts which can be counted, measured, or weighed. No one can see more distinctly than I do the wrong conclusions at which a physician may arrive by accepting as true the interpretations which fanciful patients may offer of their symptoms; but I am sure that, if we pay no heed to these mistaken notions of a suffering man, we lose our clue to the comprehension of the real nature of his malady. Morbid sensations and wrong notions are integral parts of the disease we have to study as a whole, and we are bound to interpret their value for ourselves; but we can ill afford to set them aside, when we are as yet but in the dawn of scientific pathology, and are endeavouring to clear away the obstacles that hide the truths we hope hereafter to see more clearly about the mystery of disordered life. The value of such symptoms may be slight in some kinds of disease, when compared with that of those phenomena which may be directly observed; but we are bound to remember that there are many affections of which they furnish the earliest indication, and there are not a few of which they are throughout the only signs."

VOL. XXXII, NO. CXXX.-OCTOBER, 1874.

SS