MEDICAL GAZETTE

VOL. XLI

DECEMBER, 1906

ORIGINAL COMMUNICATIONS

No. 12

HOW FAR DO HOMEOPATHIC AND OTHER PHYSICIANS AGREE, AND HOW FAR CAN THEY AGREE? *

BY RICHARD C. CABOT, M.D., INSTRUCTOR OF MEDICINE HARVARD UNIVERSITY.

A new generation has grown up since the bitterest controversies were waged between the two main sects of our profession in this country. With this growth has come the disappearance of some of the grounds of difference. Personal antagonism has largely disappeared. I suppose no homoeopath now receives from members of our school any of the social avoidance or arrogant disdain which I am told used to be meted out by the past generation. We have learned that a group of homoeopaths are very much like any other group of physicians. In your school, as in our school, there are some fools, some fanatics and some knaves, but in your school, as in ours, there are those who are intelligent, high-minded and eager for the truth wherever found.

We have begun to meet together for discussion both at the bedside and in scientific societies like this. We consult together and we study together.

These are great gains attained by the growth of a spirit of tolerance and of truth-seeking on both sides. I shall not try to estimate which of the two sects has changed most. I am quite prepared to believe that we have been more in the wrong than you, and that we have receded from more false positions than you have. But I am concerned more with the result than with the stages and processes by which it was attained; more with the question of "Where are we now?" than with the route by which we have arrived here. I am not interested in inquiring who is to blame. If you say that we, the old school men, are greatly to blame, I will cheerfully admit it, and will search my conduct for evidence of injustice or prejudice still remaining,- but my chief interest is with the present, not the past; with an attempt to get together now, rather than with an inquiry into the causes and delinquencies that have kept us apart hitherto,

*Read before the Boston Homœopathic Medical Society, November 1, 1906.

I propose, therefore, to begin with a recapulation of the points of agreement gained so far, and then to suggest some items of work and practice in which I hope we may agree still further.

I

We agree, first of all, in those fundamental sciences on which the practice of medicine is based, physics, chemistry, biology, anatomy and physiology, gross and microscopic, normal and pathological. This agreement is nothing new, but its consequences have not, I think, been fully recognized. For if we agree so far, we must also agree in all that can be strictly and legitimately deduced from the data of the fundamental sciences.

In so far as diagnosis, prognosis, or treatment are strict and logical applications of the anatomical or physiological facts of the case in hand, there can be no difference of opinion between our schools. "In so far" I say, and I am very well aware that it is not very far. Still, some examples are obvious. Physical, chemical and biological diagnosis, for example, are logical applications of the principles of physics, chemistry, biology, to the known data of anatomy and physiology. Hence it comes that on questions of physical, chemical and biological diagnosis we all agree nowadays.

I do not know whether this agreement has always existed, but my impression is that diagnosis is one of the fields in which your schools and ours have been getting together more and more in the last ten years. This is a very great gain and presages still further agreements in the near future.

II

Surgery is another example of a branch of the physician's art which is based directly on anatomy and physiology. Because the facts of anatomy and physiology are facts for us all alike we can and do agree on surgery. This, again, is especially true of late years and in this country. I find in some books by English homopathic writers a spirit of hostility to surgery quite foreign to the attitude of members of your society in this vicinity, and I am told that homœopaths are having their cases of appendicitis with abscess operated on earlier nowadays than was the custom ten years ago.

III

Hygiene and prophylaxis exemplify still further the extension of our basis of agreement as we apply further and further the principles of the fundamental sciences which all educated physicians alike acknowledge to-day. Hygiene and prophylaxis are simply the applications of bacteriology and physiology to the problem of keeping well. The isolation of infectious disease, the destruction of the excreta of the typhoid and the sputa of the tuberculous patient are typical of the many important measures for protecting the public health in which there is no longer any disagreement between us. Dietetics, physical exercise and the full use of our neglected birthright fresh air — are taught and practiced by both schools alike. because they are deductions from the data of physiology.

Whenever the treatment of a disease consists essentially in diet and good hygiene as for example in phthisis as for example in phthisis - we find no considerable difference in the practice of Homoeopaths and Old School physicians.

IV

Wherever asepsis or antisepis is demanded, there is no difference between us. Surgeons differ, of course, as to the value of particular methods of sterilizing hands, instruments, dressings, and the field of operation, but there is no distinctive old school view or homoeopathic view in such matters.

So it is in diseased conditions where local treatment is indicated. Local diseases of the skin, of the mouth, and upper respiratory passages, of the urethra, bladder, rectum, and female genitals are treated, I take it, by both schools on the same essential principles.

Whenever chemical or physiological antidotes are demanded as, for example, in poisoning cases and in the neutralization of acid by alkali, we find all well educated physicians of both schools in substantial agreement.

Mechanical therapeutics includes surgery, the application of orthopedic and other forms of apparatus, massage, manipulation, vibration, exercise, active and passive; do we not wholly agree in this branch of treatment?

I do not know whether Bier's method of treating joint diseases by the production of active hyperæmia through heat, or of passive hyperemia by bandaging, is properly to be described as homoeopathic, but whether it is homoeopathic or not, it is, I suppose, as acceptable to us all, because it rests on biology and physics, not on pharmacology.

Heat, cold, counter irritation, electricity, are applied by both i schools alike. Radiotherapeutics is, I believe, considered a striking example of the homoeopathic principle. If so, it shows the sprouting of homœopathic methods within the old school.

My impression is that hydrotherapeutics and conscious psychotherapeutics are used more extensively by our school than by yours, but this indicates no difference in principle between us for the good offices of water and mental influence are not the property of any school, and all physicians are sure to avail themselves sooner or later of any usefulness that there is in these methods.

The beneficial effects of good nursing are not subjects for controversy, and I suppose that outside the giving of medicine there is no difference between a Homoeopathic and an Old School nurse.

There remains two types of therapeutics regarding the homœopathic view of which I must ask you to enlighten me - I allude to vaccination and to serum therapeutics. There are men in both schools who refuse to vaccinate or to give antitoxin in diphtheria.

Are such persons relatively more numerous with you than they are with us? I must ask you to answer the question for me, but however, this mathematic problem may be settled, it seems to be the fact that there is no orthodox opinion among homoeopaths against the use of vaccination and antitoxic sera.

The use of tuberculin is a form of vaccination which illustrates better than any example known to me the approval of homoeopathie principles in our school. Tuberculin is, of course, not an antitoxin, but a toxin, and its therapeutic use is a form of vaccination. The poison of tuberculosis which can produce some of the symptoms of tuberculosis is here applied in small doses for the cure of tuberculosis through the production of immunity, or resisting power in the tissues. Surely, this is a case of "similia similibus curentur," as homoeopathic writers have pointed out. The use of bacterial vaccines in infectious diseases recently produced by A. E. Wright is distinctly homoeopathic.

But the revival of tuberculin therapy within the past ten years (after its abandonment in 1890) illustrates the victory of another homœopathic doctrine within our school. I mean the doctrine of the occasional utility of very minute doses. No one in this country has had so much experience with tuberculosis as Trudeau of Saranac Lake. No one has tested so critically and cautiously the merits and dermerits of this remedy. As a result of his fifteen years' experience of its use he published last August an account of his own methods, and in a recent letter to my friend, Dr. John B. Hawes, Jr., he has amplified and reiterated his statements in a most interesting way.

What dose does he use? Not the 10 milligrams often employed in the early nineties - not even the 1 milligram or milligram recommended later. At present he begins his treatment in febrile cases with 1-10,000th of a milligram and in febrile cases with a 1-100,000th of a milligram. This 1-100,000th of a milligram, when injected under the skin in a centimetre of water and absorbed into the circulation becomes diluted about 5,000,000 times by the body fluids. Hence we imagine the original milligram of tuberculin acts in a dilution of 1-500,000,000,000! What fixes this dose? Precisely the homœopathic principle, namely, to produce a definite good effect without any observable ill effects.

Of course I do not mean to imply that we have already reached an agreement as to the proper dosage of all, or even of very many, remedies. But we have now observed the occasional utility of very minute doses, and you have long since admitted the occasional benefit of very sizable doses. In principle, therefore, we already agree. It remains to work out the multitudinous details of the application of these principles.

We sometimes follow the maxim, "Similia similibus curentur." but not often. You sometimes follow it, but not always. We strike at the cause of the disease and remove it whenever we can find that cause. So do you, whenever you are convinced that it is a cause, as with intestinal worms, or head lice. Those of you who are convinced that quinine kills the malarial parasite in the blood just as a vermifuge kills an intestinal parasite in the gut, use quinine for malaria, just as we do.

We have come round to your minute doses in some cases, and there is no knowing how much further we may go. You, on the other hand, are not tied down to minute doses, but are quite ready to use larger doses when better effects are obtained thereby.

V

THE SINGLE REMEDY

Let us turn now to another cardinal tenet of homoeopathy-the single remedy. There we must frankly confess that old school practice has come much nearer to homoeopathic usage within the last ten years. We, many of us, use but one drug at a time. "Drug” is never synonymous with remedy in our terminology, and so we should rather say that we often see several remedies, e.g., regulations of the diet, fresh air, exercise, hydrotherapy and mind cure all at once, but with these remedies we perfer to combine not more than one drug-sometimes less. When I turn to some of the older books on therapeutics, some still used in our school, and see how the frail human stomach is expected to bear not only the drug but an adjuvant, a corrective, a flavor and perhaps more ingredients, I rejoice that we no longer practice what some of our text-books still preach.

There is no longer any ground for discussion between us as to the advisability of giving but one drug at a time. I think there is no longer any considerable difference between the practice of the two schools in this respect and in consultation with seven of your body, Drs. Sutherland, Batchelder, Rockwell, Moore, Carvill, Everett Jones, and Hubbell, I have found entire agreement as to the advisability, in special cases of giving several drugs alternately to the same patient.

Not long ago a meeting of this kind would be sure to attempt a discussion of the belief that Homœopaths treat symptoms while Old School practitioners treat the cause of the disease or the diseased organ itself. But in our time this, like so many other grounds of controversy, has vanished.

You and we alike treat the cause of disease whenever we can find it (which, alas! is not very often.)

You and we alike extirpate a diseased organ by surgical interference when the symptoms appear to make such action advisable. You and we alike are often unable to locate the cause of disease, or even the diseased organ, and then you and we alike fall back upon the treatment of symptoms. None of us wants to treat symptoms if we can remove their cause. All of us are forced to treat symptoms when we can't find or can't remove their cause, as is the case in the great majority of cases seen by any general practitioner. Sometimes we treat the totality of symptoms that is in our language, the evidences of disturbed functions, when we recognize them, as for example, the dropsy, dyspnoea, cough, palpitation, insomnia, nausea, oliguria and pain produced by passive congestion in uncompensated cardiac disease. Sometimes we are forced to treat a single symptom, like headache, because we can't connect it with any other symptoms or with disease of any organ.

We are all in the same box here and there is nothing to discuss.

VI

A LAW OF THERAPEUTICS

It has been perfectly just to charge our school in the past with the absence of any principle or law in therapeutics, and to contrast the order and system of homoeopathic treatment with the helter skelter omnium gatherum of merely empirical methods. But the