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Richard Hughes memorial lecture, 1959
T H E FACULTY OF HOM(EOPATHY
RICHARD HUGHES MEMORIAL LECTURE, 1959 By MArGeRY G. BLACKI~, M.D., F.F.Hom. I F~EL it a great honour to be asked to give this Memorial Lecture, but like Dr. Ross two years ago, I have found it very difficult to find any information about Richard Hughes beyond what one can glean from his writings. H a d I been giving it 30 years ago, I could have given a wonderful paper, for he was a household name with m y elderly patients. They all had a chest of remedies and often told me what I had better prescribe for them because Dr. Hughes had advised it. I had once dipped into his Pharmacodynamicsbut decided t h a t I preferred to read Kent, and until two months ago that was the extent of m y knowledge of him. I n 1877 Dr. Hughes was appointed to the Chair of Materia Medica and Therapeutics at The London School of Homceopathy (where, I wonder is the Chair?--we now only give lectures!). The sixth edition of his Pharmacodynamics was published in 1899, hard on the heels of the fifth edition of 2,000 copies, because they had sold out. I t seems incredible that this man who was renowned throughout the homceopathic world 60 years ago, and whom Dr. Dudgeon described as " b y far the greatest, ablest, and most faithful exponent of the great therapeutic truth revealed by Hahnemann, and his most zealous, enthusiastic, indefatigable and clear-headed disciple", should be almost unknown by us today. My paper is an attempt to find the reason why. I f these Memorial Lectures encourage us to go back and read the literature of the last century they will not have been given in vain. We are too apt to forget these bold and fearless men who risked professional reputation and social position for their beliefs. They were ostracized by the orthodox medical profession, but they were welcomed b y the laity. This new system gave them the opportunity to treat themselves and saved them from the risk of bleeding and purgation. From reading his writings the picture I have formed of Richard Hughes is of a clinician, interested in disease and its pathology. Having found the t r u t h and advantages of the homceopathie principle--his chief desire was t h a t everyone should benefit from it. I n his lectures to his students he says: "The Homceopathy you will learn from me will be no narrow or imperfect thing, but will embrace the whole range of Hahnemann's progress as a thinker and discoverer. While content to receive some modification of its form from the advances of modern investigation, it will be such that Hahnemann, I apprehend, would not fail to recognize as his offspring; while in no disciple of the scientific medicine of t o d a y will it be likely to excite repugnance or contempt." I n that last sentence, I think, is the key to m y question. Hughes was very anxious to interest and attract the orthodox medicals to t r y the new method. W h a t he wrote to hospital Physicians with their fuller training and opportunities bears this out. "Come and help as, bring to our enquiries and experiments your numbers, your wealth, your leisure, y o u r trained observers, your ample material. There is probably much t h a t is partial and extreme of which you can cure us. I f only with this motive, we beg you, take our Homceopathy and throw it into your crucible. We know what wealth of gold will come out and then we hope for it to go on accumulating far faster 79
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t h a n in our feeble hands. W h a t medicine might become in 10 years, ff only the profession at large would test Homceopathy as it deserves is a dream almost too bright to dwell upon." He gave up hope of seeing it in his lifetime, though he says that there were 10,000 medicals practising it in his time; but he did expect it to happen in the lifetime of the next generation. There were m a n y of his contemporaries who did not agree with his aim, for he regretted the quarrels between "those who cultivated exclusively and to the uttermost the method of H a h n e m a n n and those who sought rather to harmonize him with general medicine". We still have those among us today who hope and dream and work for this harmony, but I think history has proved them wrong. I f Hughes failed with all his zeal and enthusiasm, in a day when the newness of the method made a great impact (2,000 copies of his fifth edition selling in record time speaks for itself) how can we in this day of wonder drugs hope to succeed? Twenty or thirty years ago our homoeopathic doctors in Glasgow renewed their efforts, asking the authorities to allow them to treat casks homceopathically in their wards and under their supervision, but all in vain. Prejudice is as deeply rooted in the medical profession today as it was then. I think there is grave danger in it too. Hughes is no longer a household word, and in America where Homoeopathy was at its height in the d a y s of Kenf~-it was popularized: homceopathic medical schools were founded, and now patients tell me it is difficult to find a pure Kentian homceopathic doctor there at all. I am sure the pure Hahnemannian prescribers will always remain few in number: the extra learning and work necessary will only appeal to the doctor whose chief interest is in the wellbeing of the patient himself, rather than in the disease. W h a t then was this Homceopathy t h a t Dr. Hughes taught? His knowledge of drugs was vast and was derived from the orthodox treatises on toxicology, Materia Medica and morbid anatomy, as well as from the Materia Medica pura. This last he advised his students to study well, for there was the mine where they must dig, and they would find much treasure. He studied it himself minutely and carefully. He preferred to study the daily records of provers, and regretted that H a h n e m a n n had not preserved his, but had given a scheme of the results instead. I had not realized before with what meticulous care these provings were carried out. Provers had all to be healthy persons, who were living in contentment and comparative ease! "When an extraordinary circumstance of any kind: fright, chagrin, external injuries, the excessive enjoyment of any one pleasure, or some event of great importance supervened during the proving: then no symptom has been recorded after such an event, to prevent spurious symptoms being noted as genuine." After cross-examining the provers they offered their hands to him, the customary pledge instead of an oath, affirming that it was the truth and nothing but the truth to the best of their knowledge. But that was a digression to encourage those who take part in the provings today! Dr. Hughes taught t h a t every drug had an individual kind of action and a special centre upon which it acted. Many drugs might have the same action on an organ but there was always that little characteristic that distinguished it, which in an individual you might call the "trick-o-the voice" or the "twitch of an eyelid". I t was necessary to know the pathology of a drug, he said because mere mechanical symptom covering was as likely to miss the mark as to hit it. He agreed with H a h n e m a n n that the peculiar and unusual features, both of drugs and diseases, were of paramount importance and the subjective symptoms, especially of the mind and disposition, were more important than objective and physical ones. To add weight to these views he quoted from an address given by a Dr. Russel Reynolds to the British Medical Association in
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1874: "We are forced to remember that there are m a n y afflictions of which the subjective and mental symptoms furnish the earliest indications, and there are not a few of which they are "throughout the only signs." These views led H a h n e m a n n between 1806 and 1826 to attach less importance to the disease and to think more of the special sufferings of each patient, and this he called "individualization". There is nothing in this teaching to which we could take exception, and yet the name and teaching of Richard Hughes caused the stormiest meeting in this room t h a t I have ever attended. I cannot remember the subject of the paper but in the discussion following, the Society divided into two camps--one half praising, the other half denouncing him. This meeting ended in a discussion on potencies, always an inflammable subject. The heat of the discussion went to m y head and I remember vividly rising to m y feet for the first time to express m y opinions. I implored the erring faction to give up their evil ways and use only high potencies! Dr. Wheeler, who was in the Chair, tried to pour oil on troubled waters and no one could do it better t h a n he. He remarked t h a t most people learned to walk before they tried to run, but the young t o d a y seemed to want to fly, straight from the cradle! Let me give you two more quotations and see if they throw any light. Talking of this method called individualization, Hughes said " I doubt if it is, at least in all hands, applicable to the exigencies of everyday practice and the treatment on a large scale of acute diseases. But where there is more leisure and especially when chronic disease comes before you, I think that your best hope of making certain and speedy cures will be in your adherence to t h a t higher Homceopathy which the genius and toil of its discoverer have elaborated for us." Then he adds " I must avow at once t h a t m y ordinary standpoint is t h a t taken up b y the followers of Hahnemann's earlier method (he has described this before as the small and maybe material dose prescribed on pathological similarity). I t must almost necessarily be so", he says, "because lectures in materia medica like those on the practice of medicine, must contemplate disease as their object, while the purer homoeopathic therapeutics regard rather the sick person in his individuality. The simillimum, moreover, which I shall seek to establish between drug action and disease, will be in the main pathological. The great majority of those known as homceopaths, at least in the old world, have been converts from the recognized modes of practice. The expositors of the system which has satisfied their reason, the cures which have established their faith, have been of the kind we have seen in the earlier writings and practice of its founder. They have accepted his method as he himself then conceived it: with its law of similarity, its provings of medicine on the healthy, its single medicine and its small dose. But they do not think they need follow him in his rejection of the pathology of their day as he did in that of his. They prefer to work the rule simflia similibus with pathological similarities where these are obtainable, though in their default, and to fill in the outline they present, they thankfully use the comparison of symptoms." Accepting his statement t h a t the millionth degree hardly weakens the power of a drug for good, while it robs it of power to harm, they freely use such fractional quantities but they rarely go beyond this limit, and as a rule steer closer to the other end of the scale. They do not mix medicines but often alternate them. Hughes then mentions the Americans, m a n y of whom have become more Hahnemannian than H a h n e m a n n himself, who show an intolerant spirit towards those he has been describing, calling them "Mongrels". "Why should their stricter colleagues be impatient of their fellowship", he asks. "Their practice is surely good practice as far as it goes--far superior to t h a t of one who rejects the Master's teachings altogether." "Pathological similarity", he goes on to say, " m u s t be better t h a n no similarity at all--it m a y be a pity to alternate, but it is less injurious t h a n to mix--auxiliaries m a y be used more
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freely than is needful; but that is better than using nothing else. Of course there m a y be so frequent an employment of extraneous measures and so little cultivation of the method of similarity t h a t Homceopathy ceases to be the predominant feature in a man's practice--and in t h a t case the less he is connected with the name the better. But this is a rare occurrence: as a rule, the adoption of Homceopathy leads b y its own intrinsic value to a subordination of all other methods of treatment. Hitherto, I have been vindicating the legitimacy of the Homceopathy taught b y Hahnemarm up to 1806, to be called by that name, and to be practised by professed acceptors of the system. But it is another question whether it is wise to pause there: and whether in declining ~o follow him further in the elaboration of his method, there m a y not be involved the neglect of a more excellent way." I n his lectures Hughes said t h a t the relative superiority of the higher and lower dilutions was a moot point among them but it was a matter of fact t h a t certain remedies belonged almost exclusively to the partisans of the infinitesimals, while others were in chief favour among those who preferred appreciable fractions of the drug. This could be explained by the fact that certain drugs were comparatively inert unless attenuated to between the 2nd and 30th potencies. He quoted results in pneumonias treated in some hospitals by the 30th potency and said t h a t " T h e y made a more rapid and certain cure than those treated with the lower and that there is in the general tone of those who employ highly attenuated medicine, a confidence in their remedies, an habitual sense of power and success which cannot be disregarded." There was nothing in reason to render doubtful the apparent testimony of experience when it spoke of the efficacy of the 3rd and 2nd potencies downwards, but unless some evidence should be brought to prove t h a t we actually develop power as we go on attenuating after the Hahnemannian method, reason must certainly frown upon the higher potencies. He regretted the new American M-unit, not on grounds of science and reason but pure pharmacy. To make a lm he said, would take a man working 12 hours a day for 6 days, using one million clean bottles and 2,000 gallons of spirits of wine, one year to p r e p a r e - - a practical impossibility. He quotes a Dr. Walzxer, a most competent observer, who superintended the re-provings of Nat. tour. in Vienna, saying " I am alas! (I say alas! for I would much rather have upheld the larger doses which accord with current views) I am compelled to declare myself for the higher dilutions. The physiological experiments made with Nat. tour. as well as the great majority of the clinical results obtained therewith, speak decisively and distinctly for these preparations." From all these quotations is it not difficult to understand why Dr. Hughes taught and practised Hahnema~m's earlier method? I can only explain it by prejudice and that, having a supreme desire to see Homceopathy universally presented, he chose to teach the easier, more understandable and therefore more easily accepted method, rather than the higher Homceopathy, though he thought it might be the better way. Most of this has been theoretical--let us now look at this later method high potency prescribing, and see whether it is really a practical proposition, or, as Hughes suggests, not applicable in all hands to the exigencies of everyday practice. Let me first give you the main features in Hughes's Bryonia. I t is a pure irritant, he says, having no neurotic or h~ematic power, but sets up inflammation in the serous membranes and the organs they surround, less powerfully on mucous membranes, and is a specific irritant of muscle fibre. To Bryonia, Hughes says, as to all the great Hahnemannian medicines a special constitution and disposition has been assigned as that to which it is most suitable. I t is said
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to act best in persons of firm and fleshy fibre, of dark hair and complexion, of bilious tendency and choleric temperament, and where much irritability and irascibility are present. You must not lay too much stress on such indications; nevertheless, they sometimes guide us to the true remedy. Still more characteristic are its pains, which are always of a shooting or tearing kind. Then on the action of Bryonia in affections of the respiratory organs, which from its pathogenesis should be rather extensive: it is the best medicine--after Aconite for what is called a "cold on the chest", i.e. where a nasal catarrh has run down the air passages, as far as the first or second division of the bronchi. Heat, soreness and pain behind the sternum and an irritative, shaking cough with scanty expectoration make up the Bryonia picture. Again--in most of our text-books and domestic treatises Bryonia occupies the first place among the remedies for acute b r o n c h i t i s ~ I myself am quite unable to see its homceopathicity to this disease--when the smaller bronchiae are involved: and I have never been able to trace any good effect from it in practice. I t is otherwise with p n e u m o n i a - - f r o m what has been said indeed Bryonia can obviously do no good in the broncho-pneumonia so common in children and aged persons, where catarrh begins in the bronchial mucous membrane, affects the aircells rather in the way of cedema and collapse than of actual inflammation. But to the primary croupous pneumonia Bryonia is perfectly homceopathic, even more so than the Phosphorus which in this country usually plays the chief part in the treatment of the disease. Now let me give Clark's description of Bryonia: less rapid in its action t h a n Aconite, it goes deeper in its effects and often takes up the work where Aconite leaves off. I t not only disorders the circulation, but alters the blood itself. I t corresponds to fevers of almost all kinds, especially rheumatic, typhoid, bilious and remitting. I n these as in all other complaints the exquisite sensitiveness of the drug to movement of all kinds is a leading characteristic. The patient avoids even the movement of the eyes--raising the head from the pillow causes faintness--nausea and vomiting. Allied to this is > from pressure; from lying on the painful side---this keeps the part at rest. There is also an intense headache, dull, throbbing or sharp stabbing pains--all > pressure and < < movement. Mouth very dry, tongue coated white, lips dry and parched. Thirst for large quantities. The mucous membranes are dry, serous membranes inflamed and the seat of sharp stitching pains < motion. Later exudation occurs--the muscles inflamed and sore. Irritability of mind, easily angered with fever, stupid drowsy condition. Not much difference but the accent is more on the general condition and reactions of the patient rather than the organ affected. How different it must have been a century ago to get a clear picture of a drug from the symptoms in the Materia Medica pura. They were like skeletons t h e n - their anatomy laid out to view; but with the accumulated clinical experiences of the generations between they have now become living personalities. No one today would say whether Bryonia or Phosphorus played the chief part in pneumonia but would decide on the totality of symptoms. Prescribing with high potencies is rather like doing jig-saw puzzles the bits alone tell you nothing, b u t they will when you fit them together. Let me describe the picture we expect to see in a Bryonia or Phosphorus in an acute influenza, pneumonia or rheumatic fever, or any other acute disease. You see the Bryonia patient lying in b e d - - n o t in the least pleased to see you for he hates being disturbed in any way. He is heavy, drowsy, face puffy and bloated, the fine features gone. Lips m a y be dry and cracked. I-Ie is anxious and worried, mostly about business he mustgetbackbecausehehadleftsomethingunfinished. He shows his irritability when you examine him. One lad with pneumonia in the ward jumped out of bed in a rage when nurse was attempting to put on anti-
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phlogistine and he collapsed on the floor. E v e r y movement brings on some s y m p t o m and he keeps all painful parts still, either by pressure or lying on them. He is hot and sweaty. The Phosphorus patient is entirely different. She is delighted to see you. She is nervous alone, full of apprehension about her illness as well as other things and wants to be reassured. She is afraid something is going to go wrong--some friend on a journey will have an accident or the factory inspector is coming and she knows he'll find some fault. You see someone alive even when very ill, and often the picture of activity even to the glint in the hair. Face brightly flushed then will suddenly go pale. Her skin is dry and will only sweat on exertion, even mental exertion, either on telling you her symptoms or from fright. She likes to have things done to her and all her pains a r e ~ rubbing. She lies on the unaffected side. Dr. Hughes suggests t h a t it m a y not be possible to prescribe for large numbers of acute cases b y this method, but that when there is leisure it should be tried in chronic cases. No one will become a high potency prescriber in this way. I t is an entirely new outlook--you have to learn to think differently. You learn to think in terms of drugs, not diseases--it becomes quite automatic. You begin to pick out pieces unconsciously from the moment you first see the patient. I t is always worth fetching them from the waiting room: you'll see whether she is sitting over the fire or b y the window, whether she has her parcels all neatly b y her side, ready to jump up quickly and not keep you waiting, or whether she has them scattered over the table and chairs. You m a y find her writing letters or, as I once found a patient, sitting with her umbrella up because there was a draught! At another time a boy of 19, in trying to get politely and quickly out of m y waiting room, fell over everything, his own feet, m y feet, and anything else t h a t happened to be in his line of progress. Magazines were swept from the table and in his frantic efforts to retrieve them several more fell--in fact, chaos reigned, not just once but every time he came. After a 10m of Sulphur things greatly improved. All nothing very much but just pieces of the jig-saw that m a y be very important in the end. You notice as you shake hands with the patient whether the hand is cold, hot, moist or horny. As you follow the immaculately tidy person who had her parcels all neat and tidy, she walks quickly into the consulting room, sits down and arranges her parcels neatly again, and starts straight off with her story, almost before I ' v e sat down and anyhow before I ' v e had time to ask her name and address. She's got a tale to tell and she m a y not have time to tell it all. I t ' s a story full of trouble, and she punctuates it with how worried she is--it's all so hopeless. I have an elderly patient who is a pure Arsenic. H e r house and garden are meticulously tidy. I n spite of an unruly kind of hair and getting on in years she is conspicuously tidy and her hair is kept in order with nets and pins galore. E v e r y b o d y ' s life in her house is a misery, everything has to be done to time and in order and if anyone is late---something must have happened. I f visitors are coming she is in a state of agitation in case the dinner doesn't come up to scratch. She has a hiatus hernia and before I knew her she had a good deal of discomfort, nausea and vomiting. After a dose of Arsenicum she is much better and life for the family is comparative peace. When she begins to tell me that I ' v e been marvellous all these years in keeping her stomach going but now she's too o l d - - I can't do much more---I know that another 10m of Arsenicum is needed and she forgets her age and the hopelessness of it again for another few months. The Nat. tour. patient too, will w a r rapidly into the consulting room, but much more deliberately--she's not in a hurry to tell her s t o r y - - m o r e a look o f - -
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if it's got to be done, we might as well get it over quickly. She often puts down her parcels shakily. Alert and flushed as she comes in, she will sink back later into her chair and become sallow and greasy looking. You might have thought of Phosphorus as she came in, but not now. She is generally broadly built and a definite character. She will not be very communicative---she has a contradictory nature. She craves sympathy but will turn and rend anyone who gives it to her. She is a changeable person--may be excited or depressed and not in one state for l o n g - - m a y be laughing one moment, crying the next and you may see something of this. Twenty years ago a girl came to me with an exophthalmic goitre. She was just about to have it operated on but someone suggested her trying Homceopathy first. Never have I seen such a picture of Nat. mur. She told me she felt very irritable and depressed. Her family couldn't understand why she couldn't enjoy life like other people; they complained that she was so uncertain they never knew what she'd do. She was reading a book the day before and her sister dropped something behind her and she got up and hit her over the head with the book. Her goitre cleared up completely and she is very apt to send every goitre she meets to me to treat. The look of a patient can tell you so much. The greyish almost metallic look of Alumina--the, usually fat, mauvish face of the Graphites, almost looking as if it had been powdered. The delicate alabaster look of the China child. The constant expression of fright and terror so commonly found in Opium after fright. An elderly patient was in a bad daylight air raid with her old brother and sister-in-law, both over 80. A bomb fell near and when she could see through the dust and debris there was no sign of them--she searched frantically for two hours--then went home, and found them sitting in her garden. They had dashed into a shelter. She felt so shaken that she rang me up and I prescribed Aconite, and a day or two later Causticum. I saw her after a week, looking as scared as if it had just happened, and she said she was still so frightened and could not get over it. I gave Opium 200 and, to use her own expression, she was quite herself again in a few hours. I could go on endlessly. Then while examining the patient one will elucidate more detailed information about the thing that is worrying t h e m - - a b o u t the sore throat, the cough, the headache or backache, etc., but in a chronic ease most of the prescribing material will be in what she says and how she says it. Dr. Hughes in one of his writings says "The homceopathie physician does not listen and enquire merely to find out to what class of maladies his patients' troubles are to be relegated. For this end but few symptoms are necessary, and the rest can be left. He has to get at their totality and in pursuit of this aim he must not account any detail superfluous." I t has been objected that we should come off badly upon such a method with Mrs. Niekleby for a patient, but happily all patients are not Mrs. Nicklebys and when we do meet them, commonsense must deal with them accordingly. I say that no high potency prescribed would have any difficulty with Mrs. Nickleby. Listen to her telling her son that an eligible young man is in love with his sister: " I think it m y duty, Nicholas, m y dear, to tell you what I know: not only because you have a right to know it too, and to know everything that happens in this family, but because you have it in your power to promote and assist the thing very much; and there is no doubt that the sooner one can come to a clear understanding on such subjects, it is always better, every way. There are a great many things you might do; such as taking a walk in the garden sometimes, or sitting upstairs in your own room for a little while, or making believe to fall asleep occasionally, or pretending that you recollected some business, and going out for an hour or so, and taking Mr. Smike with you. These seem very slight things, and I dare say you will be amused at m y making them of so much importance; at
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the same time, my dear, I can assure you (and you'll find this out, Nicholas. for yourself one of these days, if you ever fall in love with anybody: as I trust and hope you will, provided she is respectable and well conducted, and of course you'd never dream of falling in love with anybody who was not), I say, I can assure you that a great deal more depends upon these little things, than you would suppose possible. I f your poor papa was alive, he would tell you how much depended on the parties being left alone. Of course, you are not to go out of the room as if you meant it and did it on purpose, but as if it was quite an accident, and to come back again in the same way. I f you cough in the passage before you open the door, or whistle carelessly, or hum a tune, or something of that sort to let them know you're coming, it's always better; because, of course, though it's not only natural but perfectly correct and proper under the circumstances, still it is very confusing if you interrupt young people when they are---when they are sitting on the sofa, and and all that sort of thing: which is very nonsensical perhaps, but still they will do it." Could anyone so loquacious and detached and so utterly self-centred need anything but a 10m of Lachesis? A patient, Miss L., aged about 30, was convinced she had heart disease. She had grasping pains with a feeling of all her blood rushing to her heart and causing palpitation. In spite of completely negative tests she retired to bed. Her relations persuaded me to get in a psychiatrist as their life was impossible. She lay in bed in a fever of planning and they had to do her bidding all day long. The psychiatrist didn't help at all, so I asked Dr. Borland to come and see her and I listened spellbound. She told him with rage what we had done. He replied most sympathetically that he could quite understand her feelings. he'd have felt exactly the same if a psychiatrist had been brought to see him. From then on she scarcely paused to draw breath. She was sure he'd understand - - n o one else d i d - - t h a t she, she, who had always managed the affairs of the family--they couldn't do a thing without her advice--even while she lay in bed feeling so ill, she still had to plan everything--how monstrous that she should be asked to see a Psychiatrist. Would she be lying in bed month after month wasting time when she had such a promising career before her if there weren't something wrong with her, and so on. The facts were that she had been trained for a career and had been an utter failure. By retiring to bed and being the centre of the house with her future and success dimly on the horizon, she was able to get some of the kick that she had hoped for on the stage. I didn't recognize her drug, but Dr. Borland said as he went out--typical Lilium
tigrinum. Another ease--I had looked after a man for years who had occasional gastric upsets. He generally cleared up quickly but this time I failed. I could get few symptoms, "just exactly the same as last time Doctor" was about all I could get, but last time's medicine nor any other did any good. I took him to an orthodox physician because he and his family were very worried. Imagine m y feelings when I heard him say, " I do hope you will get to the bottom of this, Doctor, for its affecting m y business. I've always been able to make quick decisions easily and it's essential in m y business, but now I can't make up m y mind at all and its affecting the whole office." He thought it was probably due to lack of nourishment. H e ' d always lived on fish in previous attacks, but he couldn't even digest that now. I ' d prescribed for him before the specialist had started to take the history! He clinched it when he was examining him. Looking at his hand he muttered "a little dry eczema but of no consequence" and I noted the palm dry and starting to crack. Graphites 10m cleared him quickly and that specialist is considered a genius in that family still.
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The taking of the history is not merely the collection of facts. Those sheets of questions with a space for answer which I used as a Resident are not good. The patient will probably do his best to give the right answer, but you don't get her story. A new patient is often encouraged because this is the first time a Doctor has listened to her and encouraged her to talk about her strange symptom. The consultation over, the patient will often tell you strange facts that she thinks have nothing to do with her complaints and, often on the doorstep, you get very important symptoms. Having taught the student how to observe his patient and collect facts, how do we teach him to learn his drugs? Like Dr. Hughes we tell him to read all about the drugs in all the books he c a n - - K e n t , Clark, Dr. Tyler's pictures and so o n - - h e must know them thoroughly, then to go on to Allen's Encyclopaedia to get the details of the mental and general symptoms, for now he knows his drug, they will throw more light on it. My uncle, Dr. Compton Burnett. began b y knowing l0 drugs very thoroughly before he started prescribing, I f a student knows l0 drugs like that he will be able to spot them quickly and will prescribe well for a good m a n y cases he meets in a day. From then on he adds to his repertory as he meets a new drug in a patient, and learns all about t h a t one. He will attach what he needs to that patient, and, if typical, t h a t will be his picture of the drug for all time. I remember from m y Resident days, m y first clear picture of China, Aethusa, Coccus cacti and m a n y others. How does one prescribe for acute cases in this busy life? Once again one must know well about a dozen drugs to begin with, and know them backwards. A list like Arsenicum, Bryonia, Causticum, Gelseminu~t, Kali carb., Lachesis, Nat. mur., Nat. sulph., Plwsphorus, Pulsatilla, Phytolacca and Sulphur. Dr. Tyler and Dr. Borland published Pointers to the Remedies--wonderful for gaining the local modalities--and with these aids one will soon be able to prescribe for an acute ease with high potencies as quickly as in any other way. I hope I have proved to you t h a t this system which we teach here is applicable to the exigencies of every-day practice in all hands who wish to learn it, and who are prepared to put in enough hard work in the first few years in learning a number of drugs thoroughly. I n chronic cases Dr. Hughes says the high potencies should be tried. I agree wholeheartedly--old standing cases clear up, and are often surprised and delighted t h a t something which has troubled them for a long time and which they have come to look upon as inevitable and never mentioned--has cleared up too. After m a n y years of high potency prescribing only, I have come to the conclusion that there is, too, a place for the low-potency pathological prescribing. At both extremes of life I think a medicine case of low potencies is necessary in the home. In the nursery Chamomilla at teething time, Aconite when the child comes in from playing in a cold wind crying with earache, Spongia for the croupy cough waking him in the night, Arnica for all the bumps and bruises-all these given immediately will generally stop the trouble from developing. Most old people today have to do more t h a n they are able for, with resulting tiredness, fretfulness, aching limbs and increased rheumatism and so on. I find low potencies of Arnica, Chamomilla, Nux vomica and Rhus tox., as well as others, qnite invaluable in helping them to carry on and in m a n y cases to feel surprisingly better. I n cases, too, where illness has left some more or less permanent tissue damage such as rheumatoid arthritis, cardiac conditions, emphysema, bronchiectasis and cancer, the high potency indicated will make the patient feel much better but they still have their pain and coughs and local discomforts, and for some years now I have been prescribing pathologically for the local condition and think the patients have got on more comfortably and quickly.
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For example, a man with very severe rheumatoid arthritis responded extremely well to a lOm of Rhus tox. He had been running a slight temperature for weeks, but after the Rhus it settled at once. He was much better in every way but he couldn't stand--his feet and ankles were agony and he could do nothing with his hands and ~rists without extreme pain. I gave him Calc. hypoph. 6 for a fortnight and he moved about better and with less and less pain each day. He then said his lower back was the worst spot and I gave ten days of ~at. tour. 6 until it was relieved. After this he had a bad aggravation from the first hot weather and his knees both flared up badly. I gave him Pulsatilla 10m and he had a great jump forward in every way and began to eat as he hadn't done for a year. A week or two later the only very acute pain was in his shoulder running down behind the clavicle and keeping him awake at night and I gave Sang. 6 for two or three weeks. Before trying Homoeopathy he had been off work, mostly in bed for six months and every kind of treatment had been tried including Cortisone. He went back to work to everyone's amazement four months after starting ttomceopathy. Nothing is so encouraging or so thrilling as to know that in our book of remedies there is one that will match and cure our patient, can we find it. Poor Dr. Hughes can never really have felt the thrill of the chase or he would never have advised his students to practice any other method and he would have been, I am sure, as celebrated today as he was at the end of the last century.
RICHARD HUGHES MEMORIAL LECTURE, 1959 By MArGeRY G. BLACKI~, M.D., F.F.Hom. I F~EL it a great honour to be asked to give this Memorial Lecture, but like Dr. Ross two years ago, I have found it very difficult to find any information about Richard Hughes beyond what one can glean from his writings. H a d I been giving it 30 years ago, I could have given a wonderful paper, for he was a household name with m y elderly patients. They all had a chest of remedies and often told me what I had better prescribe for them because Dr. Hughes had advised it. I had once dipped into his Pharmacodynamicsbut decided t h a t I preferred to read Kent, and until two months ago that was the extent of m y knowledge of him. I n 1877 Dr. Hughes was appointed to the Chair of Materia Medica and Therapeutics at The London School of Homceopathy (where, I wonder is the Chair?--we now only give lectures!). The sixth edition of his Pharmacodynamics was published in 1899, hard on the heels of the fifth edition of 2,000 copies, because they had sold out. I t seems incredible that this man who was renowned throughout the homceopathic world 60 years ago, and whom Dr. Dudgeon described as " b y far the greatest, ablest, and most faithful exponent of the great therapeutic truth revealed by Hahnemann, and his most zealous, enthusiastic, indefatigable and clear-headed disciple", should be almost unknown by us today. My paper is an attempt to find the reason why. I f these Memorial Lectures encourage us to go back and read the literature of the last century they will not have been given in vain. We are too apt to forget these bold and fearless men who risked professional reputation and social position for their beliefs. They were ostracized by the orthodox medical profession, but they were welcomed b y the laity. This new system gave them the opportunity to treat themselves and saved them from the risk of bleeding and purgation. From reading his writings the picture I have formed of Richard Hughes is of a clinician, interested in disease and its pathology. Having found the t r u t h and advantages of the homceopathie principle--his chief desire was t h a t everyone should benefit from it. I n his lectures to his students he says: "The Homceopathy you will learn from me will be no narrow or imperfect thing, but will embrace the whole range of Hahnemann's progress as a thinker and discoverer. While content to receive some modification of its form from the advances of modern investigation, it will be such that Hahnemann, I apprehend, would not fail to recognize as his offspring; while in no disciple of the scientific medicine of t o d a y will it be likely to excite repugnance or contempt." I n that last sentence, I think, is the key to m y question. Hughes was very anxious to interest and attract the orthodox medicals to t r y the new method. W h a t he wrote to hospital Physicians with their fuller training and opportunities bears this out. "Come and help as, bring to our enquiries and experiments your numbers, your wealth, your leisure, y o u r trained observers, your ample material. There is probably much t h a t is partial and extreme of which you can cure us. I f only with this motive, we beg you, take our Homceopathy and throw it into your crucible. We know what wealth of gold will come out and then we hope for it to go on accumulating far faster 79
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t h a n in our feeble hands. W h a t medicine might become in 10 years, ff only the profession at large would test Homceopathy as it deserves is a dream almost too bright to dwell upon." He gave up hope of seeing it in his lifetime, though he says that there were 10,000 medicals practising it in his time; but he did expect it to happen in the lifetime of the next generation. There were m a n y of his contemporaries who did not agree with his aim, for he regretted the quarrels between "those who cultivated exclusively and to the uttermost the method of H a h n e m a n n and those who sought rather to harmonize him with general medicine". We still have those among us today who hope and dream and work for this harmony, but I think history has proved them wrong. I f Hughes failed with all his zeal and enthusiasm, in a day when the newness of the method made a great impact (2,000 copies of his fifth edition selling in record time speaks for itself) how can we in this day of wonder drugs hope to succeed? Twenty or thirty years ago our homoeopathic doctors in Glasgow renewed their efforts, asking the authorities to allow them to treat casks homceopathically in their wards and under their supervision, but all in vain. Prejudice is as deeply rooted in the medical profession today as it was then. I think there is grave danger in it too. Hughes is no longer a household word, and in America where Homoeopathy was at its height in the d a y s of Kenf~-it was popularized: homceopathic medical schools were founded, and now patients tell me it is difficult to find a pure Kentian homceopathic doctor there at all. I am sure the pure Hahnemannian prescribers will always remain few in number: the extra learning and work necessary will only appeal to the doctor whose chief interest is in the wellbeing of the patient himself, rather than in the disease. W h a t then was this Homceopathy t h a t Dr. Hughes taught? His knowledge of drugs was vast and was derived from the orthodox treatises on toxicology, Materia Medica and morbid anatomy, as well as from the Materia Medica pura. This last he advised his students to study well, for there was the mine where they must dig, and they would find much treasure. He studied it himself minutely and carefully. He preferred to study the daily records of provers, and regretted that H a h n e m a n n had not preserved his, but had given a scheme of the results instead. I had not realized before with what meticulous care these provings were carried out. Provers had all to be healthy persons, who were living in contentment and comparative ease! "When an extraordinary circumstance of any kind: fright, chagrin, external injuries, the excessive enjoyment of any one pleasure, or some event of great importance supervened during the proving: then no symptom has been recorded after such an event, to prevent spurious symptoms being noted as genuine." After cross-examining the provers they offered their hands to him, the customary pledge instead of an oath, affirming that it was the truth and nothing but the truth to the best of their knowledge. But that was a digression to encourage those who take part in the provings today! Dr. Hughes taught t h a t every drug had an individual kind of action and a special centre upon which it acted. Many drugs might have the same action on an organ but there was always that little characteristic that distinguished it, which in an individual you might call the "trick-o-the voice" or the "twitch of an eyelid". I t was necessary to know the pathology of a drug, he said because mere mechanical symptom covering was as likely to miss the mark as to hit it. He agreed with H a h n e m a n n that the peculiar and unusual features, both of drugs and diseases, were of paramount importance and the subjective symptoms, especially of the mind and disposition, were more important than objective and physical ones. To add weight to these views he quoted from an address given by a Dr. Russel Reynolds to the British Medical Association in
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1874: "We are forced to remember that there are m a n y afflictions of which the subjective and mental symptoms furnish the earliest indications, and there are not a few of which they are "throughout the only signs." These views led H a h n e m a n n between 1806 and 1826 to attach less importance to the disease and to think more of the special sufferings of each patient, and this he called "individualization". There is nothing in this teaching to which we could take exception, and yet the name and teaching of Richard Hughes caused the stormiest meeting in this room t h a t I have ever attended. I cannot remember the subject of the paper but in the discussion following, the Society divided into two camps--one half praising, the other half denouncing him. This meeting ended in a discussion on potencies, always an inflammable subject. The heat of the discussion went to m y head and I remember vividly rising to m y feet for the first time to express m y opinions. I implored the erring faction to give up their evil ways and use only high potencies! Dr. Wheeler, who was in the Chair, tried to pour oil on troubled waters and no one could do it better t h a n he. He remarked t h a t most people learned to walk before they tried to run, but the young t o d a y seemed to want to fly, straight from the cradle! Let me give you two more quotations and see if they throw any light. Talking of this method called individualization, Hughes said " I doubt if it is, at least in all hands, applicable to the exigencies of everyday practice and the treatment on a large scale of acute diseases. But where there is more leisure and especially when chronic disease comes before you, I think that your best hope of making certain and speedy cures will be in your adherence to t h a t higher Homceopathy which the genius and toil of its discoverer have elaborated for us." Then he adds " I must avow at once t h a t m y ordinary standpoint is t h a t taken up b y the followers of Hahnemann's earlier method (he has described this before as the small and maybe material dose prescribed on pathological similarity). I t must almost necessarily be so", he says, "because lectures in materia medica like those on the practice of medicine, must contemplate disease as their object, while the purer homoeopathic therapeutics regard rather the sick person in his individuality. The simillimum, moreover, which I shall seek to establish between drug action and disease, will be in the main pathological. The great majority of those known as homceopaths, at least in the old world, have been converts from the recognized modes of practice. The expositors of the system which has satisfied their reason, the cures which have established their faith, have been of the kind we have seen in the earlier writings and practice of its founder. They have accepted his method as he himself then conceived it: with its law of similarity, its provings of medicine on the healthy, its single medicine and its small dose. But they do not think they need follow him in his rejection of the pathology of their day as he did in that of his. They prefer to work the rule simflia similibus with pathological similarities where these are obtainable, though in their default, and to fill in the outline they present, they thankfully use the comparison of symptoms." Accepting his statement t h a t the millionth degree hardly weakens the power of a drug for good, while it robs it of power to harm, they freely use such fractional quantities but they rarely go beyond this limit, and as a rule steer closer to the other end of the scale. They do not mix medicines but often alternate them. Hughes then mentions the Americans, m a n y of whom have become more Hahnemannian than H a h n e m a n n himself, who show an intolerant spirit towards those he has been describing, calling them "Mongrels". "Why should their stricter colleagues be impatient of their fellowship", he asks. "Their practice is surely good practice as far as it goes--far superior to t h a t of one who rejects the Master's teachings altogether." "Pathological similarity", he goes on to say, " m u s t be better t h a n no similarity at all--it m a y be a pity to alternate, but it is less injurious t h a n to mix--auxiliaries m a y be used more
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freely than is needful; but that is better than using nothing else. Of course there m a y be so frequent an employment of extraneous measures and so little cultivation of the method of similarity t h a t Homceopathy ceases to be the predominant feature in a man's practice--and in t h a t case the less he is connected with the name the better. But this is a rare occurrence: as a rule, the adoption of Homceopathy leads b y its own intrinsic value to a subordination of all other methods of treatment. Hitherto, I have been vindicating the legitimacy of the Homceopathy taught b y Hahnemarm up to 1806, to be called by that name, and to be practised by professed acceptors of the system. But it is another question whether it is wise to pause there: and whether in declining ~o follow him further in the elaboration of his method, there m a y not be involved the neglect of a more excellent way." I n his lectures Hughes said t h a t the relative superiority of the higher and lower dilutions was a moot point among them but it was a matter of fact t h a t certain remedies belonged almost exclusively to the partisans of the infinitesimals, while others were in chief favour among those who preferred appreciable fractions of the drug. This could be explained by the fact that certain drugs were comparatively inert unless attenuated to between the 2nd and 30th potencies. He quoted results in pneumonias treated in some hospitals by the 30th potency and said t h a t " T h e y made a more rapid and certain cure than those treated with the lower and that there is in the general tone of those who employ highly attenuated medicine, a confidence in their remedies, an habitual sense of power and success which cannot be disregarded." There was nothing in reason to render doubtful the apparent testimony of experience when it spoke of the efficacy of the 3rd and 2nd potencies downwards, but unless some evidence should be brought to prove t h a t we actually develop power as we go on attenuating after the Hahnemannian method, reason must certainly frown upon the higher potencies. He regretted the new American M-unit, not on grounds of science and reason but pure pharmacy. To make a lm he said, would take a man working 12 hours a day for 6 days, using one million clean bottles and 2,000 gallons of spirits of wine, one year to p r e p a r e - - a practical impossibility. He quotes a Dr. Walzxer, a most competent observer, who superintended the re-provings of Nat. tour. in Vienna, saying " I am alas! (I say alas! for I would much rather have upheld the larger doses which accord with current views) I am compelled to declare myself for the higher dilutions. The physiological experiments made with Nat. tour. as well as the great majority of the clinical results obtained therewith, speak decisively and distinctly for these preparations." From all these quotations is it not difficult to understand why Dr. Hughes taught and practised Hahnema~m's earlier method? I can only explain it by prejudice and that, having a supreme desire to see Homceopathy universally presented, he chose to teach the easier, more understandable and therefore more easily accepted method, rather than the higher Homceopathy, though he thought it might be the better way. Most of this has been theoretical--let us now look at this later method high potency prescribing, and see whether it is really a practical proposition, or, as Hughes suggests, not applicable in all hands to the exigencies of everyday practice. Let me first give you the main features in Hughes's Bryonia. I t is a pure irritant, he says, having no neurotic or h~ematic power, but sets up inflammation in the serous membranes and the organs they surround, less powerfully on mucous membranes, and is a specific irritant of muscle fibre. To Bryonia, Hughes says, as to all the great Hahnemannian medicines a special constitution and disposition has been assigned as that to which it is most suitable. I t is said
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to act best in persons of firm and fleshy fibre, of dark hair and complexion, of bilious tendency and choleric temperament, and where much irritability and irascibility are present. You must not lay too much stress on such indications; nevertheless, they sometimes guide us to the true remedy. Still more characteristic are its pains, which are always of a shooting or tearing kind. Then on the action of Bryonia in affections of the respiratory organs, which from its pathogenesis should be rather extensive: it is the best medicine--after Aconite for what is called a "cold on the chest", i.e. where a nasal catarrh has run down the air passages, as far as the first or second division of the bronchi. Heat, soreness and pain behind the sternum and an irritative, shaking cough with scanty expectoration make up the Bryonia picture. Again--in most of our text-books and domestic treatises Bryonia occupies the first place among the remedies for acute b r o n c h i t i s ~ I myself am quite unable to see its homceopathicity to this disease--when the smaller bronchiae are involved: and I have never been able to trace any good effect from it in practice. I t is otherwise with p n e u m o n i a - - f r o m what has been said indeed Bryonia can obviously do no good in the broncho-pneumonia so common in children and aged persons, where catarrh begins in the bronchial mucous membrane, affects the aircells rather in the way of cedema and collapse than of actual inflammation. But to the primary croupous pneumonia Bryonia is perfectly homceopathic, even more so than the Phosphorus which in this country usually plays the chief part in the treatment of the disease. Now let me give Clark's description of Bryonia: less rapid in its action t h a n Aconite, it goes deeper in its effects and often takes up the work where Aconite leaves off. I t not only disorders the circulation, but alters the blood itself. I t corresponds to fevers of almost all kinds, especially rheumatic, typhoid, bilious and remitting. I n these as in all other complaints the exquisite sensitiveness of the drug to movement of all kinds is a leading characteristic. The patient avoids even the movement of the eyes--raising the head from the pillow causes faintness--nausea and vomiting. Allied to this is > from pressure; from lying on the painful side---this keeps the part at rest. There is also an intense headache, dull, throbbing or sharp stabbing pains--all > pressure and < < movement. Mouth very dry, tongue coated white, lips dry and parched. Thirst for large quantities. The mucous membranes are dry, serous membranes inflamed and the seat of sharp stitching pains < motion. Later exudation occurs--the muscles inflamed and sore. Irritability of mind, easily angered with fever, stupid drowsy condition. Not much difference but the accent is more on the general condition and reactions of the patient rather than the organ affected. How different it must have been a century ago to get a clear picture of a drug from the symptoms in the Materia Medica pura. They were like skeletons t h e n - their anatomy laid out to view; but with the accumulated clinical experiences of the generations between they have now become living personalities. No one today would say whether Bryonia or Phosphorus played the chief part in pneumonia but would decide on the totality of symptoms. Prescribing with high potencies is rather like doing jig-saw puzzles the bits alone tell you nothing, b u t they will when you fit them together. Let me describe the picture we expect to see in a Bryonia or Phosphorus in an acute influenza, pneumonia or rheumatic fever, or any other acute disease. You see the Bryonia patient lying in b e d - - n o t in the least pleased to see you for he hates being disturbed in any way. He is heavy, drowsy, face puffy and bloated, the fine features gone. Lips m a y be dry and cracked. I-Ie is anxious and worried, mostly about business he mustgetbackbecausehehadleftsomethingunfinished. He shows his irritability when you examine him. One lad with pneumonia in the ward jumped out of bed in a rage when nurse was attempting to put on anti-
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phlogistine and he collapsed on the floor. E v e r y movement brings on some s y m p t o m and he keeps all painful parts still, either by pressure or lying on them. He is hot and sweaty. The Phosphorus patient is entirely different. She is delighted to see you. She is nervous alone, full of apprehension about her illness as well as other things and wants to be reassured. She is afraid something is going to go wrong--some friend on a journey will have an accident or the factory inspector is coming and she knows he'll find some fault. You see someone alive even when very ill, and often the picture of activity even to the glint in the hair. Face brightly flushed then will suddenly go pale. Her skin is dry and will only sweat on exertion, even mental exertion, either on telling you her symptoms or from fright. She likes to have things done to her and all her pains a r e ~ rubbing. She lies on the unaffected side. Dr. Hughes suggests t h a t it m a y not be possible to prescribe for large numbers of acute cases b y this method, but that when there is leisure it should be tried in chronic cases. No one will become a high potency prescriber in this way. I t is an entirely new outlook--you have to learn to think differently. You learn to think in terms of drugs, not diseases--it becomes quite automatic. You begin to pick out pieces unconsciously from the moment you first see the patient. I t is always worth fetching them from the waiting room: you'll see whether she is sitting over the fire or b y the window, whether she has her parcels all neatly b y her side, ready to jump up quickly and not keep you waiting, or whether she has them scattered over the table and chairs. You m a y find her writing letters or, as I once found a patient, sitting with her umbrella up because there was a draught! At another time a boy of 19, in trying to get politely and quickly out of m y waiting room, fell over everything, his own feet, m y feet, and anything else t h a t happened to be in his line of progress. Magazines were swept from the table and in his frantic efforts to retrieve them several more fell--in fact, chaos reigned, not just once but every time he came. After a 10m of Sulphur things greatly improved. All nothing very much but just pieces of the jig-saw that m a y be very important in the end. You notice as you shake hands with the patient whether the hand is cold, hot, moist or horny. As you follow the immaculately tidy person who had her parcels all neat and tidy, she walks quickly into the consulting room, sits down and arranges her parcels neatly again, and starts straight off with her story, almost before I ' v e sat down and anyhow before I ' v e had time to ask her name and address. She's got a tale to tell and she m a y not have time to tell it all. I t ' s a story full of trouble, and she punctuates it with how worried she is--it's all so hopeless. I have an elderly patient who is a pure Arsenic. H e r house and garden are meticulously tidy. I n spite of an unruly kind of hair and getting on in years she is conspicuously tidy and her hair is kept in order with nets and pins galore. E v e r y b o d y ' s life in her house is a misery, everything has to be done to time and in order and if anyone is late---something must have happened. I f visitors are coming she is in a state of agitation in case the dinner doesn't come up to scratch. She has a hiatus hernia and before I knew her she had a good deal of discomfort, nausea and vomiting. After a dose of Arsenicum she is much better and life for the family is comparative peace. When she begins to tell me that I ' v e been marvellous all these years in keeping her stomach going but now she's too o l d - - I can't do much more---I know that another 10m of Arsenicum is needed and she forgets her age and the hopelessness of it again for another few months. The Nat. tour. patient too, will w a r rapidly into the consulting room, but much more deliberately--she's not in a hurry to tell her s t o r y - - m o r e a look o f - -
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if it's got to be done, we might as well get it over quickly. She often puts down her parcels shakily. Alert and flushed as she comes in, she will sink back later into her chair and become sallow and greasy looking. You might have thought of Phosphorus as she came in, but not now. She is generally broadly built and a definite character. She will not be very communicative---she has a contradictory nature. She craves sympathy but will turn and rend anyone who gives it to her. She is a changeable person--may be excited or depressed and not in one state for l o n g - - m a y be laughing one moment, crying the next and you may see something of this. Twenty years ago a girl came to me with an exophthalmic goitre. She was just about to have it operated on but someone suggested her trying Homceopathy first. Never have I seen such a picture of Nat. mur. She told me she felt very irritable and depressed. Her family couldn't understand why she couldn't enjoy life like other people; they complained that she was so uncertain they never knew what she'd do. She was reading a book the day before and her sister dropped something behind her and she got up and hit her over the head with the book. Her goitre cleared up completely and she is very apt to send every goitre she meets to me to treat. The look of a patient can tell you so much. The greyish almost metallic look of Alumina--the, usually fat, mauvish face of the Graphites, almost looking as if it had been powdered. The delicate alabaster look of the China child. The constant expression of fright and terror so commonly found in Opium after fright. An elderly patient was in a bad daylight air raid with her old brother and sister-in-law, both over 80. A bomb fell near and when she could see through the dust and debris there was no sign of them--she searched frantically for two hours--then went home, and found them sitting in her garden. They had dashed into a shelter. She felt so shaken that she rang me up and I prescribed Aconite, and a day or two later Causticum. I saw her after a week, looking as scared as if it had just happened, and she said she was still so frightened and could not get over it. I gave Opium 200 and, to use her own expression, she was quite herself again in a few hours. I could go on endlessly. Then while examining the patient one will elucidate more detailed information about the thing that is worrying t h e m - - a b o u t the sore throat, the cough, the headache or backache, etc., but in a chronic ease most of the prescribing material will be in what she says and how she says it. Dr. Hughes in one of his writings says "The homceopathie physician does not listen and enquire merely to find out to what class of maladies his patients' troubles are to be relegated. For this end but few symptoms are necessary, and the rest can be left. He has to get at their totality and in pursuit of this aim he must not account any detail superfluous." I t has been objected that we should come off badly upon such a method with Mrs. Niekleby for a patient, but happily all patients are not Mrs. Nicklebys and when we do meet them, commonsense must deal with them accordingly. I say that no high potency prescribed would have any difficulty with Mrs. Nickleby. Listen to her telling her son that an eligible young man is in love with his sister: " I think it m y duty, Nicholas, m y dear, to tell you what I know: not only because you have a right to know it too, and to know everything that happens in this family, but because you have it in your power to promote and assist the thing very much; and there is no doubt that the sooner one can come to a clear understanding on such subjects, it is always better, every way. There are a great many things you might do; such as taking a walk in the garden sometimes, or sitting upstairs in your own room for a little while, or making believe to fall asleep occasionally, or pretending that you recollected some business, and going out for an hour or so, and taking Mr. Smike with you. These seem very slight things, and I dare say you will be amused at m y making them of so much importance; at
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the same time, my dear, I can assure you (and you'll find this out, Nicholas. for yourself one of these days, if you ever fall in love with anybody: as I trust and hope you will, provided she is respectable and well conducted, and of course you'd never dream of falling in love with anybody who was not), I say, I can assure you that a great deal more depends upon these little things, than you would suppose possible. I f your poor papa was alive, he would tell you how much depended on the parties being left alone. Of course, you are not to go out of the room as if you meant it and did it on purpose, but as if it was quite an accident, and to come back again in the same way. I f you cough in the passage before you open the door, or whistle carelessly, or hum a tune, or something of that sort to let them know you're coming, it's always better; because, of course, though it's not only natural but perfectly correct and proper under the circumstances, still it is very confusing if you interrupt young people when they are---when they are sitting on the sofa, and and all that sort of thing: which is very nonsensical perhaps, but still they will do it." Could anyone so loquacious and detached and so utterly self-centred need anything but a 10m of Lachesis? A patient, Miss L., aged about 30, was convinced she had heart disease. She had grasping pains with a feeling of all her blood rushing to her heart and causing palpitation. In spite of completely negative tests she retired to bed. Her relations persuaded me to get in a psychiatrist as their life was impossible. She lay in bed in a fever of planning and they had to do her bidding all day long. The psychiatrist didn't help at all, so I asked Dr. Borland to come and see her and I listened spellbound. She told him with rage what we had done. He replied most sympathetically that he could quite understand her feelings. he'd have felt exactly the same if a psychiatrist had been brought to see him. From then on she scarcely paused to draw breath. She was sure he'd understand - - n o one else d i d - - t h a t she, she, who had always managed the affairs of the family--they couldn't do a thing without her advice--even while she lay in bed feeling so ill, she still had to plan everything--how monstrous that she should be asked to see a Psychiatrist. Would she be lying in bed month after month wasting time when she had such a promising career before her if there weren't something wrong with her, and so on. The facts were that she had been trained for a career and had been an utter failure. By retiring to bed and being the centre of the house with her future and success dimly on the horizon, she was able to get some of the kick that she had hoped for on the stage. I didn't recognize her drug, but Dr. Borland said as he went out--typical Lilium
tigrinum. Another ease--I had looked after a man for years who had occasional gastric upsets. He generally cleared up quickly but this time I failed. I could get few symptoms, "just exactly the same as last time Doctor" was about all I could get, but last time's medicine nor any other did any good. I took him to an orthodox physician because he and his family were very worried. Imagine m y feelings when I heard him say, " I do hope you will get to the bottom of this, Doctor, for its affecting m y business. I've always been able to make quick decisions easily and it's essential in m y business, but now I can't make up m y mind at all and its affecting the whole office." He thought it was probably due to lack of nourishment. H e ' d always lived on fish in previous attacks, but he couldn't even digest that now. I ' d prescribed for him before the specialist had started to take the history! He clinched it when he was examining him. Looking at his hand he muttered "a little dry eczema but of no consequence" and I noted the palm dry and starting to crack. Graphites 10m cleared him quickly and that specialist is considered a genius in that family still.
RICHARD
HUGHES
MEMORIAL
LECTURE,
1959
87
The taking of the history is not merely the collection of facts. Those sheets of questions with a space for answer which I used as a Resident are not good. The patient will probably do his best to give the right answer, but you don't get her story. A new patient is often encouraged because this is the first time a Doctor has listened to her and encouraged her to talk about her strange symptom. The consultation over, the patient will often tell you strange facts that she thinks have nothing to do with her complaints and, often on the doorstep, you get very important symptoms. Having taught the student how to observe his patient and collect facts, how do we teach him to learn his drugs? Like Dr. Hughes we tell him to read all about the drugs in all the books he c a n - - K e n t , Clark, Dr. Tyler's pictures and so o n - - h e must know them thoroughly, then to go on to Allen's Encyclopaedia to get the details of the mental and general symptoms, for now he knows his drug, they will throw more light on it. My uncle, Dr. Compton Burnett. began b y knowing l0 drugs very thoroughly before he started prescribing, I f a student knows l0 drugs like that he will be able to spot them quickly and will prescribe well for a good m a n y cases he meets in a day. From then on he adds to his repertory as he meets a new drug in a patient, and learns all about t h a t one. He will attach what he needs to that patient, and, if typical, t h a t will be his picture of the drug for all time. I remember from m y Resident days, m y first clear picture of China, Aethusa, Coccus cacti and m a n y others. How does one prescribe for acute cases in this busy life? Once again one must know well about a dozen drugs to begin with, and know them backwards. A list like Arsenicum, Bryonia, Causticum, Gelseminu~t, Kali carb., Lachesis, Nat. mur., Nat. sulph., Plwsphorus, Pulsatilla, Phytolacca and Sulphur. Dr. Tyler and Dr. Borland published Pointers to the Remedies--wonderful for gaining the local modalities--and with these aids one will soon be able to prescribe for an acute ease with high potencies as quickly as in any other way. I hope I have proved to you t h a t this system which we teach here is applicable to the exigencies of every-day practice in all hands who wish to learn it, and who are prepared to put in enough hard work in the first few years in learning a number of drugs thoroughly. I n chronic cases Dr. Hughes says the high potencies should be tried. I agree wholeheartedly--old standing cases clear up, and are often surprised and delighted t h a t something which has troubled them for a long time and which they have come to look upon as inevitable and never mentioned--has cleared up too. After m a n y years of high potency prescribing only, I have come to the conclusion that there is, too, a place for the low-potency pathological prescribing. At both extremes of life I think a medicine case of low potencies is necessary in the home. In the nursery Chamomilla at teething time, Aconite when the child comes in from playing in a cold wind crying with earache, Spongia for the croupy cough waking him in the night, Arnica for all the bumps and bruises-all these given immediately will generally stop the trouble from developing. Most old people today have to do more t h a n they are able for, with resulting tiredness, fretfulness, aching limbs and increased rheumatism and so on. I find low potencies of Arnica, Chamomilla, Nux vomica and Rhus tox., as well as others, qnite invaluable in helping them to carry on and in m a n y cases to feel surprisingly better. I n cases, too, where illness has left some more or less permanent tissue damage such as rheumatoid arthritis, cardiac conditions, emphysema, bronchiectasis and cancer, the high potency indicated will make the patient feel much better but they still have their pain and coughs and local discomforts, and for some years now I have been prescribing pathologically for the local condition and think the patients have got on more comfortably and quickly.
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THE
BRITISH
HOMEEOPATHIC
JOURNAL
For example, a man with very severe rheumatoid arthritis responded extremely well to a lOm of Rhus tox. He had been running a slight temperature for weeks, but after the Rhus it settled at once. He was much better in every way but he couldn't stand--his feet and ankles were agony and he could do nothing with his hands and ~rists without extreme pain. I gave him Calc. hypoph. 6 for a fortnight and he moved about better and with less and less pain each day. He then said his lower back was the worst spot and I gave ten days of ~at. tour. 6 until it was relieved. After this he had a bad aggravation from the first hot weather and his knees both flared up badly. I gave him Pulsatilla 10m and he had a great jump forward in every way and began to eat as he hadn't done for a year. A week or two later the only very acute pain was in his shoulder running down behind the clavicle and keeping him awake at night and I gave Sang. 6 for two or three weeks. Before trying Homoeopathy he had been off work, mostly in bed for six months and every kind of treatment had been tried including Cortisone. He went back to work to everyone's amazement four months after starting ttomceopathy. Nothing is so encouraging or so thrilling as to know that in our book of remedies there is one that will match and cure our patient, can we find it. Poor Dr. Hughes can never really have felt the thrill of the chase or he would never have advised his students to practice any other method and he would have been, I am sure, as celebrated today as he was at the end of the last century.