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Why the symptom picture?
precepts of its founder. There is danger in rejecting these, of which the pluralistic school is perhaps guilty. There is also danger of fossilization in slavish adherence to original teaching, which precludes entertaining later concepts. The world does not stand still, and it is surely our task now constantly to reappraise Hahnemann's teachings in the light of current knowledge, and apply this as appropriately as possible to what we do. The risk that our successors may condemn us for departures from the Hahnemannian straight and narrow, as some now criticize Kent, is one we must be prepared to face. The second thought concerns our relations with the rest of the homoeopathic world. Much time, attention and experience has been developed in South America, Mexico, India, and several European countries, yet most of us pay it scant attention. Our attendance at international meetings is low, and our contributions have served more to emphasize differences in the ways our thinking has evolved than to establish a dialogue which fully repects others' expertise. Is it not time to broaden our horizons? Thirdly, regarding teaching; Dr Imberechts' groups are most impressive in the amount of work they do, the dedication, and the knowledge their members acquire. We may not all agree with the methods they have evolved, but how many of us could refute their assertions from our own experience? And even if we differ in our ideas re content, might there not be a lot of value in adopting the group method as a teaching/learning procedure? Is there anyone who is interested in a group based on the principles described above, and prepared to do the work involved? REFERENCE 1 Hehr GS. Was Kent a Hahnemannian? B r H o m J 1984; 73:71. The author expresses his gratitude to Dr Charles O. Kennedy and Dr Jacques Imberechts.
Why the symptom picture? BERNARD LEARY, MBBS, MRCGP, DTM&H, MFHOM Homoeopathy differs from other therapies in that notice is still taken of the views of its founder, who died one hundred and fifty years ago. In contrast, few allopaths quote Osier or Mackenzie extensively. Even acupuncturists, who may Volume 73, Number 4, October 1984
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depend upon ancient theory for point selection, are turning away from these theories as an explanation of their treatment. According to Hahnemann it is the morbidly affected vital energy alone that produces diseases. 1 The internal changes of diseases are manifested only by the symptoms. 2 Removal of these symptoms results in cure. It is theories like this which to the modern doctor seem to conflict with our scientific knowledge. While ascertainment of symptoms may lead to the selection of the remedy, few would deny that disease can exist in the body without any obvious symptoms. For example symptoms do not appear at the first moment of the incubation period of the exanthemata. The purist might argue that the symptoms are there, but that the therapist is failing to detect them. This may be true if we ignore the eighteenth century view of the symptom. There seems no reason why a symptom should not be a symptom merely because it is detectable only in the laboratory. Because we have not yet connected a raised ESR or a low white cell count with particular remedies, there is no absolute rule which says it is impossible. Indeed, if we claim to cure disease it must follow that the remedy will correct the pathological abnormalities demonstrated when the patients was ill. It should also follow that the remedy, if given for long enough, would produce those pathological signs in the healthy. Hahnemann talks of "the morbid phenomena perceptible to our senses". 3 If that perception has to rely upon a microscope it is no less valid. Even if Hahnemann's theories are accepted in full it must be accepted that the actions of a remedy must, in some way, be biochemical. After nearly two centuries, research is under way to try and determine this mode of action. What does not seem to be under investigation is why patients react in different ways to what is apparently the same disease. Why does one patient keep still and require Bryonia, and another throw himself about and need Rhus tox.? Imbued as we are with the idea of constitution, it is easy to regard a patient as a Lycopodium, or a N u x vomica, and expect reaction for that reason alone. Such an idea owes as much to Paracelsus as to homeeopathy, suggesting that the Almighty has provided a herb or mineral to correspond specifically with particular mortals. It would be logical to expect a patient who is normally nervous to present symptoms of anxiety when ill. But we are instructed to take more notice of mental symptoms which are new and unusual; 4 in other words, those that can be regarded as symptoms of disease. Consideration must be given to past causative factors in the patient's condition. Arnica is acclaimed for use in trauma, however remote, and is frequently given on an arbitrary basis. Successful cures are legion, but it must also be admitted that failures are common. We do not know when and why it works. Does it only have action when at least some of the appropriate symptoms are present? Does it act upon the products of tissue breakdown still present in the body? Sadly we have no information. The disease-based nosodes are used in two ways, either when disease effects appear to be persisting, or because of a family history. In the latter, a true constitutional basis seems possible, but there could be other reasons. Failures, again, are common. What is noticeable is that these nosodes are often administered when the history concerns a condition other than the disease itself, which homceopaths 196
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have related to it. Is it not at least as likely that Tubereulinum acts specifically upon the immune mechanisms of the body as that its effect is due to an often suspect history of tuberculosis in a grandparent or greatgrandparent? Once more we do not know. Can the reaction of patients be related to specific disease processes or to particular infecting organisms? Allopathic medicine has some crude examples of this. Infection with the pneumococcus produces a lobar infection of the lung, while other organisms give the bronchopneumonia picture. In homoeopathy there are also such cases, the clearest being the Belladonna picture in children which equates to streptococcal tonsillitis. In a review of twenty cases presenting at the surgery complaining of "cystitis" (their term, not mine), eight had typical Cantharis symptoms. All these had normal MSUs without pus cells or bacterial growth. They were presumably suffering from the urethral syndrome. So small a sample could not lead to any definite conclusion, but the national trial of Cantharis might shed more light upon the subject. If such a relationship could be established between symptom pictures and pathological investigations, the possibility of the true specific remedy for each pathological condition is opened up. However it seems unlikely that it could ever be developed to a stage where it had practical value. The number of symptom pictures for which even the common remedies are prescribed runs into hundreds. Their differentiation to a degree where minor symptom differences could be accounted for, would require investigations in numbers far greater than the worst excesses of the modern houseman, and would prove impossibly expensive. In minor cases they could not ethically be justified. However, since the reasons for patients' reactions are unknown, we ought to attempt to find out. One weapon that is becoming available is the computer. Pathological investigation in general practice is limited, so that any research would have to be hospital-based. If all hospital records were computerized, it might be possible, after a period of years, to relate some symptom pictures to particular pathological syndromes. These could be further investigated in clinical research. While this could not, in the foreseeable future, affect therapeutic methods, it might produce valuable new evidence which could help convince the establishment of the scientific basis of homaeopathy. Since records are inevitably going to be placed on computer, it would be a pity to miss an opportunity to advance our knowledge. REFERENCES 1 2 3 4
Hahnemann S. Organon, sixth edition, Translated Boerieke, ~ 12, Calcutta: Roy, 1972. Ibid. Ibid. Kent JT. Repertory, p. ix. Calcutta: Hahnemann, 1973.
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Why the symptom picture? BERNARD LEARY, MBBS, MRCGP, DTM&H, MFHOM Homoeopathy differs from other therapies in that notice is still taken of the views of its founder, who died one hundred and fifty years ago. In contrast, few allopaths quote Osier or Mackenzie extensively. Even acupuncturists, who may Volume 73, Number 4, October 1984
195
depend upon ancient theory for point selection, are turning away from these theories as an explanation of their treatment. According to Hahnemann it is the morbidly affected vital energy alone that produces diseases. 1 The internal changes of diseases are manifested only by the symptoms. 2 Removal of these symptoms results in cure. It is theories like this which to the modern doctor seem to conflict with our scientific knowledge. While ascertainment of symptoms may lead to the selection of the remedy, few would deny that disease can exist in the body without any obvious symptoms. For example symptoms do not appear at the first moment of the incubation period of the exanthemata. The purist might argue that the symptoms are there, but that the therapist is failing to detect them. This may be true if we ignore the eighteenth century view of the symptom. There seems no reason why a symptom should not be a symptom merely because it is detectable only in the laboratory. Because we have not yet connected a raised ESR or a low white cell count with particular remedies, there is no absolute rule which says it is impossible. Indeed, if we claim to cure disease it must follow that the remedy will correct the pathological abnormalities demonstrated when the patients was ill. It should also follow that the remedy, if given for long enough, would produce those pathological signs in the healthy. Hahnemann talks of "the morbid phenomena perceptible to our senses". 3 If that perception has to rely upon a microscope it is no less valid. Even if Hahnemann's theories are accepted in full it must be accepted that the actions of a remedy must, in some way, be biochemical. After nearly two centuries, research is under way to try and determine this mode of action. What does not seem to be under investigation is why patients react in different ways to what is apparently the same disease. Why does one patient keep still and require Bryonia, and another throw himself about and need Rhus tox.? Imbued as we are with the idea of constitution, it is easy to regard a patient as a Lycopodium, or a N u x vomica, and expect reaction for that reason alone. Such an idea owes as much to Paracelsus as to homeeopathy, suggesting that the Almighty has provided a herb or mineral to correspond specifically with particular mortals. It would be logical to expect a patient who is normally nervous to present symptoms of anxiety when ill. But we are instructed to take more notice of mental symptoms which are new and unusual; 4 in other words, those that can be regarded as symptoms of disease. Consideration must be given to past causative factors in the patient's condition. Arnica is acclaimed for use in trauma, however remote, and is frequently given on an arbitrary basis. Successful cures are legion, but it must also be admitted that failures are common. We do not know when and why it works. Does it only have action when at least some of the appropriate symptoms are present? Does it act upon the products of tissue breakdown still present in the body? Sadly we have no information. The disease-based nosodes are used in two ways, either when disease effects appear to be persisting, or because of a family history. In the latter, a true constitutional basis seems possible, but there could be other reasons. Failures, again, are common. What is noticeable is that these nosodes are often administered when the history concerns a condition other than the disease itself, which homceopaths 196
The British HomceopathicJournal
have related to it. Is it not at least as likely that Tubereulinum acts specifically upon the immune mechanisms of the body as that its effect is due to an often suspect history of tuberculosis in a grandparent or greatgrandparent? Once more we do not know. Can the reaction of patients be related to specific disease processes or to particular infecting organisms? Allopathic medicine has some crude examples of this. Infection with the pneumococcus produces a lobar infection of the lung, while other organisms give the bronchopneumonia picture. In homoeopathy there are also such cases, the clearest being the Belladonna picture in children which equates to streptococcal tonsillitis. In a review of twenty cases presenting at the surgery complaining of "cystitis" (their term, not mine), eight had typical Cantharis symptoms. All these had normal MSUs without pus cells or bacterial growth. They were presumably suffering from the urethral syndrome. So small a sample could not lead to any definite conclusion, but the national trial of Cantharis might shed more light upon the subject. If such a relationship could be established between symptom pictures and pathological investigations, the possibility of the true specific remedy for each pathological condition is opened up. However it seems unlikely that it could ever be developed to a stage where it had practical value. The number of symptom pictures for which even the common remedies are prescribed runs into hundreds. Their differentiation to a degree where minor symptom differences could be accounted for, would require investigations in numbers far greater than the worst excesses of the modern houseman, and would prove impossibly expensive. In minor cases they could not ethically be justified. However, since the reasons for patients' reactions are unknown, we ought to attempt to find out. One weapon that is becoming available is the computer. Pathological investigation in general practice is limited, so that any research would have to be hospital-based. If all hospital records were computerized, it might be possible, after a period of years, to relate some symptom pictures to particular pathological syndromes. These could be further investigated in clinical research. While this could not, in the foreseeable future, affect therapeutic methods, it might produce valuable new evidence which could help convince the establishment of the scientific basis of homaeopathy. Since records are inevitably going to be placed on computer, it would be a pity to miss an opportunity to advance our knowledge. REFERENCES 1 2 3 4
Hahnemann S. Organon, sixth edition, Translated Boerieke, ~ 12, Calcutta: Roy, 1972. Ibid. Ibid. Kent JT. Repertory, p. ix. Calcutta: Hahnemann, 1973.
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