§ 181–210

§ 181

Let it not be objected that the accessory phenomena and new symptoms of this disease that now appear should be laid to the account of the medicament just employed. They owe their origin to it[126] certainly, but they are always only symptoms of such a nature as this disease was itself capable of producing in this organism, and which were summoned forth and induced to make their appearance by the medicine given, owing to its power to cause similar symptoms. In a word, we have to regard the whole collection of symptoms now perceptible as belonging to the disease itself, as the actual existing condition, and to direct our further treatment accordingly.

[126] When they were not caused by an important error in regimen, a violent emotion, or a tumultuous revolution in the organism, such as the occurrence or cessation of the menses, conception, childbirth, and so forth.

§ 182

Thus the imperfect selection of the medicament, which was in this case almost inevitable owing to the too limited number of the symptoms present, serves to complete the display of the symptoms of the disease, and in this way facilitates the discovery of a second, more accurately suitable, homoeopathic medicine.

§ 183

Whenever, therefore, the dose of the first medicine ceases to have a beneficial effect (if the newly developed symptoms do not, by reason of their gravity, demand more speedy aid – which, however, from the minuteness of the dose of homoeopathic medicine, and in very chronic diseases, is excessively rare), a new examination of the disease must be instituted, the status morbi as it now is must be noted down, and a second homoeopathic remedy selected in accordance with it, which shall exactly suit the present state, and one which shall be all the more appropriate can then be found, as the group of symptoms has become larger and more complete.[127]

[127] In cases where the patient (which, however, happens excessively seldom in chronic, but not infrequently in acute, diseases) feels very ill, although his symptoms are very indistinct, so that this state may be attributed more to the benumbed state of the nerves, which does not permit the patient's pains and sufferings to be distinctly perceived, this torpor of the internal sensibility is removed by opium, and in its secondary action the symptoms of the disease become distinctly apparent.

§ 184 6th edition

In like manner, after each new dose of medicine has exhausted its action, when it is no longer suitable and helpful, the state of the disease that still remains is to be noted anew with respect to its remaining symptoms, and another homoeopathic remedy sought for, as suitable as possible for the group of symptoms now observed, and so on until the recovery is complete.

§ 185

Among the one-sided disease an important place is occupied by the so-called local maladies, by which term is signified those changes and ailments that appear on the external parts of the body. Till now the idea prevalent in the schools was that these parts were alone morbidly affected, and that the rest of the body did not participate in the disease – a theoretical, absurd doctrine, which has led to the most disastrous medical treatment.

§ 186 6th edition

Those so-called local maladies which have been produced a short time previously, solely by an external lesion, still appear at first sight to deserve the name of local disease. But then the lesion must be very trivial, and in that case it would be of no great moment. For in the case of injuries accruing to the body from without, if they be at all severe, the whole living organism sympathizes; there occur fever, etc. The treatment of such diseases is relegated to surgery; but this is right only in so far as the affected parts require mechanical aid, whereby the external obstacles to the cure, which can only be expected to take place by the agency of the vital force, may be removed by mechanical means, e.g., by the reduction of dislocations, by needles and bandages to bring together the lips of wounds, by mechanical pressure to still the flow of blood from open arteries, by the extraction of foreign bodies that have penetrated into the living parts, by making an opening into a cavity of the body in order to remove an irritating substance or to procure the evacuation of effusions or collections of fluids, by bringing into apposition the broken extremities of a fractured bone and retaining them in exact contact by an appropriate bandage, etc. But when in such injuries the whole living organism requires, as it always does, active dynamic aid to put it in a position to accomplish the work of healing, e.g. when the violent fever resulting from extensive contusions, lacerated muscles, tendons and bloodvessels requires to be removed by medicine given internally, or when the external pain of scalded or burnt parts needs to be homoeopathically subdued, then the services of the dynamic physician and his helpful homoeopathy come into requisition.

§ 187

But those affections, alterations and ailments appearing on the external parts, that do not arise from any external injury or that have only some slight external wound for their immediate exciting cause, are produced in quite another manner; their source lies in some internal malady. To consider them as mere local affections, and at the same time to treat them only, or almost only, as it were surgically, with topical applications – as the old school have done from the remotest ages – is as absurd as it is pernicious in its results.

§ 188

These affections were considered to be merely topical, and were therefore called local diseases, as if they were maladies exclusively limited to those parts wherein the organism took little or no part, or affections of these particular visible parts of which the rest of the living organism, so to speak, knew nothing.[128]

[128] One of the many great and pernicious blunders of the old school.

§ 189

And yet very little reflection will suffice to convince us that no external malady (not occasioned by some important injury from without) can arise, persist or even grow worse without some internal cause, without the co-operation of the whole organism, which must consequently be in a diseased state. It could not make its appearance at all without the consent of the whole of the rest of the health, and without the participation of the rest of the living whole (of the vital force that pervades all the other sensitive and irritable parts of the organism); indeed, it is impossible to conceive its production without the instrumentality of the whole (deranged) life; so intimately are all parts of the organism connected together to form an indivisible whole in sensation and functions. No eruption on the lips, no whitlow can occur without previous and simultaneous internal ill-health.

§ 190

All true medical treatment of a disease on the external parts of the body that has occurred from little or no injury from without must, therefore, be directed against the whole, must effect the annihilation and cure of the general malady by means of internal remedies, if it is wished that the treatment should be judicious, sure, efficacious and radical.

§ 191

This is confirmed in the most unambiguous manner by experience, which shows in all cases that every powerful internal medicine immediately after its ingestion causes important changes in the general health of such a patient, and particularly in the affected external parts (which the ordinary medical school regards as quite isolated), even in a so-called local disease of the most external parts of the body, and the change it produces is most salutary, being the restoration to health of the entire body, along with the disappearance of the external affection (without the aid of any external remedy), provided the internal remedy directed towards the whole state was suitably chosen in a homoeopathic sense.

§ 192

This is best effected when, in the investigation of the case of disease, along with the exact character of the local affection, all the changes, sufferings and symptoms observable in the patient's health, and which may have been previously noticed when no medicines had been used, are taken in conjunction to form a complete picture of the disease before searching among the medicines, whose peculiar pathogenetic effects are known, for a remedy corresponding to the totality of the symptoms, so that the selection may be truly homoeopathic.

§ 193

By means of this medicine, employed only internally (and, if the disease be but of recent origin, often by the very first dose of it), the general morbid state of the body is removed along with the local affection, and the latter is cured at the same time as the former, proving that the local affection depended solely on a disease of the rest of the body, and should only be regarded as an inseparable part of the whole, as one of the most considerable and striking symptoms of the whole disease.

§ 194

It is not useful, either in acute local diseases of recent origin or in local affections that have already existed a long time, to rub in or apply externally to the spot an external remedy, even though it be the specific and, when used internally, salutary by reason of its homoeopathicity, even although it should be at the same time administered internally; for the acute topical affections (e.g., inflammations of the individual parts, erysipelas, etc.), which have not been caused by external injury of proportionate violence, but by dynamic or internal causes, yield most surely to internal remedies homoeopathically adapted to the perceptible state of the health present in the exterior and interior, selected from the general store of proved medicines[129], and generally without any other aid; but if these diseases do not yield to them completely, and if there still remain in the affected spot and in the whole state, notwithstanding good regimen, a relic of disease which the vital force is not competent to restore to the normal state, then the acute disease was (as not infrequently happens) a product of psora which had hitherto remained latent in the interior, but has now burst forth and is on the point of developing into a palpable chronic disease.

[129] As, for instance, aconite, rhus, belladonna, mercury, etc.

§ 195

In order to effect a radical cure in such cases, which are by no means rare, after the acute state has pretty well subsided, an appropriate antipsoric treatment (as is taught in my work on Chronic Diseases) must then be directed against the symptoms that still remain and the morbid state of health to which the patient was previously subject. In chronic local maladies that are not obviously venereal, the antipsoric internal treatment is, moreover, alone requisite.

§ 196

It might, indeed, seem as though the cure of such diseases would be hastened by employing the medicinal substance which is known to be truly homoeopathic to the totality of the symptoms, not only internally, but also externally, because the action of a medicine applied to the seat of the local affection might effect a more rapid change in it.

§ 197

This treatment, however, is quite inadmissible, not only for the local symptoms arising from the miasm of psora, but also and especially for those originating in the miasm of syphilis or sycosis, for the simultaneous local application, along with the internal employment, of the remedy in diseases whose chief symptom is a constant local affection, has this great disadvantage, that, by such a topical application, this chief symptom (local affection)[130] [131] will usually be annihilated sooner than the internal disease, and we shall now be deceived by the semblance of a perfect cure; or at least it will be difficult, and in some cases impossible, to determine, from the premature disappearance of the local symptom, if the general disease is destroyed by the simultaneous employment of the internal medicine.

[130] 5th Edition footnote: Recent itch eruption, chancre, condylomata.

[131] 6th Edition footnote: Recent itch eruption, chancre, condylomata, as I have indicated in my book of Chronic Diseases.

§ 198

The mere topical employment of medicines, that are powerful for cure when given internally, to the local symptoms of chronic miasmatic diseases is for the same reason quite inadmissible; for if the local affection of the chronic disease be only removed locally and in a one-sided manner, the internal treatment indispensable for the complete restoration of the health remains in dubious obscurity; the chief symptom (the local affection) is gone, and there remain only the other, less distinguishable symptoms, which are less constant and less persistent than the local affection, and frequently not sufficiently peculiar and too slightly characteristic to display after that, a picture of the disease in clear and peculiar outlines.

§ 199

If the remedy perfectly homoeopathic to the disease had not yet been discovered[132] at the time when the local symptoms were destroyed by a corrosive or desiccative external remedy or by the knife, then the case becomes much more difficult on account of the too indefinite (uncharacteristic) and inconstant appearance of the remaining symptoms; for what might have contributed most to determine the selection of the most suitable remedy, and its internal employment until the disease should have been completely annihilated, namely, the external principal symptom, has been removed from our observation.

[132] As was the case before my time with the remedies for the condylomatous disease (and the antipsoric medicines).

§ 200 6th edition

Had it still been present to guide the internal treatment, the homoeopathic remedy for the whole disease might have been discovered, and had that been found, the persistence of the local affection during its internal employment would have shown that the cure was not yet completed; but were it cured on its seat, this would be a convincing proof that the disease was completely eradicated, and the desired recovery from the entire disease was fully accomplished – an inestimable, indispensable advantage to reach a perfect cure.

§ 201 6th edition

It is evident that man's vital force, when encumbered with a chronic disease which it is unable to overcome by its own powers instinctively, adopts the plan of developing a local malady on some external part, solely for this object, that by making and keeping in a diseased state this part which is not indispensable to human life, it may thereby silence the internal disease, which otherwise threatens to destroy the vital organs (and to deprive the patient of life), and that it may thereby, so to speak, transfer the internal disease to the vicarious local affection and, as it were, draw it thither. The presence of the local affection thus silences, for a time, the internal disease, though without being able either to cure it or to diminish it materially[134]. The local affection, however, is never anything else than a part of the general disease, but a part of it increased all in one direction by the organic vital force, and transferred to a less dangerous (external) part of the body, in order to allay the internal ailment. But (as has been said) by this local symptom that silences the internal disease, so far from anything being gained by the vital force towards diminishing or curing the whole malady, the internal disease, on the contrary, continues, in spite of it, gradually to increase and Nature is constrained to enlarge and aggravate the local symptom always more and more, in order that it may still suffice as a substitute for the increased internal disease and may still keep it under. Old ulcers on the legs get worse as long as the internal psora is uncured, the chancre enlarges as long as the internal syphilis remains uncured, the fig warts increase and grow while the sycosis is not cured whereby the latter is rendered more and more difficult to cure, just as the general internal disease continues to increase as time goes on.

[134] The issues of the old-school do something similar; as artificial ulcers on external parts, they silence some internal chronic diseases, but only for a short time, as long as they cause a painful irritation to which the sick organism is not used, without being able to cure them; but, on the other hand, they weaken and destroy the general health much more than is done by most of the metastases effected by the instinctive vital force.

§ 202

If the old-school physician should now destroy the local symptom by the topical application of external remedies, under the belief that he thereby cures the whole disease, Nature makes up for its loss by rousing the internal malady and the other symptoms that previously existed in a latent state side by side with the local affection; that is to say, she increases the internal disease. When this occurs it is usual to say, though incorrectly, that the local affection has been driven back into the system or upon the nerves by the external remedies.

§ 203

Every external treatment of such local symptoms, the object of which is to remove them from the surface of the body, while the internal miasmatic disease is left uncured, as, for instance, driving off the skin the psoric eruption by all sorts of ointments, burning away the chancre by caustics and destroying the condylomata on their seat by the knife, the ligature or the actual cautery; this pernicious external mode of treatment, hitherto so universally practised, has been the most prolific source of all the innumerable named or unnamed chronic maladies under which mankind groans; it is one of the most criminal procedures the medical world can be guilty of, and yet it has hitherto been the one generally adopted, and taught from the professional chairs as the only one.[135]

[135] For any medicines that might at the same time be given internally served but to aggravate the malady, as these remedies possessed no specific power of curing the whole disease, but assailed the organism, weakened it and inflicted on it, in addition, other chronic medicinal diseases.

§ 204 6th edition

If we deduct all chronic affections, ailments and diseases that depend on a persistent unhealthy mode of living, (§ 77) as also those innumerable medicinal maladies (v. § 74) caused by the irrational, persistent, harassing and pernicious treatment of diseases often only of trivial character by physicians of the old school, most of the remainder of chronic diseases result from the development of these three chronic miasms, internal syphilis, internal sycosis, but chiefly and in infinitely greater proportion, internal psora, each of which was already in possession of the whole organism, and had penetrated it in all directions before the appearance of the primary, vicarious local symptom of each of them (in the case of psora the scabious eruption, in syphilis the chancre or the bubo, and in sycosis the condylomata) that prevented their outburst; and these chronic miasmatic diseases, if deprived of their local symptom, are inevitably destined by mighty Nature sooner or later to become developed and to burst forth, and thereby propagate all the nameless misery, the incredible number of chronic diseases which have plagued mankind for hundreds and thousands of years, none of which would so frequently have come into existence had physicians striven in a rational manner to cure radically and to extinguish in the organism these three miasms by the internal homoeopathic medicines suited for each of them, without employing topical remedies for their external symptoms. (See note to § 282).

§ 205 (5th Ed.)

The homoeopathic physician never treats one of these primary symptoms of chronic miasms, nor yet one of their secondary affections that result from their further development, by local remedies (neither by those external agents that act dynamically,[136] [137] nor yet by those that act mechanically), but he cures, in cases where the one or the other appears, only the great miasm on which they depend, whereupon its primary, as also its secondary symptoms disappear spontaneously; but as this was not the mode pursued by the old-school practitioners who preceded him in the treatment of the case, the homoeopathic physician generally, alas!, finds that the primary symptoms[138] have already been destroyed by them by means of external remedies, and that he has now to do more with the secondary ones, i.e., the affections resulting from the breaking forth and development of these inherent miasms, but especially with the chronic disease evolved from internal psora, the internal treatment of which, as far as a single physician can elucidate it by many years of reflection, observation and experience, I have endeavoured to point out in my work on Chronic Diseases, to which I must refer the reader.

[136] 5th Edition footnoteI cannot therefore advise, for instance, the local extirpation of the so-called cancer of the lips and face by means of the arsenical remedy of Frere Cosme, not only because it is excessively painful and often fails, but more for this reason, because, if this dynamic remedy should indeed succeed in freeing the affected part of the body from the malignant ulcer locally, the basic malady is thereby not diminished in the slightest, the preserving vital force is therefore necessitated to transfer the field of operation of the great internal malady to some more important part (as it does in every case of metastasis), and the consequence is blindness, deafness, insanity, suffocative asthma, dropsy, apoplexy, etc. But this ambiguous local liberation of the part from the malignant ulcer by the topical arsenical remedy only succeeds, after all, in those cases where the ulcer has not yet attained any great size, and when the vital force is still very energetic; but it is just in such a state of things that the complete internal cure of the whole original disease is also still practicable. The result is the same without previous cure of the inner miasm when cancer of the face or breast is removed by the knife alone and when encysted tumours are enucleated; something worse ensues, or at any rate death is hastened. This has been the case times without number, but the old school still goes blindly on in the same way in every new case, with the same disastrous results.

[137] 6th Edition footnote: I cannot therefore advise, for instance, the local extirpation of the so-called cancer of the lips and face (the product of highly developed psora, not infrequently in conjunction with syphilis) by means of the arsenical remedy of Frere Cosme, not only because it is excessively painful and often fails, but more for this reason, because, if this dynamic remedy should indeed succeed in freeing the affected part of the body from the malignant ulcer locally, the basic malady is thereby not diminished in the slightest, the preserving vital force is therefore necessitated to transfer the field of operation of the great internal malady to some more important part (as it does in every case of metastasis), and the consequence is blindness, deafness, insanity, suffocative asthma, dropsy, apoplexy, etc. But this ambiguous local liberation of the part from the malignant ulcer by the topical arsenical remedy only succeeds, after all, in those cases where the ulcer has not yet attained any great size, and when the vital force is still very energetic; but it is just in such a state of things that the complete internal cure of the whole original disease is also still practicable. The result is the same without previous cure of the inner miasm when cancer of the face or breast is removed by the knife alone and when encysted tumours are enucleated; something worse ensues, or at any rate death is hastened. This has been the case times without number, but the old school still goes blindly on in the same way in every new case, with the same disastrous results.

[138] Itch eruption, chancre (bubo), condylomata.

§ 206 6th edition

Before commencing the treatment of a chronic disease, it is necessary to make the most careful investigation[139] as to whether the patient has had a venereal infection (or an infection with condylomatous gonorrhoea); for then the treatment must be directed towards this alone, when only the signs of syphilis (or of the rarer condylomatous disease) are present, but this disease is very seldom met with alone nowadays. If such infection have previously occurred, this must also be borne in mind in the treatment of those cases in which psora is present, because in them the latter is complicated with the former, as is always the case when the symptoms are not those of pure syphilis; for when the physician thinks he has a case of old venereal disease before him, he has always, or almost always, to treat a syphilitic affection accompanied mostly by (complicated with) psora, for the internal itch dyscrasia (the psora) is far the most frequent fundamental cause of chronic diseases. At times, both miasms may be complicated also with sycosis in chronically diseased organisms, or, as is much more frequently the case, psora is the sole fundamental cause of all other chronic maladies, whatever names they may bear, which are, moreover, so often bungled, increased and disfigured to a monstrous extent by allopathic unskillfulness.

§ 207

When the above information has been gained, it still remains for the homoeopathic physician to ascertain what kinds of allopathic treatment had up to that date been adopted for the chronic disease, what perturbing medicines had been chiefly and most frequently employed, also what mineral baths had been used and what effects these had produced, in order to understand in some measure the degeneration of the disease from its original state, and, where possible, to correct in part these pernicious artificial operations, or to enable him to avoid the employment of medicines that have already been improperly used.

§ 208

The age of the patient, his mode of living and diet, his occupation, his domestic position, his social relation and so forth, must next be taken into consideration, in order to ascertain whether these things have tended to increase his malady, or in how far they may favour or hinder the treatment. In like manner the state of his disposition and mind must be attended to, to learn whether that presents any obstacles to the treatment, or requires to be directed encouraged or modified.

§ 209

After this is done, the physician should endeavour in repeated conversations with the patient to trace the picture of his disease as completely as possible, according to the directions given above, in order to be able to elucidate the most striking and peculiar (characteristic) symptoms, in accordance with which he selects the first antipsoric or other remedy having the greatest symptomatic resemblance, for the commencement of the treatment, and so forth.

§ 210

Of psoric origin are almost all those diseases that I have above termed one-sided, which appear to be more difficult to cure in consequence of this one-sidedness, all their other morbid symptoms disappearing, as it were, before the single, great, prominent symptom. Of this character are what are termed mental diseases. They do not, however, constitute a class of disease sharply separated from all others, since in all other so-called corporeal diseases the condition of the disposition and mind is always altered[140]; and in all cases of disease we are called on to cure, the state of the patient's disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able therefrom to treat it homoeopathically with success.

[140] How often, for instance, do we not meet with a mild, soft disposition in patients who have for years been afflicted with the most painful diseases, so that the physician feels constrained to esteem and compassionate the sufferer! But if he subdue the disease and restore the patient to health – as is frequently done in homoeopathic practice – he is often astonished and horrified at the frightful alteration in his disposition. He often witnesses the occurrence of ingratitude, cruelty, refined malice and propensities most disgraceful and degrading to humanity, which were precisely the qualities possessed by the patient before he grew ill. Those who were patient when well often become obstinate, violent, hasty, or even intolerant and capricious, or impatient or disponding when ill; those formerly chaste and modest often frequently become lascivious and shameless. A clear-headed person not infrequently becomes obtuse of intellect, while one ordinarily weak-minded becomes more prudent and thoughtful; and a man slow to make up his mind sometimes acquires great presence of mind and quickness of resolve, etc.