LETTER \i WORTHINGTON HOOKER, M. D., OF NORWICH, IN relation to so much of his book, entitled, 'PHYSICIAN AND PATIENT," AS HAS REFERENCE TO HOMEOPATHY* By F. MATTHES, M.D BOSTON: OTIS CLAPP, SCHOOL STREET. 1850. LETTER. Sir : — The work which you have lately given to the public, under the title of " Physician and Patient," contains so much that is good, that I think it worth the trouble to call attention briefly to your evident want of information* with regard to homoe- opathy and its real importance to medical science. I do this pub- licly, because I think the community may derive benefit from this controversy ; for although I agree with you in the opinion, that those who are not physicians " should be careful not to put themselves in the attitude of clinical critics," yet I cannot deny their right to inquire, in general, into the principles by which the different schools of physicians are governed. The doctrine of limited allegiance, which has, within the past ten years, excited so much contention in Europe, would with diffi- culty ever be established in America ; you have exposed yourself, however, to the suspicion of claiming the position of an absolute supremacy for the " regular physicians," in demand- ing the confidence of the public, while at the same time you say, (p. 222,) " I presume it is sufficiently clear to the reader, from the views which I have before presented, that the com- munity cannot judge with any degree (!) of correctness direct- ly, of the practice of physicians, — either of the truth of the principles on which it is based, or of its actual results." Again, (p. 415,) " The reasons which secure their respect for other sciences fail altogether when they (intelligent men) come to medicine." Of,course, in direct opposition to this is the following passage from the code of medical ethics, * I myself, having been educated in a " regular school of medicine," and having imbibed prejudices against homoeopathy, remained for a considerable time ignorant of its value. Hence I can excuse the same ignorance in you. But I will leave it to yourself to find an excuse for having undertaken publicly to attack homoeopathy, of which you evidently knew little beyond its name. 4 (Append, p. 453) : " The public ought likewise to entertain a just appreciation of medical qualifications ; to make a proper discrimination between true science and the assumptions of ignorance and empiricism." But the reader must accustom himself to contradictions, when it is attempted to sustain an untenable position. I should far exceed the limits allowed me, were I to notice, individually, all the inconsistencies of your book. The weapon of which you make the most use in your attack upon homoeopathy, is, the expression of the low estimation in which you hold its professors as a body. In reply to this, it is needless for me to do more than to refer you to the well known article of Dr. Forbes,* entitled " Homoeopathy, Alloeopathy, &c." in which he writes as follows, p. 21: " And it (Homoeopathy,) comes before us now, not in the garb of a suppliant, unknown and helpless, but as a conqueror, powerful, famous, and trium- phant. The disciples of Hahnemann are spread over the whole civilized world. There is not a town of any considerable size in Germany, France, Italy, England, or America, that does not boast of possessing one or more homoeopathic physicians, not a few of whom are men of high respectability and learning ; many of them in large practice, and patronized especially by persons of high rank. New books on homoeopathy issue in abundance from the press ; and journals, exclusively devo- ted to its cause, are printed and widely circulated in Europe and America. Numerous hospitals and dispensaries for the treatment of the poor on the new system, have been estab- lished, many of which publish reports blazoning its successes, * John Forbes, M. D., one of the editors of the " Cyclopedia of Practical Medi- cine," editor of the British and Foreign Medical Review, etc. etc. is one of the most distinguished authorities among the " regular physicians " of Europe and America. In the article referred to, he appears as an opponent of Prof. Henderson, of Edin- burgh. Henderson's "Inquiry into the Homoeopathic Practice of Medicine," Forbes's " Homoeopathy, Alloeopathy," etc., and Henderson's letter to Forbes in relation to the preceding article, may be obtained, in one volume, in Boston, at the office of pub- lication of this journal. 5 not merely in warm phrases, but in the hard words and harder figures of statistical tables. The very fact of the publication of a third edition of such a large and expensive work as Dr. Laurie's proves how widely the practice is spread among the public generally. The last triumph which homoeopathy has achieved, is the conversion of the Professor of Pathology in the University of Edinburgh from the old faith." As regards the homoeopathic physicians of America, it may be permitted me, as a foreigner, to say, that though I have resided but' a short time in the country, yet I have become acquainted with not a few learned and most respectable men among them. I am also glad to find, (p. 120 of your book,) that of two homoeopathic physicians with whom, and undoubt- edly with whom only, you have been acquainted, one was a man " of good education." On the other hand, however, I do not by any means think myself responsible for all that has been or may be said by injudicious partisans in favor of homoeopathy. In relation to this, I claim for the homoeopathic physician, that which you claim in general for the judicious physician : "No physician should be held responsible for all the injudicious or mischievous acts, which may be done by over zealous patrons in his behalf." (p. 273.) In order to avoid all misunderstanding I will state plainly, that I recognize you as one of the best of the " regular physi- cians," so far as I have been acquainted with you through your book. I believe, in fact, that you do for your patients all that, in our days, a physician can do, who is unacquainted with homoeopathy; in particular, I believe that, by means of your knowledge and just appreciation of the constitution of the human mind, you become to your patients, not only " the sym- pathizing, but the comforting friend." In truth, I should con- sider it far beneath my dignity, to enter the list against the rabble of those who designate themselves as members of the " regular school." Enough, however, of the personal qualifications of the phy- 2 6 sicians of the opposing schools. The question is not, what can be effected by the physician whose individual circumstances are favorable to his usefulness, but in what direction will he be best able to develop his individual advantages in the curing of disease. As things now stand, — I mean, as the division of scien- tifically educated physicians into two great parties is manifest to all — this inquiry is one of great importance to the commu- nity. Indeed, it is to be wished, that every one should inform himself, so far as possible, with regard to this matter, before he is under the necessity of calling in medical aid for himself or his family, and your remark is a true one: "In the practice of medicine there are some points upon which there should be a common understanding." * When I reflect upon the obstacles thrown in their way by physicians, with which the founder of homoeopathy and his first disciples had to contend, before they could so far overcome old and deeply rooted prejudices as to gain even a standing place for the new doctrine, I cannot but think, that the homoeopathic physicians of America owe you their thanks, in this point of view, for having done so much to open the way to them in future. With the most unsparing candor you have, throughout your book, exposed the weaknesses of the " regular school," which (p. 237) you justly call " an abstruse science." To those who have hitherto been doubtful whether they have done right in turning their backs upon the " regular school," the perusal of your work may be confidently recommended.f It is true that you assert in many places, that the truly judicious physician will avoid all those dangers into which the erroneous doctrines of the old system would lead him ; but with this empty assertion one must rest contented. You have made no satis- factory statement of the leading principles by which the " truly " judicious physician is to be guided among " the fantastic and * Aet, 8e ov ftovov naQB%Giv rot Ssovra iov laxqov, xou tov voaovvxov, xort tovg nuQEOvjag, xai to. trader. Hippocrat. Aphor. I. t The work of Dr. Hooker may be obtained at the store of Otis Clapp, Boston 7 ever changing shapes of empiricism ; " and we are compelled to conjecture, that you trust mainly to " a sort of mysterious tact or skill, innate in the man, and not required like other knowl- edge." You affirm, (p. 418,) " So accustomed is he to make the requisite discrimination, that his efforts in positive medica- tion are well directed, and are almost sure to accomplish their object." I appeal to all the reflecting readers of your book, whether we are not driven to this assumption of a " mysterious tact," since, in the following sentences, you have deprived the " regular school" of every support which it has derived hith- erto from an appearance of being based upon scientific princi- ples. You say, (p. 31,) " The nature and mode of operation of the causes of many diseases are involved in mystery, and are subjects of discussion and dispute among medical men." Again, (p. 43,) " If there be so much liability to error in a disease so simple and uniform as smallpox is, it is still greater in those complaints which are more complicated, from collateral and accidental influences and affections. Perhaps I cannot adduce a better example for our purpose than is to be found in scarlet fever. There is no disease, the history of whose treat- ment shows so strikingly the uncertainty of medical knowledge and experience as this does. The most opposite and various remedies and modes of treatment have been lauded as success- ful, in standard medical works, and in medical journals, and multitudes of certain cures have been proclaimed in the news- papers. What is praised by one is condemned by another; and it is the individual experience of every rational and candid practitioner, that a mode of treatment which at one time is attended with marked success at another is wholly unsuccess- ful." (Page 45,) " I need not spend time to show how the same uncertainty must embarass us, to a greater or less degree, in our investigations of all other diseases." * (Page 49,) " The recorded experience of the medical profession is therefore * Who does not here think of the manifold treatises upon cholera, which have emanated from the " regulars." 8 encumbered with a mass of errors." (Page 202,) "There is no science in which there has been so much theorizing, as there has been in that of medicine. Its history seems to be almost altogether a history of untenable theories." (Page 217,) " The medical profession has had too much to do with theories, and modes, and systems. Every prominent theory can be shown to be unsubstantiated by facts, and is therefore valueless. Every mode or system of practice, however numerous are the facts which are adduced for its support, can be shown to exclude many facts of a valuable character ; and being thus exclusive, it must lead to practical error. All these systems, therefore, should be discarded. A true eclecticism should (!) be intro- duced* into medicine, audit should have relation not to opinions and theories, but to facts only. Whenever a fact is really ascer tained, it should be treasured up in the store-house, ready for practical use. If it be apparently inconsistent with other facts, this is no reason for rejecting i£."f (Page 218,) " And after all, though it may gratify curiosity to know how a medicine cures disease, it is comparatively a matter of little importance." (Page 219,) " The virtues which are attributed to a large por tion of the remedies in use, require to be tested,-^ in order to strip the statements which are made in regard to them of all that is inaccurate and false. Much of the positive medication of the present day will probably be proved by the tests of a rigid observation to be aimless, but by no means harmless. If now all the reasons which have hitherto contributed to inspire confidence in the positive medication of the "regular physician," are found insufficient; if the " regular physician" knows little or nothing of the causes of disease ; if the experi- ence of former ages is deceptive and worthless ; if all theories have resulted in nothing; if the virtues of most remedies require to be further tested, (and tested upon the sick) (!); if " a * What is a "true" eclecticism, and xchcn is it to be introduced? t Would not one think that Dr. H. is a partisan of homoeopathy in disguise? t According to Dr. H. (p. 218,) " at the bedside of the sick:" I pity the patients who are to be subjected to such experiments. 9 true eclecticism" must first be introduced, — how in the world can the " regular system" claim, as a science, that we should now place any confidence in it ? Does not such a claim remind us of the French romance of Soulie, in which a young lady claims to be beloved not for her youth, not for her beauty, not for her talents, not for her wealth, — in a word, not for any reason whatever, — but merely for herself? • But even the " true eclecticism " that " should be introduced into medicine," and which " should have relations not to opin- ions and theories, but to facts only," is not calculated to call forth our immediate confidence, if it rest upon no better facts than that to which you appeal, (p. 218.) You say, " No fact in medicine is better established than that Arsenic in almost all cases cures hemicrania, or periodical neuralgia on one side of the head." This " fact" may be of some value in the circle of your practice in Norwich, where nearly all cases of hemicrania may be of such a nature that Arsenic will cure them ; but as regards the treatment of the same disease in the rest of the world, it is a most doubtful remedy Canstatt, a distinguished German writer upon Pathology and Therapeutics, says, (Vol. hi. 1 p. 90) : " The direct medical cure of hemicrania must be effected by means of the peculiar anti-neuralgica, the alterantia nervina ; by Stramonium, China, Iron, Arsenic, Salt or Sea-bathing, the Chalybeates^ etc. etc.; " the obstinate character of the disease, however, renders its cure by any medication uncertain." However much you may boast of the skill of the " truly " judicious physician, so soon as he comes to the practice of positive medication he is governed by no certain law of cure, and there- fore essentially does not differ from the mere quack. Forbes has expressed himself as mildly as possible in saying, (1. c.,p. 51) : " This department of medicine (therapeutics) must, indeed, be regarded as yet in its merest infancy; " more strongly indeed, he says on the following page: " Things have arrived at such a pitch, that they cannot be worse. They must mend or end." 2* 10 It was then not only justifiable but necessary, that an attempt should be made to rescue medicine from this confusion of " fantastic and ever-changing shapes of empiricism," and to set it upon a truly scientific basis. This being so evident, why is it, that, when the attempt is successful, — when a certain law of cure has been discovered, — the members of the profes- sion themselves are the most obstinately opposed to this pro- gress ? The riddle is explained, when we reflect how deeply rooted generally are professional prejudices ; and all know how unwillingly men give up old ideas and opinions. Highly signi- ficant was the inscription placed by the ancients over the en- trance of the temple of wisdom, — uSapere audeP Homoeopathy is not a footpath which accidentally runs parallel to, and by the side of, the old system ; it is a straightforward advance of medical science, nay, of natural science in general; teaching how diseases are to be cured by the employment of positive remedies, according to fixed principles. By the law, similia similibus curantur, based on the proving of medicines upon the well, the science of Therapeutics has been elevated to a place among the exact sciences. Henceforth it will rest upon the sure basis of experiment, and is made capable of devel- opment like natural philosophy, chemistry, physiology. Results once ascertained are ascertained for ever, and later investigators may use, while they add to, the discoveries of the earlier. The proving of medicinal agents upon the well, was recom- mended long before the time of Hahnemann, and, indeed, by the founder of modern physiology, Friedrich von Haller ; Hahnemann has the credit of having been the first to put it ex- tensively into practice. Of late years the " regular physicians " have now and then made similar investigations, but their ex- periments, so far as their practice is concerned, have been pro- ductive of nothing. Professor Jorg, indeed, of Leipsic, who prosecuted such experiments to a considerable extent some twenty years ago,* warns his brethren against the use of Assa- * JOrg: Materials for a future Materia Medica. 11 foetida in hysteria and hypochondria, and of Acid, hydrocyan. in inflammation of the air-passages, " because these remedies have produced similar diseases in the well I" We find like warnings in the Therapeutique of Trousseaux and Pidoux, (new edition, "Vol. ii. p. 36 and 43.) " Opium is one of the best anti-emetica; but it must be remembered that in itself it is an active excitic of vomiting." " Whytt praises Opium in the metrorrhagia that follows miscarriage or childbirth. We confess that we cannot explain this operation of the drug ; especially as we have ascertained, by experience, that it will produce the menstrual discharge." The law, similia similibus curantur, or that in each individual case, a medicine should be chosen that can excite an affection similar fd/notov nudog') to that against which it is employed, — is " proved by a series of observations as a fact," and is not a " theory " as you call it.f Many instances of cures effected in accordance with this law, (though itself unknown,) long before the time of Hahnemann, may be found in the Organon, (3d Am. edit. p. 59 - 91.) As a mere conjecture the law also had been advanced long before Hahnemann, (1. c. p. 92.) When Hahnemann first began to practice according to the law, similia similibus, he made use of doses but little inferior, t In relation to your doubt whether certain forms of intermittent fever are cured by Cinchona and Quinine upon homoeopathic principles, I am able to present you the following statements. At the manufactory of sulphate of quinine, at Frankfort ou the Main, the greater part of the workmen, when first employed, are attacked with intermittent fever. Subsequently, however, they become so accustomed to the emanations of the drug, as to be insusceptible to its influence. Again, in the Revue Medicale de Paris, (March, 1840, p. 461,) we read: " A word with regard to a peculiar observation which we cannot pass over in silence, because it has a bearing upon certain ideas whose discussion is of interest to science, though they seem to point towards homoeopathy, which by no means we advocate. Mr. Piorry denies positively that Sulph. of Quinine, produces intermittent fever in well men. However singular this effect may appear, we can declare that we have seen many instances of it, and in support of our assertion we are happy in being able to appeal to the authority of Mr. Hippolyte Gaudorp, one of our most distinguished mi- litary physicians. It appears, from experiments made by this gentleman upon him- self, in the year 1828, that sulphate of quinine has the power of producing genuine paroxvms of intermittent fever, (veritables acces defievreintermittente,) in individuals who are in a state of sound health." Ed. Aulert, M. D. 12 in point of volumen, to the smallest doses of the old system. By experience, however, he was soon convinced, that he could better effect the end at which he aimed, — namely, the curing of disease without exciting severe medicinal symptoms, — by the use of smaller and still smaller, and even—to the senses — inappreciably small doses, than by means of such as were more palpable. Since Hahnemann, many homoeopathic phyiscians have begun their practice under the new law, with more or less palpable doses, and gradually proceeding from the lower to the higher attenuations, have been led by their experience over the same ground previously traversed by the founder of the system. Dr. Watzke, one of the editors of the Austrian Journal of Homoeopathy, in relation to some very careful provings of common salt, says : " Finally, as regards the size of the dose of this substance, I am reluctantly, — I say reluctantly, as I should much rather have advocated the larger doses, being in accordance with the common view of the subject, — compelled to declare in favor of the higher attenuations.* I cannot refrain from quoting here the following passage from Paracelsus, as it has a bearing upon the question before us. It is only of late years that his merits have been ap- preciated in Germany by different physicians of the " regular school." He was the first to contend against the absolute sovereignty of Galen in the province of medicine, and to make use of the German instead of the Latin language in his lectures ; among his professional contemporaries he was styled the Luther of physicians ; his motto was, Al'erius non sit qui suus esse potest. Paracelsus says : " Medicine must operate upon the body like fire, and must act as powerfully in diseases as fire acts upon a billet of wood. Now, the spark has no weight. As the spark acts in the wood, making itself greater or less, accord- ing to the quantity of the wood, — so also the medicine. Who attributes this to the weight of the spark ? No one, since it is due to its virtue." *Oestr. Zeitschrift. fur Horn. rv. 1, p. 251. 13 Professor Schultz, of Berlin, of the " regular school," one of the latest writers upon Materia Medica, has placed the same maxim, though expressed in different words, at the head of his work, of which as yet only the first volume has appeared. " If it is true," says Dr. Mosthaff," that Paracelsus was a drunkard, as is related by some of his contemporaries, yet it must be con- fessed, that there are teachers who have been sober all their lives and who have never said so wise a thing." You will observe, sir, that medicines, prepared according to the directions of Hahnemann, are not "more powerful," so far as regards their chemical or mechanical operation, for which nevertheless the physician must in some cases employ the substances; * but they are more powerful, so far as regards their ability to produce in the living organism certain reactions, producible only by the smallest doses, and of which reactions the physician makes use in effecting a cure. I ask you, whether, in the treatment of certain forms of diarrhoea in young children, large or small doses of Rhubarb are " more power- ful ? " In treating syphilis, which are the " more powerful," large or small and less frequent doses of Mercury f You say, (p. 57,) " The variations, in these respects, required by dif- ferent cases, have a wide range." They have, indeed, a very wide range ; much wider than you, in your school-wisdom, have ever dreamed. But, verily, the truth with regard to the effi- * For instance, when it is desired to neutralize chemically a certain quantity of poison taken into the stomach, the homoeopathic, as naturally as the " regular " physician, will employ a corresponding quantity of the antidote. I will say here, once for all, that the homoeopathic practitioner rejects nothing which may reasonably be expected to benefit the sick. A11 the means possessed by the" regular " physician are also at his disposal, and beside these he also possesses knowledge and means which place him far above the other. The word Homoeopathy, as a name for a chief law of cure, will never go out of use. If, however, in the course of forty or fifty years, the fanatical opposition of the " regulars " shall become a mere matter of history, it will then be no more necessary to speak of " homoeopathic " physicians as physicians of progress. Until then, we are compelled to call ourselves " homoeopathic " physicians, proud of belonging to the party which is fighting for progress and truth in the pr6vince of medicine. 14 cacy of infinitesimal doses will never be revealed to you in a dream. Practice, and then judge! Pardon me, sir, if in speaking of homoeopathy, I have assumed the position of a demonstrator of facts, instead of having critically analyzed your sixth chapter, which treats upon this doctrine. As you know little of homoeopathy beyond its mere name, all which you have said with regard to it is — sit venia verbo — beneath all criticism. Besides, you do not really differ so widely from homoeopathic physicians in some of your conceptions, as you yourself imagine. The cases, page 308, (a melancholic woman cured by the misfortune of her husband,) and page 314, (revelation by revelation,) and many similar passages, prove, that in regard to psychical diseases, the law, similia similibus, has impressed itself upon your mind.* But, that diseases of the mind are subjected to laws essentially the same as those which control diseases of the body and vice versa, I need not stop to demonstrate to a reflecting physician like your- self. If you properly weigh this last law, even the small doses of homoeopathy may appear to you less extraordinary, since you say, (p. 297,) " Slight causes, therefore, which would produce little or no effect upon the mind of one in firm health, may effect strongly the mind of a sick man." Again, (p. 313,) "all direct ( !) and palpable efforts to make the gloomy invalid cheerful, are almost always unsuccessful; and yet it is such efforts that are most commonly made use of by the friends of the sick." What you say with regard to the success of homoeopathic practice, is so satisfactory, that I am spared the necessity of offering statistical evidences in its favor, an abundance of which might be presented. You say, (p. 137,) "But, it is true, I most cheerfully allow, that homoeopathy is more successful than any exclusive system of practice, which is characterized by *The saints do not cure contraria contrariis, as is the practice of mortal physi- cians, but similia similibus. Acta Sanctorum, Antwerp, 11)58 Jan. p. 1092. 15 positive medication; but, it is not true, that it is any thing like as successful as a cautious eclectic practice." Now, the prac- tice of the " regular physicians" is exclusive; for they obsti- nately refuse to make any advance in which homoeopathy is their guide. On the other hand, the homoeopathic physician rejects nothing that has been tried and approved at the bar of reason and experience. But the " cautious eclectic practice," as we have before shown, is yet to be introduced, and it is prema- ture to reason now of its results. Your remarks, p. 139, upon the homoeopathic treatment of cholera, give me an opportunity to state a circumstance that is fitted to place in the brightest light, homoeopathy in general, and Hahnemann's acuteness in particular. In the year 1831, when the cholera was raging on the borders of Germany, that is, in Galicia, Hahnemann, before having seen a single case of disease, recommended, in a letter dated Cothen, 20th June, that Camphor should be employed as a remedy in certain forms of cholera. This recommendation was based upon the symp- toms of the disease as reported to him, on the one hand, and upon the proof-symptoms produced by Camphor, on the other. He refers, expressly, to a particular series of symptoms, detailed under the article, Camphor, in the Materia Medica Vol. IV. In another paper,* which appeared shortly after, he decided that the best method of administering it was, one drop of Spir. camph. (one part Camphor to twelve of Alcohol,) to be given, at first, at least every five minutes. This shows how exactly he was able to appreciate both the action of the remedy and the nature of the disease ; for, with a few exceptions, perhaps, it is just in this manner that Camphor is used now in cholera by homoeopathic physicians. Hahnemann did not stop here, however, for he knew well, " that each case is to be managed as an individual case." In the same treatise, therefore, he points to Veratrum, Cuprum, and several other * Treatment of, and Protection against the Asiatic Cholera." Sent to press by Dr. Von Bonninghausen. 1831. 16 remedies ; indeed, he left but little to exercise the judgment of his followers, in order to insure for the homoeopathic treatment of this dreaded disease, the most brilliant and striking success. It was this success which was a chief cause of the extension of homoeopathy not only in Germany, but through the whole civilized world ; and if any one can still doubt with regard to the value of homoeopathy, a glance at the comparative success of the different modes of practice in cholera, must convince him, if he will be convinced. We hope soon to receive from another pen, a review of the results of the treatment of cholera, with reference to the late epidemic. During the former epi- demic in Europe, the average mortality under homoeopathic treatment was 6 in 100 ; under the " regular," 49 in 100. {Bur- ner's Results of Treatment, etc. Munich. 1843.) How miserable a part, as regards both theory and practice, has been played by the " regular school" in the various cholera epidemics, even down to the present day, and even subsequently to the publication of the mode in which Camphor is used by homoeo- pathic physicians, is fresh in our memories ; we will, therefore, say nothing of it. I will close with the following excellent passage from your book, (p. 274,) " Neither controversy in regard to opinions, nor competition in practice, necessarily implies contention. Though the controversy may be earnest, and the competition active, so long as the former is honest and candid, and the latter is hon- orable, they will not impair the harmony of the profession, and they will greatly promote the cause of truth, and the interests of medical science." Most respectfully, &c, F. M. Boston, Mass., Dec. 1,1S49.