It is a matter worthy of remark, that, while the doctrines of
homoeopathy have fixed the attention and become the study of many
learned and experienced medical men in various parts of Europe, England is
the only country where it has only been noticed to draw forth the most
opprobrious invectives. It is certainly true that no one but an ardent
proselyte of the visionary Hahnemann could for one moment become the
advocate of all his absurd ideas; yet, while we reject his errors, great
and important truths beam from the chaotic clouds that shroud his
wanderings; and, however wild his theories may be, incontrovertible facts
have been elicited from his apparently inefficacious practice.
Before I enter into an examination of the practical views of the
homoeopathists, I shall give a brief sketch of their doctrines and of
their founder.
Samuel Hahnemann was born in Meissen in Saxony, on the 10th of April,
1755. His father was an humble porcelain manufacturer. The first rudiments
of education that young Hahnemann received were gratuitous; and his
master, pleased with the progress of his ambitious but needy scholar,
strongly urged him to repair to Leipzig, where, at the age of twenty, he
arrived, with exactly the same number of crowns in his pocket as he
numbered years. At this university he zealously pursued his favourite
studies of the natural sciences, supporting himself by translating French
works, and giving lessons; and finally he graduated in the university of
Eslan--in 1779.
It was during his arduous studies that Hahnemann was struck with the
conflicting systems and the deplorable controversies which for centuries
divided in turn the medical schools of Europe, and were triumphant or
overthrown by scholastic revolutions; each doctrine being doomed to
obscurity and oblivion in the ratio of its ephemeral splendour. The
result of his reflections and experiments was the system of homoeopathy.
Its novelty, its apparent absurdity, soon exposed him not only to
opposition, but to violent persecution. As is usual in all cases of
oppression, whether justly or unjustly resorted to, proselytes as furious
and as fanatical as his persecutors joined their chief. Despite the
sanatary regulations of Saxony, which prohibited physicians from
dispensing their medicines, Hahnemann prepared and supplied his
homoeopathic remedies; and, being expelled from Leipzig, sought a refuge
at Koethen, where, exasperated by the harsh treatment he had
experienced, he fulminated his anathema on all past and present systems of
medicine with no small degree of furious resentment, pronouncing his
doctrine to be stamped with the seal of infallibility, and denouncing all
others as the aberrations of ignorance and error, or the speculations of
imposture and fraud.
As might have been expected, few of his opponents thought it worth their
while to study his system calmly and dispassionately; nor, indeed, was
such an application necessary, for his doctrines needed no deep
investigation on the part of his foes, so fraught were they with apparent
errors and false deductions, not only from his own pretended experience,
but the experience of ages. Finding that he could not enjoy a despotic
sway over the schools, he was resolved at any rate to seek the palm of
martyrdom, and had recourse to such violence in words and actions, that
many of his enemies maintained he was a more fitting subject for a lunatic
asylum than the _soi-disant_ founder of a rational doctrine; for he and
his fanatical disciples set all ratiocination at nought, considering his
_dixit_ as a fiat of condemnation passed on all who dared to doubt his
infallibility, although at different periods their oracle was obliged to
retract many erroneous assertions and contradict fallacious statements.
In the short view of his doctrines which I am about to give, these
fallacies will become evident.
Hahnemann had observed in his studies and hospital practice that the
prevalent systems of medicine were founded on the rational principle of
combating effects by striking at morbid causes. Physicians sometimes
endeavoured to attain this desirable end by producing in the system an
artificial action differing from the nature of the malady, and founded
their practice on the scholastic axiom of _contraria contrariis curantur_;
at other times they raised or depressed the vital energies according to
the prevalence of excitement or debility, or modified the character of the
disease by revulsion and derivation, a practice which received the name of
antagonistic, or _allopathic_,--a term used by Hahnemann in
contradistinction to homoeopathy, and derived from [Greek: allos],
_different_, and [Greek: pathos], _affection_.
In his therapeutic pursuits Hahnemann had been forcibly struck with the
long-acknowledged fact that medicinal substances supposed to possess a
certain specific property in the treatment of diseases, were known in the
healthy subject to produce phenomena bearing a close analogy to the
symptoms of those identical diseases. Thus, mercurial preparations
occasioned symptoms of syphilis, sulphur produced cutaneous irritation,
and, in some instances, the exhibition of cinchona had been known to bring
on febrile intermissions. In various works he found these observations
established. For instance, amongst many others, he found in the
publications of Beddoes, Scott, Blair, and various writers, that nitric
acid, which was known to produce ptyalism, relieved salivation and
ulceration in the mouth. Arsenic, which, according to Henreich, Knape, and
Heinze, occasioned cancerous anomalies in healthy subjects, was stated by
Fallopius, Bernharde, Roennow, and many other surgeons, to be efficacious
in relieving, if not curing, similar disorders; preparations of copper
were asserted by Tondi, Ramsay, Lazermi, and numerous practitioners, to
have produced epileptic attacks; and Batty, Baumes, Cullen, Duncan, and
several experienced medical practitioners, recommended similar remedies in
epilepsy. In short, the illustrations of the power inherent in certain
substances to produce accidents analogous to the symptoms of the various
diseases in the treatment of which they had proved efficacious, induced
Hahnemann to consider whether a treatment founded on _similia similibus
curantur_ might not be found more effectual than the former practice based
upon the _contraria contrariis_. He was of opinion that no medicine was
possessed of any _curative property_, but solely acted by its _morbific
power_ of producing a disordered condition in the system; and on this and
other principles, which we shall shortly notice, he asserts that nature
does not possess any curative power, totally denying the _vis medicatrix_
of the schools. He further maintained, that there does not exist any
specific malady; but that which we consider to be a disease is nothing but
a complexity of symptoms, and that a cure can only be effected when these
complex symptoms are made to disappear.
Impressed with these ideas, he and his disciples proceeded to try various
medicinal substances upon themselves and others when in health, and,
carefully recording the symptoms which these medicines produced, they drew
up a statement of their various powers, that they might be afterwards
resorted to, to relieve the same symptoms in a morbid state. Grounding
this practice on the principle (in many instances correct) that two
similar diseases cannot coexist, they conceived that if, to counteract a
natural malady, one can produce by any medication an artificial
derangement of the same nature, the artificial disorder will overcome the
natural disease, and a radical cure be obtained. To explain more
distinctly this idea, I shall quote the author's words.
"The curative power of medicines is thus founded on the property they
possess to give rise to symptoms similar to those of the disease, but of a
more intense power. Hence no disease can be overcome or cured in a
certain, radical, rapid, and lasting manner, but through the means of a
medicine capable of provoking a group of symptoms similar to those of the
disease, and at the same time possessed of a superior energetic
power."[31] And further,
"If two dissimilar maladies happen to be coexisting, possessed of an
unequal force, or if the oldest disease is more energetic than the recent
one, the latter will be expelled by the former. Thus, an individual
labouring under a severe chronic disease will not be subject to the
invasion of an autumnal dysentery, or any other slight epidemic. Larrey
affirms that the districts of Egypt in which scurvy was prevalent were
exempt from the plague. Jenner asserts that rachitis prevents the effect
of vaccination; and Hildebrand assures us that phthysical patients never
experience epidemic fevers unless of the most severe character."[32]
"If a recent affection, dissimilar to a more ancient one be more powerful
than the latter, then will the progress of the latter be suspended until
the malady is either cured or has been expended in its career, and then
the old one will reappear."[33]
"But the result is totally different when two similar diseases meet in the
organism; that is to say, when a pre-existing affection is complicated
with one of the same nature, but possessed of more energy."[34]
"Two maladies resembling each other in their manifestation and their
effects, that is to say, in the symptoms which they determine, mutually
destroy each other, the strongest conquering the weakest."[35]
He further contends that the essential nature of every disease is unknown;
that their existence is revealed by alterations and changes in the system
perceptible to our senses, and constituting what are called _symptoms_,
and it is the series of these symptoms which characterize the disease in
its course and its development. According to his notions, the physician
has only to follow and study the succession and the grouping of these
symptoms; in short, the phases and the phenomena of diseases. Attack and
destroy these symptoms, and you will have destroyed the malady.
All classification of diseases, and their various denominations, he
therefore deemed absurd, as, according to his doctrines, no one disease
resembles another; so various were their modifications, that, with few
exceptions, it was idle to give them a particular name, since disease was
simply a derangement in our organization manifested by peculiar symptoms.
We are also, according to Hahnemann, ignorant of the essential properties
of medicines, and can only observe and record their effects by
experimental observation. Like diseases, they also produce a derangement
in our organism, manifested by peculiar symptoms, their sole action
consisting in developing specific diseases.
In conformity with these notions, to cure disease we have only to produce
a similar affection; the primitive one would then give way to the
secondary affection artificially produced, and in time the artificial one
would cease to exist when the means that produced it were no longer
brought into action.
Homoeopathic medicines, he maintained, have the property of acting in a
direct manner upon the affected part of the system; and this is proved
when the disease, and the medicine given to relieve it, produce similar
morbid manifestations: and he further contended that our vital organism
was less susceptible of the action of natural affections than of those
which are artificially produced.
On this basis did the homoeopathic doctrinarians ground their practice;
but a still more singular theory was broached by their leader; he
maintained that medicinal substances, to prove efficacious, should be
administered in an attenuated and diluted state, carried to such an extent
as to become infinite in their division; he further asserts that this
infinite division, far from diminishing their medicinal power and
properties, imparts greater energy and certainty of action when these
particles encounter in our organization an affinity of disposition, or a
homogeny in action; that is to say, that these atomic attenuations act
with greater power in those affections which manifest symptoms similar to
those which these very medicines are known to produce when experimentally
tried upon a healthy subject.
Upon this principle the homoeopathist condemns all combinations of
medicines as likely to neutralize each other's properties by their various
affinities; therefore generally speaking, no fresh medicine should be
given until the effects of the former have subsided; and to guide this
practice, while they endeavoured to ascertain the symptoms produced by
medicines, they also sought to ascribe certain limits to the duration of
their action: thus, the influence of aconite lasts forty-eight hours, and
that of crude antimony fifteen days.
Dreading all substances that could tend to weaken or neutralize the effect
of medicine, the homoeopathists made it their particular study to
discover the peculiar action of all alimentary substances on the organism,
and characterized as antidotes all such articles of food as they
considered opposed to this supposed action: thus, wine and vegetable acids
were deemed antidotes to aconite; coffee, to Angustura bark; vinegar, to
asarum, &c.
I have already stated that the homoeopathists conceive that the infinite
dilution of their atoms of medicinal substances increase their energy; and
this fact they so strenuously maintain, that they assert that accidents of
a serious nature may arise when this division is carried too far; and
these accidents are then to be met with the medicinal antidotes they
pretend to have discovered: thus, camphor is an antidote to cocculus;
opium, to the crocus sativus; camomile and camphor, to ignatia amara; and
so on.
The minuteness with which the specific actions of various medicinal
substances on certain organs is detailed is scarcely credible; and the
following extract from the homoeopathic materia medica will give a
slight idea of their industrious labours. Taking as an example phosphorus,
which they affirm produces--
Vertigo, determination of blood to the head, headache in the morning, fall
of the hair, difficulty in opening the eyelids, burning sensation and
ulceration of the internal canthus of the eye, when exposed to the open
air, lachrymation and adhesion of the palpebrae; inflammation of the eyes,
with the sensation of particles of sand having been introduced; sparks and
spangles floating before the eyes, a dark tinge in objects that are looked
on, diurnal cecity, the appearance of a gray veil drawn before the eyes,
pulsation in the ears, epistaxis, mucous discharge from the nostrils,
foulness of breath, tumefaction of the throat, whiteness of the tongue,
ulceration of the mouth, expectoration of glairy mucus, dryness of the
mouth by night and by day, spasmodic eructation, nausea, sense of hunger
after eating, anxiety after meals; in short, twenty-four octavo pages are
devoted to the innumerable effects of this substance on the organism.
Of _magnesia artificialis_ three hundred and twelve symptoms are noted;
six hundred and fifty of the _rhus radicans_; nine hundred and forty of
_pulsatilla_; five hundred of _ignatia amara_; four hundred and sixty of
_arsenic_: in short, volumes upon volumes are crowded with these
observations, not only recording physical effects, but singular results on
our moral faculties; such as serenity or moroseness, gaiety or sadness, a
disposition to commit suicide or a fond partiality to life, courage or
cowardice, a weak intellect or a vigorous conception. For
instance,--common sea-salt occasions irascibility, lowness of spirits,
taciturnity, melancholy, palpitation of heart, disposition to shed tears,
pusillanimity, and despair; while potash gives rise to ill-temper without
apparent cause at noon and in the evening, with violent paroxysms of rage
in the morning, impetuous desires, furious passion, with gnashing of
teeth, if all around does not yield to the patient's desires; while the
vision of a bird hovering about the window produces loud shrieks of alarm,
exaltation of the intellects, and a horror of the future. So innumerable,
indeed, are all these singular effects attributed to various medicines
thus experimented, that no memory, however retentive, could possibly bear
them in recollection. The following are the directions laid down for
conducting this curious inquiry:
The person upon whom medicines are tried must be free from disease; but
weak substances should be given to subjects of a delicate and sensitive
constitution. The medicine is to be tried in its most pure and simple
state, possessing all its energies, taking special care that it is not
combined with any heterogeneous substances during the day it is exhibited,
and the time while its action is supposed to last. The diet must be
moderate; all spices and high-seasoned food to be avoided, as well as
green vegetables, roots, salads, &c. which are known to possess medicinal
properties. The dose of the medicine to be similar to that which is
usually prescribed by practitioners. If, at the expiration of about two
hours, no effect is observed, a stronger dose is to be given. Should the
first dose operate powerfully at the commencement, but gradually lose its
influence, the second will be given the following morning; and a still
stronger one, four times the strength of the first, be administered on the
third day.
The result of these experiments being recorded, homoeopathic agents are
selected to oppose morbid symptoms; and when the choice of remedies has
been appropriate, an aggravation of the symptoms is observed. This
aggravation is usually considered as an increase of the disorder, whereas
it is solely the effect of the homoeopathic remedy. "For these
phenomena," say the homoeopathists, "were frequently observed by
physicians, who little thought at the time, that they were the result of
the medicines they had given." Thus, when the pustules of itch became more
rife after the exhibition of sulphur, it was thought that the increase of
the eruption was merely the affection _coming out_ more freely; whereas,
the aggravation was occasioned by sulphur. Leroy informs us that the
heart's-ease, _viola tricolor_, increased an eruption in the face. Lyrons
says that elm-bark aggravated cutaneous affections, which were cured by
this remedy; but neither of them were aware of the nature of this
homoeopathic development. For further information on this head, the
Organon of Hahnemann must be consulted.
Such were his doctrines for a period of about twenty years,--doctrines
which he emphatically pronounced infallible, and founded on the immutable
laws of homoeopathy. In 1828, however, convinced by numerous failures in
the treatment of chronic diseases, that other causes than those which he
acknowledged,--such as the improper preparation of the medicine, or
dietetic neglect on the part of the patient,--contributed to these
disappointments, he announced that he had discovered the hidden source of
the obstacles he encountered; and that, after many years of experiments
and meditation, he had come to the conclusion that almost all chronic
diseases originated from constitutional miasmatic affections or
predispositions, which he divided into _sycosis_, _syphilis_, and _psora_,
or, in plain English, the itch. To this latter affection he attributes
innumerable disorders. In diseases of a syphilitic character, he had found
his mode of treatment infallible; and he therefore concluded that all
obstinate and rebellious affections were the result of some other
constitutional predisposing circumstances. He tells us that he laboured in
profound secrecy to discover this great, this sublime desideratum: his
very pupils knew it not; the world was to remain in ignorance of his
pursuits until he could proclaim the most inestimable gift that Divinity
bestowed upon mankind. This immortal discovery was neither more nor less
than the itch; to which malady, according to his views, since the days of
Moses, seven-eighths of the physical and moral miseries to which flesh is
heir, were to be referred. Whether rendered evident by eruptions, or
latent from our cradle, it was a curse transmitted to us, by the
modification and degeneration of leprosy, through myriads of
constitutions, and which only disappears from the surface to fester in
malignity until it bursts forth again in the multifarious forms of
innumerable diseases, amongst which we find scrofula, rachitis, phthisis,
hysteria, hypochondriasis, dropsy, hydrocephalus, haemorrhage, fistula,
diseases of the head and liver, ruptures, cataracts, tic-douloureux,
deafness, erysipelas, cancers, aneurisms, rheumatism, gout, apoplexy,
epilepsy, palsy, convulsions, stone, St. Vitus's dance, nervous affections
of every description, loss of sight, of smell, of taste, stupidity and
imbecility.[36] In support of this doctrine, Hahnemann adduces ninety-five
cases recorded by medical writers, in which the disappearance of the itch
was followed by various acute and chronic maladies.
The next miasmatic generator is _sycosis_, or the disposition to warty
excrescences; but this source of disease Hahnemann does not consider so
prolific as syphilis, or his favourite psora.
Such are the principal features of the homoeopathic system. I have
already stated that its followers consider the most minute particles of
medicine more powerful than larger doses; they therefore have recourse to
infinite trituration or dilution in three vehicles which they consider
free from any medicinal property,--distilled water, spirits of wine, and
sugar of milk; by these means they procure a decillionth or a
quintillionth fraction of a grain. One drop of their solution is
considered sufficient to saturate three hundred globules of sugar of milk;
and three or four of these globules are deemed a powerful medicine. To
give a better idea of Hahnemann's notions on this subject, I shall quote
his own words:
"By shaking a drop of medicinal liquid with one hundred drops of alcohol
_once_, that is to say, by taking the phial in the hand which contains the
whole, and imparting to it a rapid motion by a single stroke of the arm
descending, I shall then obtain an exact mixture of them; but two or
three, or ten such movements, would develop the medicinal virtues still
further, making them more potent, and their action on the nerves much more
penetrating. In the extenuation of powders, when it is requisite to mix
one grain of a medicinal substance in one hundred grains of sugar of milk,
it ought to be rubbed down with force during one hour _only_, in order
that the power of the medicine may not be carried to too great an extent;
medicinal substances acquiring at each division or dilution a new degree
of power, as the rubbing or shaking they undergo develops that inherent
virtue in medicines which was unknown until my time, and which is so
energetic, that latterly I have been forced by experience to reduce the
number of shakes to two."
As a further illustration of this theory, he affirms that gold is without
any action in our organism in its natural state; but that when one grain
of this metal is triturated according to the above process until each
grain of the last triturated preparation contains a quadrillionth part of
the original grain of the mineral, it will be so powerful that it will be
sufficient to place this single grain in a phial, to be inspired for a
moment, to produce the most amazing results, and none more so than the
faculty of restoring to a melancholy individual, disposed to commit
suicide, his pristine partiality to life.
Unfortunately for Hahnemann, many of these assertions are unsupported by
facts or sound reasoning, and appear mere wanderings of an ardent
imagination; and thus soaring in regions of fancy, he himself has struck
many fatal blows to his own doctrines. For instance, what are the
arguments he adduces to prove that in two similar diseases the strongest
will overcome the weakest?
"Why," he exclaims, "does the splendid Jupiter disappear during the
twilight of morn to the eyes of the contemplator? It is because a similar
power, but possessed of greater energies, the breaking day, acts upon our
organs."
This is a defective analogy. Hahnemann tells us that a stronger power
banishes a weaker one in a permanent manner, whereas the bright planet he
here alludes to will return with the night. Then again:--
"With what do we endeavour to relieve the olfactory nerves when offended
by disagreeable odours? By snuff, which affects the nostrils in a similar
but in a more powerful manner." This is not correct: when the action of
snuff has ceased, the disagreeable effluvia become again offensive. In
some instances his poetical vagaries are preposterous. "By what means," he
adds, "do we endeavour to protect the ears of the compassionate from the
lamentations of the poor wretched soldier condemned to be scourged? Is it
not by the shrill notes of the fife united to the loud beat of the drum?
How do we endeavour to drown the roar of distant artillery that causes
terror in the heart of the soldier? By the roll of the double drum;--nor
would this feeling of compassion, this sense of terror, have been checked
by admonition or by splendid rewards. In the same manner our grief, our
regret, subside, upon receiving the intelligence, true or false, that a
more lively sorrow has affected another person." It would be idle to dwell
upon the absurdity of such visions and erroneous statements.
To support his doctrines, Hahnemann should have proved, 1st, that
medicinal powers do produce an artificial malady similar to the natural
affection; 2nd, that the organism only remains under the influence of the
medicinal disease; 3rd, that this medicinal disease is of short duration;
and 4th, that all these effects can only be produced by a medicine
selected according to their similarity of symptoms. Our theorist has
utterly failed in his endeavours to establish these facts; therefore have
his doctrines been impugned by many of his most zealous disciples, amongst
whom may be mentioned Griesselich, Rau, Schroen. The aggravation which he
asserts takes place after the exhibition of a homoeopathic medicine is
not only unsupported by proof, but positively denied by many of their
practitioners; and Hartman plainly affirms that, after a homoeopathic
dose, the patient frequently experiences a state of calm, a disposition to
slumber, and often falls into a profound sleep more or less prolonged, in
waking from which he finds himself much relieved, if not perfectly cured.
Thus several physicians who have adopted his practical views reject many
of the doctrines on which they are founded; and a homoeopathist has
justly compared his works to a wild virgin forest, in which we meet with a
number of valuable trees and plants in the midst of arid brushwood and
parasitic weeds that would check the growth of the most useful
productions.
Yet, notwithstanding the many gratuitous assertions, and consequent
erroneous inductions, we meet with in the _Organon_, it is probable that
this system is destined to operate a gradual but material revolution in
the _practice_ of medicine. As to theories, we must agree with Voltaire
when he said "En fait de systeme, il faut toujours se reserver le droit de
rire le lendemain de ses idees de la veille."
Hippocrates laid down in his Aphorisms the incontrovertible fact, "Duobus
doloribus simul obortis, non tandem eadem in parte, vehementior alterum
obscurat. A. 46." To a certain degree, it was upon this assertion, which
the experience of ages has confirmed, that Hahnemann founded the principal
and most important point of his doctrine; but, going much farther than the
father of medicine, he affirms that similar diseases effectually remove
each other. For centuries practitioners have been acting
homoeopathically; the exhibition of specifics, in fact, being nothing
else. As we have already shown, specifics are known to produce symptoms
similar to the diseases they cure. Hitherto the number of such medicines
has been confined to a very few agents; and perhaps with the exception of
mercury, sulphur, and bark, with their several preparations, scarcely any
article in the materia medica could have claimed this peculiar property.
To extend these limits, which confined in so exiguous a compass our
therapeutic agents, has been the laborious and singular study of Hahnemann
and his disciples. Haller had first given the example, and they arduously
applied themselves to discover by experiments on the healthy subject, both
upon their own persons and others, what were the peculiar effects or
symptoms produced by various medicinal substances. These observations are
so numerous and confused, that, on reading them, we feel plunged in a
chaotic labyrinth of symptoms, without any clue to extricate ourselves
from its perplexing mazes. Still, from this multifarious catalogue much
important information can be collected; and it cannot be denied that the
homoeopathist has not only thrown a new light on the action of many
medicines which we daily prescribe, but brought into practical
consideration the necessity of attending to dietetic discipline, by an
investigation of the several properties of our usual _ingesta_.
It is obvious that any enthusiast who would blindly embrace the foregoing
doctrines without serious and deep investigation, and boldly apply the
wild theory to practice, would at once throw open the flood-gates of
absurdity, and lend his aid in destroying, if possible, with one fell
swoop, the result of ages of mature study and experience. Hahnemann, to
fertilize the fields of science, had recourse to inundation instead of
wise and cautious irrigation; and the fury with which he and his rash
disciples maintained their opinions materially tended to retard their
progress. Truth needeth not violence; its own lustre will beam through
surrounding darkness, without being dragged into light.
The objections to Hahnemann's doctrines are glaring. The art of healing,
from the dawn of science until the present day, has been more or less
founded on the faculties of reasoning. We are taught, in the first
instance, to observe carefully the phenomena of disease, and, by referring
effects to probable causes, endeavour, however difficult the task, to
trace their catenation. Many of these causes are perhaps sealed for ever
in the inscrutable book of our destinies; yet, if we cannot obtain a
knowledge of the origin of these disorders, still when we take into mature
consideration the complication of all accidental circumstances, and from
visible effects seek invisible relations, guided by our experience in
anatomy, physiology, and the revelations of pathology, we may find this
pursuit less difficult than it may be imagined. But the homoeopathist
despises and rejects as idle, all those collateral means of diving into
nature's arcana. He bids us dwell only upon evident symptoms, or, in other
words, look to the effects alone, and cast away all thoughts of
discovering their causes. Nothing can be more illogical than this
argument; for certainly we can scarcely hope to remove effects without
striking, as far as in our power lies, at their cause. To deny the
existence of any specific affection because we cannot account for its
origin, is absurd. As well might we reject the use of medicines known to
possess specific properties, from our utter ignorance of their _modus
operandi_. The exclusive consideration of symptoms would lead us into
lamentable error, since the same symptoms are observable in various
diseases. Similar pains, for instance, may be the symptoms of rheumatism,
nephritic affections, and calculus; headaches may arise from inflammation,
and from various and well-known sympathies with distant organs: yet,
without seeking to ascertain these relations, the mechanical and
empirical homoeopathist will prescribe such medicines as are known to
occasion pains in the loins, or headaches; only bearing in mind
perceptible derangements, heedless of the phenomena of organization, the
state of the secretions and excretions, the history, the rise and progress
of the disorder, or the idiosyncrasy of the patient. The liver is
diseased; the discovery is of no importance. We have only to attend to the
pain extending up the clavicle and shoulder, or the uneasiness experienced
in the right hypochondrium: the pulse, the respiration, the condition of
the excretions, the temperature of the skin, the appearance of the tongue,
are all regarded as minor considerations. It is not _hepatitis_ that we
are called upon to cure; it is to relieve a pain in the shoulder and in
the hypochondrium, or a difficulty of lying on the left side.
No one will pretend to deny that our safest, perhaps our sole, guide in
the study of disease is the group of symptoms, that become more and more
perceptible during the course of our investigations. It was principally on
the study of symptoms that the most learned practitioners of every age and
country grounded their diagnosis and their prognosis; but they never
viewed them either singly, or in their complexity, as unconnected with the
particular diseases to which they were not only essentially united, but
from which they originated, and of the existence of which they were to be
considered the diagnostic signs. Therefore did the ancients classify them
as principal and accessory, univocal and equivocal, characteristic or
common, as they afforded more or less information in our pathological
deduction; and in that light they were weighed with greater or less
application, as our judgment could only be formed by the attentive
consideration of the phenomena of the organism in health and in disease.
But while the homoeopathist's attention is chiefly directed to the
discovery of means that can enable him to produce symptoms analogous to
those of the disorder, he seems to disregard the laws of sympathy, by
which our organism appears to be ruled; a mysterious agency which can only
be ascertained by observation and experiment, when, to use the words of a
distinguished writer,[37] "by the former we may be said to listen to
nature, by the latter to interrogate her." Health depends upon the due
co-operation of all these associations; and one organ in the wonderful
machinery cannot be deranged in its functions without influencing others,
however distant and unconnected they may appear. In this co-ordination,
these vital relations have been very properly divided into mechanical,
functional, and sympathetic. Their study constitutes the groundwork of all
rational induction. It is not by individual or complex symptoms that we
can decide where the want of equilibrium is to be traced. Various have
been the theories on this most important subject, and great have been the
erroneous ideas dogmatically laid down. The illustrious Bichat himself
erred when he maintained that sympathies were aberrations--morbid
developments of our vital properties. Sympathies, on the contrary, may be
considered as constant phenomena, essential and inseparable from our
organism, whether in health or in sickness; and are, if I may be pardoned
the expression, co-ordinated to co-operate with each other in their
mechanical, their functional, and their sympathetic associations.
An incarcerated hernia causes hiccup, nausea, vomiting. Will the
homoeopathist tell us that we must seek in his catalogue of innumerable
effects some substance which is known to produce similar symptoms? Surely
the rupture must first call our attention. This example is adduced as
referring to nearly every case in which it might be rashly attempted to
separate causes from effects. The mammary glands are variously affected in
uterine diseases; their impressions are reciprocal, yet the uterine
affection must be the chief object of our solicitude. A peculiar pruritus
is a symptom of calculus. Are we then to administer a homoeopathic dose
of _cannabis_, or any other medicine which may give rise to a similar
sensation? It may be objected to this observation that these are purely
surgical cases, in which we need not be guided by symptoms to discover
causes; but it has too frequently happened that nausea and vomiting have
been attended to, while the hernia was overlooked, until fatal accidents
were manifested. Moreover, a diseased liver, a diseased spleen or kidney,
would be just as perceptible as hernia or calculus, if these parts could
be brought into view or contact.
It may be said that an erroneous notion of Hahnemann's doctrines on this
subject has been taken; it is therefore necessary to quote his own words:
"It may be easily conceived that the existence of a malady presupposes
some alteration in the interior of the human organism; but our
understanding can only lead us to suspect this alteration in a vague and
deceitful manner, from the appearance of the morbid symptoms, the sole
guide we can depend on except in surgical cases. The essence of the
internal and invisible change is undiscoverable, nor have we any means of
guarding against deceptive illusions."[38]
"The invisible substance that has undergone a morbid alteration in the
interior of the human body, and the perceptible changes, which are
externally developed,--in other words, symptoms,--form by their union what
is called disease; but the symptoms are the only points of the malady
which are accessible to the physician, the sole indication whence he can
derive any intuitive notion, and the principal objects with which he ought
to become acquainted to effect a cure. From this incontestable truth there
is nothing discoverable in disease beyond the totality of its symptoms to
guide us in the selection of our curative means."[39]
It is not to be supposed that an experienced physician, although a
homoeopathist, will rest satisfied with this study of symptomatic
medicine, without endeavouring to attach these effects to some cause,
however occult it may appear; but such a doctrine becomes pernicious,
since it bids us close the only book of truth that can reveal our
errors,--_post mortem_ investigations. Surely, if a group of certain
symptoms attend a disease which, when terminating fatally, shows
disorganization in certain viscera, we are not only justifiable in giving
to that disorganization a specific name in our scientific classification
and categories, but in considering the symptoms of no other importance
than as corroborative of those facts that morbid anatomy daily brings to
light.
It is generally admitted that most nosologies are imperfect, and may
occasionally lead the young practitioner into error. This is easily
accounted for when we consider the Protean forms that the same disease
assumes in different individuals; yet, without this classification, the
science of medicine could not be studied. A certain arrangement is
necessary to simplify all our pursuits in natural science, and to seek a
variety we must know the order and the genus.
Had Hahnemann given a better system of nosology than those we possess, and
with his truly praiseworthy zeal and industry enumerated the various
symptoms of disease as minutely and as accurately as he has recorded the
effects of medicinal substances, his labours might have proved a most
valuable addition to our store of knowledge.
Let us now direct our attention to the absurdities to which these opinions
have led. Solely attentive to effects, and heedless of the
disorganization of various important parts of the human economy which
morbid anatomy detects, Hahnemann endeavours to discover the occult
causes--the original source--the germ--of the malady, which most likely
are beyond the reach of our researches; and he boldly affirms that all
chronic diseases spring from syphilis, a disposition to warts and the
itch. Now experience has proved that such an assumption is unfounded. The
most healthy subjects, those who attain the finest old age, are more
liable to this disgusting affection than the wealthy and cleanly part of
the community. The Irish and Scotch peasantry from their infancy, and
through life, are most subject to psora; and certainly our soldiers and
sailors, amongst whom the disease is common, are not more predisposed to
chronic diseases than any other classes of society, of course not taking
into consideration the effects of unhealthy climates.
Syphilis, it will be readily granted, has a considerable share in
producing anomalous _sequelae_, more especially when in combination with
mercury. Warts, except of a syphilitic character, were never known to
germinate diseases; indeed, they affect the most healthy and robust
individuals. Yet to these three miasmatic causes does Hahnemann attribute
nearly every disease that was ever known to afflict mankind; while he
passes over in silence the predisposition to scrofula, gout, rheumatism,
to which we can unfortunately trace with too much certainty the source of
much human misery.
That the itch is a disease of great antiquity is a matter of doubt. It has
been maintained that it is the same eruptive disorder described by Celsus
under the appellation of _scabies_; yet this writer does not allude to its
contagious nature, and moreover says, that in some cases it disappears
completely, whereas in others it is renewed at certain periods of the
year.
Celsus, moreover, includes other forms of pustular eruptions among the
different species of scabies, not sufficiently distinguishing them from
each other. The character of his scabies is more analogous to the lichen
agrius of Willan.
Nor did the ancients consider their _psora_ as our itch. It appears to
have been the scaly tetter, which they sometimes denominated _psoriasis_,
at others _lepra_, a synonymous affection; but neither pustular nor
vesicular. Leprosy, indeed, is a malady totally distinct from the itch in
all its characters. Hahnemann asserts that the species of leprosy that
afflicted the Jews, and which is described by their legislator in the 13th
chapter of Leviticus, was the itch; but any one who will peruse this
description will perceive that it does not bear the slightest resemblance
to that disorder. It appears, on the contrary, to have been that kind of
leprosy called _leuce_ by the ancients. Nor was leprosy constantly
attended with itching, one of the chief characteristics of the malady, and
from which sensation it derives its very name. Hippocrates mentions a
leprosy that usually occasioned a prurience before rain. There are no
diseases in the classification of which more obscurity exists than in
cutaneous affections; and Hahnemann's ideas would tend to increase this
confusion, since he tells us that he considers the _framboesia_ of
America, the _sibbens_ of Norway, the _pellagra_ of Lombardy, the _plica_
of Poland, the _pseudo-syphilis_ of the English, and the _asthenia
Virginiensis_ of Virginia, complications of his three miasmatic
principles; and he further informs us, no doubt on the faith of some idle
tradition, that _psora_ lost its external deformity on the return of the
Crusaders, who brought from the Holy Land the use of linen shirts, a
cleanly and salutary precaution that eradicated the disease at a period
when France had no less than two thousand hospitals for the reception of
_itch_ patients,--a plain proof that he confounds leprosy with itch, since
the hospitals he alludes to were distinctly considered leper-houses.
It is certainly true that there does exist in our system a constant
predisposition to eruptive affections of some kind or other. We are born
heirs to certain exanthematic affections, such as the measles and
smallpox; and it would be as difficult to find a being morally immaculate
as an individual free from speck or blemish. Many of these eruptions are
considered of a critical and salutary nature; and the ancients fancied
that nature relieved herself by throwing upon the surface some "peccant
humours." Hence their dread of the retrocession of any of these "breakings
out;" and there is no doubt but that accidents frequently followed their
sudden disappearance, in the same manner as drying up an issue or a
blister established for some time, and become habitual, may occasion
internal mischief; but to maintain that all chronic diseases arise from
three eruptive principles is a most gratuitous and untenable assertion.
Enthusiastically anxious to support his doctrines, Hahnemann is frequently
led into erroneous assertions. Thus he tells us that life will suddenly
cease if a little water, or the mildest liquid, is injected into a vein;
whereas experience has proved, in the treatment of cholera, and various
other instances, that the most stimulating solutions may be thus
introduced, not only with impunity, but with salutary results.
It is needless to enter more deeply into the ungracious business of
pointing out errors, many of which were evident to Hahnemann himself;
since, not only in the several editions of his Organon, but in various
paragraphs in the same volume, he contradicts himself.
A much more gratifying and important task is now undertaken, to prove, by
the evidence of facts, supported by practical reasoning, that the art of
healing is more indebted to the homoeopathic doctrines than to any
system that has hitherto been delivered in our schools.
That the all-bountiful Creator, in permitting, for purposes unknown to us,
mankind to be visited by so many scourges, has also scattered around us
means to counteract these evils, cannot be a matter of doubt. Instinct
leads animals to find out these salutary agents, and various specifics
have been discovered by man. The rudest savage is in possession of
curative substances unknown to civilized man, and performs cures where
learning and experience have proved of no avail.
To extend the limits of specifics, must therefore be considered a most
desirable step towards adding to our means of relieving disease; and in
this pursuit it is impossible to bestow too much praise on the
homoeopathic observer. Enthusiasm--predilection to a favourite but
persecuted system--may induce an ardent proselyte not only to deceive
others, but unwittingly to deceive himself. It is therefore not only
possible, but probable, that in the experimental investigations of the
effects of medicine, Fancy, in her multifarious colours, may have
depicted, with apparent fidelity, a state of body and mind that only
existed in an excited imagination; but when we behold various individuals,
distant from each other, and totally unconnected, observing similar
results from the exhibition of various medicinal substances, we have no
right to call their assertions into doubt. These assertions, moreover, are
not laid down dogmatically, but are earnestly recommended to be submitted
to the test of experiment. For instance, the homoeopathist has found out
that certain substances, by diminishing the energy of the heart and
arteries, subdue inflammatory action as effectually as venesection. This
is a fact daily witnessed, and of which any practitioner may convince
himself. It is not asserted, that in cases of sudden determination of
blood, which require immediate revulsion and abstraction of the vital
fluid, homoeopathic remedies will be found possessed of sufficient
activity to afford prompt relief; but experience has fully proved that in
cases which can admit of a few hours' delay, these medicines very
frequently supersede the necessity of debilitating the patient by a
copious loss of blood.
Dr. Paris, in his admirable work on Materia Medica, has justly observed,
"that observation or experiment upon the effects of medicine is liable to
a thousand fallacies, unless it be carefully repeated under the various
circumstances of _health_ and _disease_, in different climates, and on
different constitutions." This has been the main object of the
homoeopathist; and a further quotation from the above distinguished
writer will illustrate the importance of their labours. "It is impossible
to cast our eyes over such multiplied groups (of medicinal substances)
without being forcibly struck with the palpable absurdity of some, the
disgusting and loathsome nature of others, the total want of activity in
many, and the uncertain and precarious reputation of _all_, without
feeling an eager curiosity to inquire, from the combination of what causes
it can have happened that substances at one period in the highest esteem,
and of generally acknowledged utility, have fallen into total neglect and
disrepute. That such fluctuation in opinion and versatility in practice
should have produced, even in the most candid and learned observer, an
unfavourable impression with regard to the general efficacy of medicines
can hardly excite our astonishment, much less our indignation; nor can we
be surprised to find that another portion of mankind has at once arraigned
physic as a fallacious art, or derided it as a composition of error and
fraud. A late foreign writer, impressed with this sentiment, has given the
following _flattering_ definition of our profession: _Physic is the art
of amusing the patient, while Nature cures his disease_."
With such a lamentable view of the practice of medicine, can we be too
thankful to those observers who strenuously endeavour to rescue it from
the dark trammels in which prejudice and interested motives have bound it?
In no country more than in Great Britain is such an investigation
desirable. We have become proverbial from our incessant abuse of a farrago
of medicinal substances; and what is usually termed an _elegant
prescription_ signifies an amalgam of various drugs and preparations,
which most probably, by their affinities, neutralize the expected effects
of each other; for, however great and flattering may have been the
discoveries of modern chemistry, many of these affinities are unknown to
us. Surely when our labours cannot detect any difference in the component
parts of the purest Alpine atmosphere and the deleterious air of a
loathsome dungeon, we cannot expect to form a correct idea of pharmaceutic
combinations.
The mere hopes of being able to relieve society from the curse of constant
drugging, should lead us to hail with gratitude the homoeopathist's
investigations. That many physicians, but especially apothecaries, who
live by overwhelming their patients with useless and too frequently
pernicious medicines, will warmly, nay furiously inveigh against any
innovation of the kind, must be expected as the natural result of
interested apprehension; and any man who aims at simplicity in practice
will be denounced as guilty of medical heresy. Have we not seen
inoculation and vaccination branded with the most opprobrious epithets,
merely because their introduction tended to diminish professional lucre?
In these remarks upon medicinal combinations, it is not meant to infer,
that, because they are chemically incompatible, they are
ineffectual,--experience has proved the contrary; but no one will contend
that, if we can attain the same beneficial results from a single
ingredient, administered in small quantities and at distant periods, as
from the exhibition of repeated and nauseous doses of pills, powders,
draughts, potions, &c. which hang over the bed of sickness, nay, of slight
derangements, like the sword of Damocles, we have not effected a most
salutary reform in the practice of physic. It is related of one of these
ingenious and industrious practitioners, that, having seen a prescription,
that only contained half a dozen medicines, he exclaimed, "What! nothing
more?" To which the prescriber replied, "If you choose, sir, we'll step
over to the apothecary, and see what else he has in his shop."
Specifics may be divided into two classes; the one producing a peculiar
effect upon particular organs, the other producing general results. Thus,
the action of cantharides and digitalis on the urinary system, of emetics
on the stomach, of certain purgatives on the small intestines, and of
others on the large ones, are generally known; whereas the action of
mercury and opium is still a matter of controversy. A study of these
effects constitutes the chief object of the homoeopathist; and, having
determined their peculiar action, these medicinal agents are given
singly, and, as we have already observed, in the most minute doses.
It is this division into infinite fractions that has drawn upon the
homoeopathic practice the denunciation of the allopathic physicians, as
it is considered utterly impossible that such imponderable particles can
produce any beneficial or prejudicial effect; and the Academy of Medicine
of Paris, when officially condemning the doctrine, asserts, in support of
this argument, that great danger arises from it "in frequent and serious
cases of disease, where the physician may do as much injury, and cause no
less mischief, by ineffectual means as by those which are prejudicial."
This is perhaps one of the most important points of the homoeopathic
doctrine. If these fractional doses are inert, and yet the disease is
cured, then must the successful treatment be solely ascribed to the
dietetic regimen and the efforts of nature. However, experience has
afforded abundant proofs that these infinite atoms do produce positive and
evident effects. What appears to our feeble organs an atomic fraction may
produce phenomena on the organism which we cannot comprehend, but should
not therefore be denied. Let one grain of iodine be dissolved in one
thousand five hundred and sixty grains of water, the solution will be
limpid; let two grains of starch be dissolved in two ounces of water and
added to the first solution, and the liquor will forthwith assume a blue
tint. In this experiment the grain of iodine has been divided into
1/15360. Dissolve the four-hundredth part of one grain of arsenic in four
hundred thousand parts of water, and the hydric-sulphite will bring it
into evidence. Let a five-thousandth part of arseniate of ammonia be
dissolved in five hundred thousand parts of water, and the addition of the
smallest proportion of nitrate of silver will obtain a yellow precipitate.
Numerous experiments of a similar nature may be daily resorted to, to
prove that the most minute particles of two substances possessed of
chemical affinities may be brought into action, although diluted _ad
infinitum_. But the power that the smallest particle possesses in
producing natural phenomena cannot be more evidently proved than by
Spallanzani's experiments in fecundation. This physiologist having wrapped
up a male frog in oil-silk, fecundation could not take place; but having
collected on the point of a camel-hair pencil a particle of the
fecundising fluid, he succeeded in vivifying thousands of eggs. Surprised
at this result, he dissolved three grains of the secretion in a pound of
water, and one globule of the solution was endowed with the same faculty.
In this case the globule of water only contained 1/2994687500 part of one
grain. This curious experiment has been tried with a similar result by
Prevost and Dumas. How imponderable and impalpable must be the effluvium
which enables the dog to track his master for miles! the particle of atter
of roses that perfumes a whole chest of clothes! and what must the power
of the aroma be which is preserved for thousands of years in some Egyptian
mummies! Would the vulgar believe in the wonders of the solar and gaseous
microscopes unless they were exposed to view? In these we behold in
amazement myriads of individuals in one drop of fluid, each of them as
perfect in organization as the mighty mammoth of old or the sagacious
elephant of our days, endowed with distinct habits, destructive and
reproductive propensities and faculties.
It has been advanced by the opponents of homoeopathy that the
insignificant dose of three or four medicinal globules cannot possess any
power, since one might swallow a thousand of them with impunity. To this
it is answered, that it is only under certain morbid conditions that these
medicines act by their homoeopathic affinities. Moreover, it is well
known that small doses of medicinal substances will frequently produce
more powerful effects than larger quantities. Tartar-emetic, sugar of
lead, calomel, afford daily instances of this fact; and it is also
admitted that many substances act differently upon the healthy or the
sick. An individual in health can take any food without apprehension; but
when his functions are deranged, the slightest imprudence in regimen may
lead to serious consequences. There are primordial and inscrutable
peculiarities in our constitution that cannot be accounted for; and the
medicine which relieves one patient will aggravate the sufferings of
others. The exhalations of the American _rhus_ are deadly to some persons,
but innocuous to others; and many poisons which cause instantaneous death
to some animals may be given with safety to others. Whence has arisen the
controversy regarding damp sheets, which many maintain are not dangerous,
simply from the fact that a healthy person with a vigorous circulation may
sleep in them with impunity, when a feeble and languid subject will be
exposed to some dangerous determination of blood?
A learned writer already quoted thus expresses himself on this
matter:[40] "The virtues of medicines cannot be fairly nor beneficially
ascertained by trying their effects on sound subjects, because the
peculiar morbid condition which they are calculated to remove does not
exist." It may be said that this observation militates against the
homoeopathic experiments, and to a certain extent it evidently does; but
it cannot be inferred that because a medicinal substance will occasionally
act differently in health and in disease, that it may not frequently
operate in a similar manner when the morbid condition does prevail, since
it is generally admitted that medicines act in a relative manner according
to the state of the system. Hence classifications of medicines are too
frequently erroneous and imperfect. The doses of medicines determine their
effects. Linnaeus says, "Medicines differ from poisons, not in their
nature, but in their dose;" and Pliny tells its aphoristically, "_Ubi
virus, ibi virtus_." According to their doses, medicines will produce a
general or a local effect; and Dr. Paris, whom I feel much gratification
in quoting, lays down as a rule that "substances perfectly inert and
useless in one dose may prove in another active and valuable." It would be
foreign to my purpose to enter more fully into this most important
subject; but the cases which shall be adduced will be deemed sufficient to
convince the most incredulous, of the power of homoeopathic doses.
Those who have denied this property have boldly attributed homoeopathic
cures to dietetic means. Admitting this statement by way of argument,
surely, if any observer, by ascertaining the peculiar action of our
ingesta, can so regulate the regimen as to produce salutary effects
without the aid of medicine, mankind would be most essentially benefited.
How many persons do we not daily meet with, who have never taken any
medicine since their childhood, when maternal care strove to destroy their
digestive organs with apothecary's _stuff_, and who regulate their
functions by mere attention to their mode of living. I know one gentleman,
a physician, who relieves constipation by green chilies; another, with
cold milk; a third, with warm milk: in some habits spinach and sorrel will
act as a powerful and safe aperient; in others, cheese, or a hard egg,
will operate in a contrary way. Fermented and spirituous liquors all
possess specific properties. Some gouty persons cannot drink Claret
without bringing on a paroxysm, and others dread a glass of Champagne or
Burgundy. Nay, different wines have been known to bring on arthritic
attacks in particular parts; and I have known Champagne to produce gout in
the wrist, and Burgundy in the knee, in subjects who under other
circumstances never experienced the disorder in those articulations. Our
peculiar aversion, nay, our dread, of various alimentary substances are
well known. The odour of cheese, of strawberries, have occasioned fainting
and convulsions; and in certain constitutions, several articles of diet
bring on indigestion. In short, the study of our ingesta is one of the
greatest importance; and here again the homoeopathist is entitled to our
best thanks.
This investigation will moreover prompt physicians to be more attentive in
inquiring into the various effects of alimentary and medicinal substances
on their patients. Instead of hastily drawing out routine prescriptions
for such and such a disorder, they will accurately ascertain the physical
and moral condition of the subject, taking into due consideration previous
habits, predispositions, and pursuits in life. Indeed, it would be
desirable that practitioners followed the example of army medical men, who
keep an exact register of every individual they attend, and in which is
diligently recorded every circumstance connected with the disease and its
treatment.
Moral influence has also been called into aid in opposition to this
practice, and cures have been attributed to the mere power of fancy and
credulity. We have certainly known superstition and mental imbecility to
be productive both of good and evil,--to have created some maladies, and
cured others; but homoeopathy has succeeded when the patient was unaware
of the treatment to which he was submitted. But, conceding the point, and
admitting that inert substances, such as starch, (and this experiment was
resorted to in Paris,) may have obtained singular beneficial results,--the
results of a weak imagination, this circumstance alone would be
illustrative of the power of moral agency; and who would not gladly wish
for a mental relief in lieu of a nauseating and injurious course of
medicine?
Others will exclaim, although the homoeopathist disavows the _vis
medicatrix naturae_, that he solely succeeds by leaving the malady to the
salutary efforts of the constitution. Here again we must admit, that, were
we to leave many diseases to run their course, we might be more successful
in obtaining a cure than by a rash and detrimental interference, founded
on the principle that a physician "must order something."
But the facts I am about to record,--facts which induced me, from having
been one of the warmest opponents of this system, to investigate carefully
and dispassionately its practical points,--will effectually contradict all
these assertions regarding the inefficacy of the homoeopathic doses, the
influence of diet, or the agency of the mind; for in the following cases
in no one instance could such influences be brought into action. They were
(with scarcely any exception) experiments made without the patient's
knowledge, and where no time was allowed for any particular regimen. They
may, moreover, be conscientiously relied upon, since they were made with a
view to prove the fallacy of the homoeopathic practice. Their result, as
may be perceived by the foregoing observations, by no means rendered me a
convert to the absurdities of the doctrine, but fully convinced me by the
most incontestable facts that the introduction of fractional doses will
soon banish the farrago of nostrums that are now exhibited to the manifest
prejudice both of the health and the purse of the sufferer.