What Constitutes a Scientific Prescription?
P.P. Wells, M.D.
THE HAHNEMANNIAN MONTHLY, 1867
reprinted
THE HOMEOPATHIC HERITAGE (Delhi)
Vol. 8, No. 1, Jan. 1983, pp. 3-9
Editor's Introduction:
This article by Dr. Wells is in reply to some writer's article which appeared under the title given above. That writer had enumerated four elements of what he thought could be a scientific prescription. These four points have been referred to and reproduced in italics with the serial number in the text of Dr. Wells' comments. The word “writer” referred to in this article refers to that writer and not to Dr. Wells. (S.P.K.)
In this time, when the word “scientific” carries in it so great a force and charm to so many minds, we should prefer the question in this form: What constitutes a prescription Scientific? Prescription, as a duty, is only related to the “science of therapeutics.” It is “scientific” only when, and just in proportion as, it is in accord with this “science.” The prescription is “scientific’' when it has been made in compliance with the requirements of the law of similars. All prescriptions otherwise made, i.e., all into the basis of which elements have been omitted or excluded which this law requires, are by these facts made “Unscientific.”
Then the subject is resolved into the answer to this other question -- what does the law which underlies therapeutics require in a prescription? It requires that all knowable phenomena of a sickness shall have their counterpart in the record of the agent the prescription presents for its cure. This faithfully complied with, and neither law nor the cure require anything more or beyond this. This prescription is scientific, and no other is, whatever of other sciences remotely related to that of therapeutics may have been lugged in as helps in the process of its make up. Indeed, it is but too often the case that the more these have been brought into the discharge of this duty the more “unscientific” has been the prescription, and unsatisfactory the result. Simple compliance with law gives to the sick the “scientific” prescription which alone is adequate to the speediest and safest cure the case admits of, and this without the interference of any accessories whatever.
The writer gives four peculiarities which, as he understands it, constitutes a scientific prescription. They are as follows:
1. A remedy or remedial measure which antidotes, or neutralizes, or counteracts the cause.
It is a sufficient reply to this that many prescriptions are necessitated, where the prescriber is ignorant of the “cause” of the sickness he is expected to cure. And then, further, it is the effects of the cause he is to cure and not the cause. Now in prescribing for a case Migraine. What does the prescriber know of the cause of this? It is wholly beyond his reach oftener than otherwise, and he is only concerned with the sufferings this cause has produced. And by strict compliance with the demands of law he may hope to cure its pains with no reference whatever to “antidoting,” “neutralizing,” or “counteracting” the cause of which he knows nothing, and this just as certainly as if he knew all about it. But it is not to be denied that there are cases of sickness where a true knowledge of the cause may help the prescriber greatly in his search for his specific. A knowledge of this, when it can be had, is never to be despised or neglected, though a prescription may be a compliance with new demands of law without this, and therefore be a “scientific prescription.”
In illustration of the writer's idea of the importance of a knowledge of the cause of sickness, after naming many different causes of these, he says:
“Are we to treat morbid states resulting from such diversified causes upon the one undeviating principle or method, that of their symptomological similar? Dolor, calor, and rubor may appear in some phase of the disease resulting from every cause specified, and shall pain, heat and redness form the basis of a prescription, whatever their origin, or whatever organ or tissue they may involve?”
This would look a little as if the writer had very imperfectly comprehended the scope of our law, or when writing the above was for the time unmindful of its requirements. Has he met many cases for treatment composed only of the three elements he has instanced? These three elements are often met, but they do not often compose all the symptoms of a case, hence they are but a part of the facts which are to be accepted as the basis for a “specific prescription,” and presumably if this writer will give the other symptoms of his case their proper place, with these three, in the basis of his clinical prescriptions, and then deal with the whole as the law requires, he will find less of occasion for criticism, and none for dissatisfaction with the results of his treatment. It is not easy, before the problem of a specific, or “scientific prescription,” which we take to be the same thing, to say what importance can attach to his diverse causation, as elements in this problem, unless these different causes produce different effects. Nor what to these different effects, unless the difference is perceptible to the prescriber. Nor how this difference can appear otherwise than in the symptoms. So that, after all, the talk of the importance of causation as a controlling factor in specific prescribing (or “scientific”) we are forced back on the totality of the symptoms for all knowledge we can possibly have of the effects of different causations in producing morbid states of functions or tissues. If different causes produce identical effects, then the specific for these is in the one drug. If the effects of different causes are not identical, the specific is pointed out by the differences in their actions. The totality of these decides the question of specificity, and also the “scientific” character of the prescription founded on it. And this totality will prove as sure a guide to this knowledge as it is to that of the single specific, which homoeopathy presents as our only guide. With this knowledge, however, we are to accept all the effects of whatever cause, or we are never to come to this knowledge, without which, indeed a successful prescription may be possible, but then it is never “scientific,” but only a fortunate blunder.
The writer's second elements in a “Scientific prescription” he gives in these words:
2. A remedy or remedial measure which harmonizes with the natural principles involved, be they mechanical, chemical or dynamical.
With this there may be no complaint. But with the illustrations given us his idea of this proper relationship, and of this as opposed to, or in any way an addition to, or improvement of, the directions of our law for dealing with the sicknesses resulting from varied causations, we should object. And first -- of his abscess -- of his overloaded stomach, etc.
Where there are mechanical conditions, the law is, treat with chemical means. [I should point out that Indian homeopaths have discovered that homeotherapeutics are astonishingly curative in snake bites, which is more than expected and seems to have only been possible to have been learned in a snake-infested environment like India.] There is nothing different from this in our law of therapeutics, or in any intelligent advocacy of this law. That this should be assumed by implication reminds one somewhat of the old-time opposition to a practice based on the totality of the symptoms, which represented this practice as though it pretended to reduce fractures and dislocations by powders and pellets. The “natural principles involved” in all cases of sickness outside the circle which embraces those of chemical and mechanical origin are dynamic in their nature, and are best dealt with by means which are of a similar nature. [That means homeopathically for all diseases.] To resort to these for the relief of mechanical conditions can only be the act of a professional idiot. [However, I point out that parturition is a largely mechanical procedure where we have command of the situation, as is herniated disks which we also command, and other seemingly purely mechanical problems also respond to correct homeopathy.] In this it would be on the same plane of intelligence as that which would resort to chemical means for the relief of dynamic conditions. [That is to say, allopathy has no place in diseases.] In dealing with the results of chemical causes [i.e., poisonings], only chemical means are in place [but remember what I just said about snake-bite cases in India], while the cause continues to act chemically. After this action has ceased, the case is to have the dynamic remedy, which has in its record facts which are most like those dynamic results, which remain to be cured after the cessation of the chemical action of the cause.
The writer under his second head has spoken plainly and well of the microbes as causes of diseased action, and of treatment based on their supposed character as causes. To his utterances on these subjects intelligent men may safely say, amen!
The third peculiarity of a “scientific prescription” is given by the writer in these words:
3. A remedy or remedial measure which fulfills the indications of the pathological condition.
Of course this is not to be left out of a prescription which is intended to be “scientific.” But what is this “pathological condition,” anyway, and how is it to be discovered? It is talked of much, and much insisted on as a necessary element in therapeutic problems, but oftener than otherwise with no very clear idea of what this really is, or of its true place in clinical duties. It is not always clear, so it would seem, to those who talk most, and most earnestly of pathology, its “states” and “conditions,” that the “science” of therapeutics is one thing and that of pathology another [emphasis mine]. And that, strictly regarded, the relations of the two are only remote, if indeed they are not independent of each other, though both enter into, and are parts, in all clinical duties. The “science” of therapeutics is that which teaches how to come to a knowledge of the specific remedy for a case of sickness. The law which underlies this “science,” and which is the only known and sure guide in its practical application, requires the comparison of two known factors in every case of sickness to be cured, that the demanded similarity of each to the other may be ascertained before it will accept the one as the curative of the other, and the pathological condition is not one of these factors [emphasis mine]. This is a necessity in the case, because the law requires known factors for its demanded comparison, and the pathological condition is often largely, and always more or less, a matter of guessing.
The pathological “condition” is a supposed condition of internal parts which are not and cannot be seen. Why is this “condition,” then, supposed to be thus or thus? Why, indeed, but because certain perceptible phenomena are supposed to be indicative of this. These perceptible phenomena (symptoms) are all there is known about it and these the “science” of therapeutics claims as its own, and uses them, and by this use constitutes any presumptions founded on them “scientific.” Pathology only uses these as a basis for guessing and therefore just so far as these guesses have entered into the making of a “presumption,” they have made it, of necessity, “un-scientific.” The guesses of the pathologist have no place with the factors therapeutics accepts as helps in its practical application [emphasis mine]. The intelligent pathologist uses his guesses, founded on symptoms, to help his judgment in deciding as to the curability of his case and in forecasting its probable future. If he brings them at all into the duty of selecting the specific curative (making a “scientific prescription”), he violates, by so doing, the law, obedience to which alone can constitute any prescription “scientific.
The science of pathology has its place with the sciences the physician should know, but knowing this is not all there is of it, and if he does not know also where and when it is to find its appropriate place and use in practical duties, it is of no earthly value to him, talk of it and boast of it as much as he will. And in search for, and discovery of, the specific for a given case of sickness, this has no place [emphasis mine]. Its only place in clinical duties is in the prognosis of the case, and is not, and never can be, rightly brought into the question of selecting its specific curative. These facts, we think, dispose effectually of our author's third element of a “scientific prescription.” And then his attempts to illustrate the necessity of a recognition of this “condition” of “scientific prescribing” are so many evidences that he has wholly failed to comprehend the first principles of homeopathic philosophy. He gives several symptoms of Calcarea carb. and says:
“They are given as characteristic indications for the administration of the remedy”; and that “one reputable author advises its use upon these indications in ninety named diseases, which involves probably, every tissue and organ of the body, every function, diseases acute and chronic, toxic and benign, organic and functional, and those representing exaltation and depression indiscriminately.”
Just so. While we would again remind our author that homeopathy demands that which is most like all the symptoms of a case, to constitute any member of materia medica its curative, and therefore its selection a fulfillment of whatever pertains to a “scientific prescription,” we would advise him, in any case where he finds the symptoms he has given, to carefully consider Calcarea before he selects another remedy in its place, and only to do this after he has found some other remedy more like the demanded totality than is Calcarea. If, after such examination he finds the Calcarea the most like, he can give it with the utmost confidence, and expect a successful result with it. And further: The remedy will act out its own nature in restoring sick forces, and in doing this, if its actions be really most like those of the morbid process, it will cure asking few or no questions as to “causes” or “pathological conditions,” because this is law that it shall do so. The difficulty with this writer in understanding homeopathic law and philosophy is his notions of “causes” or ”pathological conditions,” with which true “scientific,” i.e., homeopathic “prescribing” has so small concern, seems to get between his vision and the demands of law, so that they are very imperfectly seen and comprehended. The Calcarea will care nothing for the names of these ninety diseases to which he has alluded, but only whether its actions be more like the morbid phenomena which characterize them, however caused, or whatever the pathological condition, than is that of any other drug. If this be so, then Calcarea is curative of one and all of them by reason of this fact.
Our much-loved and honored Carroll Dunham gave the true definition of pathology when he declared it to be “science of symptoms.” This our author has quoted, but he seems to have failed to apprehend the scope of this definition, which effectually disposes of his third element in his “scientific prescription,” where he seems to present his “pathological condition” as a necessary element, to be added to the proper consideration of the symptoms of a case, to constitute any prescription for its cure “scientific.” Presumably preconceived notions of the much-talked-of “causes and conditions” obscured his vision, as we have already suggested.
His fourth element which he gives as necessary to a “scientific prescription” was evidently intended to cover all possible grounds, not already considered, under the treatment of his three preceding ones. It is given in these words:
4. ”A remedy or remedial measure which characteristically fulfills the law of similars, as regards all subjective and objective signs, organic affinities, order of progression, and primary and secondary manifestations of both disease and drug.”
This seems an example of an effort to load down the simplicity of our law of therapeutics with considerations of which it has no need, and which can in no wise be helps to it in the duty of prescribing. It is but another of the many utterances we have heard from thoughtful men, who could not be content with its sole requirement of likeness to the “totality of the symptoms.” There must be something more to give “scientific” character to prescriptions, and the “scientific” they would have. It is not enough that the remedy chosen proves curative, which it certainly will, if it be most like this totality -- it must also be “scientific” to satisfy our pride. We say satisfy our pride, because we can see no other end gained by incorporating into the process of finding the specific curative, considerations of other questions, or sciences, not included in this totality. These outside considerations only obscure the light which discloses the true curative, and in no way or time do they, or can they, contribute aught to its discovery.
It is not denied, and should not be forgotten, that when the prescriber enters the sick room there should go with him a knowledge of many sciences, and that he may have use for either, or all of them before he leaves it. And this consideration gives opportunity for the remark, that clinical duties and the duty of finding the specific curative are not interchangeable terms [emphasis mine]. The one may involve a knowledge of etiology, pathology, diagnosis, prognosis, sanitation, etc.; the other, a knowledge of the “totality of the symptoms,” and of the remedy, the record of the actions of which on the organism is most like this “totality.” To attempt to combine aught of knowledge of these other sciences with that the law requires for the discovery of the curative, is only to introduce confusion where the God-given law only deals successfully with plainest simplicity. Keep this distinction clear in the mind, and much confusion is saved.
What our author seems to have forgotten in that after “profound studies” Hahnemann, fearless among the learned and 'scientific” of his generation, would cure the results of the action of the discovered causes of disease, based his prescriptions on a knowledge of the “totality of the symptoms,” and not on any pathological conditions supposed to have resulted from these causes. And his record of cures will stand through all time with that of those who have cured most, safest and speediest of those prescribed for -- and this because his prescriptions were par excellence “Scientific.”