i

“A CRITICAL STUDY OF RICHARD HUGHES VIEWS

ON HOMOEOPATHIC PHILOSOPHY AND ITS

CLINICAL UTILITY”

by

DR G. KARTHIKEYAN

Dissertation Submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of

The requirements for the degree of

Doctor of Medicine in

Organon of Medicine & Homoeopathic philosophy

Under the guidance of

DR. SHIVA PRASAD K. BSc., B.H.M.S., MD(Hom)

Professor

Head of the Department of Organon of Medicine and

Homoeopathic Philosophy.

Father Muller Homoeopathic Medical College

Deralakatte, Mangalore,

2011

  ii

Certificate by the guide

This is to certify that the dissertation entitled “A CRITICAL STUDY

OF RICHARD HUGHES VIEWS ON HOMOEOPATHIC PHILOSOPHY AND

ITS CLINICAL UTILITY”. is a bonafide research work done by

DR G.KARTHIKEYAN under my guidance and supervision during the

year 2008 – 2011, in partial fulfillment of the requirement for the award

of the degree of “DOCTOR OF MEDICINE” (ORGANON OF

MEDICINE & HOMOEOPATHIC PHILOSOPHY)

I have satisfied myself regarding the authenticity of his

observations noted in this dissertation and it conforms to the standards of

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. It has

not been submitted (partial or full) for the award of any other Degree or

Diploma.

Date: GUIDE

Place: Mangalore

DR SHIVA PRASAD K. BSc., B.H.M.S., MD(Hom)

Professor,

Head of the Department of Organon of

Medicine and Homoeopathic Philosophy,

Father Muller Homoeopathic Medical

College and Hospital

Deralakatte, Mangalore.

  iii

Declaration by the candidate

I hereby declare that this dissertation entitled “A CRITICAL STUDY

OF RICHARD HUGHES VIEWS ON HOMOEOPATHIC PHILOSOPHY AND

ITS CLINICAL UTILITY” is a bonafide and genuine research work carried

out by me, under the guidance of DR SHIVA PRASAD K. Head of

Department of Organon of medicine and Homoeopathic philosophy, during

the year 2008–2011, in partial fulfillment of requirement for the award of

DOCTOR OF MEDICINE (Organon Of Medicine & Homoeopathic

Philosophy) .

I have not previously submitted this work (partial or full) to any

other university for the award of any other Degree or Diploma.

Date:

Place: Mangalore DR G. KARTHIKEYAN

  iv

Endorsement by the HOD, Principal/ Head of the Institution

This is to certify that the dissertation entitled “A CRITICAL STUDY

OF RICHARD HUGHES VIEWS ON HOMOEOPATHIC PHILOSOPHY AND

ITS CLINICAL UTILITY”  is a bonafide research work carried out by

DR G. KARTHIKEYAN under the guidance and supervision of

DR SHIVA PRASAD K. during the year 2008 – 2011, in partial

fulfillment of the requirement for the award of the degree of “DOCTOR

OF MEDICINE” (ORGANON OF MEDICINE & HOMOEOPATHIC

PHILOSOPHY) .  

We have satisfied regarding the authenticity of his observations

noted in this dissertation and it conforms to the standards of Rajiv Gandhi

University of Health Sciences, Karnataka, Bangalore. It has not been

submitted (partial or full) for the award of any other Degree or Diploma.

HEAD OF THE DEPARTMENT PRINCIPAL

DR SHIVAPRASAD. K DR SRINATH RAO Bsc. , B.H.M.S. , MD(Hom) MD (Hom)

Professor, HOD HOD of Materia Medica

of Organon of Medicine and Fr. Muller Homoeopathic

Homoeopathic philosophy, Medical College,

Fr. Muller Homoeopathic Medical Deralakatte, Mangalore.

College, Deralakatte, Mangalore

Date: Date:

Place: Mangalore Place: Mangalore

  v

COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka, Bangalore shall have the rights to preserve, use

and disseminate this dissertation / thesis in print or electronic format for

academic / research purpose.

Date:

Place: Mangalore DR G. KARTHIKEYAN

© Rajiv Gandhi University of Health Sciences, Karnataka

  vi

Acknowledgement

I would like to express my sincere and heartfelt thanks to my respected teacher,

Vice Principal and guide, professor Dr Shiva Prasad K, B.Sc., B.H.M.S., MD(Hom), Vice

Principal, Head of the Department of Organon of Medicine and Homoeopathic

Philosophy, for his valuable guidance, timely support and encouragement in this

endeavour. His unfailing helpfulness in every aspect offered the inspiration towards

fulfilment of this work.

I express my gratitude to Rev.Fr.Patrick Rodrigues, Director, and

Rev. Fr. Baptist Menezes, Ex Director of FMCI and Administrator Rev. Fr. Wilfred

Prakash and Former Administrator Rev. Fr. Stany Tauro of Fr. Muller Homoeopathic

Medical College, Mangalore for providing me an opportunity and adequate facilities to

carry out this work to my satisfaction in this reputed institution.

My sincere thanks to our principal professor Dr Srinath Rao, BHMS, MD (Hom).,

Head of Department of Homeopathic Materia Medica. Professor Dr Shashikant

Tiwari DMS, Dip, NIH, MD (Hom) Ex-principal Fr. Muller Homoeopathic Medical College

and Hospital and Dr. Sunny Mathew BHMS, MD Medical Superintendent, Fr. Muller

Homoeopathic Medical College and Hospital, for their encouragement and valuable

advices during the course of study.

My Special thanks to my respected teacher professor Dr. Roshan Pinto BHMS,

MD (Hom), Professor Department of Organon of Medicine and Homoeopathic Philosophy,

for his valuable guidance and support throughout my course of study in this institution.

  vii

I express my gratitude and thankfulness to all my teachers for enlightening me

and inculcating discipline and human value in me.

I am indebted to my parents and brother for their love, support and

encouragement.

I thank my senior and friend Dr. Ramesh Paramanand BHMS, MD (Hom),

helped me in this endeavour.

I thank all the patients on whom this study has been conducted, without whom

this work would never been possible.

I thank our OPD staff, library staff and non – teaching staff of Fr. Muller

Homoeopathic Medical College and Hospital for their Co-operation.

Finally, I extend my sincere thanks to Staff of Microbits who helped my efforts in

the form of manuscripts into a reality named book.

Dr. G. Karthikeyan

  viii

I Dedicate this work to

My Loving Parents

Mrs. G Shanthi

Dr. K. Guna Sekaran

My Loving Brother

Manoharan

&

Dr. P. S. Kambli

LIST OF ABRREVATIONS

  ix

A/c : Acute

A/F : Ailment From

Allo. Rx : Allopathic Remedy

Ayur. Rx : Ayurvedic Remedy

Br : Brother

B/L : Bilateral

BA : Bronchial Asthma

C : Centesimal

Ca : Cancer

C/o : Complaints of

Creps : Crepitations

CVS : Cardiovascular System

COPD : Chronic Obstructive Pulmonary Disorder

DM : Diabetes Mellitus

Fa : Father

H/o : History of

HTN : Hypertension

Mo : Mother

OA : Osteo – Arthritis

P/H : Past History

θ : Tincture

R/o : Rule out

SL : Placebo

Sr : Sister

< : Aggravation

> : Amelioration

↑ : Increase

↓ : Decrease

ABSTRACT

  x

Background of Study

  Hahnemann discovered Homoeopathic System of Medicine. From the inception it

has undergone various modification and many stalwarts had explained the Homoeopathic

concepts according to the changes occurred in the Medical Science during their time

period. J. T. Kent, H.A. Roberts, Stuart Close, Dunham, Dudgeon etc., had their own

views on Homoeopathic principles, these stalwarts rarely stood out of Hahnemannian

concepts except one that is Richard Hughes. Richard Hughes criticized few concepts put

forwarded by our Master Hahnemann and because of this he faced lot of criticism inside

Homoeopathic fraternity. He boldly proposed that we should be Homoeopathist not

Hahnemannian. He also questioned existence and validity of Vital Force, Psora Theory

and Drug dynamization. He could able to withstand in midst of oppositions and he

proved the usefulness of his theories. Richard Hughes put forward his views on

Homoeopathy based on the development of other contemporary sciences. He

concentrated more on pathogenesy and used lower potencies in his treatment.

Objectives

1. To make a comprehensive study of Richard Hughes Philosophy

2. To highlight the practical utility of Richard Hughes concepts in Clinical Practice

Methodology

A total number of 30 patients with chronic respiratory disorder were selected. All

the cases were analysed and worked out according to Richard Hughes Philosophy to find

out the similimum

Results:

  xi

Females showed more prevalence of Respiratory disorders than males. Majority

of patients belonged to 55-68 years of age group. Bronchial asthma was commonly

reported. Majority of cases were suited for Generic and Individual classification of

totality according to Richard Hughes philosophy. Majority of the patients showed

significant improvement.

Conclusion

Out of 30 cases, majority were in 55-65 years of age group predominantly

females. Remedy selected based on Generic and individual totality according to Hughes

philosophy showed significant improvement and required infrequent repetition of

Indicated medicine. Assessment of disease symptom and pathogenesy of drugs played

major role in the selection of potency and repetition.

Key Words: Generic Similarity, Specific Similarity, Individual Similarity, Vital force,

Psora theory, drug dynamization, Drug pathogenesy.

 

 

 

 

CONTENTS

  xii

 

 

 

LIST OF TABLES

S. No. TOPIC Page No.

1. INTRODUCTION 1 

2. AIMS AND OBJECTIVES 3 

3. REVIEW OF LITERATURE 4 

4. MATERIALS AND METHODS 95 

5. RESULTS 98 

6. DISCUSSION 109 

7. CONCLUSION 110 

8 SUMMARY 112 

9 BIBLIOGRAPHY 113 

10. ANNEXURES

ANNEXURE - I

ANNEXURE - II

 

115 

133 

  xiii

S. No. CONTENTS PAGE No.

1. Difference between right and left lung 10

2. Difference between Hahnemannian and Hughesian concepts 94

3. Distribution of cases According to Gender 98

4. Distribution of cases According to the Age group 99

5. Distribution of cases According to Diagnosis 101

6. Distribution of cases According to Totality 102

7. Distribution of cases According to Associated Complaints 103

8. Distribution of cases According to the duration of treatment in

OPD 105

9. Distribution of cases According to Analysis of Result 107

10. Potency distribution of the cases 108

LIST OF FIGURES

  xiv

S. No. Contents Page No.

1. Pathogenesis of respiratory failure 19

2. Etiopathogenesis of emphysema 26

3. Distribution of cases According to Gender 98

4. Distribution of cases According to the Age group 100

5 Distribution of cases According to Diagnosis 101

6 Distribution of cases According to Totality 102

7. Distribution of cases According to Associated Complaints 104

8. Distribution of cases According to the duration of treatment in OPD 106

9. Distribution of cases According to Analysis of Result 107

  

 

 

 

 

 

 

  xv

Introduction

 

  1

INTRODUCTION

“No other gift is greater than the gift of life! The patient may doubt his relatives,

his sons and even his parents. But he has full faith in his physician. He gives himself up

in the doctors’ hands and has no misgivings about him. Therefore, it is the physician’s

duty to look after him as his own……”

Prescribing is the art of fitting pathogenetic to clinical symptoms and as such at

present requires a special aptness in grasping the essential points of symptom images,

great drudgery and mastering a working knowledge of our large materia medica or a most

skilful use of many books of reference.

In 1796 Hahnemann discovered Homoeopathic System of Medicine. From the

inception it has undergone various modification and many stalwarts had explained the

Homoeopathic concepts according to the changes occurred in the Medical Science during

their time period.

J. T. Kent, H.A. Roberts, Stuart Close, Dunham, Dudgeon etc., had their own

views on Homoeopathic principles and they were successful in their practice. These

stalwarts rarely stood out of Hahnemannian concepts except one that is Richard Hughes.

Richard Hughes criticized few concepts put forwarded by our Master Hahnemann and

because of this he faced lot of criticism inside Homoeopathic fraternity. He boldly

proposed that we should be Homoeopathist not Hahnemannian and its is the direct

statement against Hahnemann, ever made by any of his disciples. He also questioned

existence and validity of Vital Force, Psora Theory and Drug dynamization. He could

  2

able to withstand in midst of oppositions and he proved the usefulness of his theories. He

says Hahnemann discovered Homoeopathy and showed the pathway for healing the sick.

Homoeopathy should be ever developing system, its development should not stand still

Richard Hughes put forward his views on Homoeopathy based on the development of

other contemporary sciences. He concentrated more on pathogenesy and used lower

potencies in his treatment.

An attempt is made to present the efficiency of Richard Hughes Principles and his

Philosophy in clinical utility.

  3

Aims & Objectives

  3

AIMS AND OBJECTIVES

1. To make a comprehensive study of Richard Hughes philosophy

2. To highlight the practical utility of Richard Hughes concepts in clinical practice

  4

Review of Literature  

  4

ANATOMY OF LUNGS

The lungs are a pair of respiratory organs situated in the thoracic cavity. Each

lung invaginates the corresponding pleural cavity. The right and left lungs are separated

by the Mediastinum.

The lungs are spongy in texture. In the young, the lungs are brown or grey in

colour. Gradually, they become mottled black because of the deposition of inhaled carbon

particles. The right lung weighs about 700g, it is about 50-100g heavier than the left lung.

Features

Each lung is conical in shape. It has

1. An Apex at the upper end.

2. A base resting on the diaphragm

3. Three borders ie anterior, posterior and inferior

4. Two surfaces i.e. costal and medial. The medial surface is divided into vertebral

and mediastinal parts.

Apex – The apex is blunt and lies above the level of the anterior end of the first rib. It

reaches nearly 2.5cmabove the medial one third of the clavicle medial to the

supraclavicular fossa. It is a covered by the cervical pleura and by the suprapleural

membrane and is grooved by the subclavian artery on the medial side and in front.

Base - The base is semilunar and concave. It rests on the diaphragm which seperates the

right lung from the right lobe of the liver, and the left lung from the left lobe of the liver,

the fundus of the stomach, and the left lung from the left lobe of the liver, the fundus of

the stomach, and the spleen.

  5

Anterior Border – The anterior border is very thin. It is shorter than the posterior border.

On the right side it is vertical and corresponds to the anterior (or) costo mediastinal line

of pleural reflection. The Anterior border of the left lung shows a wide cardiac notch

below the level of the fourth costal cartilage. The heart and pericardium are uncovered by

the lung in the region of this notch.

Posterior Border – The posterior border is thick and ill defined. It correspons to the

medial margins of the heads of the ribs. It extends from the level of the seventh cervical

spine to the tenth thoracic spine.

Inferior Border - The inferior border seperates the base from the coastal and medial

surfaces.

The costal surface is large and convex. It is in contact with the costal pleura and

the overlying thoracic wall.

The medial surface is divided into a posterior or vertebral part and an anterior (or)

mediastinal part. The vertebral part is related to the vertebral bodies, intervertebral discs,

the posterior inter costal vessels and the splanchnic nerves. The mediastinal part is related

to the mediastinal septum, and shows a cardiac impression which differ on the two sides

various relations of the mediastinal septum, and shows a cardiac impression which differ

on the two sides. Various relations of the mediastinal surfaces of the two lungs.

Fissures and lobes of the lungs

The right lung is divided into 3 lobes (upper, middle and lower) by two fissures,

oblique and horizontal.

The left lung is divided into two lobe by the oblique fissure.

  6

The oblique fissure cuts into the whole thickness obliquely downwards and

forwards, crossing the posterior border about 6cm, below the apex and the inferior border

about 5 cm, from the median plane. Due to the oblique plane of the fissure the lower lobe

is more posterior and the upper and middle lobe more anterior. In the right lung, the

horizontal fissure passes from the anterior border upto the oblique fissure and seperates a

wedge – shaped middle lobe from the upper lobe. The fissure runs horizontals at the level

of the fourth costal cartilage and meets the oblique fissure in the mid axillary line. The

tongue shaped projection of the left lung below the cardiac notch is called the lingula. It

corresponds to the middle lobe of the right lung. ‘

The number of lobes may vary in either lung. The right lung may have only two

lobes, upper and lower and the left may have three lobes. Accessory lobes may also be

present.

The lungs expand maximally in the inferior direction because movements of he

thoracic wall and diaphragm are maximal towards the base of the lung.

The presence of the oblique fissure of each lung allows a more uniform expansion

of the whole lung.

ROOT OF THE LUNG

Root of the lung is a short, broad pedicle which conneets the medial surface of the

lung to the mediastinum. It is formed by structures which either enter or come out of the

lung at the hilum. The roots of the lung lies opposite the bodies of the fifth, sixth and

seventh thoracic verterbrae.

Contents

The root is made up of the following structures.

  7

i. Principal bronchus on the left side and eparterial and hyparterial brhonchi on right

side.

ii. One pulmonary artery

iii. Two pulmonary veins, superior and inferior.

iv. Bronchial arteries, one on the right side and two on the left side.

v. Bronchial veins

vi. Anterior and posterior pulmonary plexuses of nerves

vii. Lymphatics of the lung

viii. Bronchopulmonary lymph nodes.

ix. Areolar tissue1

Arrangement of structures in Root

A. From before backwards. It is similar on the two sides

- Superior pulmonary vein

- Pulmonary artery

- Bronchus

B. From above downwards. It is different on the two sides

Right side - Eparterial bronchus

- Pulmonary artery

- Hyparterial bronchus

- Inferior pulmonary vein

Left side - Pulmonary artery

- Bronchus

- Inferior pulmonary vein

  8

Relation of the Root

Anterior

a) Common on the two sides

- Phrenic nerve

- Pericardiophrenic vessels

- Anterior pulmonary plexus

b) On the right side

- Superior vena cava

- A part of the right atrium

Posterior

a) Common on the two sides

- Phrenic nerve

- Pericardiophrenic vessels

- Anterior pulmonary plexus

b) On the right side

- Superior vena cava

- A part of the right atrium

Posterior

a) Common on the two sides

- Vagus nerve

- Posterior pulmonary plexus

b) On left side

- Descending thoracic aorta

  9

Superior

a) On right side – Terminal part of azygous vein

b) On left side – Arch of the aorta

Inferior – pulmonary ligament

SURFACE MARKING OF THE LUNG

The apex lung coincides with the cervical pleura and is represented by a line

covex upwards rising 2.5cm above the medial one third of the clavicle.

The anterior border of the right lung corresponds very closely to the anterior

margin or costomediastinal line of the pleura and is obtained by joining.

i) A point at the sternoclavicular joint

ii) Another point in the median plane at the sterna angle, and

iii) A third point in the median plane just above the xiphisternal joint. The anterior

border of the left lung corresponds to the anterior margin of the pleura upto

the level of the fourth costal cartilage it passes laterally for 3.5cm from the

sterna margin and then curves downwards and medially to reach the sixth

costal cartilage 4cm from the median plane. In the region of the cardiac

match, the pericardium is covered by a double layer of pleura. The area of the

cardiac notch is dull on percussion and is called the area of superficial cardiac

dullness.

The posterior border coincides with posterior margin of the pleural reflection

except that its lower end lies at the level of the tenth thoracic spine.

The oblique fissure can be drawn by joining

(i) A point 2cm lateral to the third thoracic spine

  10

(ii) Another point on the fifth rib in the mid axillary line, and

(iii)A third point on the sixth costal cartilage 7.5cm form the median plane.

The horizontal fissure is represented by a line joining

(i) A point on the anterior border of the right lung at the level of the fourth costal

cartilage and

(ii) A second point on the fifth rib in the mid axillary line

Table 1: DIFFERENCE BETWEEN RIGHT AND LEFT LUNG

RIGHT LUNG LEFT LUNG

1. It has 2 fissures and 3 lobes 1. It has only one fissure and 2 lobes

2. Anterior border is straight 2. Anterior border is interrupted by the cardiac notch

3. Larger and heavier weighs about 700g 3. Smaller and higher weighs about 600g

4. Shorter and broader 4. Longer and narrower ARTERIAL SUPPLY OF LUNGS

The bronchial arteries supply nutrition to the bronchial tree and to the pulmonary

tissue. These are small arteries that vary in number, size and origin, but usually they are

as follows.

(1) On the right side there is one bronchial artery which arises either from the third

posterior intercostal artery or from the upper left bronchial artery.

(2) On the left side there are two bronchial arteries both of which arise from the

descending thoracic aorta, the upper opposite fifth thoracic vertebra and the lower

just below the left bronchus.

Deoxygenated blood is brought to the lungs by the pulmonary arteries and

oxygenated blood is returned to the heart by the pulmonary veins.

  11

There are pre capillary anastomoses between bronchial and pulmonary arteries.

These connections enlarge when any one of them is obstructed in disease.

VENOUS DRAINAGE OF THE LUNGS

The venous blood from the first one or two divisions of the brhonchi is carried by

bronchial veins. Usually there are two bronchial veins on each side. The right bronchial

veins drain into the azygous vein. The left bronchial veins drains either into the left

superior intercostal vein or into the hemiazygous vein.

The greater part of the venous blood from the lungs is drained by the pulmonary

veins.

LYMPHATIC DRAINAGE OF THE LUNGS

There are two sets of lymphatics, both of which drain into the bronchopulmonary

nodes.

1. Superficial vessels drain the peripheral lung tissue lying beneath the pulmonary

pleura. The vessels pass round the boarders of the lung and margins of the fissure

to reach the hilum.

2. Deep lymphatics drain the bronchial tree, pulmonary vessels and the connective

tissue septa. They run towards the hilum where they drain into the broncho

pulmonary nodes.

The superficial vessels have numerous valves. The deep vessels have only a few

valves or no valves at all. Though there is not free anastomosis between the superficial

and deep vessels some connections exist which can open up, so that lymph can flow from

the deep to the superficial lymphatics when the deep vessels are obstructed in disease of

the lungs or of the lymph nodes.

  12

NERVE SUPPLY

1) Para sympathetic nerves are derived from the vagus. These fibres are

a) Motor to the bronchial muscles and on stimulation cause broncho spasm

b) Secretomotor to the mucous glands of the bronchial tree

c) Sensory, the sensory fibres are responsible for the stretch reflex of the lungs

and for the cough reflex.

2) Sympathetic nerves are derived from second to fifth spinal segments. These are

inhibitory to the smooth muscle and glands of the bronchial tree. That is how

sympathomimetic drugs, like adrenalin, cause bronchodilatation and relieve

symptom of bronchial asthma.

Both parasympathetic and sympathetic nerves first from anterior and posterior

pulmonary plexuses situated in front of and behind the lung roots; form the plexuses

nerves are distributed to the lungs along the blood vessels and brhonchi2.

Bronchial Tree

The trachea divides at the level of the lower border of the fourth thoracic vertebra

into two primary principal brhonchi, one for each lung. The right principal bronchus is

2.5cm long. It is shorter, wider and more in line with the trachea than the left principal

bronchus. Inhaled particles, therefore tend to pass more frequently to the right lung, with

the result that infections are more common on the right side than on the left. The left

principal bronchus is 5cm. it is longer, narrower and more oblique than the right principal

bronchus.

Each principal bronchus enters the lung through the hilum and divides into

secondary lobar brhonchi, one for each lobe of the lungs. Thus there are three lobar

  13

bronci on the right side, and only two on the left side. Each lobar bronchus divides into

tertiary (or) segmental brhonchi, one for each broncho pulmonary segment; which are to

on the right side and 10 on the left side. The segmental brhonchi divide repeatedly to

form very small branches called terminal brhonchioles still smaller branches are called

respiratory brhonchioles.

Each respiratory brhonchiole aereates a small part of the lung know as pulmonary

unit. The respiratory brhonchiole ends in microscopic passages which are termed.

(i) alveolar ducts (ii) Atria (iii) air saceules and (iv) pulmonary alveoli. Gaseous

exchanges take place in the alveoli.

BRONCHO PULMONARY SEGMENTS

These are well defined sectors of the lung, each one of which is aerated by a

tertiary or segmental bronchus. Each segment is pyrnidal in shape with its apex directed

toward the root of the lung.

The most widely accepted classification of segments. There are 10 segments on

the right side and 10 on the left.

Inter segmental planes. Each segment is surrounded, by connective tissue which is

continuous on the surface with pulmonary pleura. Thus the broncho pulmonary segments

are independent respiratory units.

The connective tissue septa between adjoining segments form intersegmental

planes which are crossed by the pulmonary veins and occasionally by the pulmonary

arteries. During removal of a segment or segmental resection, the surgeon works along

the pulmonary veins to isolate a particular segment.

  14

Relation to pulmonary artery. The branches of the pulmonary artery accompany

the brhonchi. The artery lies dorsolateral to the bronchus. Thus each segment had its own

separate artery.

Relation to pulmonary vein, the pulmonary veins do not accompany the brhonchi

(or) pulmonary arteries. They run in the intersegmental planes. Thus each segments has

more than one vein and each vein drains more than one segment. Near the hilum the

veins are ventromedial to the bronchus.

It should be noted that the bronchopulmonary segment is not a bronchovascular

segment because it does not have its own vein. There is considerable variation in the

above pattern of brhonchi, arteries and veins, the veins being more variable than arteries,

and the arteries more variable than the brhonchi3.

HISTOLOGY OF TRACHEA AND LUNG

Trachea and Intrapulmonary brhonchi have pseudo stratified ciliated columnar

epithelium with goblet cells. Lamina propria contains connective tissue and ducts of

glands presents in submucosa.

No muscularis mucosa is present. Submucosa contains mucous and serous acini,

outermost is musculo cartilaginous layer with ‘c’ shaped hyaline cartilage and smooth

muscle fibres joining the two ends of ‘c’ shaped cartilage. Outermost is connective tissue.

Intra pulmonary bronchus epithelium is same as in trachea. The epithelium is

thrown into folds lamina propria is same as in trachea. The lamina propria is surrounded

on all sides by thins sheet of smooth muscle fibres. Out side the muscle layer are small

pieces of cartilage with glands in between these pieces. Outer most is the connective

tissue.

  15

Terminal brhonchiole is lined by columnar epithelium with no cilia (or) goblet

cells. Smooth muscles surround it all around. No cartilage or glands are seen. Connective

tissue is seen outside.

Respiratory brhonchiole is lined by cuboidal cells. There are outpocketing of

alveoli. Smooth muscle fibres and connective tissue surround it. No glands, or cartilage is

seen. Alveoli are lined by squamous cells, few cuboidal cells producing surfactant are

seen. No muscle, no gland, no cartilage seen. Interalveolar connective tissue contains

capillaries5.

DEVEOPMENT OF RESPIRATORY SYSTEM

During fourth week of embryonic life the tracheobronchial or lung bud appears as

a diveaticulum from the ventral wall the foregut. As this bud descends downwards it gets

separated from oesophagus by oesophagotracheal septum. The two, however maintain

communication at the level of laryngeal inlet.

The lung bud forms trachea and two bronchial buds one on each side of trachea.

Each bud forms right and left principal brhonchi. The right one divides into the three and

the left one into two lobar brhonchi.

The developing lung buds invaginate and expand into pericardioperitoneal canals,

the primitive pleural cavities are get covered by visceral and parietal pleura.

The brhonchi divide into 18 generations before birth and six generations after

birth to reach the final stage.

Maturation of lung occurs through pseudo glandular period (5-16 weeks),

canalicular period (16-26 weeks), terminal sac period 26 weeks to birth) and alveolar

period (Eighth month to childhood).

  16

Epithelial living of trachea, brhonchi till alveoli including the glands are

endodernal in origin. The cartilages, muscles, connective tissue develop from splanchnic

mesoderm around the foregut7.

CLINCIAL ANATOMY

1. Usually the infection of a segment remains restricted to it, although some

infections like tuberculosis may spread from one segment to another

2. Segments are no barriers to the spread of bronchogenic carcinoma.

3. Knowledge of the detailed anatomy of the bronchial tree helps considerabley in

- Surgical removal of a segment or segmental resection

- Drainage of lung abscess or brhonchiectarin by making the patient adopt a

particular posture called postural drainage.

- Visualizing the interior of the brhonchi through an instrument passed through

the mouth and trachea the instrument is called a bronchoscope and the

procedure is called bronchoscopy

- In understanding why abscesses are more common in some segments like the

posterior segment of the right upper. Lobe and the apical segment of the right

lower lobe2.

  17

RESPIRATORY DISORDERS

PLEURAL EFFUSION

The accumulation of serous fluid within the pleural space is termed pleural

effusion. Accumulation of frank pus (empyema) or blood (haemothrax) represent

separate conditions.

In general pleural fluid accumulates as a result of either increase d hydrostatic

pressure or decreased osmotic pressure (transudative effusion’ as seen in cardiac, liver or

renal failure) or from increased microvasculary pressure due to disease of the pleural

surface itself of injury in the adjacent lung (exudative effusion).

Causes:

• Tuberculosis

• Malignant disease

• Cardiac failure

• Pulmonary infarction

• Pheumatoid disease

• Systemic lupus erythematous

• Obstruction of thoracic duct

Clinical Assessment:

Symptoms and signs of pleurisy often preceed the development of an effusion,

especially in patients with underlying pneumonia, pulmonary infarction or connective

  18

tissue disease. However the onset may be insidious. Breathlessness is the only symptom

related to the effusion and its severity depends on the size and rate of accumulation.

RESPIRATORY FAILURE

The term respiratory failure is used when pulmonary gas exchange fails to

maintain normal arterial oxygen and carbon dioxide levels. Its classification into type I

and type II relates to the absence or presence of hypercapnia (raised pco2). The

physiological basis of respiratory failure is described.

ADULT RESPIRATORY DISTR ESS SYNDROME

ARDS is known by various synonyms such as shock- lung syndrome, diffuse

alveolar damage (DAD), acute alveolar injury, traumatic wet lungs and post- traumatic

respiratory insufficiency.

Etiology:

o Shock due to sepsis, trauma, burns

o Diffuse pulmonary infection, chiefly viral pneumonia

o Pancreatitis

o Oxygen toxicity

o Inhalation of toxins and irritants. Eg: smoke, war gages, nitrogen dioxide, metal

fumes etc.

o Narcotic overdose

o Drugs eg- salicylates, colchicines

o Aspiration pneumonitis

  19

o Fat embolism

o Radiation7

Pathogenesis:

Acute Alveolar Injury

Release of cytokines

Hyaline membrane

STIFF LUNG

Resolution, organization, death8

Figure 1: Pathogenesis of respiratory failure

By activated macrophages

(IL-1, IL-8, TNF)

By activated neutrophils

(proteases, PAF, Oxidants, leucoterines)

Local tissue damage,

Intra- alveolar edema,

Surfactant inactivation

Mcrophages derived fibrogenic

Cytokines (TGF, PPGF)

  20

Clinical features:

Sudden and severe respiratory distress

tachypnoea, tachycardia, cyanosis

Severe hypoxaemia that fails to respond oxygen therapy and assisted ventilation

PULMONARY HYPERTENSION

Normally the blood pressure in the pulmonary arterial circulation is much lower

than the systemic blood pressure, it does not exceed 30/15 mm Hg even during exercise

(normally blood pressure in the pulmonary veins is between 3 and 8 mm Hg). Pulmonary

Hypertension is defined as a systolic blood pressure 30 mm Hg. Pulmonary Hypertension

is broadly classified into 2 groups primary (idiopathic) an d secondary, the later being

more common.

Primary (idiopathic) Pulmonary Hypertension

Primary Hypertension is an common condition of unknown cause. The diagnosis

can be established only after a thorough search for the usual cause of secondary

Pulmonary Hypertension. The patients are usually young females between the age of 20

and 40 years, or children around 5 years of age.

Etiopathogenesis

• A neurohumoral vasoconstrictor mechanism

• Unrecognized thromboemboli or amniotic fluid emboli during pregnancy

• There is suggestion that pulmonary hypertension may be a form of collagen

vascular disease

• Pulmonaryveno occlusive disease

  21

• Ingestion of substance

• Familial occurrence

Secondar Pulmonary Hypertension

When pulmonary hypertension occurs secondary to a recognized lession in the

heart or lungs, it is termed as secondary pulmonary hypertension. It is more common type

and encountered at any age but more frequently over the age of 50 years.

A. Passive pulmonary Hypertension

B. Hyperkinetic (Reactive) pulmonary hypertension

C. Vaso- occlusive pulmonary hypertension

- Obstruction type

- Obliterative type

- Vaso constrictive type

PNEUMONIA

Pneumonia is defined as acute inflaumation of the lung parenchyma distal to the

terminal brhonchioles which consist of the respiratory brhonchiole, alveolarducts,

alveolar sacs and alveoli. The terms pneumonia and ‘pneumonitis’ are often used for

inflammation of lungs, while ‘consolidation’ (meaning solidification) is the term used for

macroscopic and radiologic appearance of the lungs in pneumonia7.

Pathogenesis:

The micro organism gain entry into the lungs by one of the following four routes

- Inhalation

- Aspiration

  22

- Haematogenous spread

- Direct sp read

Predisposing factors:

- Altered consciousness

- Depressed cough and glottis reflexes

- Impaired mucocilary transport

- Impaired alveolar ma crophage function

- Endobronchial obstruction

- Leucocyte dysfunctions

Classification:

1. Lobar pneumonia

2. Bronchopneumonia

3. Interstitial pneumonia

Pathological changes:

1. Stage of congestion

2. Red Hepatisation

3. Grey Hepatisation

4. Resolution

Complication:

- Organisation

- Pleural effusion

  23

- Empyema

- Lung abscess

- Metastatic infection

Clinical features

- Shaking chills, fever, Malaise with pleuritic chest pain. Dyspnoea, cough with

expectoration which may be mucoid, purulent or even bloody.

- The common physical signs fever, tachycardia and tachypnoea and cyanosis if the

patient is severely hypoxaemic.

- Chest radiographs reveal consolidation.

CHRONIC OBSTRUCTIVE PULMONARY DISORDER

COPD or chronic obstructive airways disease ( COAD) are commonly used

clinical terms for a group of pathological conditions in which there is chronic, partial or

complete, obstruction to the airflow at any level from trachea to the smallest airways

resulting in functional disability of the lungs. The obstructive pulmonary disease must be

distinguished from restrictive pulmonary disease.

I. Chronic Bronchitis

II. Emphysema

III. Bronchial Asthma

IV. Brhonchiectasis

Chronic bronchitis and emphysema are quite common and often occur together. More

recently small airways disease involving inflammation of small brhonchi and

brhonchioles has been added to the group of COPD.

  24

CHRONIC BRONCHITIS

It is a common condition defined clinically as persistent cough with expectoration

on most days for at least three months of the year for two or more consecutive years. The

cough is caused by over secretion of Mucus.

Etiopathogenesis

- Smoking

- Atmospheric pollution

- Occupation

- Infection

- Familial and genetic factors

Clinical factors

There is considerable overlap of clinical features of chronic bronchitis and

pulmonary emphysema as quite often the two coexist. The contrasting features of

predominant emphysema and predominant bronchitis are presented. Some important

features of predominant bronchitis.

1. Predominant cough with copious expectoration of long duration, initially

beginning in a heavy smoker with morning catarrh or throat clearing which

worsen in winter.

2. Recurrent respiratory infections are common

3. Dyspnoea is generally not prominent at rest but more on exertion

4. Patient are called ‘blue bloaters’ due to cyanosis and oedema

5. Features of right heart failure (cor pulmonale) are common

  25

6. Chest x-ray shows enlarged heart with prominent vessels

EMPHYSEMA

The WHO has defined pulmonary emphysema as combination of permanent

dilatation of air spaces distal to the terminal brhonchioles and the destruction of the walls

of dilated air spaces. Thus emphysema is defined morphologically, while chronic

bronchitis is defined clinically.

Classification:

The pulmonary emphysema, it is classified according to the portion of the acinus

involved into 5 types.

- Centriacinar

- Panacinar

- Para septal

- Irregular (Para- cicatrical)

- Mined (unclassified) emphysema

Etipathogenesis:

The commonest form of COPD is the combination of chronic bronchitis and

pulmonary emphysema. The association of the two conditions is principally linked to the

common etiologic factors; most importantly, tobacco smoke and air pollutants7.

  26

Smoking

↓ ANTIPROTEASE ↑PROTEASE

(1- Antitrypsin Deficiency) (↑NEUTROPHIC ELASTASE)

ELASTIC DAMAGE

↑EMPHYSEMA8

Figure 2: Etiopathogenesis of emphysema

Clinical Features

1. There is long history of slowly increasing severe exertional dysponea

2. Patient is quite distressed with obvious use of acc essory muscles of respiration

3. Chest is barrel- shaped and hyper-resonant

4. Cough occurs late after dysponea starts and is associated with scanty mucoid

sputum

5. Recurrent respiration infections are not frequent

6. Patient are called pink puffers as they remain well oxygenated and have

tachypnoea

7. Weight loss is common

8. Features of right heart failure and hypercapneic respiratory failure are the usual

terminal events

9. Chest x-Ray shows small heart with hyperinflated lungs

  27

BRONCHIAL ASTHMA

Asthma is a disease of air ways that is characterized by increased responsiveness

of the trachea bronchial tree to a variety of stimuli resulting in wide spread spasmodic

narrowing o f the air passages which be relieved spontaneously or by therapy Asthma is

an episodic disease manifested clinically by paroxysms of dyspnoea, cough and

wheezing.

Etiopathogeneim and types

Based on the stimuli initiating bronchial asthma, two broad etiologic types are

traditionally described.

- Exterinsic (atopic, allergic) asthma

- Interinsic (idiosyncratic, non atopic) asthma

- Mixed type

Clinical features

Asthmatic patients suffer from episodes of acute exacerbations interspersed with

symptom free periods.

- Paroxysms of dyspnoea

- Cough and wheezing

- Most attacks typically last for a few minutes to hours. When attacks occur

continuously it may result in more serious condition called status asthmaticus.

The clinical diagnosis is supported by demonstration of circulation eosinophilia and

sputum demonstration of churchman’s spirals and charcot- Leyden crystals. More chronic

cases may develop corpulmonale.

  28

BRHONCHIECTASIS

It is defined as abnormal and Irreversible dilatation of the brhonchi and

brhonchioles (greater than 2mm in diameter) developing secondary to inflammatory

weakening of the bronchial walls. The must characteristic clinical manifestation of

brhonchiectasis is persistent cough with expectoration of copious amounts of foul-

smelling, purulent sputum. Post infections cases commonly develop in childhood and in

early adult life.

Etiopathogenein

- Endobronchial obstruction

- Infection

These 2mechanisms- endobronchial obstruction and infection, are seen in a number of

clinical settings these are as under

1. Hereditary and Congenital factors

2. Obstruction

3. As secondary Complication

Clinical features

The clinical manifestation of brhonchiectasis typically consist of chronic cough

with foul smelling sputum production, haemoptysis and re current pneumonia. Sinusitis is

a common accompaniment of diffuse brhonchiectasis Development of clubbing of the

fingers, metastatic abscesses (often to the brain) amyloidoxin and corpulmonale are late

complications occurring in cases uncontrolled for years.

  29

IMMUNOLOGICAL LUNG DISEASE

Immunological mechanism play an important role in a number of lung disease.

These include

1. Bronchial Asthma

2. Hypersensitive pneumonitis

3. Pulmonary eosinophillia

4. Good pastures syndrome

5. Pulmonary alveolar proteinosis

COLLAGEN- VASCULAR DISEASE

A number of collagen disease may result in chronic interstitial fibrosis and

destruction of blood vessels. These diseases are occur as involvement in important forms

of collagen disease.

1. Scleroderma

2. Pheumatoid Arthritis

3. Systemic lupus Erythematosus

4. St’ Jogren’s syndrome

5. Dermatomyositis and polymyositis

6. Wegener’s Granulomatosis

  30

TUMORS OF LUNGS

Bronchogenic Carcinoma

Through the term bronchogenic carcinoma is commonly used for cancer of the

lungs, it includes carcinomas having bronchial as well as bronchiolar origin.

Incidence:

Bronchogenic Carcinoma is the most common primary malignant tumour in men

in industrialized nations and accounts for nearly one third of all cancer death in both

sense.

Etipathogenesis

1. Smoking

2. Atmospheric pollution

3. Occupational causes

4. Dietary factors

5. Genetic factors

6. Chronic scarring

SPREAD - Bronchogenic carcinoma can invade the adjoining structures directly, or may

spread by lymphatic and haematogenous routes.

- Direct spread

- Lymphatic spread

- Haematogenous spread

  31

Clinical features:

1. Local symptoms- cough, chest pain, dyspnoea and haemoptysis

2. Bronchial obstructive symptoms – occlusion of a bronchus may result in

bronchopneumonia, lung abscess and brhonchiectasis in the lung tissue distal to

the site of obstruction and cause their attendant symptoms like fever, productive

cough, pleural effusion and weight loss.

3. Symptoms due to metastases- A number of paraneoplastic syndromes are

associated with lung cancer.

These include the following:

- Ectopic hormone production

- Other systemic manifestation7

STAGING AND PROGNOSIS

The widely accepted clinical staging of lung cancer is according to the TNM

classification, combining features of primary Tumors, nodal involvement and distal

metastain TNM staging divides all lung cancers into the following 4 stages.

Stage I- Tumor less than 3cm, with or without ipsilateral nodal involvement

- No distant metastasis

Stage II – Tumor larger than 3cm, with ipsilateral hilar lymph node involvement

- No distant metastasis

Stage III – Tumor of any size larger than 5cm has worse prognosis

In general, tumor size larger than 5cm has worse prognosis. The overall prognosis

of bronchogenic carcinoma is dismal8.

  32

RICHARD HUGHES – BIOGRAPHY

Richard Hughes 1836 – 1902 was an orthodox physician who converted to

homoeopathy to become Editor of the British Journal of Homoeopathy and Permanent

Secretary of the Organization of the International Congress of Homoeopathy Physicians.

Richard Hughes was the ‘Grand Old Man’ of British homoeopathy. The Faculty

of Homoeopathy still conducts annual Richard Hughes Memorial Lectures.

In 1898, Richard Hughes was present when Samuel Hahnemann‘s body was disinterred

from his tomb, for reburial under a more suitable memorial at the Cemetery of Pere

Lachaise. Francois Cartier was Secretary to the Sub Committee in Charge of Samuel

Hahnemann‘s tomb, alongside Brasol, Richard Hughes, Bushrod James and Alexander

von Villers.

Richard Hughes was born in London, England. He received the title of M.R.C.S.

(Eng.), in 1857 and L.R.C.P. (Edin.) in 1860. The title of M.D. was conferred upon him

by the American College a few years later.

Richard Hughes was a great writer and a scholar. He actively cooperated with

Timothy Field Allen to compile his ‘Cyclopedia of Drug Pathogenesy‘ and rendered

immeasurable aid to Robert Ellis Dudgeon in translating Samuel Hahnemann’s ‘The

Materia Medica Pura‘ into English.

In 1889 he was appointed an Editor of the ‘British Journal of Homoeopathy‘ and

continued in that capacity until his demise.

  33

In 1876, Richard Hughes was appointed as the Permanent Secretary of the

Organization of the International Congress of Homoeopathy Physicians in Philadelphia.

He also presided over the International Congress in London.

English homoeopath Richard Hughes (1836-1902) started the debate on high

potency vs low potency which still gets argued today…

What may be called the English school of homoeopathy in the nineteenth century

produced two writers of outstanding importance, Robert Ellis Dudgeon and Richard

Hughes….

Important though Robert Ellis Dudgeon’s contribution is, however, it was his

friend and colleague Richard Hughes whose personality stamped itself most emphatically

on British homoeopathy at this period.

Although he was at one time on the staff of the London Homoeopathic Hospital,

Richard Hughes spent most of his medical career in practice in Brighton, though it is

difficult to believe that he had a lot of time to spare for actually seeing patients.

He organized the five-yearly International Homoeopathic Congresses and he

edited the Annals of the British Homoeopathic Society.

His most important and influential role, however, was as a teacher and writer.

He was appointed Lecturer in Materia Medica by the British Homoeopathic

Society and his lectures were published and used as the basis for instruction of doctors up

to his death in 1902.

His views on homoeopathy were endorsed by Robert Ellis Dudgeon and others as

an authentic up to date interpretation of homoeopathy. Richard Hughes became in fact the

  34

Grand Old Man of British homoeopathy in the nineteenth century (though to be sure he

was only 62 when he died).

It is therefore legitimate to speak of Hughesian homoeopathy, though it must be

understood that this was not Richard Hughes’s view alone but was the orthodox British

homoeopathy of the day.

Hughesian homoeopathy -The essential character of Hughesian homoeopathy was

that it lay at the “scientific” end of the homoeopathic spectrum of opinion. That is, it was

pragmatic and anti-mystical.

On the theoretical level Richard Hughes, Robert Ellis Dudgeon and other leading

British homoeopaths of the day rejected Samuel Hahnemann’s concept of the vital force,

his theorizing about how homoeopathic medicines worked, and the psora theory.

They were also unhappy about potency. In practice, they were prepared to

concede that some high dilutions – at least up to the 30th centesimal – did seem to work,

but they recognized the difficulty of explaining this in terms of the contemporary

knowledge of physics and chemistry.

The vast majority of British homoeopathic prescribing at this time was based on

the use of very low (material) dilutions – 6c and below. As for the claims of Caspar Julius

Jenichen, Constantine Hering and others to be able to produce ultra-high potencies by

various non-Hahnemannian techniques, Richard Hughes and Robert Ellis Dudgeon

treated these with gentle derision.

As a homoeopath Richard Hughes naturally placed the similia principle at the

centre of the stage but his attitude to it was relaxed and non-dogmatic. It was, he said, not

a law of nature as Samuel Hahnemann claimed but simply a rule of thumb – a skeleton

  35

key to try in the therapeutic lock. It often gave the right answer but not invariably, nor

was it the only key worth trying.

Richard Hughes believed, moreover, that if you are serious about the similia idea

you must take pathology into account. It was all very well for Samuel Hahnemann to say

that nothing could be known about the mechanism of disease; in his day that might have

been true, but times had changed and quite a lot was now known about pathology and the

new knowledge needed to be incorporated into homoeopathy.

Richard Hughes believed that medicines should be chosen not just on subjective

symptoms they produced but on the basis of their known pathological effects on human

beings and even (daringly) on animals. For example, if your patient is suffering from an

ulcer you should choose a medicine known to produce ulcers, and so on.

This insistence on the role of pathology in prescribing was to cause later

generations of homoeopaths, who were following a very different star, to adopt a superior

attitude to Richard Hughes and to label him pejoratively as a mere “pathological

prescriber”.

Important though all these ideas were for British homoeopathy, what really

distinguished Richard Hughes was his critical and scholarly approach. Most homoeopaths

of the day outside Britain, especially in America, based themselves on Samuel

Hahnemann’s later work almost exclusively – that is, on the fifth edition of The Organon

and on The Chronic Diseases.

Richard Hughes, in contrast, looked at Samuel Hahnemann’s writings as a whole.

He carefully charted the way the Master’s thought had evolved over the years and was

not afraid to say in what ways he thought it had changed for the worse.

  36

He pointed out, for example, that Samuel Hahnemann’s laying down the rule that

the 30th potency should be used for all purposes had fossilized homoeopathy most

undesirably. He also showed that the so-called provings of The Chronic Diseases could

not have been carried out in the same way as those of The Materia Medica Pura and so

could not be relied on as accurate descriptions of the effects of the new medicines.

Such views, of course, were lese-majeste in the view of the large number of

homeopaths for whom Samuel Hahnemann’s words were law.

Richard Hughes’s contribution to homoeopathy was not confined to critical

discussion of Samuel Hahnemann’s writings. His most important undertaking was

undoubtedly his attempt to revise and purify the homoeopathic materia medica, which

resulted in his rather ponderously titled Cyclopedia of Drug Pathogenesy.

Richard Hughes had earlier collaborated with the American Timothy Field Allen

in the production of that editor’s Encyclopaedia, but later he came to feel that Timothy

Field Allen had been too uncritical and had included much that would have been better

omitted.

The problem with the materia medica, as Richard Hughes saw it, was that it had

moved a long way from the original idea of basing everything on provings or reports of

poisoning.

Many of the symptoms recorded in homoeopathic textbooks were “clinical”,

without a basis in provings, and many were the result of uncritical copying by one author

from another.

  37

Richard Hughes’s aim was to sift all this material and publish only what he

thought was reliably established. This was a truly monumental undertaking. The four

volumes of the Cyclopedia of Drug Pathogenesy took seven years to prepare (1884-91).

It was a joint enterprise, in which the British Homoeopathic Society collaborated

with the American Institute of Homoeopathy; nevertheless the impetus behind it came

from Richard Hughes and he carried out most of the work.

His intention was to include all the reliable information available in his day apart

from that in Samuel Hahnemann’s writings. This involved a vast amount of translating,

sifting and editing.

A number of rules were adopted to eliminate untrustworthy reports. No purely

clinical symptoms were included, of course, and nor were symptoms obtained with high

dilutions (above 6c) unless confirmed by provings of more material doses.

A very important feature was that all the provings were given in narrative form so

that they could be read consecutively.

The Cyclopedia of Drug Pathogenesy was a unique attempt to present a truly

critical collection of the materia medica and demanded a high degree of dedication from

its readers.

Even though the symptoms were presented in narrative form rather than as lists,

they were so compressed that they were hard to take in. Richard Hughes was evidently

sensitive on this score, for he wrote:

“It seems to be the impression of some that our Cyclopedia of Drug Pathogenesy

is a mere luxury of pathogenesy, quite beyond the requirements of the student and the

practitioner, and only really valuable to the teacher or writer on the subject.”

  38

But it was the student who was expected to use the Cyclopedia of Drug Pathogenesy.

Thanks to it the subject “will be found full of life and meaning; and materia medica,

hitherto the dullest and most hopeless, will become the most interesting of studies.”

Richard Hughes’s contemporaries shared his enthusiasm. At his death an

obituarist in the American ‘Hahnemannian Monthly‘ described the Cyclopedia of Drug

Pathogenesy as “a work without parallel in all medical literature” (which was

undoubtedly true) and went on to say that

“It is a work – we had almost said THE work – from which the future materia

medical authority will compile all that is best and most reliable in his new textbook; and

it requires no prophetic vision to foretell that its pages will be even more frequently

explored at the end of the twentieth century than at its beginning.”

Alas for prophecy. Within a few years of Richard Hughes’s death his Cyclopedia

of Drug Pathogenesy, together with the rest of his work, had been forgotten almost as if it

had never been, and later generations of homeopaths were to drink from a very different

source.

To some extent this surprising turn of events can be explained as a natural

reaction by British homoeopaths against the ideas of a man whose influence had been

paramount for so many years.

Richard Hughes was in many ways open-minded and undogmatic but it was no

doubt inevitable that his teaching would eventually harden into a kind of orthodoxy.

Paradoxically however it was Richard Hughes’s very absence of dogmatism that

made him seem to some later homoeopaths a traitor to the cause, for this trait led him to

minimize the differences that separated homoeopathy from orthodox medicine.

  39

It took considerable courage for a doctor to declare himself a homoeopath in

Richard Hughes’s day; nevertheless Richard Hughes seems to have felt no reciprocal

hostility for his orthodox opposite numbers and indeed, in his last published work, The

Principes And Practice of Homoeopathy, he made a remarkable plea for reconciliation.

He was well aware, he wrote, of the many shortcomings of homoeopathy and of

the “fancies and follies” that had become incorporated in it. What was needed, he said,

was for orthodox doctors to bring their resources of time, expertise, and intellect to bear

on homoeopath and help to put it on a sound scientific footing.

Richard Hughes himself had no doubt about where such a change would lead:

“Do our brethren know what would be the result of such generous policy? We

should at once cease to exist as a separate body. Our name would remain only as a

technical term to designate our doctrine; while “homoeopathic” journals, societies,

hospitals, dispensaries, pharmacopoeias, directories, under such title, would lose their

raison d’etre and cease to exist.

“The rivalry between “homoeopathic” and “allopathic” practitioners would no

longer embitter doctors and perplex patients.

I suspect that it was this wish to unite homoeopathy with orthodoxy, rather than

his more technical views about the right way to choose medicines, that was the real

reason for the virtual suppression of Richard Hughes’s ideas by later homeopaths.

If Richard Hughes had succeeded in effecting a reconciliation between

homoeopathy and orthodoxy it is likely that – as Richard Hughes himself realized – the

result would have been the disappearance of homoeopathy as a separate form of

medicine; this did in fact happen later in the USA.

  40

Hughesian homoeopathy exhibits both the strength and the weakness of the

scientific version of homoeopathy.

To a modern doctor Richard Hughes’ writings and those of his friend Robert Ellis

Dudgeon are among the most accessible of homoeopathic texts, including those of the

twentieth century.

Although the medical ideas with which these authors worked are long out of date,

their pragmatic and critical attitude makes them surprisingly modern in tone and readable

even today.

Nevertheless after Richard Hughes’s death British homoeopathy moved

decisively away from science, and Richard Hughes himself received the contemptuous

Hahnemannian label of “half-homoeopath”.

In subsequent chapters I shall look at the reason for these developments continue

reading:

Richard Hughes is the author of Manual of Pharmacodynamics and he co-

authored the Cyclopedia of Drug Pathogenesy with Jabez P Dake in 1885, A Repertory to

the Cyclopaedia of Drug Pathogenesy, The Principles And Practice of Homoeopathy, he

co-edited the British Journal of Homoeopathy (including this one on Cholera), The

Materia Medica Pura of Samuel Hahnemann, co-edited with Robert Ellis Dudgeon, The

Knowledge of the Physician: A Course of Lectures Delivered at the Boston… , On the

Sources of the Homœopathic Materia Medica: Three Lectures Delivered … , A Manual of

Therapeutics According to the Method of Hahnemann, he contributed to the American

Institute of Homoeopathy Proceedings… and the Transactions of the Homoeopathic

  41

Medical Society of the State of New York, the Hahnemannian Monthly and many other

pamphlets and journals on both sides of the Atlantic.

It is a tribute to Dr. Hughes’s in domitable energy, Patience and Courage that in

spite of the deepest admiration and respect for the founder of Homoeopathy he examine

minutely each and every symptom in Hahnemann’s records, going to the very original

sources in the effort to separate and wheat from the Chaft.

CONTRIBUTIONS

• The principle and practice of Homoeopathy

• A manual of pharmacodynamics

• A cyclopaedia of drug pathogenesy, four volumes

• Hahnemann as a medical philosopher

• Manual of therapeutics

• The knowledge of the physician9.

  42

RICHARD HUGHES VIEW ON HOMOEOPATHY

HOMOEOPATHY: ITS NATURE AND ORIGIN

It is a therapeutic method formulated by the rule SIMILIA SIMILIBUS

CURENTER” let likes be treated by likes”. The two elements of the comparison herein

implied are the effects of drugs on the healthy body and the clinical feature of diseases, in

either case all being taken into account, which is appreciable by the patient or cognizable

by the patient or cognizable by the physician, but hypothesis being excluded. Medicine

selected upon this plan are administered single is without administered single and in

doses too small to encite aggravation on collateral disturbance.

But in adopting this method of Hahnemann as our chief guide in therapeutics, we

do not necessarily become followers of his, in other departments of thought; we are

homoeopathists, not Hahnemannians. The steam engine of today is not altogether that of

Watt. Homoeopathy, like the candlestick of Hebrew Tabernacle, has been shaped by

hammering not by casting: or rather, it is a vital thing, growing as the years go on, and

legitimately influenced by its environments. It is in our hands some what different from

what it was when it dropped from Hahnemann’s; but it is Hahnemann’s still. All study,

exposition, practice of it must start from and the results it achieves must be accounted a

monument reared to his honour.

He believes that nine – tenths at least of the adherents of homoeopathy would

accept this as a true account of all that is essential to it. If it be so, it is obvious that the

thing with which we shall have to do is a METHOD not a doctrine or a system. If belongs

to the art of medicine rather than to its science. Of course, the rules of art need not be,

  43

should not be, merely empirical they should be in harmony with philosophy and science,

and framed with correct conception and from sound induction.

The minute dose was in fact the last development of the four and derived entirely

from Hahnemann's experimentation. Therefore, we do not need to explain that as an

aspect of the central problem we are addressing here about origins. It comes in later as a

secondary development. The same can also be said about single drugs, the use of which

can be explained mostly from Hahnemann's penchant for simplifying things, like most

Enlightenment thinkers of his day:

'Then let us...agree to give but one single, simple remedy at a time, for every

single disease...' [Are the Obstacles to Certainty and Simplicity in Practical Medicine

Insurmountable?, 1797, in Lesser Writings, p.320]

'Hippocrates sought the simplest from out an entire genus of diseases...and gave

single simple remedies from the then scanty store...' [Are the Obstacles to Certainty and

Simplicity in Practical Medicine Insurmountable?, 1797, in Lesser Writings, p.321]

'Dare I confess, that for many years I have never prescribed anything but a single

medicine at once, and have never repeated the dose until the action of the former one had

ceased....and always a simple, never a compound remedy...' [Are the Obstacles to

Certainty and Simplicity in Practical Medicine Insurmountable?, 1797, in Lesser

Writings, pp.321-2]

'...wise nature produces the greatest effects with simple, often with small

means...more frequently with one alone, we may restore to normal harmony the greatest

derangements of the diseased body...' [The Medicine of Experience, 1805, in Lesser

Writings, p.469]

  44

He had long railed against the weird mixtures of the apothecaries as being an

outdated, essentially harmful, uncurative and unscientific approach, and thus again, the

problem of the origin of homoeopathy is not really pivotal around the origin of the use of

the single drug:

'His next article was 'Are the Obstacles to Certainty and Simplicity in Practical

Medicine Insurmountable?' [1797]. In it he argues in favor of simple, careful

methods...at this time Hahnemann was habitually depending on the single remedy at a

time for every single disease, and says in this essay that it has been a long time since he

has given more than one remedy at a time. He also prescribed according to the law of

similars. He was in the habit of preparing and dispensing his own medicines independent

of the apothecaries.'

'Hahnemann was the first to raise his voice against the compounding of

prescriptions, holding that the effects of compounds on disease could never be known

precisely.' [Coulter, Vol. 2, p.335]

Thus we are left with two central problems which he faced at the beginning, and

which do deserve greater attention: the law of similars and the proving.

The proving derives very largely from reaching a position of having abandoned

allopathic practice completely and then wanting to know in detail the precise therapeutic

action of a single drug. This forms the crux of Hahnemann's problem right at the start of

his search and is a fair account of the position he found himself in. How can one

determine the action of any single drug, if one has already abandoned the dictates of

signatures and tradition? It seems like a conundrum which is impossible to solve. The

only way is to test drugs on the healthy, which is what he did. If you combine this knotty

  45

problem with Hahnemann's obsession throughout the 1780s with poisons and their

effects, then it is possible to show that some experimentation on his part with mild self-

poisonings using single drugs was more or less inevitable at that point in time. That

arguably forms the basis for his discovery of the proving as a technique. Added to which

are the influences of von Stoerck, and others, already alluded to in quotation.

'Hahnemann's dose reduction made possible the systematic use of poisons in

medicine. While this had been recommended by von Stoerck and others, it could not be

practised as long as large doses were considered necessary…the homoeopathic

pharmacopoeia later used dozens of the most powerful poisons: Belladonna, Aconite,

Arsenic, Strychnine, Rattlesnake…' [Coulter, pp.403-4]

Essentially, it came down to a straight choice between signatures and provings:

'There is, afterall, an important difference between the selection of a medicine on

the basis of its ability to reproduce, in a healthy person, the symptom complex manifested

in a patient, and the selection of a medicine on the basis of some physical resemblance

between it and the organ affected...' [Nicholls, 1988, p.8]

Thus having dealt with three out of the four, we have now narrowed down our

search into the origin of homoeopathy to a single question, which concerns his discovery

of the law of similars. This also forms the basis for the name 'homoeopathy' a word

carefully chosen by 'Hahnemann the linguist' to most accurately portray the central, most

essential and most dominant feature of his system: the use of drugs based upon similia

similibus rather than upon the ancient Galenic principle of contraria contrariis, which

forms, then as now, the basis for allopathy: cure by opposites, using mixed drugs in high

doses and selected upon the basis of signatures and trial and error rather than provings.

  46

Regarding mixed drugs, Hahnemann's instinct left him in no doubt:

'Sophistical whimsicalities were pressed into the service...from these ancient times

came the unhappy idea, that if sufficient number of drugs were mixed in the receipt, it

could scarcely fail to contain the one capable of triumphing over the enemy of health...'

[Aesculapius in the Balance, 1805, in Lesser Writings, p.420-1]

Hahnemann's scornful view of Galen is also painfully apparent:

'But not long after them came Claudius Galen...the torch and trumpet of general

therapeutics, a man more desirous of inventing a subtle system than of consulting

experience. Disdaining to learn the powers of medicines by instituting experiments, he

gave the bad example of generalizing and framing hypotheses.' [On The Helleborism of

the Ancients, 1812, in Lesser Writings, p.592]

The law of similars was mentioned by Hippocrates [Lesser Writings, p.460] and

occasionally by other medical writers in history, but it seems never to have been regarded

as a dominant healing principle.

'In the Hippocratic text 'Of The Places In Man', probably written around 350 BC,

the writer holds that the general therapeutic rule is 'contraria contrariis curentur' but

notes 'Another type is the following: through the similar the disease develops and

through the employment of the similar the disease is healed'.' [In Nicholls, 1988, p.16]

It was revived for a brief time by Paracelsus before it sank back into obscurity.

Thus it does seem exceptional that Hahnemann stumbled upon it and elevated it into the

central principle of his new homoeopathic system. Therefore, in order to understand the

origin of this most central aspect of homoeopathy we need to more clearly delineate his

method of working. It is notoriously difficult to accurately recreate the situation of a

  47

long-dead person, let alone their thinking and the evolution of an idea, but we must at

least try.

Though it is true to say that Hahnemann in the 1780s was 'groping in the dark'

nevertheless we are right in saying that it was a partially illuminated darkness. It seems

that there are certain things he had already ruled out of his search, and certain things he

had already ruled in. For instance, he had more or less ruled out all the four central pillars

of Old Physick: signatures, large doses, mixed drugs and contraries, which he at least

suspected of being bogus. Once he had clearly identified these four principles [which

happened around 1783], then from that point forwards, we might conclude that he

conceived their opposite principles, at the outset, to be worth investigating more

thoroughly: i.e. provings, small doses, single drugs and similars.

Well, it is a neat idea, but the known facts simply do not support the notion. If he

had conceived a four-fold grand system early on, based simply upon some principles the

exact opposite to those of allopathy, then we could surely expect to find him reducing his

doses and conducting provings much earlier than he did? His first proving is likely to

have been conducted in 1790 and he did not reduce doses significantly and in truly

potentised form until 1799.

'In his early years of practice Hahnemann used doses comparable to those of his

colleagues: 5-50 grams of Antimony, 20-70 grams of Jalap Root…his 1796 Essay

mentions 'moderate' doses. In 1799 he first announced the principle of the infinitesimal

dose, and after 1800 his dose sizes were gradually reduced…' [Coulter, p.400]

  48

'We cannot fail to be struck by the sudden transition from the massive doses he

prescribed in 1798 to the unheard-of minuteness of his doses only one year later, and we

can but guess the causes for this abrupt transition.' [Dudgeon, 1853, pp.395-6]

He was still using material doses as late as 1798. That is 8 years after his

Cinchona bark proving and thus at least two elements of homoeopathy [the proving and

small doses], could not have been formulated at an early stage [even in his mind] in some

grand plan in the 1780s. It clearly does not seem to suggest, therefore, a system

formulated in one piece at an early stage in response to an early rejection of allopathy's

four principles.

'[After the first proving] Hahnemann waited some time before giving vent to these

ideas… 'The Essay on a New Principle'...did not appear until 1796. And a further

fourteen years passed before the first edition of 'The Organon' appeared...' [Nicholls,

p.10]

Rather, it seems to signify a piecemeal approach, a slow elaboration, probably

derived from 'groping in the dark', great uncertainty and a surprisingly slow evolution in

his thinking and experimentation. It suggests that his ideas meandered around somewhat,

and also that the first proving of 1790 might not have been such a great illumination to

him as is commonly supposed by us now looking back. If he had nurtured a grand plan

preconceived at an early stage, then why did he wait so long and delay his experiments?

Surely he would have pursued quickly, and with vigour, a systematic investigation much

earlier than he actually did? That certainly characterised his general approach to most

matters.

  49

The fact that he did not do that but meandered around for at least 8 years, quite

strongly implies that he was no nearer conceiving homoeopathy as a full system at an

early stage. Thus it seems clear that homoeopathy as a full system was not hit upon in one

go, but that its four main tenets were unravelled quite slowly and haphazardly in a

gradual and piecemeal fashion.

As well as not knowing precisely which principle of homoeopathy he came to

solidly embrace at what time or in what sequence, nor do we know in what order

Hahnemann definitely relinquished the 4 dogmas of Old Physick. We can merely guess

these things from what he said at various stages. But we do know that he detested high

doses of drugs from an early stage [see quote below from Lesser Writings, pp.747-9], and

that he railed against mixed drugs in general:

'I have no hesitation in asserting that whenever two medicines are mingled

together, they almost never produce each its own action on the system, but one almost

always different from the action of both separately - an intermediate action, a neutral

action, - if I may be allowed to borrow the expression from chemical language.' [Are the

Obstacles to Certainty and Simplicity in Practical Medicine Insurmountable?, 1797, in

Lesser Writings, p.320]

Afterall, these facts comprised the main reasons that he abandoned allopathic

practice [on his move to Dresden in the Fall of 1784; see Cook, pp.46-7 and Bradford,

p.36] in the first place. He also bemoaned, from an early stage, the use of signatures as

'an absurd and fabulous folly':

'I shall spare the ordinary school the humiliation of reminding them of the folly of

those ancient physicians who, determining the medicinal powers of crude drugs from

  50

their signature, that is from their colour and form...but I shall refrain from taunting the

physicians of the present day with these absurdities, although traces of them are met with

in the most modern treatises on materia medica.' [Examination of the Sources of the

Common Materia Medica, 1817, in Lesser Writings, p.670]

'...the mere suppositions of our superstitious forefathers, who had childishly

enough asserted certain medicinal substances to be the remedies of certain diseases,

merely on account of some external resemblance of those medicines with

some...[signature], or whose efficacy rested only on the authority of old women's tales, or

was deduced from certain properties that had no essential connexion with their fabulous

medicinal powers...' [On the Value of the Speculative Systems of Medicine, 1808, in

Lesser Writings, p.502]

All this therefore probably implies that he begrudgingly tolerated the contraria

principle much longer than most homeopaths today would care to imagine, i.e. for

virtually all the 1780s. Finally, we can add that in the same period of time [1782-99] he

published numerous papers on Chemistry and Medicine in the journals, and translated

into German over twenty large medical texts from English, French, Latin and Italian, plus

a growing number of original essays on homoeopathy. Thus he had other reasons to be

seeming to make such slow progress.

Once he had completely abandoned mixed drugs and signatures then he was

forced to contemplate how to determine what the action of a single drug is upon the

healthy organism. This forms the central and most pivotal event in the development of

homoeopathy, in my view, as it shows a major turning point in his thinking. We can now

focus on this central problem. At that point in his knowledge Hahnemann must have

  51

found himself gazing at several rivers of thought converging before him. As we pointed

out above, in order to determine the action of a single drug you either have to follow

tradition and signatures or you do what? What other means is there to find out except by

giving it to the sick? Thus he faced two choices: give the drug to the sick or to the

healthy. He was averse to the former, as it proves so hard to distinguish the symptom

elements of the illness from the effects caused by the drug.

'The dispute as to whether the brooklime [Anagallis arvensis] and the bark of

Misletoe [Viscum album] possess great curative virtues or none at all, would immediately

be settled, if it were tried on the healthy whether large doses produce bad effects, and an

artificial disease similar to that in which they have been hitherto empirically used.' [Essay

On a New Principle for Ascertaining the Curative Powers of Drugs, 1796, in Lesser

Writings, pp.269-70]

Another stream of ideas flowed from his deep interest in poisons, which reveal the

effects of drugs upon the healthy. For example, his publications: On Arsenical Poisoning,

1786; The Complete Mode of Preparing The Soluble Mercury, 1790; On The Best

Method of Preventing Salivation and The Destructive Effects of Mercury, 1791; What

Are Poisons? What are Medicines?, 1806.

'All other substances which excite antagonistic irritability and artificial fever

check intermittent fever, if administered shortly after the attack...all bitter plants excite,

in large doses, some artifical fever, however small, and thus occasionally drive away

intermittent fever by themselves.'[Bradford, p.49]

'Hahnemann very carefully argues the question of the new law; he adduces many

results of poisonings by drugs, gives his experiences in the uses of medicines...and

  52

records the symptoms that certain medicines produced on himself and others.' [Bradford,

p.58]

If the effects of poisons on the healthy can be delineated in such detail, then why

not the effects of any drug at all? Thus at least two forces were pushing him in the same

direction towards the first proving. Yet another important event also pushed him along

the same path: the side-effects of high doses, especially of mercurials for Syphilis became

a central problem of his early practice. He knew that Mercury could cure Syphilis. He

had a mercury preparation named after him [Mercurius solubilis Hahnemannii] which

also shows how much interest he took in the treatment of that condition.

It is at this point also that the work of the English surgeon, John Hunter [1728-

93], becomes an important influence upon Hahnemann. Coulter suggests [p.356-7] that

Hahnemann gained some insights into the tenet: 'what will cause can cure' from reading

Hunter's work on the Mercurial treatment of Syphilis:

'This new approach [i.e. the proving]…was inspired by the writings of the

profoundly original and pathbreaking Scottish physician, John Hunter [1728-1793].'

[Coulter, p.356]

Hunter had worked on venereal diseases and later published texts on that subject

[e.g. A Treatise on the Venereal Disease, Longmans, London, 1837]. Hahnemann

referenced Hunter's work in his early work on Syphilis published in 1786 [Instructions

for Surgeons on Venereal Diseases, Leipzig, 1789; see Cook, p.51; Gumpert, p.58]:

'Although the translation of Cullen's treatise appears to have been a crucial

turning point in Hahnemann's thought, he was neither the first to have suggested the

simile - as he admitted - nor was its presence entirely absent from his own thinking prior

  53

to 1790. John Hunter's essay, 'Treatise on the Venereal Diseases', in which he observed

the effects of venereal inoculation, seems to have been influential. Certainly, Hunter's

work is mentioned by Hahnemann in his own publication of 1789, 'Instructions for

Surgeons'...and indications of the subsequent direction of Hahnemann's ideas, realised in

the 'New Principle' essay of 1796, may be found here.

One of the most immediate precursors of Hahnemann was Anton von Stoerck

[1731-1803] who, in the late 1760s, suggested the treatment of diseases with poisons

according to the principle of similars....since Hahnemann had studied medicine under

Joseph von Quarin at Vienna, who in turn had studied under von Stoerck, one of the

more proximate sources of Hahnemann's thinking is perhaps indicated here.' [Nicholls,

1988, p.12; see also Bradford, p.50]

'…the parallels between the two works are striking. To Hunter is thus due a share

of the credit for Hahnemann's discovery of the drug proving.' [Coulter, p.356]

The important line of Hahnemann's reasoning here must be teased right out into

the open, as it reveals quite clearly how the observations he made were suggestive of

what later became elevated into important homoeopathic principles.

He knew that Mercury can cause as many symptoms as it can cure and that the

higher the dose the more aggravated are the symptoms it produces. This taught him the

curious and sensitive relationship between toxic and therapeutic action. Thus we can

safely conclude from this the line of reasoning which must have trickled through

Hahnemann's mind when observing such events. He must have realised that crude doses

in general are bad because they produce unwanted aggravations and iatrogenic diseases

[side-effects]:

  54

'The mischievous effects of...overloading them with strong unknown drugs, will be

perfectly obvious...every medicine is a disease-creating substance, consequently every

powerful medicine taken day after day...will make healthy persons ill...long-continued

doses of strong allopathic medicines...[leads to] the establishment of permanent

alterations of our organisms...that is not capable of being cured and removed by any

human art...for which there is and can be no remedy on earth, no antidote, no restorative

medicines in nature.' [Allopathy: A Word of Warning To All Sick Persons, 1831, in

Lesser Writings, pp.747-9]

Yet he also knew that Mercury in small doses could greatly improve or even cure

Syphilis. Thus he must have conceived from such observations the thought that the most

similar medicine [what he called a 'specific' but not meaning the same as a specific in

medicine] has a special and unique power.

He was the first to see a polarity principle operating in relation to dosage. Thus

for Merc and Syph, for Bell and Scarlet fever and also for Cinchona and Malaria. This

revealed that the specific drug [i.e. the most similar or homoeopathic to the patient] has a

very special power over its similar disease [patient]. Small doses cure while large doses

aggravate. What he next had to do was to experiment with crude doses of ANY drug to

see what they could produce in the healthy. Poisons are special, and stand out from all

other drugs, by virtue of their strong power to produce symptoms. Indeed, the 'power to

produce symptoms' can in fact be regarded as the guiding aphorism which led

Hahnemann ['torch and trumpet'] to the realisation that poisons held an important key to

solving his central problem about similars and the action of the single drug. It is this very

axiom which I think must have droned through Hahnemann's mind continuously like a

  55

loud mantra. Again we see, all roads led him to the proving, i.e. experiments with mild

self-poisonings. The purpose? His purpose was to settle for once and all, unequivocally

and without the use of signatures, what the therapeutic action of a single drug is.

But to deliberately write him off as merely yet another 'system-builder' in

medicine is to woefully misapprehend the man, and his work:

'After all, Hahnemann had cast homoeopathy in substantially the same eighteenth

century mold that had given shape to the systems of Cullen, Brown and

Rush...homoeopathy offered an unambiguous example of extreme rationalism informing a

dogmatic system of practice with dire consequences.'[Warner, pp.52-3]

'Thus Hahnemann reduced most conditions to the itch and most treatments to the

like cures like theory and the high dilution formulas, somewhat as Dr. Still would later

reduce all pathologic processes to spinal conditions and all therapeutic practice to spinal

manipulations.' [Shryock, 1966, p.171]

That he thoroughly detested medical systems of ideas and speculations is very

apparent in all his writings:

'There was now the influence of the stars, now that of evil spirits and witchcraft;

anon came the alchymist with his salt, sulphur and mercury; anon Silvius, with his acids,

biles and mucus...our system-builders delighted in these metaphysical heights, where it

was so easy to win territory; for in the boundless region of speculation every one

becomes a ruler who can most effectually elevate himself beyond the domain of the

senses.' [Aesculapius in the Balance, 1805, in Lesser Writings, p.421-2]

  56

He also edged closer to settling the question of dosage. All this work also

explained to him the fundamental nature of what similar really means. And also in this he

found the primary and secondary or 'biphasic action' of drugs too:

' ..close inspection of the action of medicinal substances on the healthy led to a

major discovery – the biphasic action of drugs.' [Coulter, p.363; see also Nicholls, p.78]

Thus we can begin to see that all of this research and experimentation in the

1780s and 90s led him to contemplate and grapple with all these profound and unresolved

aspects of medicine. He could also address the problem of the similarity between a drug

and its disease. The fact that Bell and Scarlet fever and Merc and Syph resonated with

each other so well and so profoundly allowed him to see that the law of similars as

formulated by the doctrine of signatures, though imperfect, was perhaps closer to the

truth afterall and capable of being forged into an infinitely more precise and workable

therapeutic weapon against disease than contraries ever could. In some manner therefore

he must have sensed the superiority of the law of similars. Arguably, it was only through

his deep and sustained contemplation of the notion of similars and poisonings which led

him finally to his 'home port' of the proving technique.

Indeed, in the period in question, Hahnemann seems to have been pretty well

assailed on all sides by many difficult and unresolved medical problems at the same time

as to make his task so much more difficult, and this, probably explains the relatively slow

pace of his progress between 1782 and 1799. Like a military commander besieged and

fighting on several active fronts at the same time he could only devote a small amount of

his time, energy and intelligence to any one problem at a time. In short, this meant that he

was flooded out with too many questions to solve to allow him the time to disentangle

  57

them quickly into some kind of meaningful framework. It really is a testament to his

inventive genius that he did settle all these complex problems in less than two decades.

Only when we today contemplate the vast size of the homoeopathic materia medica, our

relatively detailed and exhaustive knowledge of each drug and all the information in the

Organon about drug actions, can we fully appreciate the staggering achievement of

Hahnemann.

At that early stage he had no materia medica at all, worthy of that name, and stood

at the base of what would soon become one of mountainous proportions. For example,

how was he to know that the symptom phenomena he had observed with Cinchona,

Mercury and Belladonna also applied to all other drugs? He had no way of knowing if the

production of symptoms in the healthy was a principle applying to all drugs. Only after

he had proved tens of drugs was he able, confidently and unambiguously, to declare that

the proving seemingly was a universal and immutable principle. Very gradually he solved

all these complex, profound and mutually entangled problems, to create an entirely new

medical system founded solely upon experimentation and sound principles - the very

things which eighteenth century allopathy was woefully devoid of, being in fact a mass of

warring factions:

'Physiology...looked only through the spectacles of hypothetical conceits, gross

mechanical explanations, and pretensions to systems...little has been added...what are we

to think of a science, the operations of which are founded upon perhapses and blind

chance?' [Aesculapius In the Balance, 1805, in Lesser Writings, pp.423-6]

'...because they placed the essence of the medical art, and their own chief pride,

in explaining much even of the inexplicable...this was the first and great delusion they

  58

practised upon themselves and on the world. This was the unhappy conceit which, from

Galen's time down to our own, made the medical art a stage for the display of the most

fantastic, often most self-contradictory, hypotheses, explanations, demonstrations,

conjectures, dogmas, and systems, whose evil consequences are not to be overlooked...'

[On the Value of the Speculative Systems of Medicine, 1808, in Lesser Writings, pp.489-

90]

Thus all these considerations reinforce the impression we have made regarding

the remarkable nature of Hahnemann's achievement. What is remarkable about him is

that in the same period of time he managed to identify and distance himself from the 4

fundamental principles of Old Physick, to formulate and develop the principles of

homoeopathy, to investigate the primary and secondary actions of poisons and drugs and

to investigate the polarity principle of dosage [see Coulter, pp.363-7]. He thoroughly

tested and established all of these four aspects of his search. And he did all these things

entirely on his own. He was the only person to do this. Only through thoroughly

immersing himself in all of that could he confidently emerge from it at the end both with

a full practical system of therapy in his hands that worked as well as one which rested

upon a firm bedrock of clear principles. Homoeopathy as a working system was the child

of his practical experimentation, while the Organon sprang into life from his investigation

of the theoretical principles of medicine in general, both of which he had researched

pretty exhaustively between 1782 and 1799. The fact that he had read so widely of other

medical writers and translated so many important texts into German, demonstrate the

seriousness and great learning he brought to his task:

  59

'Let it be borne in mind that he was a thoroughly well-posted physician, skilled

both in theory and practice, better read in the various notions of the medical books of the

time than most of his fellows.' [Bradford, p.35]

He tried to show us that Hahnemann’s method fulfils these requirements that his

way of regarding disease and drug action is eminently philosophical, that his direction to

treat likes with likes results logically from a true induction from the facts of the matter

and his reduction of dose follows as a necessary corollary thereto. But it remains a

method still and noting more and not Hahnemannian but Homoeopath.10

THE ORGANON

1. The organon was first issued in 1810. A second edition appeared in 1819; a third in

1824: a fourth in 1829; and a fifth and last in 1833. Each of these is described as

“augmented” (2nd), “Improved” (3rd), on both “augmented and improved” (4th and 5th);

and in truth all save the third, show considerable changes as compared with their

immediate predecessors. It is quite impossible to form an adequate estimate, either of the

work or of its author, without some knowledge of the changes it has undergone in its

successive stages, without this, neither for can critics are never weary of ridiculing as one

of the fundamental principles of Homoeopathy, first appeared in the fourth edition, i.e., in

1829. Theory of the dyanmization of medicines – i.e. in 1829. Theory of the actual

increase of power obtained by attenuation, when accompanied by maturation or

succession is hardly propounded, when accompanied by trituration on sucessussion – is

hardly propounded until the fifth edition. Again, there is the doctrine of a “vital force”, as

the source of all the phenonuna of life, as the sphere in which disease begins and

  60

medicines act. This has been regarded by Many of Hahnemanns followers as an essential

part of his philosophy. “Voki donc” enelaims M leon Simon.

But the earliest mention of this conception occurs in the fourth edition; and the

full statement of it with which we are familiar in the fifth (§ 9-16) appears there for the

first time)11.

2. The “Organon” is Hahnemann’s experition and vindication of his therapeutic method.

It had been preceded by a number of essays in HUFELAND’S JOURNAL – the leading

Medical organ of the time, in Germany, of these the most noteworthy were “on a new

principle for ascertaining the curative powers of Drugs” (1792). “Are the obstacles to

certainty and simplicity in practical medicine insurmountable? (1797); and “the medicine

of experience” (1806) the time seemed now to have come when there should be published

separately a fully account of the new departure he was advocating; and hence the

“organon” of 1810.

He gave his treatise this name because, there can be little doubt, have had

Aristotle in memory, whose various treatises on logic were summed up under the

common little “organon”, logic the art of reasoning – is the INSTRUMENT of research

and discovery; Hahnemann designed his method as one which should use for the

discovery of the best remedies for diseases. But the example immediately before his

mind, and through whom he was probably led to Aristotle, must have been Bacon. The

second treatise of the “Instauration Majra” of the English chancellor is entitled “Novum

organism”, it was the setting forth of a new mode of reasoning, which in scientific

research should supersede that of Aristotle and lead to developments of knowledge

hitherto unattained. That Hahnemann should aspire to do such work for medicine as was

  61

done for science in general by Bacon has been scouted by his enemies, and even

deprecated by his friends, as presumption, and yet no comparision could better illustrate

the real position of the man both in its strength and in its weakness. If he erred as to

special points of pathology, and even of practice, we must remember that Bacon was a

doubtful acceptor of the Copernican Astronomy and ridiculed Harvey’s doctrine of the

circulation, while he saw no difficulty in the transmutation of metals on the other side,

how truly Baconian is the whole spirit and aim of the “organon” I like his great exemplar,

Halenemann sought to recall men from the spinning of facts, like him, he set up the

practical - which in this case is the healing of disease – as the proper aim of medical

philosophy not seeking in knowledge a terrace, for a wandering and variable mind to

walk up and down with a feier prospect, but rather accounting it” a rich store house for

the glory of the creatoa, and THE FEUEF of MAN’S ESTATE”

Hahnemann first called his work “organon of the Rational Medical Science !

(HEILKUNDE); but from the second edition onwards the little was changed to “organon

of the Healing Art” (HEILKUNST) – the “rational being here, and in all other places of

its occurance, either dropped or replaced by “true” or genuine” (WAHRE). Why this

alteration? The elimination of the term “rational” has been supposed to “imply that his

followers were required to accept his doctrines as though they were the revelations of a

new Gospel, to be received as such, and not to be subjected to rational criticism

3. On the title page of his first edition, Hahnemann placed a motto from the prect Gellert,

which has been rendered into English thus.

“The truth we mortals need

us bless to make and keep

  62

the all – wise slightly covered O’er

But did not bury deep”

This was replaced in subsequent edition by the words “Aude Sapere”, but it

continued to denote the profound conviction and motive inspiration of Hahnemann’s

mind. It was the same though as that which he expressed in the “Medicine of Experience”

“As the wise and beneficent creater has permitted those innumerable states of the human

body differing from health, which we team diseases. He must at the same time have

revealed to us a distinct mode whereby we may obtain a knowledge of diseases that shall

suffice to enable us to employ the remedies. Capable of subduring them, He must have

shown to us an equally distinct mode whereby we may discover in medicines those

properties that render them suitable for the cure of diseases.

If we were going through the introduction in detail, there woruld be many points

on which criticism and correction would be necessary, but the general soundness of its

attitude must be sufficient for us to day. It bears to the body of the work the same relation

as bacon’s “Deaugmentin” to his “Novum Organism” and the treatise on “Ancient

Medicine” to the “Sphorism” of Hippocrates.

5. We come now to the “organon” proper. It consist of a series of aphorism in its latest

form 294 in number, to which are appended numerous and often lengthy notes. This is a

form of composition eminently suggestive and stimulating. It is endeared to many of us

by coleridge’s “Aids to Reflection”, but Hahnemann must have taken it from “Novum

organism” Perhaps also with a recollection of the father of medicine which derives its

name there from.

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While each aphorism is complete in itself and might be made the text of medical

discourse, the work they collectively constitute has a definite outline and structure which

remains unchanged through the successive editions, and is as evident in the first as in the

last.

The three desiderata of physician, these are

1st the knowledge of the morbid state which supplies the indication

2nd the knowledge of medicinal powers – which gives the instrument

3rd the knowledge how to choose and administer the remedy – which is the thing

indicated.

The first part of the organon (down to § 70) treats of these points doctrinally, by

way of argument; second practically, in way of argument; second practically, in the form

of precept. The summing up of the doctrinal portion is contained in § 71.

In § 71, Hahnemann propounds the practical questions, which in the remainder of

the treatise he seeks to answer, thus.

1. How is the physician to ascertain what is necessary to be known in order to cure

the disease?

2. How is he to gain a knowledge of the instruments adapted for the cure of the

natural disease – the pathogenetic powers of medicines?

3. What is the must suitable method of employing these artificial morbific agents

(Medicines) for the cure of natural disease.

In reply to the first question, he gives rules for the examination of the patient; to

the second, for the moving of medicines upon the healthy to the third, for the

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determination of similarity, the choice and repetition of the dose, the preparations of

drugs, the diet and regimen to the observed, and so forth10.

THE KNOWLEDGE OF DISEASE

In dealing with three elements of the method of Hahnemann the aspect it takes of

disease are

a) The mode in which it ascertains drug action

b) The principle on which it fits the one to the other

c) And the two elements of comparison i.e.

• Effects of drugs on the healthy body

• Clinical features of the disease

Disease

Etiology and pathology are uncertain but signs and symptoms never change from

the time of Syderham, Hippocrates.

So Hahnemann took those features as the disease basic of method. He rejected the

pathology absolutely for the therapeutic purposes. Only “TOTALITY OF THE

SYMPTOM” is to the therapeutist, the disease. Is this position tenable? No if we were

dealing with an object of science it is uncertain that symptamatology would be an

insufficient basis for our knowledge.

“Infectious Diseases” In Zeimssen’s Cyclopedia same symptoms can be given by

two diseases so knowledge of pathology is must.

- Uses of knowledge of disease / pathology – knowledge of morbid state is

needed for prognosis.

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- For the general management of the patient

- For estimating the influence of treatment.

All this time we have been dealing with general principles: but us look at special

forms of disease, and see whether or not the Hahnemann mode of regarding them is

sufficient for their treatment12.

1. The FEVERS constitute a group which plays a large part in daily practice. They are

maladies in which morbid increase of temperature exists prior or out of proportion to

any local inflammation which may be present. The theory of this state is still a moot

one. According to some pathologist it depends upon excessive heat production,

according to other upon deficient heat radiation, while yet another class believe that

both factors operate at one time or another in the process. But whatever be the geneim

of fever, it remains a positive fact, a clinical entity, with which we have to deal. Upon

the Homoeopathic principles we have to treat it with drugs capable of producing

fever. How they do so, we may not know, but our ignorance of the process matters

little if we are sure about the result, “An infinitesimal quality of Atropia – a mere

atom,” writes Dr. John Herely” as soon as it enters the blood, originates an action

which is closely allied to, if it be not identical with, that which induces the circulatory

and nervous phenomena accompanying Enteric or they pus fever. This is to be a fact

from Hahnemann’s proving of Belladonna, yet minute quantities of Atropia became

in our hands trusted remedies for these very fevers.

2. After fevers, the most important group of disease consists of the

INFLAMMATIONS. To the pathology of this morbid process many pages are

devoted at the commencement of very treatise on medicine on surgery. Whether, after

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all that has been written, we know much about it in its essence, may well be doubted,

but even if we do, of what avail is our knowledge for treatment – at any rate for

medicinal treatment?. The old phenomenal signs, DOLOR, CALOR, RUBOR,

TUMOR, still for all practical purposes constitute INFLAMMATION, when

externally manifested and when it is internal, and so invisible, the facts which lead us

to infer its presence and seat are no less of the symptomatic order. To treat

inflammation homoeopathically, it is only necessary to find a drug capable of setting

it up, at the same spot, and in the same manner, as evidenced by the symptoms.

3. The NEUROSES, of which in the third place Hughes speak, are still – as Libermeister

says symptomatic groups. Their unity is one neither of cause nor of lesion, it is

clinical only. It is of much interest to know what is the seat and process of the

epileptic paroxysm, but our choice of anti – epileptic remedies must be determined

mainly by the power they have of inducing similar paroxysm in the healthy subject,

explain it or not as we can. In like manner is it with cholera and tetanus and hysteria,

no conceivable knowledge we can gain as to their intimate nature would make us

better able to fit Homoeopathic remedies to them than we should be, if we possessed

their symptomatic analogues in drugs.

It thus appears that of the three elements which exist in all knowledge –

phenomena, laws and causes, it is the first which for positive therapeutic action chiefly

concerns us in disease. Not that the other two are worthless to us, even for this end our

laws here are classification – the recognition in morbid states and genera, species and

varieties analogous to those of animated nature. These enable us to form groups of

remedies associated with them, instead of having to wander through the whole materia

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medica for each prescription. They also give continuity to medicinal treatment, without

which the USUS IN MORBIS were of no avail. Hahnemann led the way here, by

constantly insisting on the existence of fixed and definite types of disease, to which

standing remedies should be applied and by giving us group of “Antipsorics”. I fear,

however, that he must be considered as having rejected all enquiries into causes – I mean

proximate causes, the noumena of the phenomena – in this sphere. In so doing we need

not follow him. His ground for taking symptoms as the element of parallelism between

disease and drug action was that they only were surely known in his day this was true,

and his selection of them was must prudent. But to maintain that they alone were

knowable us unwarrantably to bar the progress of science. His stricter followers have

acted on the DICTUM, and have looked askance on the positive pathology of the present

day, with its physical diagnosis and post – mortem confirmations. They have always been

a decade or more behind hand in their recognition of such distinction as those between

typhus and typhoid, between chancre and chancroid and in their use of such means as

auscultation and thermometry. Now this is altogether wrong. An inference from

symptoms if sure is as good a basis for treatment as symptom themselves. This sureness

is assumed in the prognosis given and the general management instituted.

Why should it not be also for purposes of drug selection? By proceeding upon it

we secure another route to the SIMILE we desiderate, we use symptoms to reach it,

because they are its most certain expression, but if it can be otherwise attained, the

alternative access may often be useful10.

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THE KNOWLEDGE OF MEDICINES

The knowledge of medicine is the tools of the healing art, as disease is the

material on which it works? What are medicines? I do not know that any better definition

of them can be given than that which was forts by Hahnemann in 1805, in the preface to

his “Fragmenta de Viribus Medicamentorum Positivis” his own difference with him

would be that I should place the corollary foremost and define a medicine as a substance

which has the power of changing sickness in to health and therefore – on the principle,

“Nil prodest quod non loedit idem of altering health into sickness.

On what ground is any substance to be reckoned a medicine? And how is it to be

ascertained what are the morbid condition and process it can favourably modify? There

are but few ways by which to arrive at such conclusions.

- Empirical – Pseudo – rational

- Rational – True – rational

In the suggestion of 1796 and the examination of the source of the common

Materia medica of 1817 Hahnemann has fully considered the empirical and pseudo

rational ways of arriving at the knowledge of medicines, and has proved the wanting.

1. Many perhaps most, of the ordinary remedial uses of drugs, have been stumbled upon

by chance. It has generally been stumbled upon by chance. It has generally been the

“common man” (as Hahnemann calls him) Sometimes even the still lower brute that

has discovered them and the professional healer has taken the hint and adopted the

practice. After his manner has been gained bark as a remedy for ague, burnt sponge

for Goitre, Arnica for the effects of falls and strains, Graphites for tetters, sulphur for

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the itch not less empirically though among the practitioners of medicine, has arises

the use of mercury and Iodide of potash in syphilis etc.

Now it would be the height of unwisdom to neglect information from this

source. A remedy is a remedy, however comes at, and whether conforming or not to

any laws of action we may suppose to prevail.

2. There are certain pseudo – rational modes of discovering remedies which have

brought undeserved slight on those truly bearing the name. Such is the doctrine of

“signatures”, and much of the iatro – mechanical and iatro – chemical theory of

former and later times. When a real medicine has been gained by these means – as

chelidonium in disorders of the liver and muriatic acid in low fevers – it has been by

coincidence, not from induction. The result is practically empirical. The truly rational

method is that which infers the place and the power of a drug in disease from its

behavior in health. Every such substance, on being introduced into the animal

organism, causes certain disturbances, certain changes, each has its proper series of

effects each selects certain organs and tissues, or certain tracts and regions of the

body, and there sets up phenomena of a definite kind.

The organisms on which the effects of drugs can be ascertained are those of the

drugs, can be ascertained are those of the lower animals and of man.

1. There was a time when the corpus vile of mites was thought the only ground on

which FIET EXPERIMENTUM, and even now it plays by far the largest part in the

pharmacological research of the profession at large. If this were sound practice,

Hahnemann would be somewhat discredited; for he, recognizing that it was available,

deliberately rejected it. But have his arguments against its adequacy ever been

answered?10,12

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SIMILIA SIMILIBUS

The two elements contained in the maxim simila similibus curentur – the

phenomena and sensations of disease and of drug – action respectively. It now becomes

our task to see how we are to put the SIMILIA together so as to curare by their means.

1. Drugs, being material substances, must if introduced in sufficient quantity into the

body, act MECHANICALLY, by their bulk and weight, and so forth. Such properties of

theirs have found little use in medicine – the swallowing of crude mercury to overcome

instestinal obstruction, of alive oil to detach Biliary calculi, being the only familiar

instances. Whatever its value – and the latter practice seems effective and is certainly

harmless – it has noting to do with out present subject; SIMILIA SIMILIBUS has no

application here.

2. Drugs, when taken from the mineral kingdom have CHEMICAL properties, and they

exert these within the organism as they do outside it, with such modification as the higher

laws of life there regining impose upon their action. An alkali will mentralise an Acid in

the stomach as in a test-tube, and so may give immediate relief of heartburn. A solvent of

wric acid such as the Boro-citvate of Magnesia seems, and piperatin is reputed, to be –

will act thus upon it in the kidney almost as well as in the apparatus of the laboratory.

These are examples of the chemical action of medicines.

3. We are thus shut up, for the sphere of Homoeopathic action, to the third and last kind

of drug – energy, which may be called DYNAMIC from its analogy with the forces of

Nature generally VITAL From its manifestation only in the presence of life. It is the

reaction which drug-stimuli excite in living matter. But even here we must recognize a

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limitation vital action which is exclusively topical does not necessarily, or even

ordinarily, conform to the law of similar. It may do so.

The local application of nitrate of silver in inflammations of skin and mucous

membrane, which traussean cited as the cardinal example of the great therapeutic

principle of substitution which at present rules supreme in medical practice – this is

obviously an illustration of SIMILIA SIMILIBUS as the same writer admits.

But if we follow up our topical agents, we shall find the relation of similarity to

fail us. The action of Armica in easing the pain and promoting the resolution of

contusions is a dynamic one; but no such condition can be induced by applying Arnica to

a healthy part. Calendula is a vulnerary by no chemical or mechanical properties it

possesses; it cannot act otherwise than vitally; yet it has no power of causing wounds on

the unbroken skin. And conversely, it does not follow that because the fumes of osmium

set up eczema on the parts exposed to them, that metal taken internally will act upon

idiopathic eczema as eg: srsemic. The later inflames the kin, however introduced into the

system it is therefore constitutionally Homoeopathic to Dermatitis, while the other is only

locally so.

Dynamic action, to be available according to the law of similar, must thus not be

topical only. It must further be exerted on the living matter of the patients self, and not on

that of guests to which he is against his will playing the part of host. It is not by

Homoeopathic action that Sulphur ointment cures the Itch, for its influence is exerted on

the Acarus Scabiei rather than on the skin that parasite irritates. The same statement may

be made as to the living creatures which infest the intestines.

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Santonine kills the round worm, filix mas the Taemia, by dynamic toxic power

directly exerted; the practice is as rational as that which we follow scabies, but there is

nothing in it which lends itself to the rule SIMILIA SIMILIBUS.

It is nevertheless, within this sphere that the method finds its place, it is

dynamically acting drugs influencing living matter which is neither parasitic nor

adventitious and doing this constitutionally and not merely topically, which can become

Homoeopathic remedies. From their list we reach these, ordinarily, by the rule “let likes

be treated by likes”. The similarity here required is, as we have seen, to be found in the

pathogenetic effects of drugs of drugs as compared with the phenomena of disease. To

establish it, therefore, a collection of such of these effects as had been hitherto observed,

and a systemic eliciting and recording of fresh ones, was necessary. This task was

initiated by Hahnemann, and has been continued by his followers, in the manner I have

already described from the four large volumes of his “materia medica pura” and “chronic

disease” and the similar number complementary thereto of the “cyclopaedia of drug

pathogenesy.

We have got, then our dynamic constitutionally, acting drugs; we have the record

of their effects of this kind in health. There are Hahnemann has pointed out, three modes

and three only, in which such application can be made.

• Having ascertained that a given substance has the power of exciting any bodily

function you give it in disease of other parts when you think such excitation desirable.

Thus you administer diuretic in Hydrothorax and pragmatics in apoplexy. It is not

kidney or bowels are inert and require rising to their normal activity, but it is that we

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think an exaggeration of their ordinary function likely to benefit the water – logged

pleura, or the congested brain.

Here there is no relationship between the physiological effects of the drug and

the phenomena of disease. They are foreign, the one to the other; we may fairly cell

the practice so exemplified Alloeo (or) Allo-pathic.

• The same discovery having been made, you apply your knowledge in dealing with

opposite conditions of such functions themselves. They give diuretic in Ischuria and

your purgative in constipation, and they administer paralyzing agent for spasm and

anaesthetic for pain. Here we are acting directly on the part affected and the

symptoms of drug and disease admit of true comparison. The relation between them

is expressed by the ancient formula. “CONTRARIA CONTRARIS” The practice is

enantio or Antipathic.

• But there is yet a third alternative still acting upon the part affected, you may give

your drug in morbid states thereof similar instead of opposite to its physiological

effects. You may administer your diuretic in polyuria, your cathartic in Diarrhoea:

you may treat mania with stramomium and tetanus with strychnia. If you do so, you

are, as Sir Thomas Watson recognized in regard of the later pick of practice, acting”

according to the Hahnemanic doctrine – SIMILIA SIMILIBUS CURANTUR – a

doctrine much older, however than Hahnemann” SIMILIA SIMILIBUS”

By cognate reason it is easy to show the superiority of the third or

Homoeopathic method. Like the Antipathic, it acts directly on the affected parts,

leaving healthy regions unharmed; but this last end it is more certain to secure, from

the non – perturbing dosage which answers its purpose. It is thus gentle in its manner,

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opening the closed door of the disease body, not by smashing the lock with a

crowbar, but by finding the proper key. Homoeopathic treatment, moreover, is

complete, it does not, like its rival, employ bits of physiological action, but opposes

wholes to wholes, tracking – by its investigation of the totality of symptoms – the

malady in its entire evolution and so reaching it in root as well as in branches.

For the law of action and Re-action which makes the secondary effects of

Antipathic palliatives injurious have operates beneficially.

He had already cited from the organon, the three further points – the safety of

the method, the superiority in KIND of the remedies it educes, and the success which

it has uniformly displayed when fairly contrasted with traditional medication.

The Antipathic and the Homoeopathic modes of applying the pathogenetic

effects of drugs to the treatment of disease have this advantage in common over the

Allopathic that they act directly on the affected parts and avoid disturbing those that

are healthy. But then, of the two, the Homoeopathic use commends itself to us by its

greater gentleness. The Antipathic drug has to oppose the morbid process that is

going on.

In Alleopathic and Antipathic medication alike they have to induce the

physiological action of drugs – that is, you employ them as poisons. In the

Homoeopathic we convert them into medicines. “Their whole physiological action”

as our lamented Drydale used to say” is absorbed into their therapeutics”. They need

no large quantities; and here come in one characteristic feature of Homoeopathy – the

smallness of its dosage.

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• But Homoeopathy has further claims than such negative ones as these. Its remedies

are inoffensive; they are non – perturbative, they are liable to do no injury from too

liberal or long – continued use, but they are also positive agents, of a kind which

forms, they highest DSIDERATA of medicine. Homoeopathy is specific medication

and SIMILA SIMILIBUS is an instrument for the discovery of specific – not for

types of disease merely, but for each individual case. Hahnemann claimed this place

for his method, simply “specific” and even after he had began in that year to use the

term Homoeopathic.

There could only be one challenge to this inference the appeal to facts. If in spite

of its pleasantness and harmlessness and of the theoretic promise of the remedies it

employs, homoeopathy had failed to hold its own in actual practice, we should have to

keep silence about it, and at the best wait for a brighter day.

The conclusion arrived at is that homoeopathic remedies are, from their nature,

from their negative advantages, and from the comparative results obtained with them, the

best that can be employed and such as should always be resorted to when practicable10.

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THE SELECTION OF SIMILAR REMEDY

That likes should – wherever practicable – be treated by likes and that the

elements of the comparison should ordinarily be the clinical features of diseases and the

symptoms produced by drugs in the healthy – these points have now been established can

be used as it would seem we could proceed at once to select our remedies.

It might have appeared to Hahnemann at first at the problem was thus simple. Put

in the fourth edition of the ‘organon’ (1829) he introduced a paragraph which recognized

the necessity for wider considerations. It is that numbered 85 in the fifth edition, which is

the one we have in our hands as translated by Dr. Dudgeon. i.e “useful to the physician

in assisting him to cure, are the particular of the most probable exciting cause of an acute

disease, as also the most significant points in the whole history of a chronic disease, to

enable him to discover its fundamental cause, which generally depends on a chronic

miasm. In these investigations, the apparent physicals on a chronic miasm. In these

investigations, the apparent physicals on a chromic miasm. In these investigations, the

apparent physical constitution of the patient (especially when the disease is chronic), his

moral and intellectual character, his occupation, mode of living and habits, his social and

domestic relations, his age, sexual functions etc to be taken into consideration.

There are, we will deserve, two distinct points made in this aphorism. The first is

that the causes of disease, predisposing and exciting are to be taken into account, not

merely that they may be removed where possible, but as guides to the selection of the

remedy. Thus, in choosing between Nux Vomica and pulsatilla in a case of dyspepsia, the

sex, temperament and disposition of the patient, as also the kind of food which most

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disagrees, go for something in including the balance; in prescribing for rheumatic pains,

we think of Aconite or Bryonia if dry cold, of Rhustox has been the enciting causes. If a

morbid condition is traceable to a fit of anger, we are thereby inclined to give chamomilla

for it, if to a fright Aconite or opium: if to long, continued depressing emotions,

phosphoric acid.

For complaints giving origin is an injury, Arnica is always useful, not only

immediately upon its reception, but long afterwards.

But Hahnemann speaks further of ascertaining the ‘fundamental cause’ of chronic

disease, which (he says) is generally a “chronic miasm” referring to his doctrine of the

origin of a large proportion of such disease in syphilis, sycosis or psora. This we have

discussed already as one of Hahnemann’s theories.

This question now is, why it is useful to have this causation known? Hahnemann

again shall speak for himself. In a note to §80 of the fifth edition of the ‘organon’.

How much greater cause is there now for rejoicing that the desired goal has been

so much more nearly attained in as much as the recently discovered and for more specific

Homoeopathic remedies for chronic affections resulting from psora (properly termed

antipsorics) and the special instructions for their preparation and employment, have been

published; and from among them the true physician can now select for his creative agents

those whose medicinal symptoms corresponds in the most similar manner to the chronic

disease he has to cure and thus from the employment of (Antipsorics) medicines more

suitable to this miasm.

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Now this is obviously bringing pathology to the aid odsymptomatology and

supplies another instances of its usefulness. Nor does is stand alone in Hahnemann’s

writings.

He ever recognized that there were certain number of disease of fixed type

acquiring this by origination from a specific cause; and to these he appropriated one or

more specific remedies, as always applicable and usually indispensable10.

Reference in Support of this statement

Hahenemann’s earliest and fullest utterance on the subject may be read in his

“Medicine of Experience” (1806) we observe, “he there writes, “a few disease that

always arise from one and the same cause Ex: the miasmatic remedies- Hydrophobia, the

venereal disease, the plague, yellow fever, small pose etc. Which bear upon them the

distinctive mark of always remaining disease of a peculiar character; and because they

arise from a contagious principle that always remains the same in character and pursue

the same course, excepting some accidental concomitant circumstances.

Another class of specific disease recognized by him here are the epidemic fevers.

There are not indeed to be referred to known types and treated accordingly, for each

epidemic has features of its own. However, it is the product of a single cause and all

instances of it are amenable to one and the same specific remedy, which is to be reached

by a study of the phenomena of several cases carried on untill the symptom totality of the

epidemic is reached and its similimum found (§73,100-102,235-242)11.

According to Hughes the most recent nosologists have attempted to do this; their

genera should be what I call the peculiar characteristics of each disease, their species the

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accidental circumstances, “later, in the” organon’, Hahnemann took a faster view of what

is specific and generic in disease.

Thus the “general symptoms”, which are characteristic of all fevers, should surely

be classed as generic; these marked and special symptoms”, which characterize the

particular epidemic under observation, as “specific”. We shall thus have another category

left, answering to the “varieties” of natural history; and in this we can place the

“accidental circumstances” of Hahnemann’s previous description, which are the

peculiarities due to the individual Idiosyncrasy.

Similarity between disease and drug action should thus be generic, specific and

individual.

1. Generic: Similarity is that expressed in the saying “NIL PROEST QUOD NON

LOEDIT IDEM” and “MAGIS VENENUM, MAGIS REMEDIUM”. To make

his case simile of drug action at all, a person must be ill ; on the other side of h e

be ill his remedy must be one capable of causing illness in the healthy, and the

more seriously ill he is, the more potent should be the poison with which he is

treated these are broad generalities, but they are the basis of Homoeopathy and

surer one from such breadth. If his illness is febrile, his remedy must be pyreto-

genetic; if the one be an inflammation, the other must be an irritant.

2. Specific similarity: (it use the word now it in its scientific not its medicinal

sense) implies the existence of species. These in natural history, means forms

capable of reproducing their kind; and such we have in the infectious diseases.

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The specific morbid states cannot be convinced of as having been fresh creations,

full blown at first and ever since the same. In this way the predispositions defines

of which Tessier speaks have been established resulting, under the action of

common causes, in fined forms of disease. In this way specific viruses,

themselves the seed of fresh disease of he same kind, have been slowly distilled in

the alembic of the organism, till they have become what they are

1. The first requisite for specific similarity is that the drug shall have the same seat

of action as the disease. Had already shown how provision is made for their

necessity in the rule that the totality of symptom is to be covered.

• Identity of seat is half the battle ; only half it is true, but to the have conquered so

far is fair promise of entire victory, and the promise is often fulfilled.

• The “Seat of disease contemplated by Dr. Sharp is, as his name for the method

implies, an ORGAN, but he is careful to postulate that the skin shall for such

purposes be accounted an organ. It is really a tissue and this leads us to see that

action upon the tissue involved in the disease is sufficient for specific similarity,

though there be no correspondence in the localization.

2. Seat of action is of such value in endeavour after specific similarity; but kind of

action is of no less importance by this he mean something more than was spoken

among the elements of generic similarity, viz that the pathological process shall

be the same – fever, inflammation, ulceration and so forth.

To reach the most suitable remedies for the qualities of morbid processes is no

easy task. It requires symptomatic comparison, pathological inference, analogy and

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clinical experience. In the superiority of colchicum in gouty inflammation to the bryonia

or pulsatella, the arthritis would otherwise demand, is an instance in point.

3. Another features of specific similarity is that modification of disease which its

originating cause impress upon it. It differs according as it is of physical or mental

origin and these classes have to be further sub-divided in rheumatism arising from

dry cold is one thing, from damp cold another.

4. Another useful point of comparison between disease and drug action is the

character of the pains and other sensations present. There is a reason why one

should complain of burning pain, another of tearing, of growing and so forth, use

we may not be able to explain it, but the kind of sensation present characteristics

the suffering of the drug which causes it. The burning pain of Arsenic is a good

example the more so because it is at present inexplicable. It has bee thought to

depend on mucous membrane being the seat of its action; but this cannot hold

good of its neuralgia, where it no less obtains.

5. Lastly of concomitance, that is the coincidence of two or more marked symptoms

in the pathogenesis of drug and in the phenomena of a disease. Its value rests on

the mathematical law of combination or as it is technically called permutations.

Then if three distinctive symptoms of a case can be found to have been excited by

a medicine, there is already considerable likelihood of its acting on the same parts

and in the same manner; and that the adds in its favour increase rapidly as the

points of analogy are multiplied.

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Seat of action, then, in organ or kind of action in diathesis or other quality in

causative modification in character of sensations, and in concomitance and sequence of

symptoms these are the main elements of specific similarity.

3. Individual Similarity: We have considered some of the elements which go to make

up generic and specific likeness and have now to see what can further be done by way of

making the similarity individual. That it should so be, if possible must be evident. Even

the essential, typical disease affect each subject in his own way, so that he presents a

variety of species and that which is distinctive in him must be taken into account.

Individualisation is as import in therapeutics as it confessedly is in education.

1. To almost every medicine of importance in homoeopathic practice has been assigned,

as it has become well known, a type of patient to whom it is suited. Eg. Bryonia

corresponds to brunettes of bilious tendencies and choleric temper, with firm flesh;

arsenic to worn and exhausted constitution; nux vomica to vigorous persons of dry

habits and tense fibre, addicted, it may be to “ high thinking” but not to “ plain

living”.

2. The mental and moral state of the patient is often a feature of his general

temperament, but it may also supervene in the course of his existing malady. It is a

matter on which Hahnemann always laid much stress.

“In all cases of disease” he wrote in the “organon” ( aph – 210 ), “That we are called

onto cure, the state of the patients” disposition is to be especially noted, along with

the totality of the symptoms, if we would trace an accurate picture of the disease, in

order to be able therefrom to treat it homoeopathically with success.

  83

This holds good to such an extent, that the state of the disposition of the patient often

chiefly determines the selection of the homoeopathic remedy.

3. Condition of aggravation and amelioration have always played a large part in

homoeopathic therapeutics and as there must be cause for them, it would be wrong to

ignore them, it is certainly of account of bryonia aggravated by motion, those of rhus

tox (at any rate after the first ) relieved by it; and here it may plansibly be suggested

that the difference depends on the more acute and inflammatory, like character of the

former. The increase of the head pains of belladonna on lying down and of those of

spigelia on stooping, the aggravation of lachesis after sleep, and the ameliorations of

nux vomica from the same cause.

4. The side of the body which is affected may be thought a thing of no moment some

when unilateral organs are concerned. Sometimes, indeed the determination of the

malady thereto may be thus accounted for, as when we find right supraorbital pain

associated with herpetic disorders, and calling for chelidonium, while on the left side

it is often traceable to the stomach and is relieved by kali bichromicum.

5. The time of day at which symptoms occur or undergo aggravation is made no small

account of by many homoeopathic practitioners. The pulsatilla in the evening were

early noted by Hahnemann, and we have since come to fix those of lycopodium for

4 p.m. Dr. Dunham here conducts his inidvidualisation by means of a single peculiar

symptom one of those of which we shall have here after to speak under the title of

“characteristic”.

This is ideal homoeopathy and should always be aimed at, but a very little

experience will show that it is always attainable. The deficiency may be either on the side

  84

of specific qualities or on that of individual features, or it may be on both. Clinical

experience will here often come to our aid, but if we homoeopathize it all, we must do it

by way of individualization by itself or by that of generalisation by itself.

Administration of similar remedy:

After obtaining the similar remedy, and have only to consider how to administer

it, as we divided its elements of similarity into generic, specific and individual, so let us

say that it should be administered, as a rule, singly, rarely, constitutionally and minutely.

The first there of these points will occupy our attention today.

Hahnemann, very early to entertain a strong aversion to the polypharmacy so

prevalent in his day. In the essay of 1791 are the obstacles to simplicity and certainity in

practical medicine, in surmount table? One of his points was the impossibility of

obtaining definite results unless remedies were given singly, and of his own practice at

this time he writer “Dare I confess that for many years I have never prescribed anything

but a single at once, and have never repeated the dose until the action of the former one

had ceased; a venesection alone, a purgative alone and always a simple, never a

compound, remedy and never a second until I had got a clear notion of the operation of

the first?”

In contrast to polypharmacy, homoeopathy has like its founder “dared to confers”

that the single remedy has always been the rule in its hand when we say “single, it must

of course be understood that we do not exclude the use of chemical compounds like that

of salts or of vegetables products, as opium, which analysis may find of complex

constitution. If we know their physiological action as simples then as simples they can be

employed. This matter of alteration requires some further treatment here. In the organon,

  85

Hahnemann from the first deprecated it, on the ground of the possible interference of the

two drugs one with another. In the last edition he disallows it on another ground. If he

waiter (δ169, 170) “on the first examination of a disease and he first select ion of a

medicine, we should find that the totality of the symptoms of the disease would not be

sufficiently covered by the disease elements of a single medicine – owing to the sufficient

member of known medicines, but that two medicines content for the preference in point

of appropriateness, one of which is more homoeopathically suitable for one part, the

other for another part of the symptoms of the disease, it is not advisable, after the

employment of the more suitable of the two medicines to administer the other without

fresh examination, for the medicine that seemed to be the next best might not, under the

change of circumstances that has in the mean time taken place, be suitable for the rest of

the symptoms that then remain, in which case consequently, a more appropriate.

Homoeopathic remedy must be selected in place of the second medicine, for the set of

symptoms as they appear on a new inspection10.

THE PHILOSOPHY OF HOMOEOPATHY:

• Is a method

• Reached by inductive generalization

• Tested by deductive verification

• Let likes be treated by likes

In homoeopathy similarly acting remedies were used but they are with in the

system of antipathy and allopathy? Ie primary action and secondary action.

  86

The 1st sage of the drug action into the 2nd stage, of the disease, there by filling up

a want, and not over powering an scatted diseased action by a still greater action.

• Drug selection – similar

• Drug action – contraria

Criticism of Richard Hughes:

Through out its history homoeopathy has been characterized by tow divergent

trends. Some homoeopaths such as Richard Hughes were confined to build bridges to

orthodox medicine and were reluctant to accept the nurse extreme homoeopathic

doctrines of vitalism, miasms and ultra high potencies and others, such as Constantine

Hering and James Tyler Kent, accepted these ideas enthusiastically and ignored

conventional medicine or rejected it out right. Richard Hughes criticizes

• Vital force

• Psora theory

• Drug dynamization10

Vital force: § 9

First of this hypothesis is vital force has been source of all the phenomena of life

and sphere in which disease begins and medicines acts. He early more over, employed the

turn “dynamic” to denote the sphere in which true disease took its origin and those effects

of drugs which require vitality for their production disease has it “Material morbid” and

organic changes; but all these may be Hahnemann would have it always were secondary

products and effects the primary derangement being invisible and intangible manifest

  87

only in altered sensations and functions. Drugs again produce many of them chemical and

mechanical effects but this might occur in the dead as in the living body.

Had he gone no further all would be well? it is easy to read into his language the

present, protoplasmic doctrine of life, while the frequent commencement of disease in

molecular rat her than molar changes and the dynamic as distinct form the mechanical

and the chemical action of drugs, are recognized by all. But in this later years

Hahnemann advanced from this thoroughly tenable position into one for less easy to

maintain. He adopted the view that vitality was a force analogue t o the physical

agencies so called, wit h out which the material organism would lack sensation and

energizes it doing life and leaves it at death this “vital force” (LEBENSKKAFT) which

primarily deranged in illness and on which morbific potencies both natural and medicinal

act through the sensory nerves. Its behavior under medicinal influence is ingeniously

imagined and elaborately described. δ-127 and in 5th edition of the organon it is

frequently mentioned as the action as suffer where previously another had been content to

speak of the organism.

Now Hahnemann can hardly be thought the worse of for entertaining this view,

since in some form a other, it was almost universally prevalent in his day. If the advice of

the present pope has been taken, It is still the teaching of all roman catholic itself derived

from Aristotle recent science is to regard the organism as no monarchy, wherein some

archaens lives and rules, but as a republic in which every part is equally republic in which

every part is equally alive and independently active, the unity of the whole being secured

only by the common circulation and the universal telegraphic system of nerves. It is

unfortunate. Therefore, that Hahnemann should have committed himself and his work to

  88

another conception, either a neither may be wholly true, but one would have been glad if

the “organon” had kept itself clear of such questions. And had occupied only the solid

ground of observation and experiment11.

PSORA THEORY:

This is far two large a subject if for justice to be done it here, a certain proportion

of the affections so characterized were traceable to veneral infection syphilitic (or)

sycotic it (gonorrheal) an it seemed to him that the remaining govern – eights must have

some analogous “miasmatic” origin. In the medical literature of his day he found

numerous observations of he superventions of such disease upon the suppressing of

cutaneous eruption of such diseases among which scabies then very prevalent held a

prominent place. In this last he had found the miasm he wanted it resembled syphilis in

its communication by contact, its stage of incubation, and its local development.

While it was for more general. He there upon propounded it as together with the

other contagious skin affections, the tinea etc, which he regarded as varieties of it the

source of the non specific chronic diseases, understood as defined.

Now It is easy for us, knowing what we know (or suppose we know) about its to

make merry over this theory of Hahnemann’s but to condemn or ridicule him for it, is a

gross anachronism.

Learned physicians of his time, knew all about it, and had in 1792 written upon it,

he nevertheless, in 1816, described scabies as specific miasmatic disorder, forming itself

in the organism after contagion (as syphilis toes) and announcing by the itch vesicle its

complete development within it was thus regarded t hat the propounded it as the origin of

  89

so much chronic disease we understanding it better, must refuse it such a place, but when

we look beneath the surface of his doctrine, we find it far from being bound up with his

view of scabies12.

DRUG DYNAMIZATION:

Theory of drug dynamization is a subject quite distinct forms that of infinitesimal

dosage. We have seen that Hahnemann was led to adopt and defined the later on grounds

whose legitimacy all must admit, what eve they may think of their validity,

Hahnemann’s dynamization in the light later science must be held untenable, but to this

day we have nothing to put in its place and eve if we had, we should not less honor the

philosopher who perceived the necessity of the explanation, who brought to light the

hitherto unknown phenomena and set us to work at giving a scientific account of them.

I must advice you to reject the preparations, not so much upon the grounds of

science and reason as upon those of pharmacy. They are simple impossibilities. It has

been calculated that to make the millionth potency of a single medicine according to

Hahnemann’s instructions would require 2,000 gallons of alcohol and would occupy

more than a year in the process which is practically impossible10.

  90

REPERTORIAL APPROACH

REPERTORY TO THE CYCLOPEDIA OF DRUG PATHOGENECITY

OUTLINE OF SCHEMA – RESPIRATORY ORGANS

Nose

External

Inflammation

Sensations

Swellings

Internal

Pains

Catarrah

Coryza

Dryness

Epistaxis

Inflammation

Sensations

Sneezing

Soreness

Throbbing

Smell

Anosmia

Hyperosmia

Illusomy

Perverted

  91

Larynx and Trachea

Pains

Burning

Cough

Inflammation

Irritation

Laryngismus

Mucus In

Paralysis

Roughness

Sensations

Swelling

Voice Hoarse

Lost

Sudden

Weak

Other Alterations

Brhonchi and Lungs

Asthma

Breath, Altered

Bronchitis

Bronchorrhoea

Catarrh

Congestion (of Lungs)

Constriction (of Chest)

  92

Emphysema (of Lungs)

Expectoration

Haemoptysis

Edema (of Lung)

Oppressions

Pain

Paralysis (of Lungs)

Pneumonia

Sensations

Respiration, Difficult

Interrupted

Irregular

Laboured

Noisy

Painful

Paralyzed

Quickened

Retarded

Short

Sighing

Suspended

P.M. Pneumonia

Chest Walls

Pains

Sensations

  93

Spasm

Swelling

Tenderness

Pleura

Diaphragm

Generalities

Adiposis

Attacks

Bones

Cachexia

Cancer

Carbuncle

Cyanosis

Dropsy, Serous Sacs

Surface

Emphysems (Cutaneous)

Erethism

Gangrene

Glands

Hysteria

Jaundice

Joints

Modalities

Muscles

Neurits, Peripheral

  94

Pthisis

Prostration

Restlessness

Scrofula

Sedation

Status Pituitosus

Steatosis

Stiffness

Stimulation

Typhoid Conditions

Wasting

Weakness

Weariness13

Table 2: Difference between Hahnemannian and Hughesian concepts

Hahnemannian Hughesian • Added other medicines to Sycosis &

Syphilis acc.to stages of pathology • First person attempted to modify the

terms miasm or psora as morbid diathesis

• Attempted to update pathology in homoeopathy according to his study and experience

• Confidence in oneself & Boldness to tell what he practiced and hence not a blind follower of Hahnemann so that became a true disciple.

• It was a materialistic study and hence superficial and confused

• It is a partial study as many things in chronic diseases regarding suppression, direction of cure, anamnesis, constitution and temperament etc. were not highlighted

• Did not made attempts to explain miasms in depth and criticize it on pathological (allopathy) basis and terms used in that time.

• Not willing to commit himself in saying Hahnemann had fore visions.

• Inability to realize higher potencies and their good effect in chronic diseases

• Diluting the concept of Individualization

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Materials & Methods

 

  95

MATERIALS AND METHODS

This work includes cases which were selected keeping in mind the need to

highlight the Richard Hughes view on Homoeopathic Philosophy and its practical utility.

For a Successful achievement of aims and objectives of the case, study should be in a

systemic way.

The materials used for the study were

1. Standardized Case Record (SCR)

2. Master Chart

SCR:

Cases were recorded in the standardized case record, as well as I.P.D charts.

Information obtained in an ordinary and sequential manner like chief complaint, history

of chief complaints past history, family history, physical attributes, life space

investigations with derivation of intellectual emotional status with reactions and

examinations findings which enable to arrive at therapeutic problem definition and

resolution.

INCLUSION CRITERIA

1. Samples of both sex and all ages

2. Suffering from chronic disease of the respiratory system

3. Had continued Homoeopathic treatment for at least more than 3 months

 

  96

EXCLUSION CRITERIA

1. Dropped out (or) those cases which have not regularly attending for follow-up

2. Paediatric cases were not taken up for the study

METHODOLOGY

Cases were selected randomly from the Fr. Muller Homoeopathic Medical

College Hospital Out Patient Department.

• A minimum of 30 cases will be selected randomly as per the inclusion criteria and

will be followed for a minimum period of 3 months to 1 year of duration.

• Every case will be worked out with Hughesian philosophy

• Each case will be evaluated after the treatment

• The Group of patients selected was from both sexes and all ages.

• A total of 30 patients presented with respiratory disorders were included for this

study.

• Diagnosis was based on the clinical presentation and examination findings and

investigations.

• The name, age sex, religion and detailed history of each patient were recorded in

SCR considering age of onset, duration of complaints, peculiar sensation and

modalities, details of any previous treatment, family history.

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• All the patients were examined in detail for the presenting complaints sequence

and prodrome of the episode, any associated complaints like, Diabetes mellitus,

Rheumatic fever, IHD, Osteoarthritis, Cerebrovascular accidents etc.

• A through systemic examination was done in each case

• References from materia medica and repertories of Richard Hughes were done.

• Follow up criteria were made for every case

• Potency selection and repetition of medicines varied according to the need of the

case

In this study the patient’s who were treated in Fr. Muller Homoeopathic Medical

College, OPD were taken for the study, where I used Richard Hughes principles and his

philosophy to find out the similimum.

  98

Results

 

  98

RESULTS

30 patients who were treated in Fr. Muller Homoeopathic Medical College

Hospital out patient Department with respiratory disorders were taken for the study.

These cases were subjected to statistical study and their analysis is as follows.

Table 3: Distribution of cases According to Gender

Sex No. of Cases Percentage

Male 11 36.6%

Female 19 63.3%

The incidence of male : female ratio for respiratory disorder in out patient

department for the 30 cases was 11(36.6%) males and 19(63.3%) females.

Figure 3: Distribution of cases According to Gender

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Table 4: Distribution of cases According to the Age group

Age Male Percentage Female Percentage Total

15-25 2 6.6% 2 6.6% 4

25-35 2 6.6% 2 6.6% 4

35-45 3 10% 2 6.6% 5

45-55 1 3.3% 2 6.6% 3

55-65 5 16.6% 4 13.3% 9

65-75 2 6.6% 3 10% 5

In this 30case study the maximum prevalence of respiratory disorder, 9 cases

were noted in the age group between 55-65 yrs in that 5 cases were belonging to male

category (16.6%), and 4 cases were belonging to female category (13.3%), 5 cases each

were noted in the age groups between 35-45yrs and 65-75yrs in that 3 cases (10%) were

belonging to male category 2 cases (6.6%) were belonging to female category similarly, 2

cases (6.6%) belonging to male and 3 cases belonging to female category respectively, 4

cases (13.3%) were noted in the age groups between 15-25yrs, 25-35 yrs in that 2 cases

(6.6%) were males and 2 cases (6.6%) were females. 3 cases (10%) was noted in the age

group between 45-55 yrs in that 1 case (3.3%) belonging to male and 2 cases (6.6%)

belonging to female category

  100

Figure 4: Distribution of cases According to the Age group

  101

Table 5 : Distribution of cases According to Diagnosis

Diagnosis No. of Cases Percentage 1. Allergic Rhinitis 4 13.3% 2. Bronchitis 2 6.6% 3. Brhonchiectasis 1 3.3% 4. Bronchial Asthma 15 50% 5. COPD 2 6.6% 6. Eosinophilia 2 6.6% 7. LRTI 1 3.3% 8. Pharyngitis 2 6.6% 9. Tuberculosis 1 3.3%

In this 30 case study the maximum prevalence of respiratory disorder present was

Bronchial Asthma 15 cases (50%), Allergic Rhinitis 4 cases (13.3%), 2 cases (6.6%) each

with Bronchitis, COPD, Eosinophilia and pharyngitis, 1 cases (3.3%) each with

brhonchiectasis, LRTI and tuberculosis.

Figure 5: Distribution of cases According to Diagnosis

  102

Table 6: Distribution of cases According to Totality

Totality No. of Cases Percentage

Generic 5 16.6%

Specific 12 40%

Individual 12 40%

In this 30 cases study the maximum prevalence of 12 cases (40%) each were

presented with specific and individual totality, 5 cases (16.6%) presented with generic

totality.

Figure 6: Distribution of cases According to Totality

  103

Table 7: Distribution of cases According to Associated Complaints

Diseases No. of Cases Percentage

1. Amenorrhoea 1 3.3%

2. Arthritis 1 3.3%

3. Diabetes Mellitus 3 10%

4. Hypertension 2 6.6%

5. Low back pain 1 3.3%

6. Osteo Arthritis 1 3.3%

7. Sinusitis 1 3.3%

8. UTI 1 3.3%

9. Urticaria 1 3.3%

10. Vertigo 1 3.3%

Out of 30 case study maximum prevalence of 3 case (10%) presented with

associated complaints of Diabetes mellitus, 2 cases (6.6%) with Hypertension. And one

case (3.3% ) of each presented with Amenorrhoea, Arthritis, low back pain, osteoarthritis,

sinusitis, UTI, urticaria and vertigo.

  104

Figure 7: Distribution of cases According to Associated Complaints

  105

Table 8 : Distribution of cases According to the duration of treatment in OPD

Duration in months No. of Cases Percentage

0-2 2 6.6%

2-3 0 0%

3-4 9 30%

4-5 4 13.3%

5-6 1 3.3%

6-7 2 6.6%

7-8 1 3.3%

8-9 2 6.6%

9-10 0 0%

10-< 9 30%

Out of 30 cases, 9 cases (30%) each were on the course of treatment for 3-4

months and more than 10 months, 4 cases (13.3%) for 4-5 months, 2 cases (6.6%) each

for 0-2 months, 6-7 months and 8-9 months, 1 case (3.3%) each for 5-6 months and 7-8

months respectively.

  106

Figure 8: Distribution of cases According to the duration of treatment in OPD

  107

Table 9: Distribution of cases According to Analysis of Result

Result No. of Cases Percentage

Unchanged 11 36.6%

Improved 15 50%

On Improving 1 3.3%

Recovered - 0%

Worse 2 6.6%

Cured 1 3.3%

Out of 30 cases study 15 cases (50%) were Improved Symptomatically, 11 cases

(36.6%) were unchanged, 2 cases (6.6%) become worse , 1 case (3.3%) each were on

improving and cured.

Figure 9: Distribution of cases According to Analysis of Result

  108

Table 10: Potency distribution of the cases

Potency φ 6C 30 200

φ 1

6C 2

30 12 5

200 6

Out of 30 cases, 12 cases were started with 30 potency and continued in same

potency. In 5 cases started with 30 potency. In 5 cases started with 30 potency and

followed by 200 potency. 6 cases were started with 200 potency and continue the same. 2

cases started with 6c potency and continued same 1 case started with φ

  109

Discussion

 

  109

DISCUSSION

The current study is a comprehensive study of Richard Hughes Philosophy and

his concept in clinical practice.

The subjects of the study were selected from those patients with chronic

respiratory disorders attending OPD of Fr. Muller Homoeopathic Medical College

Hospital, as per inclusion criteria. A total of 30 cases were selected and presented in the

Standardized Case Record (SCR). Minimum duration of study was of 3 months. 3 months

was also considered for analysis.

All the cases between the age group 15-75 years were selected for the study.

These cases were diagnosed based on clinical History and clinical examination. Subjects

who have associated psychiatric condition, pediatric and dropped out cases were

excluded from the study.

For the assessment of the clinical status before, during and after treatment follow-

up criterias were used.

Out of 30 cases, majority of patients belong to the age group of 55-65,

constituting around 30% out of 30 case studied, 19 were females and 11 were males.

Maximum number of female patients top the age group 55-65 around 16.6%.

In the study group maximum prevalence of respiratory disease noted is Bronchial

Asthma (50%).

Out of 30 case study 12 cases (40%) of each were treated according to specific

and individual similarity of Richard Hughes Philosophy.

Out of 30 cases 9 cases (30%) each were on course of treatment with Regular

follow-up in OPD for more than 3 and 10 months respectively.

  110

Conclusion 

  110

CONCLUSION

• Prevalence of respiratory disease was seen more in females (63.3%)

• Maximum prevalence was noted in the age group between 55-65 years

• Maximum prevalence of Respiratory disease noted is Bronchial Asthma (50%)

• Maximum number of cases presented with associated complaint of Diabetes

Mellitus 10%

• Out of 30 cases 12 cases of each are treated according to specific and individual

similarity (40%)

• Out of 30 cases 9 cases of each were on course of treatment in OPD fore more

than 3 and 10 months 30%.

LIMITATIONS

The limitations encountered during the study were the following

• As the study was done on the patients treated in out patient department, in

majority of cases, the long term effects of the homoeopathic medicines were not

studied due to the time limit.

• As there is no much extensive investigation procedure was used in this study, the

differentiation of causes and diagnosis of cases done with the history and basic

investigation chest x-ray for few cases

  111

• There were no control groups, because of sample size

• This study would have been still better if the blinding technique would have been

included considering the time and sample size it was not followed in this study.

• Study of single respiratory disease entity would have provided better inferences

• There was difficulty in framing the analysis of totality because of inadequate data

and most of the cases were not presented with picture completely according to

Richard Hughes philosophy

• Follow up criterias were not analysed strictly in few cases

• Few cases were prescribed with higher potencies which is not according to the

philosophy

RECOMMENDATION

1. Bigger sample , with extended time of research would provide better result

2. This study confined only to chronic respiratory disorders, it would be better to

study at all disorders.

3. Hughes concept of posology can be considered in future studies.

  112

Summary

 

  112

SUMMARY

A total of 30 cases were selected for the study based on the inclusion and the

exclusion criteria. Same group was used as control and intervention group. Cases were

followed regularly and at the end of the study, arrived at certain conclusion.

In this study, majority were in 55-65 age group, Predominantly females, Many of

the cases presented in specific and individual similarity according to Richard Hughes

Philosophy. Majority of cases not showed significant improvement. Treatment based on

Individual similarity required only infrequent repetition of the indicated medicine.

Concept of Hughes doesn’t follow all cardinal principles of homoeopathy. Assessment of

the disease symptom and drug pathogensy played major role in the selection remedy and

potency.

  113

Bibliography  

  113

BIBLIOGRAPHY

1. Datta A.K. Essentials of Human Anatomy, Vol-1, 6th edition, Reprint. Kolkata:

Current Book International. 2004. p.24-45.

2. Chaurasia’s B.D. Human Anatomy Vol-I. 4th edition. New Delhi: CBS Publishers

and distributors; 2004. p. 217-231.

3. Singh Inderbir. Text book of Anatomy with colur atlas Vol-II. 4th edition. New

Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2007. p. 454-460.

4. Netter H. Franklin, Atlas of Human Anatomy. 4th edition, Pennsylvania: Elsevier

inc; 2006.p.198, 201.

5. Singh Inderbir. Textbook of Human Histology. 5th edition, New Delhi: Jaypee

brothers Medical Publishers (P) Ltd; 2006. p. 216-222.

6. Derrickon Bryan; Toratra. J Gurard.Principles of Anatomy and Physiology. 11th

edition. New Jersey: John Wiley and Sons, Inc. p.848.

7. Walker R. Brian; Colledge R. Nicki; Boon A. Nicholas. Davidson’s Principles

and Practice of Medicine, 20th edition. Edinburgh; Elsevier inc; 2006. p. 651-737.

8. Mohan Harsh. Text Book of Pathology. 5th edition. Jaypee Brothers Medical

Publishers (P) Ltd; p. 537-549

9. www.homoeocases.org/atticle.aso, 4/11/09.

10. Hughes Richard. The principles and practice of Homoeopathy. Reprint edition.

New Delhi: B. Jain Publishers (P) Ltd.; 1999. p. 1-179.

  114

11. Hahnemann Samuel. Organon of Medicine. 6th edition. New Delhi: Indian Books

and Periodical Publishers; p. 58.

12. Hahnemann Samuel. Chronic disease Vol-1. New Delhi: B. Jain Publishers (P)

Ltd. p.167-170.

13. www.homeoint.com 29/10/09

14. Hughes Richard. A course of lectures. The knowledge of the physician. Reprint

edition New Delhi: B. Jain Publishers (P) Ltd; 2000: p. 22-45.

15. Hughes Richard. A Repertory to the cyclopaedia of Drug Pathogenesy. Reprint

edition. New Delhi: B. Jain Publishers (P) Ltd; 1992: p. 26

16. www.similima.com 4/11/09

17. www.hpathy.com. 27/10/09.

18. Nicholas PA. British Homoeopathic Journal. 1991.9.201.

19. Hughes Richard. A manual of Pharmacodynamics, 6th edition. New Delhi: B.Jain

Publishers (P) Ltd; p. 17-106.

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  115

Annexures  

  115

ANNEXURE - I

CASE - 1

PRELIMINARY DATA

Name : Mrs. G.A.

Age : 69 Years

Sex : Female

Religion : Hindu

Occupation : Beedi Rolling

Marital Status: Married

Date : 8/7/10

Reg. No. : 18098/10

CHIEF COMPLAINT

LOCATION SENSATION MODALITY CONCOMITANT

Respiratory System

Chest

Since 6 months

Taken Allo Rx , Ayur Rx but not better

o Dry cough

o Constricted pain in throat

o Dyspnoea

o Difficulty in Expectoration

< inspiration

< 12.00 – 1.00 am

< Cold exposure

< Lying down

> Rest

> Warm drinks

Weakness

Decreased sleep

HISTORY OF CHIEF COMPLAINTS:

Patient was apparently wells 6 months back, gradually started with complaints of

cough with difficulty in sputum and dryness in throat for which she had taken Allopathic

and Ayruvedic treatment but not better.

  116

Her complaints gets worse during inspiratory phase, before midnight (12.00-

1.00am), Exposure to cold and while lying down, feels better on Rest and by taking warm

drinks. Her complaints are associated with weakness and disturbed sleep

PAST HISTORY

Nothing Significant

FAMILY HISTORY

Fa - HTN

Mo - Asthmatic

PATIENT AS A PERSON

Appearance : Lean

Appetite : Decreased

Thirst : decreased

Cravings : Fish, veg

Aversion : Spinach

Bowel : Regular, 1-2 times/ day

Bladder : 4-5 times / day

Sleep : Disturbed due to complaint

Thermal State : Chilly Patient

Mental Constitution

o Anger – irritable

o Fear of disease

o Anxiety about health

  117

GENERAL PHYSICAL EXAMINATION

Patient is Moderately built and nourished

No signs of pallor, Cyanosis, Icterus, clubbing, Oedema , Lymphadenopathy.

Vital signs

Temperature: Afebrile

Pulse: 74 /min regular, good volume normal in character

No pallor, cyanosis, clubbing, icterus.

Local examination

Respiratory system

Upper respiratory tract : NAD

Lower respiratory tract :

Inspection :

Trachea centrally placed respiratory movements are bilaterally symmetrical

No visible pulsation no scar marks accesspry muscles are acting

Palpation :

Inspectory finding are confined, no tenderness respiratory movements are bilaterally

symmetrical apical pulsation felt in left 5th intercoastal space tactile vocal resonance –

normal.

Percussion:

Resonance all over the lung field normal cardiac and liver dullness

Auscultation:

Rhonchi all over the lung field, no crepitation

  118

Provisional diagnosis:

Extrinsic bronchial asthma:

A/F dust, change of weather

cough with breathlessness < night, cold food

with scanty expectoration

On examination: Rhonchi occasionally

FH of bronchial asthma

Differential diagnosis: Bronchitis it usually with purulent expectoration,expectoration

absent in this case and also crepitation is marked in bronchitis which is absent in this

case.

Generic Totality according to Hughes

- Dry (spasmodic) cough

- Scanty and difficulty in expectoration

- Constricted sensation in throat

- Dyspnoea

- Worse during inspiration and before mid night

- Weakness.

First Prescription

Rx

1. Spongia 6

3-0-3

2. 3 grain tab

1-0-1

  119

FOLLOW- UP CRITERIA

o Cough and dryness

o Constriction of throat

o Breathlessness

o Expectoration

o Weakness

Follow ups

Date. Symptom changes. Prescription.

1 2 3 4 5 > > S S ↓

22/7/10

Rx 1. No ii pills

3-0-3 2. 3 grain tablets 1-0-1

1 2 3 4 5 >+ > S > ↓↓

5/8/10

Rx 1. No ii pills

3-0-3 2. 3 grain tablets 1-0-1

1 2 3 4 5 ↑ S S S ↓

19/08/10

C/o cough with breathlessness Since a week O/E Chest – B/L Rhonchi+

BP – 150/90

Rx 1. Spongia 6 3-0-3 2. 3 gr tab 1-0-1 3. SL packets 0-1-0

1 2 3 4 5 > > > + ↓↓

2/9/10

O/E – Chest occational Rhonchi+ BP – 130/90mmHg

Rx 1. No ii pills 3-0-3 2. 3 gr tab 1-0-1

  120

1 2 3 4 5 > + >+ > > ↓↓

21/9/10

Rx 1. No ii pills 3-0-3 2. 3 gr tab 1-0-1

1 2 3 4 5 ↑ ↑ ↑ + ↓↓

5/10/10

C/o cough since 4 days < cold exposure Breathlessness+

Difficulty in Expectoration+

Rx 1. Spongia 200 (3P) 1-0-1 2. 3 gr tab 1-0-1

  121

CASE - 2

PRELIMINARY DATA

Name : Mrs. L

Age : 61 Years

Sex : Female

Religion : Hindu

Occupation : Beedi Rolling

Marrital Status: Married

Date : 4/12/2009

Reg. No. : 15749/09

CHIEF COMPLAINT

LOCATION SENSATION MODALITY CONCOMITANT

1. Respiratory system

Since 7-8yrs

Increased since 2 weeks

o Dyspnoea3

o Cough(dry)

o Scanty, difficult expectoration

o Think and sticky sputum

< exertion3

< cold weather3+

< Dust exposure2

< Night2

> Warm drinks2

< Evening (7.30pm)

> Sitting2

Weakness

Skin

Since 2 yrs

- Itching

- Blackish discoloration

< Rainy season2

  122

HISTORY OF CHIEF COMPALINTS:

Patient was apparently wells 6 months back, gradually started with complaints of

severe cough with expectoration for which she had taken allopathic medication but not

better.

Her complaints used to get worse on exertion, exertion, climbing up, evening and

feels better on Rest and warm drinks etc.

PAST HISTORY

OA knee

Allergic dermatitis

FAMILY HISTORY

Fa - Ca, stomach

Sr -

Mo - Bronchial Asthma

Br -

PATIENT AS A PERSON

Appearance : Stocky

Appetite : Decreased

Thirst : Increased

Cravings : Fish

Perspiration : Decreased

Bowel/Bladder : Regular, Generally No change

Sleep : Disturbed due to complaint

Thermal State : Chilly Patient C3H2

  123

Mental Constitution

o A/F – fathers deaths

o Exhausted feeling

o Intellectual state

o Anguish

o Fear

o Metrological – Chilly Patient

GENERAL PHYSICAL EXAMINATION

Patient is moderately built and nourished

No signs of pallor, Cyanosis, Icterus, clubbing, Oedema, Lymphadenopathy.

VITAL SIGNS

Temperature - Afebrile

Pulse - 104minute – Regular rhythm, moderate volume, vessel wall not

palpable

Pulse - 24 breaths/ minute

BP - 120/80 mmHg

LOCAL EXAMINATION

Respiratory System

Inspection

- No visible scars, dilated veins, (or) precordial bulge seen

- Trachea seems to be centrally place

- Respiratory movements seems to be bilaterally symmetrical

  124

Percussion

o Hyper resonant node over lung fields

o Normal cardiac and liver dullness felt

Auscultation

o Bilateral air entry equal and symmetrical

o Bilateral rhonchi and crepitations heard

SYSTEMIC EXAMINATION

Cardiovascular System

S1S2 heard, No added sounds

PROVISIONAL DIAGNOSIS

Bronchial Asthma

o Dyspnoea

o Cough with scanty whitish expectoration

o Aggravation during cold weather, exertion, better by sitting and warm drinks

o Family History of Bronchial Asthma

O/E Rhonchi+ B/L

DIFFERENTIAL DIAGNOSIS

Chronic Bronchitis

R/o – Since there is no characteristics productive cough which persist predominately on

most of the days. Hence it is ruled out.

Specific totality

Location

Respiratory system – lungs, Bronchial tree

  125

Sensation

- Dyspnoea (Oppression)

- Dry cough

- Scanty Expectoration

Modalities

- < Evening 7.30 pm

- < Night

- < Cold Exposure

- < Exertion

- > Sitting drinks

- > Warm drinks

Concomitance - Nil

General Management

a. Adequate Rest

b. Avoid cold exposure and cold food and drinks

First Prescription

Rx

1. Ars. Alb 6

4-4-4

2. 3 grain tab SL

1-1-1

FOLLOW- UP CRITERIA

o Dyspnoea

o Cough

  126

o Expectoration

o Weakness

o Chest – Rhonchi+ and crepitation

Follow ups

Date. Symptom changes. Prescription.

1 2 3 4 5 S S S S +

18/12/10

O/E Temperature – Normal BP – 130/70 Chest – B/L Rhonchi+, Creps+

Rx 1. SL Packets

(12) (1P) HS 2. 3 grain tablets 1-1-1

1 2 3 4 5 > S > > ↓

01/01/2010

O/E Chest Rhonchi-

Creps+

Rx 1. SL Packet

1P HS x 15days

2. 3 grain tab 1-1-1

1 2 3 4 5 ↑ sd since 1 wk

+ + >+ ↓↓ 22/01/10

O/E – Temp – Afebrile BP – 120/80 Chest – Creps + Lt – side

Rx 1. Ars. Alb 30

4-0-4

1 2 3 4 5 > > + + ↓

19/2/10

O/E: BP 130/80 Chest – Creps+

Rx 1. SL packets (1P) HS x 1 month 2. 3 gr tab 1-0-1x1 month

  127

CASE - 3

PRELIMINARY DATA

Name : Mrs. S. A.

Age : 35 Years

Sex : Female

Religion : Hindu

Occupation : Nil

Marital Status: Married

Date : 24/9/10

Reg. No. : 18975

CHIEF COMPLAINT

LOCATION SENSATION MODALITY CONCOMITANT

1. Respiratory System:

> 6 months

Taken Allo Rx but not better

o Cough3 (Dry)

o Expectoration2 whitish

< Night3

< Lying2

> Day time2

> cold drinks3

> after expectorating

- Weight loss

- Weakness

HISTORY OF CHIEF COMPALINTS:

Patient was apparently well 6 months back, gradually started with complaints of

severe cough with expectoration for which she had taken allopathic medication but not

better.

Her complaints gets worse during night, lying while, by taking cold food and

drinks and feels better during daytime, warm drinks and by expectorating. Her respiratory

complaints are associated with weakness and weight loss.

  128

No H/o – chest pain, fever, dyspnoea, Hemoptysis

PAST HISTORY

Nothing significant

FAMILY HISTORY

Fa - DM, HTN

Mo - ?Psychiatric / Dementia

Sr - Respiratory complaints

PATIENT AS A PERSON

Appearance : Moderately built and nourished

Appetite : Good

Thirst : Decreased

Cravings : Curd3, Pickles3, spicy3

Aversion : Sweets3

Perspiration : Increased on palms / soles

Bowel : Regular once/day

Bladder : 2-3 times/ day

Sleep : Disturbed due to complaint

Dreams : Nothing significant

Thermal State : Hot patient H3C2

Mental Constitution

o Weepy Nature

o Anxiousness

o Fear of dead bodies

  129

o Sympathetic

GENERAL PHYSICAL EXAMINATION

Patient is moderately built and nourished

No signs of pallor, Cyanosis, Icterus, clubbing, Oedema , Lymphadenopathy.

VITAL SIGNS

Temperature - Afebrile

BP - 140/90 mmHg

Pulse - 76 beats/ mt, Regular rhythm, moderate volume,

Vessel wall not palpable

Respirator rate - 18 breaths / mt

LOCAL EXAMINATION

Respiratory System

Inspection

- No visible scars, dilated veins (or) precordial bulge seen

- Trachea seems to be centrally placed

- Respiratory movements seems to be bilaterally symmetrical

Palpation

o Inspectory findings were confirmed

Percussion

o Normal resonant node heard all over lung field

o Normal cardiac and liver dullness felt

  130

Auscultation

o Bilateral air entry equal

o B/L Rhonchi+

SYSTEMIC EXAMINATION

Cardiovascular System

S1S2 heard, No added sounds

PROVISIONAL DIAGNOSIS – BRONCHITIS

o Prominent cough

o Expectoration

o Recurrent cough since > 6 months

O/E Rhonchi+ B/L

DIFFERENTIAL DIAGNOSIS

Pulmonary Tuberculosis

R/o – Since there is no significant weight loss evening rise of temperature, sweating,

Hemoptysis. Hence it is ruled out

Individual similarity according to Hughes classification

1. Mental and moral state

o Weepy nature

o Anxiousness

o Fear of dead bodies

o Sympathetic

2. Modalities

o < Night

  131

o < lying

o > Day time

o > Cold food and drinks

3. Side affection – Nothing significant

4. Time Modality

< Night3

> Day time

5. Characteristics

o Dry cough

o Expectoration thick whitish

o Weakness

First Prescription

Rx

1. Pulsatilla 30(3P)

1-0-1

2. SL Pills

4-4-0

3. 3 grain tablets

0-0-1

FOLLOW- UP CRITERIA

o Cough

o Expectoration difficult

o Weakness

  132

o Appetite

o Sleep

o Chest – examination

Date. Symptom changes. Prescription.

1 2 3 4 5

S S S S S

1/10/10

O/E Chest – clear

Rx

1. Puls 30 (3P)

1-0-1

2. SL Packet

0-0-1

1 2 3 4 5

S > S S S

8/10/2010

O/E BP – 140/70

Chest – clear

Rx

1. SL Packet

0-0-1

3. Puls (0)

1-0-1 (3P)

1 2 3 4 5

> ↓↓ ↓ G G

4/11/10

O/E Chest – clear

Rx

1. Puls 30

0-0-4

4. 3 grain tab

1-1-0

  133

ANNEXURE – II : MASTER CHART

Totality according to Hughes Philosophy Sl. No. Preliminary data

Diagnosis Generic Specific Individual

Association complaints

Remedy given Duration Inference

1. Mrs. G, 69yrs, F Married Derlakatte Reg No. 18098 Date – 8/7/10

B.A • Dry cough (spasmodic)

• Chest pain (Burning)

• Oppression of chest

• Difficulty in expectoration <climbing up

• Constricted sensation in throat

Spongia 6 3mths Improved

2. Mrs. A.P. 45yrs, F Married Reg. No. 14334 Date : 27/7/09

B.A with A/C bronchitis

• Cough with breathlessness

• Scanty expectoration, thick yellowish

• Hemophysis

Dyspepsia LBP

Blatta or 3x Nat Sulp 200

5mths Unchanged

3. Mr. U.S. 65yrs, M Married, Belthangady, Reg. No. 58050 Date : 5/10/10

B.A. • Scanty white expectoration

• Cough with difficulty

• Rattling in chest

• Dysponoea on exertion

Kali Mur 6x

3mths Improved

  134

Totality according to Hughes Philosophy Sl. No. Preliminary data

Diagnosis Generic Specific Individual

Association complaints

Remedy given Duration Inference

4. Mrs. T. D, 60yrs, F Married Kodikal Reg. No. 58177 Date : 12/10/2010

C/C: pharyngitis

• Dryness and burning in throat

• Constricted sensation

• Short cough • Sore throat • Itching in

throat

Spongia 30

6mths Improved

5. Mrs. S.B., 65yrs, M Married Manjanady Reg. No. 18426 Date : 06/8/10

Allergic rhinitis

• Sneezing • Coryza

offensive • Blockage of

nostrils (right side)

• <weather change

Pulsatilla 30

10 mths improved

6. M r. T, 30yrs, M. Married Reg. No. 12646 Date : 19/12/08

Allergic rhinitis

• Location –URT, nostrils

• A/F: exposure to cold

Sensation • Sneezing • Thin watery coryza • Burning sensation

in nostrils Modalities: <cold, <dust; >warmth Concomitance – watering of eyes / itching

Ars Alb 30

1yr Improved

  135

Totality according to Hughes Philosophy Sl.

No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

7. Ms. N, 55yrs, F Derlakatte Reg. No. 12488 Date : 28/11/08

pharyngitis

Location - Throat Sensation • Pain with earache • Hoarseness of

voice • Sneezing with

avoid coryza Modalities • A/F weather

change • <exposure to least

cold • <cold things ;

<night • <warmth Concomitance itching in ear with pain

Hep Sul 30 3mths Cured

8. Mrs. M, 35yrs, F Married Natikal, Reg. No. 13986 Date : 15/6/09

B.A. Location : chest Sensation – cough with rattling in chest, difficult sputum • Dysponea Modality : <night <lying, >expectoration Concomitants: tickling sensation in throat

Arthritis Ant tart 30

3mths Unchanged

  136

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

9. Mrs. RT, 24yrs, F Married Reg. No. 57619 Date : 21/8/10

Eosinophilia

Location - lungs bronchioles Sensation – dyspnoea • Cough with rattling in

chest • Right chest pain Modality: <damp, <cold food, Concomitance - headache

Urticaria sinusitis UTI

Nat Sulp 30

1yr, 2mths Improved

10. Mrs. J.K. 39yrs, F Married, Belthangady Reg, No. 51673/09

Allergic rhinitis

Location : nose & nasal mucosa Sensation : watery corzya, sneezing, itching in throat Modalities: <cold bath, >warmth Concomitance : ↑sed thirst, headache

Bryonia 30

2yrs Improved

11, Ms. D.A. 20yrs, F Single Trissur Reg. No. 17414 Date : 30/4/10

B.A Location : chest Sensation : dyspnoea • Cough (dry) • Scanty expectoration • Constricted feeling Modalities : <midnight • <cold drinks <lying

>rest >sitting, Concomitant : ↑sed

Ars. Alb 30

3mths Improved

  137

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

12. Mr. B.D’s, 50yrs M, Derlakatte, Reg. No. 15430 Date : 6/11/09

B.A. Location : Chest Sensation : • Dyspnoea • Hoarsness • Wheezing • Difficulty

expectoration Modalities • <Evening • <sensation • <night • >sitting >rest

• HTN Ant. Tart 30

2yrs Unchanged

13. Mrs. L. 61yrs, F Married Kuthar Reg. No. 15748 Date: 4/12/2009

B.A. Location - Chest Sensation • Dyspnoea • Cough with

scanty expectoration (whitish)

Modalities • <cold exposure

<night • >warm drinks

OA Nat Sulp 30

3mths Unchanged

14. Mrs. M. D’s 65yrs, F, married Reg. No. 17717 Date : 28/5/10

C/C bronchitis

Mental state: • Loquacious • Company

aversion • Irritable Modalities • <Night

<warmth Side of affection • (lt) chest pain

suffocation

Diabetic ulcer

Lachesis 30

4mths Unchanged

  138

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

15. Mrs. C.F, 73yrs, F, Married Karwar Reg. No. 17605 Date: 17/5/10

B.A. Location : Nose, chest Sensation : dry cough • Sneezing • Breathlessness Modalities • <Lying ; <dust • <Night <winter • >hot drinks Concomitants weakness

DM Bryonia 30

4mths Unchanged

16. Mrs. N.P. 42yrs, F Married Harekkala Reg. No. 17890 Date: 19/6/10

Eosinophilia Location • Respiratory tract,

blood Sensation • Dyspnoea • Cough with

difficult expectoration

Modalities • <Midnight

<exertion Concomitants • Weakness

Ars a/b30 3mths Unchanged

17. Mrs. K. N.A. 25yrs , F. Married Deralakatte Reg. No. 18027 Date : 1/7/10

Allergic rhinitis

Location – nose Sensation : watery coryza • Nose block • Dry cough with

hoarseness • Chest burn • Rattling Modalities • <Midnight • >Motion

Bronium 30

3mths Improved

  139

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual

Association

complaints

Remedy given Duration Inference

18. Mr. A.N. 62yrs M. Reg. No. 51019 Date ; 20/1/09

COPD Mental constitution • Suppressed

emotion • Weepy na ture Temperament – Choleritic Modalities <Sun exposure, <night, <noise, >open air, <10.00a.m

Nat M 30 1 ½ yrs Improved

19. Mr. J.K, 20yrs, M unmarried Bantwal Reg. No. 51304

B.A. Mental constitution Fear of ghost / dark Startled to noise <contradiction Temperament Phlegmatic Modalities <cold climate, <night <warmth, <3.00a.m. Characteristics Dyspnoea

Kali.carb 30

1yr Improved

20. Mrs. U.S. 30yrs F, Married Reg. No. 57833 Date : 14/9/10

Recurrent LRTI

Mental state: Likes company Brooding Temperament Plethoric Characteristics Cough with expectoration Modalities <evening <warmth >cold exposure

Fever Puls 30 1 ½ yrs Improved

  140

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

22. Mrs. N. M, 33 F, Married Deralakatte Reg. No. 131-42 Date – 26/2/09

BA - Mental State - Obstinate - Irritable - Anger, violent Characteristics - Cough with

expectoration Temperament - Prilious temperament Modalities - <Morning, <mental

extertion - < @ eating - > Rest

Dysponea, cough

Dyspepsia Nux.vom 30

6 months Improved

23. MRs. S 47 yrs, M Married Kanhangad Reg. No. 14599 Date : 20/8/09

B.A. Mental State - Self oriented - Irritable Temperament Bilious, Modalities - < after food < exertion - > Rest

Nux.vom 200

7 months Unchanged

24. Mr. I 43 yrs, M Married Natekal, Reg. No. 13982 Date 12/1/09

Bronchiectasis

Mental State - Anxiety, irritable - Sensitive Temperament - Bilious Modalities - < morning, < talking, <

eating, > Rest Characteristics - Couth with dyspnoea -

Functional Dyspepsia

Nux. Vom 30

3 months Un changed

  141

Totality according to Hughes Philosophy Sl. No. Preliminary data Diagnosis

Generic Specific Individual Association complaints

Remedy given Duration Inference

25

Mr. M. M 55yrs M Married Reg. No. 13982 Date: 12/1/09

Tuberculosis Mental state: - Irritable during

complaint - Fear of dark - Anxious about

health Temperament - Phlegematic Characteristic - Cough with chest

pain Modalities - A/F rainy season < Ice cream, < cold drinks, > Hot weather

Phos. 30 3 months Improved

26. Mr. S. D 62 yrs, M Married Naringana Reg. No. 17734 Date: 31/05/10

B.A. Mental State - Reserved;

family oriented - Responsible Characteristic - Dry cough

Modalities - < night; < 4./00

am, < exertion - > sitting, > rest

HTN Kali. Bich 30

4 months Increased

27. Mrs. Z. A 40yrs F Married Konayi Reg. No. 13340 Date: 23/2/09

BA Mental state: - Weak memory - Anxiety about

children Characteristic - Breathlesness Modalities - < 2-9 pm - < lying on back

Amenorrhoea

Med 30 3 months Unchanged

  142

Totality according to Hughes Philosophy Sl.

No. Preliminary data Diagnosis Generic Specific Individual

Association complaints

Remedy given Duration Inference

28

Mr. P 70yrs M Married Deralakatte Reg. No. 12891 Date : 23/01/09

COPD Location - Chest Sensation Dyspnoea; cough Wheez Modalities < dust, < Night, < lying > sitting upright Concomitant Thirst Weakness

Ars. Alb. 30

3 months Improved

29. MR. S Dsouza 62 yrs, M Married Naringana Reg. No. 17734 Date : 31/5/10

B.A. Mental State - Reserved family

oriented - Responsible Thermal State – Hot Characteristics - Dry cough Dysponea Wheezing Modalities < Night < climbing stairs3 < 2 am – 4 am < Exertion Hot weather

> Rainy season > sitting

HTN Kali. Bich 200

4 months Increased

  143