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Lecture on Aphorism 38 to 39

Last month we discussed the first (among three) case when two diseases meet in a body. We saw that the second disease, if weaker than the former, is repelled or not allowed to affect the body. We also understood that this happens because the second disease, being different, does not match your level of health and susceptibility. This month we will study the second case, when the disease coming later is stronger than the former. Hahnemann has described this case in detail in aphorism 38, so let’s read it first.

§ 38

II. Or the new dissimilar disease is the stronger. In this case the disease under which the patient originally labored, being the weaker, will be kept back and suspended by the accession of the stronger one, until the latter shall have run its course or been cured, and then the old one reappears uncured. Two children affected with a kind of epilepsy remained free from epileptic attacks after infection with ringworm (tinea) but as soon as the eruption on the head was gone the epilepsy returned just as before, as Tulpius1 observed. The itch, as Schopf2 saw, disappeared on the occurrence of the scurvy, but after the cure of the latter it again broke out. So, also the pulmonary phthisis remained stationary when the patient was attacked by a violent typhus, but went on again after the latter had run its course.3 If mania occur in a consumptive patient, the phthisis with all its symptoms is removed by the former; but if that go off, the phthisis returns immediately and proves fatal.4 When measles and smallpox are prevalent at the same time, and both attack the same child, the measles that had already broken out is generally checked by the smallpox that came somewhat later; nor does the measles resume its course until after the cure of the smallpox; but it not infrequently happens that the inoculated smallpox is suspended for four days by the supervention of the measles, as observed by Manget,5 after the desquamation of which the smallpox completes its course. Even when the inoculation of the smallpox had taken effect for six days, and the measles then broke out, the inflammation of the inoculation remained stationary and the smallpox did not ensue until the measles had completed its regular course of seven days.6 In an epidemic of measles, that disease attacked many individuals on the fourth or fifth day after the inoculation of smallpox and prevented the development of the smallpox until it had completed its own course, whereupon the smallpox appeared and proceeded regularly to its termination.7 The true, smooth, erysipelatous-looking scarlatina of Sydenham, with sore throat, was checked on the fourth day by the eruption of cow-pox, which ran its regular course, and not till it was ended did the scarlatina again establish itself; but on another occasion, as both diseases seem to be of equal strength, the cow-pox was suspended on the eighth day by the supervention of the true, smooth scarlatina of Sydenham,8 and the red areola of the former disappeared until the scarlatina was gone, wherein the cow-pox immediately resumed its course, and went on its regular termination.9 The measles suspended the cow-pox; on the eighth day, when the cow-pox had nearly attained its climax, the measles broke out; the cow-pox now remained stationary, and did not resume and complete its course until the desquamation of the measles, had taken place, so that on the sixteenth day it presented the appearance it otherwise would have shown on the tenth day, as Kortum10 observed.

Even after the measles had broken out the cow-pox inoculation took effect, but did not run its course until these measles had disappeared, as Kortum likewise witnessed.11

I myself saw the mumps (angina parotidea) immediately disappear when the cow-pox inoculation had taken effect and had nearly attained its height; it was not until the complete termination of the cow-pox and the disappearance of its red areola that this febrile tumefaction of the parotid and submaxillary glands, that is caused by a peculiar miasm, reappeared and ran its regular course of seven days.

And thus it is with all dissimilar disease; the stronger suspends the weaker (when they do not complicate one another, which is seldom the case with acute disease), but they never cure one another.

1 Obs., lib. I, obs. 8.

2 In Hufeland’s Journal, xv, 2.

3 Chevalier, in Hufeland’s Neuesten Annalen der franzosichen Heikunde, ii, p.192.

4 Mania phthisi superveniens eam cum omnibus suis phaenomenis auffert, verum mox redit phthisis et occidit, abeunte mania. Reil Memorab., fasc. iii, v, p.171.

5 In the Edinb. Med. Comment., pt. i, 1.

6 John Hunter, On the veneral Disease, p.5.

7 Rainey, in the Edinb. Med. Comment., iii, p.480.

8 Very accurately described by Withering and Plenciz, but differing greatly from the purpura (or Roodvonk), which is often erroneously denominated scarlet fever. It is only of late year that the two, which were originally very different diseases, have come to resemble each other in their symptoms.

9 Jenner, in Medicinische Annalen, August, 1800, p.747.

10 In Hufeland’s Journal der praktischen Arzneikunde, xx, 3, p.50.

11 Loc. cit.

The first few lines of this aphorism are rather straightforward. Hahnemann is saying that if the disease coming later is stronger, then it will be able to affect the organism despite it being different, and while it completes its course, the former will remain dormant or suspended. As soon as the second disease has completed its course, the first one becomes active again.

Now the first question that should come to one’s mind, is that if the second disease is dissimilar, then why is it able to affect the body this time. For this you need to understand that for a disease to affect us, it needs two factors – sufficient susceptibility of the host and sufficient virulence of the pathogen. In most infections the two factors need to be there. Day in and day out we breathe, eat and drink bacteria and viruses – even disease causing ones. They are literally omnipresent. Then why are we not sick all the time? Because in most cases the virus or bacteria are not virulent enough for you. Virulence does not only refer to the hardiness of the pathogen or its ability to cause disease but it also relates to the quantum of infection that you receive. So even if you ingest a few disease-causing pathogens, you are unlikely to develop the disease.

The more susceptible you are, lesser is the quantum or infection that you need to catch a disease. The more susceptible you are, lesser is the virulence (potential to cause disease) needed to cause disease in you.

So this explains why you are able to catch certain infections easily; why some people catch a cold or sore throat very easily while others are able to resist those infections, even when living in the same household.

But how can a disease that is dissimilar, to which you are not susceptible, affect you? The answer lies in the virulence. Not being susceptible does not mean that you are totally resistant to an infection. It only means that you are not going to get that infection easily. But you can still get it occasionally. And when does this ‘occasionally’ happen? It happens when the pathogen is very virulent. When the pathogen is very hardy or the quantum of infection is large, the disease is going to develop in nearly anyone. And this is what happens during epidemic diseases. A new pathogen or a new virulent strain of an existing pathogen comes up and human masses fall ill in waves, irrespective of their underlying susceptibility in most cases.

Another question can come to the mind for those who have followed my earlier lectures. While explaining the vital force, I had said that the ‘derangement of the vital force’ is the primary cause of disease and the bacteria/viruses etc are the secondary cause of disease. So you can ask that if the vital force is not deranged, how and why the secondary causes can affect us? The answer to this question lies in understanding what can cause the derangement of the vital force. The vital force can get deranged by any ‘stress’ – be it physical, mental or emotional.  You become susceptible to infections if your vitality is deranged due to any stress.

An infection also adds to the stress of the body because it sucks more energy from the system. If the pathogen is very virulent and infects the system without any underlying susceptibility then it works as the primary stress or the primary cause of disease.  So infection in such cases serves as both the primary and secondary cause of disease. And this whole phenomenon is not against our basic understanding of vital force and susceptibility, that we have studied so far.

We have talked about why the second dissimilar disease can affect the body at all. But this aphorism is not about that, it is about what happens when two dissimilar diseases meet in the human body and the second one is stronger. We have already seen that Hahnemann says in such cases the second disease would suspend the former, while it completes its course. But how? To understand this we need to go through the examples Hahnemann has given to substantiate his words.  The real juice of this aphorism lies there. There are two types of examples:

1.   The first disease is chronic and the second is a dissimilar acute.

2.   The first disease and the second disease are both acute and dissimilar.

Most of the examples are quoted from other sources and I will explore each example individually to understand its rationality and validity. It is difficult to come across these specific examples in current times, but I’ll try to explore these examples as much as possible and wherever possible will try to explain the physiological processes behind it. The first example is:

Two children affected with a kind of epilepsy remained free from epileptic attacks after infection with ringworm (tinea), but as soon as the eruption on the head was gone the epilepsy returned just as before, as Tulpius1 observed.

Here the first disease (epilepsy) is chronic and the second is a fungal skin infection. Tulipus had observed that an epileptic patient did not suffer from fits while he was infected with the Tinea, but as soon as the Tinea disappeared, the convulsions reappeared. This was Tulpus’ observation in two cases, but it is not necessary that it will happen the same way in every case. Complex diseases do form in nature and we will discuss them in the next few aphorisms.

It is difficult to explain such examples in terms of physiology. But that does not mean that they cannot, or do not happen. My personal understanding is that any disease and the symptoms arising thereof, are the result of the disease force, plus the immune response of the body. When a body is affected by any disease that is more acute or virulent, it diverts its resources, both in terms of the vital energy as well as the immune response towards the greater newer threat. This makes the effect of the first disease less perceptible while the disease coming later is perceived with full intensity. The first disease is not palliated in its true sense. It either manifests less or it is just perceived less.

Let me explain this in a very different way…

In a kingdom called YourBody, once there was a king named Vital Force. VF used to rule YourBody effectively and harmoniously. The kingdom was healthy and prosperous.  One day VF’s wife Harmony drowned in a river. VF loved harmony and her loss made him feel sad, alone and debilitated.  He was not the perfect ruler anymore. Due to this, unrest arose in many parts of the kingdom (First disease). VF just used enough forces to keep any big trouble at bay but the problem never went away because the problem was not in the unrest, but the real cause was the debilitated king Vital Force.

There was a kingdom nearby called PathWorld. It was ruled by the ferocious king called ‘Secondary Cause’ (SC). When SC saw that VF was not working effectively anymore, he saw this as an opportunity to invade, attack and then rule YourBody.  He immediately sent his army, which attacked YourBody with full force (Second Disease).  When king Vital Force perceived this major threat, he arose from his slumber and called on all his strength and reserves to save his kingdom. During this phase VF could not think about the unrest going on in his kingdom.  He just focused on the enemy attack and everything else became immaterial for the time being. There was a big fight in which Vital Force and his army defeated Secondary Cause and the army of PathWorld.

It was quiet once again, but Harmony was still not there and the King VF was still not normal…

Now there can be many turns to this story.

1.   If the king VF remains unchanged, the civil unrest will become visible again and VF will again feel the old problems. He is likely to be attacked by someone else in the future, and will succumb either to a foreign attack or the chronic unrest going within.

2.   If the king marries someone else (a remedy), his sadness and debility will resolve. The Harmony would return in essence and the civil unrest will disappear for ever (cure).

Can you see and understand the derangement of vital force (homeopathic), accession of the first disease, onslaught of the second dissimilar disease, appearance of the first disease when the second one subsides and the potential of cure with a remedy? Do I need to explain it any further? I feel the example makes it amply clear, so let’s move on to the next example.

The itch, as Schopf2 saw, disappeared on the occurrence of the scurvy, but after the cure of the latter it again broke out.

This example is flawed. Scurvy, we now know, is not an acute disease and is caused by Vitamin C deficiency. It cannot be cured by medicine. So Schopf seems to have made a mistake in this diagnosis and we need to eliminate this example from our books. Next example…

So, also the pulmonary phthisis remained stationary when the patient was attacked by a violent typhus, but went on again after the latter had run its course.

…is again similar to the previous examples. A chronic pulmonary disease is felt less when a strong gastro-intestinal infection (Typhoid fever results from infection in the intestines) affects the same patient. When the dissimilar acute is over, the chronic disease gets the focus of our body again and is felt more.

If mania occurs in a consumptive patient, the pthisis with all its symptoms is removed by the former; but if that go off, the phthisis returns immediately and proves fatal.

Before I explain this example, I would like to make clear that ‘Consumption’ and ‘Pthisis’ are old terms for pulmonary tuberculosis. So the example says that if a patient suffering from tuberculosis is affected by Mania, then Pthisis is removed. To me this example again looks flawed for several reasons. One, the second dissimilar disease cannot remove the former. It can only suspend and reduce its manifestation. Two, Mania by itself is not a specific disease. In old medical literature the term Mania was used as synonymous with Insanity. Mania can be acute (acutely manifested), but will happen only when the patient is chronically psychologically ill. So this example is also worth discarding.

So far we have dealt with examples in which the first disease is chronic in nature and the second one is acute. Now we will examine the examples given by Hahnemann for cases when two dissimilar acute diseases meet in a body. These examples are even more interesting!

When measles and smallpox are prevalent at the same time, and both attack the same child, the measles that had already broken out is generally checked by the smallpox that came somewhat later; nor does the measles resume its course until after the cure of the smallpox; but it not infrequently happens that the inoculated smallpox is suspended for four days by the supervention of the measles, as observed by Manget,5 after the desquamation of which the smallpox completes its course. Even when the inoculation of the smallpox had taken effect for six days, and the measles then broke out, the inflammation of the inoculation remained stationary and the smallpox did not ensue until the measles had completed its regular course of seven days.6 In an epidemic of measles, that disease attacked many individuals on the fourth or fifth day after the inoculation of smallpox and prevented the development of the smallpox until it had completed its own course, whereupon the smallpox appeared and proceeded regularly to its termination.7

Smallpox was indeed a more serious disease than measles (measles has a mortality of 0.2% whereas smallpox had an average mortality of 30%) and Hahnemann acknowledges it in the example saying that if a person has develop measles and then smallpox breaks out, the measles is suspended. Smallpox completes its course and then measles resumes its course.

The other three examples where he says measles comes after smallpox are actually not about the natural disease smallpox but ‘smallpox inoculation’, that is, the earliest vaccine against smallpox which contained live virus, but that of Variola minor, the less severe form of smallpox. Inoculation started in Europe as early as 1721 and the examples Hahnemann is giving relates to this form of immunization using a milder form of smallpox virus occouring in nature. In Britain, Europe and the American Colonies the preferred method for Inoculation was rubbing material from a smallpox pustule from a selected mild case (Variola minor) into a scratch between the thumb and forefinger. This would generally be performed when an individual was in normal good health, and thus at peak resistance. The recipient would develop smallpox; however, due to being introduced through the skin rather than the lungs, and possibly because of the inoculated individual’s preexisting state of good health, the small inoculum, and the single point of initial infection, the resulting case of smallpox was generally milder than the naturally-occurring form, produced far less facial scarring, and had a far lower mortality rate. As with survivors of the natural disease, the inoculated individual was subsequently immune to re-infection.

So now you understand what is meant by smallpox inoculation and it is very easy to understand why the stronger natural measles is able to suspend the weaker smallpox inoculation. Let’s move to the next example.

The true, smooth, erysipelatous-looking scarlatina of Sydenham, with sore throat, was checked on the fourth day by the eruption of cow-pox, which ran its regular course, and not till it was ended did the scarlatina again establish itself; but on another occasion, as both diseases seem to be of equal strength, the cow-pox was suspended on the eighth day by the supervention of the true, smooth scarlatina of Sydenham,8 and the red areola of the former disappeared until the scarlatina was gone, wherein the cow-pox immediately resumed its course, and went on its regular termination.9 The measles suspended the cow-pox; on the eighth day, when the cow-pox had nearly attained its climax, the measles broke out; the cow-pox now remained stationary, and did not resume and complete its course until the desquamation of the measles, had taken place, so that on the sixteenth day it presented the appearance it otherwise would have shown on the tenth day, as Kortum10 observed.

Scarlatina of Syndenham refers to Scarlet fever, which is an infection of Streptococcus pyogenes and is characterized by sore throat, fever, rash on body and strawberry coloured tongue. Cowpox is a skin disease caused by a virus known as the Cowpox virus. The pox is related to the vaccinia virus, and got its name from the distribution of the disease when dairymaids touched the udders of infected cows. The ailment manifests itself in the form of red blisters and is transmitted by touch from infected animals to humans.

In these examples, Hahnemann has compared diseases, which have relatively the same level of morbidity/mortality and are yet dissimilar. The examples tell us that in such cases, whichever strain is more virulent in a person will dominate and suspend the other.

So we have discussed all the examples given by Hahnemann. Now I have a question for our readers. Have you seen similar examples of any disease in your clinical practice? If you have seen a case where a chronic or acute disease gets suspended by another dissimilar strong acute, share it with me either through the comment form at the end of this article or drop me an email at mail@hpathy.com

Now let’s move on to the next aphorism.

§ 39

Now the adherents of the ordinary school of medicine saw all this for so many centuries; they saw that Nature herself cannot cure any disease by the accession of another, be it ever so strong, if the new disease be dissimilar to that already present in the body. What shall we think of them, that they nevertheless went on treating chronic disease with allopathic remedies, namely, with medicines and prescriptions capable of producing God knows what morbid state – almost invariably, however, one dissimilar to the disease to be cured? And even though physicians did not hitherto observe nature attentively, the miserable results of their treatment should have taught them that they were pursuing an inappropriate, a false path. Did they not perceive when they employed, as was their custom, and aggressive allopathic treatment in a chronic disease, that thereby they only created an artificial disease dissimilar to the original one, which, as long as it was kept up, merely held in abeyance, merely suppressed, merely suspended the original disease, which latter, however, always returned, and must return, as soon as the diminished strength of the patient no longer admitted of a continuance of the allopathic attacks on the life? Thus the itch exanthema certainly disappears very soon from the skin under the employment of violent purgatives, frequently repeated; but when the patient can no longer stand the factitious (dissimilar) disease of the bowels, and can take no more purgatives, then either the cutaneous eruption breaks out as before, or the internal psora displays itself in some bad symptom, and the patient, in addition to his undiminished original disease, has to endure the misery of a painful ruined digestion and impaired strength to boot. So, also, when the ordinary physicians keep up artificial ulcerations of the skin and issues on the exterior of the body, with the view of thereby eradicating a chronic disease, they can NEVER cure them by that means, as such artificial cutaneous ulcers are quite alien and allopathic to the internal affection; but inasmuch as the irritation produced by several tissues is at least sometimes a stronger (dissimilar) disease than the indwelling malady, the latter is thereby sometimes silenced and suspended for a week or two. But it is only suspended, and that for a very short time, while the patient’s powers are gradually worn out. Epilepsy, suppressed for many years by means of issues, invariably recurred, and in an aggravated form, when they were allowed to heal up, as Pechlin1 and others testify. But purgatives for itch, and issues for epilepsy, cannot be more heterogeneous, more dissimilar deranging agents – cannot be more allopathic, more exhausting modes of treatment – than are the customary prescriptions, composed of unknown ingredients, used in ordinary practice for the other nameless, innumerable forms of disease. These likewise do nothing but debilitate, and only suppress or suspend the malady for a short time without being able to cure it, and when used for a long time always add a new morbid state to the old disease.

1 Obs. phys. med., lib. ii, obs, 30.

In this aphorism Hahnemann is stating three things:

  1. Allopaths ignored the cures of nature and although nature never cures with dissimilars, allopaths continue to give dissimilar medicines.
  2. They did not learn from nature but their miserable results from allopathic treatment should have opened their eyes.
  3. The allopathic treatment, produces an artificial dissimilar disease state, which suspends the former natural disease state and the patient may be temporarily ameliorated. But as soon as the treatment is stopped, the old disease manifests with full force. And if the suppressive treatment is not stopped, a complex disease may arise.

Here I would like to state that Hahnemann had mention four different methods of applying medicines – Isopathy (same), Homeopathy (similar), Allopathy (bearing no relation to disease condition) and Antipathy (producing exactly opposite state). Today the word Allopathy is used to denote the conventional system of medicine. The examples Hahnemann has given primarily relate to the allopathic method of drug application (neither similar, nor opposite), but today’s allopathic system is primarily based on antipathy. But even with antipathic medicines, you can either suppress or palliate a chronic disease state. The cure never results.

The examples in this aphorism are self-explanatory but before I end this lecture, I would like to explain at least one old terminology here – ‘issues for epilepsy’. It took me lot of digging in 19th century medical books to understand what this term meant. ‘issues’ referred to the process of creation of raw areas of skin by burning the upper layer of skin and maintaining these open granulating areas to ensure that the serous discharge continues. There were two favorite varieties – ‘caustic issues’ and ‘moxa issues’. In caustic issues, the raw area was created with Pottash and in Moxa issues, the raw area was created by burning Artemsia leaves. They were believed to have curative effects. For example, in epilepsy, two ‘issues’ were created on the nape of neck, and in Tuberculosis, two issues were created below the clavicles. It might sound ridiculous to us but in the 19th century this was all scientific, well proved and well-established!

So this brings us to the end of this lengthy exploration of aphorisms 38 and 39. We have now understood what happens when two dissimilar diseases meet in a body and the later disease is stronger than the former. Next month we will discuss the formation of complex diseases.

 

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