Dr A.L.Patil MD(HOM)
Principal & Hospital Suptdt
Government Homoeopathic Medical College.Bangalore-79
Susceptibility primarily as the reaction of the organism to external and internal influences. While we may point out striking illustrations of susceptibility in the vegetable kingdom or among the lower animals, the best illustrations are to be found among those human beings with whom we come in contact.
We see very frequently the susceptibility to climatic conditions, as well as all other phases of environment. One person will thrive in a rigorous climate where another will become seriously ill; one will thrive in dampness to which another would succumb. Altitude affects some individuals kindly and some adversely. The seashore improves one man ‘s condition while it makes another man ill.
The power of assimilation and nutrition is one of the phases of susceptibility. One easily assimilates a certain kind of food while another finds the same food indigestible. “One man ‘s meat is another man ‘s poison.”
Human beings are susceptible to infection and contagion in varying degrees. One man will become infected in contact with diseased individuals while another will experience no ill effects whatever. One person is made ill by noxious plants while another man can handle them with impunity. Certain people are capable of making a wonderful proving of a drug, whereas others will show no reaction whatever.
All these reactions have to do with susceptibility. Contagious diseases thrive in childhood because of the extreme susceptibility of the miasmatic influence; this susceptibility has an attractive force which draws to itself the disease which is on the same plane of vibration and which tends to correct this miasmatic deficiency. After having drawn to itself this other disease manifestation, the child becomes immune to further onslaughts of the same condition; his system has become somewhat cleared by this attraction of what Hahnemann calls a “similar disease” condition.
Susceptibility varies in degree in different patients, and at different times in the same patient. Homoeopathic application of a remedy is an illustration of meeting the susceptibility and filling the vacuum that is present in the sick individual. In other words, the vibrations of the sick individual call aloud for something to meet the need.
The proving of the remedy on a healthy individual gives us the basis of similarity of remedies to sick individuals because in a proving the remedy produces an artificial susceptibility similar to the susceptibility of the sick individual. The application of the homoeopathic remedy in sicknesssatisfies this natural susceptibility.
It is incumbent upon us to recognize, conserve and utilize normal susceptibility, to physical environments, to foods, to remedies and to toxic agencies. It should be our aim never to use any agent or anything of any nature, or to adopt any procedure, that would in the least diminish or destroy this power of susceptibility and the reaction of the organism in its normal manner. Upon this normal susceptibility and reaction depends the status of health.
To do anything to diminish or destroy the normal reaction is not the province of a physician; rather it is the province of the physician to conserve natural susceptibility, for without a recognition of this power all our efforts as physicians would be worthless. It is just as much the province of the physician to exercise conservation of susceptibility in the organism that it may act defensively against a toxin, contagion or infection, as it is to have this susceptibility react constructively to food and drink or to the curative remedy. Again, it is just as natural and important for the organism to react pathogenetically to the size and power of a dose of poison as it is for it to react to the demand for food.
Thus we see that susceptibility and reaction are basic principles, and are very closely allied to the problems of immunization. A proper concept of these principles is something that the homoeopathic physician must seriously consider; the interplay of these principles must become as second to him, if he wishes to use well the forces of nature in healing the sick.
Susceptibility, Reaction and Immunity
By susceptibility we mean the general quality or capability of the living organism of receiving impressions; the power to react to stimuli. Susceptibility is one of the fundamental attributes of life. Upon it depends all functioning, all vital processes, physiological and pathological. Digestion, assimilation, nutrition, repair, secretion, excretion, metabolism and catabolism, as well as all disease processes arising from infection or contagion depend upon We power of the organism to react to specific stimuli. The cure and alleviation of diseases depend upon the same power of the organism to react to the impression of the curative remedy.
Men we give a drug to a healthy person for the purpose of making a homœopathic “proving” or test, the train of symptoms which follows represents the reaction of the susceptible organism to the specific irritant or stimulus administered.
When a homœopathically selected medicine is administered to a sick person, the disappearance of the symptoms and restoration of the patient to health represents the reaction of the susceptible organism to the impression of he curative remedy.
The homœopathic aggravation,” or slight intensification of the symptoms which sometimes follows We administration of the curative remedy, is merely the reaction of the organism, previously perhaps inactive or acting improperly because of lowered susceptibility, as it responds to the gently stimulating action of the medicine. As a piece of machinery in which the bearings have become dry or rusty from disuse, creaks and groans when it is again started up into action, so the diseased, congested, sluggish organs of the body sometimes squeak and groan when they begin to respond to the action of the curative remedy. All this, and much more is included in the Hahnemann doctrine of Vitality, under the Newtonian principle of Mutual Action, (“Action and reaction are equal and opposite”) restated in medical terms by Hahnemann as “Similia Similibus Curantur,” and employed by him as the law of therapeutic medication.
It is understood that action and reaction in the medical and physiological sense takes place only in the living organism, and that it depends upon that fundamental quality and attribute of life which we call susceptibility.
We shall see that the kind and degree of reaction to medicines depends upon the degree of susceptibility of the patient, and that the kind and degree of susceptibility, in any particular case or patient, depends largely upon how the case is handled by the physician; for it is in his power to modify susceptibility. Indeed, this power to modify susceptibility is the basis of the art of the physician.
If the physician knows how to modify susceptibility in such a way as to satisfy the requirements of the sick organism and bring about a true cure, then is he a physician indeed; since cure consists simply in satisfying the morbid susceptibility of the organism and putting an end to the influx of disease-producing causes. To accomplish this he must know that susceptibility implies and includes affinity, attraction, desire, hunger, need; that these all exist and express themselves normally as states and conditions in every living being; but that they may become morbid and perverted and so cause disease, suffering and death. He knows also that susceptibility implies the existence of the wherewithal to satisfy susceptibility; to supply need, hunger, desire, affinity, attraction, and he knows how and where to find the necessary modifying agents.
It is a well-known fact that the living organism is much more susceptible to homogeneous or similar stimuli than to heterogeneous or dissimilar stimuli. Throughout the entire vegetable and animal kingdom we find the law of development and growth to be like appropriating like. Organism and organs select elements most similar to their own elements. The same law holds good in excretion, each organ excreting or throwing off elements analogous to those of its, own basis structure.
So it is in satisfying the morbid susceptibility which constitutes disease. As hunger demands food, so disease demands medicine. But the demand is always consistent with the universal law. It is for the symptomatically similar medicine, because that is the only thing that really satisfies the susceptibility.
This morbid susceptibility which constitutes disease may exist toward several different medicines, the degree of susceptibility to each depending upon the degree of symptom similarity; but the highest degree of susceptibility exists toward the most similar – the simillimum, or equal. Hence, a given patient may be cured of his disease homœopathically by either of two methods; by giving several more or less similar medicines in succession, or by giving one exactly similar medicine–the similimum or equal. It depends upon whether he is being treated by a bungler or an expert. The bungler may “zig zag” his patient along through a protracted illness and finally get him well, where an expert would cure him by the straight route with a single remedy in half the time.
The sick organism being so much more susceptible to the similar medicine than the well organism, it follows that the size or quantity of the dose depends also upon the degree of susceptibility of the patient. A dose that would produce no perceptible effect upon a well person may cause a dangerous or distressing aggravation in a sick person, just as a single ray of light will cause excruciating pain in an inflamed retina, which in its healthy condition would welcome the full light of day.
Susceptibility as a state may be increased, diminished or destroyed. Either of these is a morbid state which must be considered therapeutically from the standpoint of the individual patient. Morbid susceptibility may be regarded as a negative or minus condition a state of lowered resistance. J. J. Garth Wilkinson (Epidemic Man and His Visitations) says:
“One man catches scarlet fever from another man, but catches it because he is vis minor to the disease, which to him alone is vis major. His neighbor does not catch it; his strength passes it by as no concern of his. It is the first man’s foible that is the prime reason of his taking the complaint. He is a vacuum for its pressure. The cause why he succumbed was in him long before the infector appeared. Susceptibility to a disease is. sure in the individual or his race to be (come) that disease in time. For the air is full of diseases waiting to be employed.
“Susceptibility in organism, mental or bodily, is equivalent to state. State involves the attitude of organizations to internal causes and to external circumstances. It is all the resource of defense or the way of yielding. The taking on of states is be history of human life. Pathology is the account of the taking on of diseased states, or of definite forms of disease, mental or bodily.
“In health we live and act and resist without knowing it. In disease we live but suffer; and know ourself in conscious or unconscious exaggeration.”
We must also predicate a state of normal susceptibility to remedial as well as toxic agencies, which it is the duty of the physician to conserve and utilize. No agent or procedure should be used as a therapeutic measure which has the power to, diminish, break down or destroy the normal susceptibility or reactibility of the organism, because that is one of the most valuable medical assets we possess. Without it all our efforts to cure are in vain. To use agents in such a manner or in such a form or quantity as to diminish, impair or destroy the power of the organism to react to stimuli, is to align ourselves with the forces of death and disintegration. Conservation of the power of the organism to react defensively to a toxin, a contagion, or an infection is as important as it is to conserve the power to react constructively to food and drink, or curatively to the homœopathic remedy. It is as normal and necessary for the organism to react pathogenetically to a poison, in proportion to the size and power of the dose, as it is to react physiologically to a good dinner.
The problem is one of adjustment to conditions. The point to be kept in mind is to recognize and conserve normal susceptibility in all our dealings with the sick and to do nothing to impair it. Every remedy or expedient proposed for treatment of the sick should be submitted to this test. Does it respond to the demand of the suffering organism as expressed by similar symptoms? Does it supply the organic need? Does it satisfy the susceptibility without injury or impairment of function? In short, does it cure? Unquestionably many remedies, methods and processes more or less popular even to-day, in this ultra-scientific age, do not and cannot conform to this standard.
Many substances are used medically in such form, in such doses, by such methods and upon such principles as to be distinctly depressive or destructive of normal reactivity. They are forced upon or into the suffering organism empirically without regard to nature’s laws. So far as their effect upon disease is concerned they are in no wise curative, but only palliative or suppressive and the ultimate result, if it be not death, is to leave the patient in a worse state than he was before. Existing disease symptoms are transformed into the symptoms of an artificial drug disease. The organism is overwhelmed by a more powerful enemy which invades its territory, takes violent possession and sets up its own kingdom.
Such victories over disease are a hollow mockery from the standpoint of a true therapeutics.
We do not have to seek far for illustrative examples:
Professor James Ewing, of Cornell University Medical College, in a lecture upon Immunity (1909), called the problem of the endotoxins “The stone wall of Serum Therapy.” He said:
“The effort to produce passive immunity against the various infections by means of sera may fail in spite of the destruction of all the bacteria present in the body, by reason of the endotoxins thrown out in the process of bacteriolysis resulting from the serum injections.
“The action of endotoxins of all kinds is similar: there is a reduction of temperature but an active degeneration of the organs –a status infectiosus. Thus sterile death is produced where cultures from the organs and tissues show that the bacteria in question have all been destroyed;but the animal dies.
“This problem of the endotoxins is at present the stone wall of Serum Therapy.”
Prof. Ewing cited the case of a patient who received injections of millions of killed gonococci for gonococcic septicæmia; the temperature came down to normal, but the patient died. He continues: “An animal whose serum is normally bacteriolytic may, on immunization, lose this power; the bacteria living in the serum, but not producing symptoms.
“Thus, a rabbit’s serum is normally bacteriolytic to the typhoid bacillus, but the rabbit is susceptible to infection. If, however, the rabbit is highly immunized the serum is no longer bactericidal, the typhoid bacilli living in the serum, but the animal not being susceptible of infection. The animal dies.” “It seems therefore that the. effort must be made in the future to enable the tissue and the bacteria to live together in peace rather than to produce a state where the serum is destructive to the bacteria.”
These are strong and significant words from the highest authority on pathology in America.
In the cases cited by Prof. Ewing we see the destruction, partial or complete, of susceptibility-of the normal power of the organism to react to the stimulus of either the sera or the bacilli.
In the case of total destruction of the susceptibility death followed. The condition of the patients in whom destruction was only partial may be better imagined than described. A rabbit or a man, whose fluids and tissues are in such a depraved or vitiated :state that typhoid or other virulent organisms live and thrive in them without producing symptoms, and who will no longer react to a powerful serum, is not in a state of health to say the least. It is a condition which reminds us of the scathing words of Jesus; – “Woe unto you, Scribes and Pharisees, hypocrites! for ye are like whited sepulchres, which indeed appear beautiful outwardly, but within are full of dead men’s bones and all uncleanness.”
The use of antiseptics in the treatment of disease, or surgically (in the field of operation), is another means of impairing or destroying normal susceptibility.
Articles have appeared in leading medical journals of the dominant school (Boston Surgical journal, and the Therapeutic Gazette), in which it was pointed out that the use of antiseptics in the treatment of tonsillitis increased the inflammation, prolonged the disease and retarded convalescence. It was explained that by diminishing the number of bacteria in the crypts which were generating toxin, the period required for the formation of the requisite amount of antibodies was unduly prolonged. They had just waked up to the fact that the living organism, even if diseased, has some means of self -protection and that, other things being equal, the automatic formation of the antitoxins and antibodies in the organism goes on at about an equal pace with the generation of toxins.
The destructive action of the antiseptics upon the living tissue cells and phagocytic leucocytes of the host-otherwise the patient -was also pointed out as contraindicating their use by these discerning authorities. In destroying these bodies we are destroying the physical basis of life itself. We slay our best friends. They further showed that the depression of vitality thus caused resulted later in increase of fever and cervical adenitis, due to the increased absorption of toxins. What they failed to see and explain, however, was that the increased fever and inflammation were in reality the manifestation of that vital reaction or resistance on the part of the organism, which is the means by which the real, natural curative antibodies and antitoxins are produced, and that this should never be interfered with.
Inflammation and fever are not evils per se. They are merely the signs of normal reaction and resistance to an irritant or poison by which nature protects herself. They are not enemies to be resisted, but friends and allies to be co-operated with in the destruction of a common enemy.
Inflammation and fever mean simply greater vital activity, more rapid circulation, respiration and oxygenation, more rapid and thorough elimination of waste or toxic substances, and the concurrent formation of natural antitoxins and antibodies by means of which recovery is brought about.
Pain, inflammation and fever are not the real disease nor the real object of treatment. To view them as such leads logically and inevitably to mere palliation or suppression of symptoms, than which there are no greater medical evils. It is based upon a false and illogical interpretation of the phenomena of disease which mistakes results for causes.
Stimulants and Depressants.-Prof. James C. Wood, veteran surgeon and author -of Cleveland, Ohio, in a letter to the writer, dated February 20, 1922, following the publication of this article in the Homœopathic Recorder, wrote as follows:
“There is one remedy you have omitted in your discussion of shock, namely, strychnia or nux vomica. Crile in his experimental work on shock has shown that it is almost impossible to differentiate true shock from strychnia poisoning. As a result of his experimentation surgeons have pretty largely discarded strychnia in the treatment of shock, Crile proving that they are killing more than they are curing by full doses of strychnia in dealing with the same. On the other hand, I am using it in small doses with the, greatest possible advantage, showing conclusively, I think, its homœopathicity in shock.”
It seems to be pretty well established that alcohol, the typical and perhaps most commonly used stimulant, adds nothing to the physiological forces of the body. It takes of what might be called the “reserve fund” of organic force and uses it up a little faster than nature would otherwise permit. It acts like the whip to the tired horse, not like rest, water and food, which nourish, strengthen, repair and replace worn-out tissues. Its action on the brain and nerves is well known. Many have seen, on the dissecting table, the characteristic watery, contracted brain of the chronic alcoholic. We know the power of alcohol to harden and shrivel and devitalize organic tissues Its power to paralyze the vaso-motor system is seen in the flushed face, congested capillaries and ruby nose of the inebriate. We are aware of its inhibiting effect upon the sensory nerves, by which it makes its victim insensible to the impressions of heat, cold and pain, so that, in extreme intoxication, he falls on a red-hot stove and is burned to death, or staggers into a show bank and freezes to death without knowing it.
All these things define the nature and measure of power of alcohol to decrease or destroy normal susceptibility.
Less only in proportion to the amount used is its influence to lessen susceptibility when used as a stimulant in disease. Here, as in all other realms, the law holds good: “Action and reaction are equal and opposite.” Stimulation and depression are equal and opposite. Whip the exhausted horse and he will go on a little ways and then drop. No amount of whipping will start him up. again. He soon reaches a point where his susceptibility to, that kind of a stimulant is exhausted. Overstimulate the weakened or exhausted patient and the same thing will happen.
This is not to say that there is no place for physiological drug stimulants in the healing art, but only to point out that the place which they legitimately fill is an exceedingly small one and rarely met. Certain rare cases of typhoid fever, diphtheria, and perhaps a few other similar conditions, may be benefited by very small doses of pure brandy and tided over a crisis by that means when they might otherwise die. But the amount of stimulant necessary to accomplish that end is extremely small. More than the necessary amount will assuredly hasten death, because the margin of strength is so small the least waste by overuse may prove fatal.
The proper use of stimulants in the type of cases referred to was once illustrated by Dr. P. P. Wells. In a critical case of typhoid fever which he saw in consultation, the patient had suffered :a severe hemorrhage from the bowels, was very weak, nearly unconscious and bad a soft compressible pulse. Dr. Wells directed that six drops of brandy be put into six teaspoonfuls of milk and the whole given in three doses of two teaspoonfuls each, at intervals of two hours; to be repeated if reaction did not follow. The effect was surprising. Reaction quickly followed and the patient made a rapid recovery.
We may smile at the size of the dose until we recall how many patients in a similar condition have died under tablespoonful doses of brandy, or hypodermics of strychnia and whiskey. Dr. Wells knew how to correctly measure a patient’s susceptibility and he knew how to conserve the last, feeble, flickering remnant of vitality in such cases and make the best of it. He knew better than to waste it by violent measures, as is so often done in cases of shock when hypodermics of brandy and strychnine and other powerful stimulants are used.
The idea held by many that large and powerful doses and strenuous measures are necessary in such cases is entirely wrong. The conception of disease and the interpretation of symptoms is wrong. The resultant treatment is wrong. The imaginary Idea of violence, of the malignity and rapidity of the disease, is forced to the front and dwelt upon until it seems rational to believe that the treatment must also be violent, active, “heroic.” This is practicing homœopathy with a vengeance!
Such an error arises naturally from considering the disease to the exclusion of the patient. Look at the patient who is suffering from shock. He is pale, his, features are sunken, his skin and muscles relaxed, he is covered with a cold, clammy sweat. His respiration is feeble, his pulse almost or quite extinct, he is perhaps almost or quite unconscious. Everything indicates that life :and strength are at lowest ebb. The store of vital energy is almost exhausted. The margin left to work upon is very narrow. There is but a step between him and death. The slightest false move, the least violence, is likely to force him across the line which marks the boundary between life and death.
If there is any condition which would seem to demand the use of mild, of the very mildest and most delicate, means, this is one. Reaction, as an expression of susceptibility in such cases, is like the love of fair women-something to be wooed delicately; not brutally and fiercely as among barbarians. The condition of shock, or of extreme exhaustion, is no occasion for heroic doses or strenuous measure, but rather for the greatest gentleness and most refined doses. Let the patient inhale camphor, or vinegar, or ammonia (very carefully) if only these domestic remedies are at hand; or give him two or three-drop doses of brandy in a teaspoonful of water; if that is at hand. Teaspoonful doses of hot black coffee may be useful. But as soon as possible, give our potentiated Arnica, Arsenicum, Nux vomica, Veratrum or Carbo veg. Or whatever other remedy may be indicated by the etiology and symptoms of the case. The results will be infinitely better than the results of the strenuous method.
“Never,” said Dr. Wells, “give brandy or any other stimulant with a hard and wiry pulse.”
Deficient reaction or diminished susceptibility may exist in a case or appear during treatment and constitute a condition requiring special treatment. This is especially true in the treatment of chronic diseases, where improvement ceases and well selected remedies do not seem to act. Under such circumstances it may sometimes be necessary to give a due of what is called an “intercurrent remedy.” Bœnninghausen mentions as appropriate in such cases: Carbo veg., Lauroc., Mosch., Op., Sulph. To these may be added the typical nosodes: Medorr., Psor., Pyrog., Tuberc., Syphil.,. and also Thuja. The choice of any particular one of these remedies must be governed by the history and symptoms.
Excessive reaction, or irritability, is a condition sometimes met where the patient seems to suffer an aggravation from every remedy, without corresponding improvement. There is a state of general hypersensitiveness.
For such a state, Bœnninghausen recommends Asar., Cham., Coff., China, Ign., Nux v., Puls., Teuc. and Valer.
Aggravation after Mercury requires Hep. or Nit. ac.
Therapeutic suggestion is of use in all such cases, to calm, and soothe terrified or excited patients. But in these, as in all other cases, the case and remedy must be carefully individualized.
We see, therefore, that the cure or successful treatment of disease depends not only upon conserving and utilizing the natural susceptibility of the living organism, but on properly adjusting both remedy and dose to the needs of the organism so that susceptibility shall be satisfied, normal reaction induced and equilibrium or health restored. The “Law of the Least Plus” should never be forgotten:-“The quantity of action necessary to effect any change in nature is the least possible.”
Immunity which is obtained at the cost of the integrity and purity of the vital organism and its fluids is too early purchased.
Inoculation of crude, pathological products like animal sera and vaccines confers only a spurious immunity through impairment or destruction of normal susceptibility. It results in the contamination or poisoning of the entire organism, sets up a morbid condition instead of a healthy one and leads to physical degeneration.
The homœopathic remedy, correctly chosen upon indications afforded by the anamnesis and symptoms of the disease as manifested in the individual and the community, and administered in infinitesimal doses, per oram, satisfies the morbid susceptibility, supplies the need of the organism and confers a true immunity by promoting health, which is the true object to be gained.