DEPARTMENT OF HOMEOPATHIC PHILOSOPHY. Stuart Close, M. D., Editor, 248 Hancock Street,
Brooklyn, N. Y.
DISCUSSIONS OF THE THEORY AND PRINCIPLES OF HOMOEO THERAPEUTICS AND RELATED MEDICAL TOPICS.
THE CHALLENGE OF THE CHRONIC CASE,
From the point of view of orthodox medicine, it is claimed that the span of life has been lengthened and certain acute infectious diseases have been “eliminated” from vast areas. By dint of a long research the proximate causes of certain parasitic diseases, such as hookworm disease, amoebic dysentery, yellow fever, and malaria have been revealed, and more or less effective preventive measures were found. The chemist, the sanitarian, and the bacteriologist working together have undoubtedly accomplished much in the field of preventive medicine. The general extension of the knowledge of the laws of health, hygiene, and physical culture among the people and the improvement of living conditions, in general, have also tended toward the reduction of mortality and lengthening of life.
For this amelioration of a lot of suffering of humanity, however, the physicians, strictly speaking, can claim only a small share of the credit. It is only as they have utilized and participated in the labors of the publicist, the sanitarian, the chemist, and their collaborators that they have made any substantial advances. In their own special field, the treatment and cure of disease, they have nothing to boast of. Indeed it is a question if in his treatment of disease the orthodox medical man has not done more harm than good. No question at all if the consideration is limited to the use of drugs or medicines, including serums and vaccines. The best confirmation of this statement is the fact that the use of drugs has been abandoned by all really progressive physicians of the dominant school of medicine, and that they have come to rely almost solely upon rest and nursing, and other hygienic measures for results. Even so, the mortality of acute infectious diseases, such as pneumonia, has been lessened but very little, if at all.
Against the gratifying rests of preventive medicine, some of the acute infectious and epidemic diseases are increasing and the mortality of chronic diseases. seventy years ago such conditions caused one-fifteenth of the total number of deaths. Today they are responsible for more than one-half of all deaths and the rate is steadily increasing. Here there has been no progress, but only retrogression.
This constitutes not only a challenge to the medical profession but an indictment. It stands indicted for ignorance, incompetence, and malfeasance in its own special office and field. Here it cannot shine in the reflected light of other sciences nor claim credit for the work of others. It must stand or fall by its own record.
There are many causes for the increase of chronic disease Probably the most important one is the unscientific treatment of acute diseases. Suppressed or palliated, even more than neglected acute disease tends to become a chronic disease, and with this kind of treatment, there is more than enough.
The physician who sees nothing but the obvious in disease, who mistakes effects for causes and treats the patient with a view to the mere ablation of certain symptoms and the temporary relief of his pain or suffering, is an active agent in the causation of chronic disease and disability, a disgrace to his profession and a constant menace to the lives and health of the community.
The world. would be better off without his services. Ignorant or contemptuous of the existence of a healing principle or law in nature, and of a method of treatment based upon it; superficial in his knowledge of the real nature and causes of disease; unobservant and unthinking in his relations with his patients; ready in his acceptance of every new fad or nostrum brought to his attention by the drug manufacturers-such a physician goes his way leaving behind him a trail of disease, disability and death.
With every opportunity to observe and study the nature and causes of chronic ailments in individuals, in hospitals, and in the homes for incurables and almshouses of the country, nothing is done.
In 1924, E. P. Boas (“The Challenge of The Chronic Patim, Sarvey,” found “that the scientific study of disease in such homes was almost entirely ignored. Inmates are looked upon as beyond rehabilitation. The 1910 census showed that nearly two-thirds of the 84,000 paupers in almshouses suffered from physical or mental defects and that the death rate among them was 207.7 per thousand enumerated. The condition did not improve in the next ten years. In New York, in 1921, 67 percent, of nearly 9000 inmates of almshouses were sick or infirm.
Outside of institutions and in general practice the situation is but little better. Aside from a few individuals who specialize in its study and treatment, little or no attention is paid to chronic disease as such. The chronic patient is treated no differently, so far as medication is concerned, from the acute patient. Both are treated “symptomatically,” that is, given something to deaden pain, stimulate sluggish functions, or cover up unsightly lesions. These failing, surgical obliteration of supposedly responsible organs follows. The chronic patient is regarded as a nuisance by some, or a commercial source of steady income to be jollied and bamboozled along by others.
The assurance, the smug self-satisfaction, and the benevolent expansiveness displayed by some of the would-be leaders of regular medicine in their calm assumption of the therapeutic supremacy of “modern medicine” is amazing. Addressing the annual meeting of the Montefiore Hospital of New York not long ago, Dr. James Alexander Miller, President of the New York Tuberculosis Association, said: “As doctors are primarily interested in acute disease (they) neglect chronic cases, now the main source of disease and death since we have conquered the acute disease.”
Leaving aside for the moment the ridiculous and unverifiable statement that acute diseases have been “conquered,” we may agree that chronic cases are “neglected” but not exactly in the sense in which that word was probably taken by those to whom it was addressed. If Dr. Miller had said that chronic cases are neglected scientifically while they are exploited commercially, by many, he would have been more.
The sordid fact is that the average doctor does not “neglect chronic cases. He cherishes them assiduously and keeps them coming. They are to him as children were to the Psalmist, “As Arrows are in the hand of a mighty man. Blessed is the man who hath his quiver full of them.”
It may be that the doctor does not recognize them as chronic cases; but that, if true, merely impales him on the other horn of the dilemma. He either knows they are chronic and continues his ineffective treatment for pecuniary reasons, or he does not know a chronic when he sees it and treats them all alike, symptomatically. Be that as it may, the chronic cases are more numerous, come oftener, stay longer and warm more chairs in the “popular” doctor’s office than any other class of patients-poor
deluded creatures that they are. For what do they get, as a rule?
The welcoming smile of the white-uniformed office nurse, (who as often as not administers the “treatment”) the “glad hand” of the suave doctor who gives each of them about three minutes of his valuable time; a spray for the throat or nose, a dab of the swab, an instillation of “drops” for the eyes by the nurse; “tab lets for the pain” or “something for the nerves” and an appointment card for a day after tomorrow at 3 P. M., from the doctor, who bows them out and complacently pockets his five or ten dollar fee
No, these gentry do not “neglect” the chronic cases financially. Far from it. Yet there is neglect-serious, inexcusable, criminal neglect, tragic in its consequences. Just where and what is it? It lies in the lack of principle; in ignorance or contempt of the law of cure; in the setting up and worship of false gods; in commercialism and professionalism; in bigotry and prejudice; in selfishness and brutality.
The Great Physician said to the “doctors” of old: “Woe unto you, Scribes and Pharisees, hypocrites! for ye pay tithe of mint and anise and cummin, and have omitted the weightier matters of the law, judgment, mercy and faith; these ought ye to have done and not to leave the other undone.”
There appears to be an almost total failure on the part of medical men-physicians or surgeons of all schools of medicine many to clearly identify the individual, concrete chronic case and grasp its significance from the standpoint of therapeutics.
Theoretically, they recognize the existence of certain chronic diseases to which they attach many names-cancer, tuberculosis, gout, syphilis, etc. -but practically these academic conceptions, such as they are, do not influence them in their treatment of the individual patient, nor lead to the selection of the individual curative medicine. In the chronic, as in the acute case, it is the disease and not the patient that is treated; and the treatment, even by nominally homeopathic doctors, is merely symptomatic, with drugs selected and used solely for their so-called “physiological” action, without regard to their homeopathic or curative relation. In a word, the treatment is merely palliative. This results inevitably in suppression, complication, and metastasis of acute disease, or acute exacerbation of the chronic disease, which thus becomes inveterate.
The pitiable plight of the chronic patient makes a strong appeal to the sympathies as well as to the technical skill of the thoughtful physician. If he is a young man he will not have been long in practice before he realizes that his education in medicine has been deficient in the management of these cases. Among the first who will call upon him for aid, after he has chosen his location and hung out his shingle, will very likely be some of these old chronic patients. They exist in every community. They have gone the rounds of the local doctors and have been relegated to chronic invalidism-poor, pitiful wrecks, a burden to themselves and all their relatives, if not a charge on the community. The coming of a new doctor awakens a ray of hope. Perhaps, they think, being a young man fresh from the centers of learning, he has learned something new about the treatment of such cases and will be able to help them. And so they make one more effort to regain a measure of their lost health.
If the young doctor has been so fortunate as to have come under the influence or instruction of a teacher who has made a study of chronic diseases and their treatment, especially as taught by Hahnemann and his followers, he will welcome his first chronic patients and use them as a foundation for building a successful practice. If he goes about it in the right way-intelligently and systematically he will soon be on a fair way toward the attainment of a valuable reputation. For he will succeed, in a fair proportion of cases, in giving such a measure of relief and restoration as will create confidence and grateful recognition of skill and ability. The rest of the professional benefits are so to come. The relief of suffering, the putting on his or her feet again of a single chronic invalid, will do more to enhance the reputation of a new physician in the community than many cases of acute diseases, most of which everybody knows tend to get well of themselves. And the thing can be done.
How shall the young physician go about it? It is assumed that
he will know, having been taught, or at least had his attention
called to the subject by a teacher who does know:
1. That there is a distinct field or department of medicine that
deals with the hygienic and medicinal treatment of chronic dis cases, as such:
2. That this field is a special one, developed by the leading minds of homeopathy from Hahnemann down:
3. That curative treatment is based upon general principles of therapeutic medication that have been specially applied in this field after exhaustive research, first by Hahnemann and later by his greatest contemporaries and followers:
4. That there is a great and comprehensive literature devoted to the subject of which Hahnemann’s Organon and Chronic Diseases and Bonninghausen’s works are the types and forerunners:
5. That these works represent and record the highest development and greatest attainments of the science and art of Homoeopathy by its greatest masters.
Here, then, lying open before the young physician is a large field, sparsely occupied, in which the more or less “elegant leisure” which is the privilege of every beginner in practice, may well be employed. With his first chronic patient comes the opportunity to begin a course of post-graduate self-instruction. Slight and superficial though his previous instruction in this special field may have been, if he has been taught the rudiments and principles of the Scientific Method in medicine and had his attention directed to literature upon the subject, he will know how to approach the case.
“An he be wise,” he will begin and continue the formation of a library of homoeopathic classics, of which Hahnemann’s Organon and The Chronic Diseases, Bonninghausen’s Therapeutic ebook and his “Lesser Writings,” Von Grauvogl’s Text of Homropathy (out of print, but available in its most tant part in Dr. John H. Clarke’s admirable little “Constitutional Therapeutics”), Dunham’s “Science of Therapeutics,” Farmington’s “Clinical Materia Medica,” Kent’s Lectures on Bopathic Philosophy and his Materia Medica, and Close’s “The Genius of Homoeopathy are the most important. These works deal not only with the elements and principles of home pathy, but with its highest scientific and philosophical aspects
For his mental refreshment, and as the first practical step in taking up the study and treatment of a chronic case the beginner, young or old, will review Hahnemann’s instructions in the Or an on the examination of the patient for a homeopathic prescription For it must be understood that the ordinary routine, examination made by the old school clinician, no matter how scientific and up-to-date it may be, reveals little or nothing of special value for the homoeopathic prescriber, however valuable they may be for the general consideration of the case. His special approach to the case is from an entirely different angle-that of pure vital-dynamical, or functional, symptomatology, subjective as well as objective-a phase of the case not covered or considered by the ordinary clinician.
From Hahnemann, primarily, he will learn what facts or symptoms he is to seek, how he is to frame his questions in order to bring out the essentials of the case and what use he is to make of them in selecting his remedy. The other authors already referred to will illustrate and explain Hahnemann’s teaching, baden and clarity his vision, sharpen his perceptions and then his powers of observation.
No one, of course, will neglect taking and recording the regular clinical history, nor making the necessary physical examination and laboratory tests which are essential to the full understanding of my chronic case. Neither will he fail at least to attempt to make a correct pathological diagnosis. But he will not allow his mind to be biased or turned aside from his special therapeutic course by any of these procedures. Rather will he use these and other means, as far as he may, to give him a complete, well-rounded conception of the case as a whole, and of its peculiar distinguishing features in particular
Having carried out Hahnemann’s instructions in eliciting a the particular symptoms of the case, (analysis) one will be guide by Bonninghausen and his successors as he proceeds to classify them according to their location, character and conditions of existence and manifestation in the individual (synthesis). This done, one begins, more strictly speaking, to “generalize” the case; that is, by logically contemplating the groups he has formed with the purpose of deducing or drawing out those features of resem blance or relation which are common or general to them all, thus establishing the characteristics of the case as a whole, or, in a word, the patient. These take rank as essentials, facts of the highest importance, indispensable in the further study of the case and selection of the indicated remedy under the homoeopathic principle of therapeutics.
Other minor generalizations, applied to particular groups of symptoms, relating to some part or organ of the patient, rank sec ond in value, while unrelated, or doubtfully related particular symptoms and indefinite “common” symptoms-so-called “gen eralities”-rank lowest as of no technical value or of slight im portance in the final summing up. They may be rejected entirely.
The paramount object of the homeopathic inductive process, briefly described above, is the creation or construction from the materials at hand of a symptomatic image or picture of the disease from which the patient is suffering. It must embody or express all the morbid traits, peculiarities and characteristics of the individual patient, with the normal individual as a background, or better, as a model.
It follows that no true image of the morbid individual can be constructed, no intelligent conception or interpretation of his morbidity be made, without accurate knowledge of his morphology of his original and existent physical and mental constitutional fact the importance of which has generally been overlooked until recently.
As there is a very definite method and process in homeopathy for the investigation and construction of the case, there is an equally definite method and process-a technique for the selection of the curative remedy, which is the third step in the homeopathic treatment of the patient. This step in the process has for its object the discovery of a medicine which in its symptomatology, as derived from tests or experiments with drugs upon the living, healthy subjects and recorded in the materia medica, is similar to, or corresponds with, the symptoms of the patient. The same rules which govern the examination of the patient and construction of the case govern the study of the materia medica and vice versa. They are virtual counterparts of each other and the process is simply one of logical comparison of the two sets of symptoms.
As the materia medica is of such vast extent, including practically every known drug in greater or less detail of symptomatology, it becomes necessary to have means and methods to make it easily available for reference and comparison. Hence, various repertories or classified indexes have been constructed, by means of which this work may be done with comparative ease. No human mind or memory is capable of retaining more than the mere outlines and a few characteristics of a few of the most important medicines, and memory is at best but an uncertain reliance. But with the repertories and knowledge of how to use them, the task is greatly simplified and the competent prescriber may, if he will, find the curative medicine in nearly every case. Of the results of such prescribing in acute or chronic cases, when conscientiously done, nothing need here be said, except that they so far surpass the results of all other methods as to be in a class by themselves.
It is, or should be, evident to any intelligent physician that here we have a field and an opportunity for the exercise of the high powers and qualities of the human mind. The homoeopathic art and science stand related in one way and another with nearly the entire “Circle of the Sciences.” The light of all knowledge of man and his world can be focused upon the problems of dis tale and disability. Nothing comes amiss to the true physician.
His mission in the world is one of the highest and most useful, and from the conscientious performance of his professional duties he may derive deep and soul-satisfying compensation.
In homoeopathic practice, the minds of its best thinkers and greatest leaders have always, as a rule, turned to the study and treatment of chronic diseases, since those present the most complicated and difficult, but at the same time most fascinating problems in medicine, and consequently challenge most sharply the attention and ability. Here, if anywhere, is a legitimate and little practised speciality for which our qualified young men should definitely and methodically prepare themselves. Reputation, honour and empowerment wait upon their success. The need for men competent to treat chronic patients scientifically is great. The demand is great, but the supply is small. The older men, experts in this difficult but most important work, are passing over. But their published works, and those of their great predecessors, remain as a heritage and treasury of inexhaustible riches which their successors may freely draw upon for all time.