Not every case which presents itself to the physician requires medicine. It may only require the searching out and correcting of some evil habit, some error in the mode of living, such as faulty diet, unsanitary surroundings, non-observance of ordinary hygienic requirements in regard to breathing, exercise, sleeping, etc.
In Par. 4 of the *Organon Hahnemann says : “He (the physician) is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health.”
In Par. 5 the physician is enjoined to search out “the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease to enable him to discover its *fundamental cause, which is generally due to a chronic miasm.”
In making these investigations he directs our attention to “the *physical constitution of the patient, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual functions, etc.”
But this line of investigation is equally fruitful and necessary in dealing with the indispositions of which I am particularly speaking.
In the note to Par. 7, Hahnemann says: “As a matter of course every sensible physician will remove such causes at first, after which the indisposition will generally cease spontaneously.” By way of illustration he goes on to say: “He will remove from the room strong smelling flowers, which have a tendency to cause syncope and hysterical sufferings;” (and I may add that he will order hysterical and neurotic “lady patients” to abandon the use of the strong perfumes and sachet bags with which they render the air of their rooms unfit to breathe, aggravate their complaints and make themselves a nuisance to everyone who comes near them); “extract from the cornea the foreign body that excites inflammation of the eye; loosen the over-tight bandage on a wounded limb, ligature the wounded artery, promote the expulsion of poisonous ingesta by vomiting, extract foreign substances from the orifices of the body, crush or remove vesical calculi, open the imperforate anus of the new born infant, etc.”
In short, Hahnemann has done his best to make it clear that the use of *common sense is not incompatible with homoeopathic practice, his enemies and some of his overzealous followers to the contrary notwithstanding.
The young homoeopathic doctor, fresh from the halls of materia medica, with his brand new case of medicines, is apt to be like the small boy with his first jack-knife who wants to carve and whittle everything within reach- a simile, by the way, quite as applicable to the young surgeon! Both of them leave a trail which to follow does not require the sagacity of a Sherlock Holmes.
Consider for a few moments, then, that class of cases which require for their use only the correction of faulty habits and the removal of exciting causes. Consider also that it often requires the exhibition of as much wisdom, skill, good judgment and tact to perform this function as it does to prescribe medicine; indeed, it often requires more. It is much easier to deal out medicine and dismiss the patient, than it is to make a careful investigation of the habits and circumstances of a patient who probably does not need medicine at all, but only wise and kindly advice on how to live.
Great is the power and value of Homoeopathic medicine, but, like all other good things, it can be abused. Even high potencies can be abused and cause mischief, as I saw illustrated very strikingly when I was sent for in haste to see a patient for whom I had prescribed a few days before. I relate the case because it not only illustrates the particular point I am discussing now, but also the subject of posology which I shall take up subsequently. The patient was an old gentleman who was in a state of mild senile dementia, with enfeebled power of thought, loss of memory, tendency to involuntary urination and defaecation, rather persistent sleeplessness, and becoming careless in his personal habits.
But he had been perfectly tractable and mild in his demeanor, and had made no trouble for his family. The symptoms led me to prescribe a remedy, which I gave in the two hundredth potency, with directions to take two doses daily. Three days later I was sent for in haste to see him. I found him in a highly excited state of mind, with flushed face, widely dilated pupils, staring expression and suspicious of being poisoned. He excitedly and harshly accused me of giving him “another man’s medicine” which had “filled his bowels up;” he had removed all his clothes, refused to put them on again, and was going about the house nude before the women, without shame, and had tried to go out of doors in that state.
I recognized the symptoms immediately, as I hope you have done. Probably most of you will be able to name the remedy. It was Hyoscyamus, of course.
On making inquires I found that instead of taking the remedy twice a day as directed, owing to a misunderstanding, he had been taking it *every two hours. Of course he was making a proving – of *the two hundredth potency! A single dose of Belladonna, two hundredth, removed the whole trouble in a few hours, and he resumed his ordinary placid course of life.
An experience of that kind has a strong tendency to remove any scepticism one may have as to the power of high potencies. It also conveys an impressive warning against too frequent repetition of doses. Moreover, it upsets the theory that high potencies do not act upon the aged. Incidentally it shows the possibility, sometimes denied, of making provings with highly potentiated medicines and substantiates the claims of those who hold that no remedy can be considered as well proved until it has been proved in the potencies as well as in crude from.
It is well known that the most valuable part of a drug action, the finer shadings of symptomatology, are almost never brought out under the use of the tinctures and low potencies. These appear usually under the action of a medium or high potency, or toward the close of a proving of a low potency, long after the first effects of the drug have passed away; so that it has come to be a maxim among experienced provers that *the last appearing symptoms in a proving are the most valuable and characteristic.In the same way, the *last appearing symptoms in a disease, especially chronic disease, are of the highest rank in selecting the remedy- a practical point it is well to remember. We should never neglect to inquire of a patient *whether any new symptoms have appeared since the last visit or prescription and value any such highly.
Returning to the subject of indisposition: Having discovered such a case and determined that it does not require medication, the question arises, how is such a case to be managed? At first sight it would seem to be a very simple matter; merely to tell the patient bluntly that he does not need medicine, but only to mend his life and correct his habits according to the advice and instruction which you have given or will give.
This view of the matter does not take into consideration the peculiarities of human nature as formed by ages and generations of habit and custom. Only occasionally do we meet a patient to whom we can give ideal advice and treatment. In spite of the rapid growth of the no-drug idea as promulgated by the various modern cults, the average patient *who goes to the doctor, expects to get medicine. If he is so far advanced in his ideas as to believe in the no- drug theory he will probably not go to the doctor at all, but will seek out the osteopath or the Christian science healer.
The patient who believes in drugs and goes to a doctor for treatment will be very likely to listen incredulously to your well-meant advice and will depart to tell his friends in anything but a respectful manner, that he thought you were a doctor, but he found that you were only a half-baked Christian scientist after all, or something to that effect. To direct his attention to his errors of living and order him to correct them is to apparently put the burden of cure upon him, and that is not what he wants at all. He expects us to bear that burden.
That is what he comes to us for. Besides that, he often resents the assertion that his trouble is due to his own ignorance or willfulness. There is a large class of people today – selfish, pleasure – seeking, luxury-loving, dissipating creatures, male and female – who demand of the physician relief from the pains and penalties of their hygienic sins, but are not willing to do their necessary part toward bringing this about. They want to “eat their cake and have it too.”
We cannot afford to antagonize this class, either for their sakes or our own. We owe them a duty as well as ourselves, and few of us can afford to pick our patients. We must take them as they come and adjust ourselves to their individual needs and peculiarities. These in general are some of the cases which require tact in management. “You can catch more flies with molasses than with vinegar.” We can gradually lead some of these people into better ways of life and thought and cure them of both their sickness and their sins, if we are patient and wise and tactful; while at the same time we are increasing the extent and influence of our practice.
The physician who aims to be something more than a mere dispenser of palliatives, pills, and piffle, will never lack opportunities to magnify his profession and become a power for righteousness in his community, as well as a healer of its diseases. It is in dealing with such cases – the indispositions and habit disorders – that the *”second best remedy in the materia medica” so often comes into use. Of course you all know what the second best remedy is. No? I am surprised that your education has been so neglected! But I am glad it is to be my privilege to teach you something you do not know. There are so few things that the average young doctor does not know!
In order to fully appreciate the value of the second best remedy we must first clearly understand what is the best remedy in the materia medica. There cannot be any doubt in your minds as to that, I am sure. It is the *indicated remedy. You also know that having once been found, the best remedy must be given time to act, and that its action must not be interfered with by other drugs or influences until it has accomplished all of which it is capable. You also know, or, if you do not, you will learn (if you keep your eyes open and your wits about you ) that too many doses of the best remedy may spoil the case.
One of the distinguishing characteristics of a great painter is that he *knows when to stop. Many a painting which would have been great, if the artist had known when to stop, has been weakened and spoiled by over-finishing. In his anxiety to perfect a few insignificant details he robs his work of its vitality- kills it. It is the same in treating a case. The problem is to give just enough medicine and not too much. Too many doses may spoil the case. I have referred to the class of people who expect and demand *medicine, and are not satisfied unless they get it, until they have been taught better.
Now just here comes in the *second best remedy, without which no good homoeopathist could long practice medicine. Its technical name is *saccharum lactis officinalis; abbreviated sac. lac. or s. 1.; just plain sugar of milk! The young homoeopath’s best friend, the old doctor’s reliance and a “very present help in time of trouble!”
The doctrine of *placebo, from the Latin *placere, to please; future, *placebo “I shall please,” is as old as medicine itself. Its psychological value is commensurate with the frailties and peculiarities of human nature. The traditional “breadpill” of our medical ancestors has given place, in the march of scientific progress, to the more elegant powder of virginal white, pure sugar of milk; or to the seductive little vial of sugar pills or tablets, artistically labelled and bestowed with impressive directions as to the exact number of pills for a dose and the precise hours of taking, with confident assurances of the happy effects to be expected, if directions are faithfully followed!
Marvellous are the results witnessed from the resort to this remedy in cases where it is indicated. I have seen it bring sleep to the “insomniac,” when even morphine had failed. I have heard patients declare that it was the most effective cathartic they had ever taken and ever taken and beg for a generous supply for future use; which supply I have usually refused on the ground that it was too powerful a remedy to be entrusted to the hands of the unskilled. It is indeed too powerful and too useful a remedy to be held lightly, or to be lightly used. The knowledge of its use is too dangerous to be disseminated among the laity. It should be as jealously guarded as a “trade-secret” worth millions. Never admit its use to any but the initiated, if you value your influence and reputation, but never fail to use it when your judgment dictates it.
Let us glance at a few of the practical uses of the placebo. You are called to a new case. You see the patient and make your examination. You decide that it is a case for medication. You have written down your symptom-findings and glanced over the record.The case is difficult and you are not able to decide off – hand what remedy is indicated. You must have time and opportunity to study it up. The patient and friends want something done at once. Rapidly you run over the case in your mind. this patient is seriously ill. To make a mistake in the first prescription might be fatal, or it might prejudice the case by confusing it so that a quick and satisfactory cure would be impossible. Your reputation in the new family will depend upon your success. You must retain the confidence of the patient, but you must *have time and make no mistake.
This is where your knowledge of the second best remedy comes into use. Calmly and confidently you prepare and administer a generous “s. 1.” powder, leave explicit directions for the use of as many subsequent doses as you deem judicious, make an appointment to see the patient again in an hour or two, or three, and then hie you to the seclusion of your library, where you proceed to apply your knowledge of how to study the case and find the remedy according to the principles of the Organon.
When you have worked out your case and found the remedy, you return. Then you enter the patient’s presence as *master of the situation. – unless the Master of Destiny has ordained otherwise
Does anybody consider that lost time? It is a pity that more time is not lost in that way! Thousands of cases might have been saved and many a professional reputation, by following such a course, instead of yielding to the silly panic-impulse to “do something quick,” which almost invariably results in doing the wrong thing.
Patients do not usually die in a minute. There is always plenty of time to *do the right thing. always, at the right time. If you *know what the right thing is without reflection and study, do it at once. Give your remedy at once if you are sure of it, but not otherwise. If you are not sure, give sac. lac.
If the case is *really pressing and demands immediate medication, retire to another room with your repertory then and there.
The very greatest of our prescriber – men like Boenninghausen, Hering, Lippe, Wells, Biegler, of those who are gone, and almost all our expert prescriber of today, do not fail to carry their repertory with them to all cases, nor hesitate to use it the presence of the patient if necessary. Instead to arousing distrust on the part of the patients, as you might think, it awakens confidence. To see a physician making a through examination, studying, “taking pains,” showing a real interest in the case and a determination to do his best at the “psychological moment” (which is always the *present moment with the man who is suffering), is calculated to inspire confidence at all times- except with fools, whom no physician wants for patients and who ought to be permitted to get off the earth as soon as possible for the benefit of posterity anyway.
Another use for the second best remedy is as a supplement to the indicated remedy. Experience shows that Hahnemann was right when he advised that *the remedy should be stopped as soon as signs of improvement appear, and the curative reaction be allowed to go on without further repetition of doses as long as it will. This, of course, refers to the cases where repeated doses are given from the beginning. When improvement begins and you desire to cease medication, you will simply substitute sac. lac. for the remedy and watch your case.
The same course is pursued when treatment is begun with the *single dose, by which method many of the most brilliant cures are made.
We may give enough sac. lac. powders to last during the interval between visits, or a vial of blank tablets or pellets; but be sure to moisten the tablets and pellets with alcohol, or put some unmedicated pellets in the sac. lac. powders. Patients have a way of investigating powders sometimes and counting the pellets. If they find no pellets they may become suspicious.
The medicine case should always contain a vial of blank pellets property labelled for such use. One friend of mine always carries a duplicate case of vials containing black pellets, but labelled as medicines to disarm suspicion.
These are some of the ways to use the second best remedy. If you follow the right course you will find more and more use for it, except with a few rare patients whom you can gradually educate up to the point where they come to realize that but little medicine and few doses are necessary, when a case is skill fully conducted.All this is quite in line with the most up-to-date teaching and thinking on therapeutic subjects. The use of placebo is simply one form, and a very powerful form of therapeutic suggestion; or, to use the still more recent term, psycho- therapy. In the habitual, systematic and judicious use of the harmless little powder of sac. lac. the homoeopathist antedated all the modern cults of drugless healing, and even they have devised no more powerful nor efficient measure.
We are not under the necessity of sending our patients away, as Dr. Wm. Gilman Thompson, of Cornell University Medical College, had to do. He was holding a medical clinic before the senior class. To this clinic came a woman whose case was diagnosed as neurasthenia. Among the multitude of complaints she poured forth, she laid most stress upon *constipation; but declared that she *could and *would not take any more cathartics.
Dr. Thompson pondered over the problem a few moments and the turned to the class and said: “Gentlemen. there is but one thing to do for this patient. We will send her to Boston. There, they will give her a *subconscious pill, and she will get an *Immanuel Movement!”
Many who are not susceptible to the “subconscious pill” will respond to the somewhat more tangible but none the less efficient sac. lac. powder, even among those who live in Boston!
Objection has been made to this mode of dealing with cases, by certain individuals with *very delicate consciences, on the ground that it was not strictly honest! To practice even such a mild deception upon patients would violate their fine sense of honor! Besides, it tended to engender in patients a *habit of dependence upon sac. lac. and to demoralize the physician who followed the practice!
Recall the words of HIM who said: “Woe unto you, Scribes and Pharisees, hypocrites! for ye pay tithes 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. Ye blind guides which strain at a gnat and swallow a camel!”
He who said that, anointed the eyes of a blind man with “clay mixed with spittle,” bade him go and wash in the pool of Siloam, and he recovered his sight-healed by *faith; awakened by the therapeutic suggestion of a *clay placebo and an order to take a bath!
Any harmless measure which tends to arouse the curative reaction of the organism through the awakening of faith and confident expectation, is not only right but legitimate and sometimes indispensable.