Read before the February, 1923, meeting of the Homoeopathic Medical Society of the County of New York.
The expression “chronic cases” is so very indefinite from the general medical point of view that I feel some hesitancy in using it before this body physicians.
Yet to those of us how are familiar with the works of Hahnemann and are accustomed to homoeopathic methods of prescribing, the term is intelligible and carries a certain rather unique definition.
By the term “chronic disease” Hahnemann meant not merely a disease extending over a long period of time; or necessarily a definite disease entity such s cancer or eczema, but rather an individual state of ill health resulting usually from some deep seated condition, perhaps an hereditary matter, or the result of suppression of some external or paroxysmal state.
The manifestation of the “chronic disease” may even assume different forms during the life of an individual. Be that as it may, one who studies disease from the Hahnemannian point of view soon learns that success in dealing with his chronic cases is likely to be proportioned to the keenness of his powers of observation and his ability to understand his patient as an individual exhibiting characteristic a little different from every other individual and this regardless of the classification of his immediate group of disease symptoms, for symptoms arise in the human body along lines of least resistance and the especial group that a given individual may be afflicted with at some period of his life is determined largely by the state of an organ or group of organs at that time.
Consequently in selecting remedies for sick individuals the important thought is not whether a medicine may be valuable in nephritis or tibial ulcer or what not, his present group of symptoms. In other words, there must be a homoeopathicity (harmonious relation) existing between drug and patient as individuals as well as between symptom groups.
A curative remedy must be one that has a certain homoeopathicity to the patient and that will develop in the healthy human being a condition similar to the existing state of illness as determined by the above tests.
With these preliminary thoughts in mind, let us inquire into the practical application of our principles – how are we to determine what remedies may be suitable for certain individual cases and what results may we expect?.
Through the influence of traditional medicine it is hard not to fall into the habit of grouping in our minds certain drugs as having especial value in the treatment of certain diseases: Arsenic in cancer, Mercury syphilis, Iron or Arsenic in anemic and so on; while it is true that these medicines are perhaps more frequently indicated than others in the mentioned diseases it is also true that if we attempt to treat our cases as they come in this routine manner we shall find very little satisfaction in the handling of chronic cases.
It must continually be borne in mind that while the diagnosis of the diseases from which our patient is suffering is important the diagnosis of the homoeopathic remedy with which we propose to attacks his illness is even more important and that the two may best be kept entirely separate in our minds.
It is imperative that we homoeopaths should be expert diagnosticians, our training in observation should make this a natural expectation, but once having made a correct diagnosis, of the disease and thus forearmed ourselves in matters of procedure, physical care and prognosis we may then put aside this knowledge, so to speak, and proceed in an unprejudiced and orderly manner to study the patient as an individual entirely apart from his pathological state with a view of determining what medicine may offer help in the rebuilding of his body and the consequent amelioration or eradication of his disease. Before proceeding far we shall be confronted with two questions that are of considerable moment, viz:
To follow Hahnemann-what is curable in disease and what is curative in medicine? For instance, it would be a bold physician who would claim o have cured a case of epilepsy because the patient had had no seizures for one or two months after coming under treatment, for is it not a well known fact that a large majority of these cases show improvement for a time after beginning any new treatment? Four or five years should elapse before one would feel that a cure had been made.
No one would claim to have cured a case of manic-depressive insanity on the passing of the stage of exhilaration and the appearance of a temporary normal state. No more should one consider malaria to be cured after the suppression of the paroxysms of chill and fever by Quinine, for does not the disease reappear year after year under favorable conditions in various forms until eradicated by correct individual homoeopathic medicine?.
Thus before we may essay to achieve desirable results we must know from experience what is disease in curable. Again, what is curative in medicine. The answer to this question presupposes a knowledge of the relative value of drugs from a homoeopathic standpoint, of their provings and what they may reasonably be expected to do both in the healthy subject and in disease.
Thus we may not expect to cure a long-standing, chronic case with remedies of very limited scope such as Cepa, Lobelia or Cocculus, even though the symptoms may agree with the immediate picture of the case. It is imperative that we extend our vision in order to take in the whole life of the patient and note down carefully the various manifestations of his sickness and his personality as they have developed from the beginning.
We must know our drugs in the same way that we know our friends, as individuals, as definite personalities each with its especial characteristics. Here is the explanation of Hahnemanns remarkable success as a prescriber, his intimate acquaintance with his tools; through the many provings that he made on himself and others, he got at his drugs first hand and knew exactly what they might be expected to do in sickness because he had tested their reactions on the healthy.
Very few physicians of today have done much proving; in fact, we could hardly find the time for it were we so inclined, though it is a great misfortune that we cannot.
In its place many of us have substituted repertory analysis of cases, a poor substitute though under present conditions indispensable. Hahnemann had no repertory. He did not need one. He knew every drug he had occasion to use as he knew his neighbors and he knew just what they could be depended on to accomplish.
The next generation of homoeopathic physicians, beginning with Boenninghausen began to make repertories and they have been at it ever since. There has never been a perfect one; there never will be; however, a few of these books, especially those of Boenninghausen and, greatest of all, that of Kent, ar monumental works, almost as great as the materia medica itself. We could hardly practice without them today.
It goes without saying that if one knows his chronic patient intimately, in other words, if he had “taken the case” accurately and thoroughly and if he is equally familiar with his drugs it is not especially difficult to prescribe well and obtain good results, but what one of us is really able to measure up to such a standard? If we were, homoeopathy would soon sweep all before it, for we all of us have occasional brilliant results that seem to the uninitiated little short or miraculous.
Practically, however, only the rare man–the Hahnemann, the Boenninghausen, Hering, Lippe, Kent–is ever able to achieve wholly satisfactory results in more than a small percentage of his cases, but these are so very satisfactory that we must continually strive to approach in some measure the records of the greatest of our predecessors.
In view of the practical aspect of our art at the present time it is hard to see how any one can expect to get results without preliminary repertory analysis in practically every case of any importance, otherwise our materia medica is a closed book.
I will pass over the “taking of the case,” which really means the careful and painstaking investigation of the life of the individual and his intimate personal characteristics. This matter is elaborated in the “Organon” and in Hahnemanns “Chronic Diseases,” and has recently been restudied and presented in a most helpful manner by Dr. Stearns, of this city. Suffice is to say that the foundation of all success in this field is largely dependent on the care with which this initial study is made.
Of all the repertories that have ever been published only two are suitable for such analysis–Boenninghausen and Kent–and the latter is by far the more comprehensive of the two and is used exclusively by most students today.
We can do no better than to follow as accurately as possible the plan of Dr. Kent, to first study through the aid of the repertory the individual in his most intimate aspects, what are his personal reactions to his environment as shown by mental symptoms, temperature symptoms, sexual or menstrual function, idiosyncrasies of food, and so on. These great general symptoms being ascertained, it will usually be found that the minor, passing and particular symptoms will be included in the anamnesis of any medicine that covers the case.
Having, by the use of the repertory narrowed the group of possible remedies down to three or four, it is then not difficult to make a cheerful study of the provings of this small number and thus to determine the probable similimum. This is a simple and orderly procedure not over-taxing, and, while it may consume one or two hours at the beginning of a given case, it is really a time-saving method in the end, for it your first choice does not prove satisfactory you are then able to draw on other drugs of the group already considered for further study and use.
The acme of our homoeopathic art as elaborated by Hahnemann is reached in the treatment of our chronic cases. Acute diseases are largely self-limited. Their symptoms are easily discernible, often dramatic in their rapid development and clear-cut form. It is comparatively easy to recognized the symptoms of the conditions calling for such remedies as Aconite, Belladonna, Bryonia or Phosphorus.
It was when Hahnemann felt that this his success should not be limited to these comparatively simple cases that he began the study of the class of drugs which he termed Antipsorics and their application to chronic states which he had heretofore been unable to reach that he developed the foundation of all our later work in this field.
In order to better illustrate the method of a few cases have been selected for brief survey.
Miss G. presented herself at Woodside in October, 1904, at forty years of age, a “nervous wreck” after a summer of European travel. When she was two and one-half years of age her mother and died of tuberculosis; a brother had recently succumbed to the same disease; a sister was a nervous invalid.
The patient had suffered severely from dysmenorrhoea, for which an operation had been performed ten years before. She had scarlet fever in childhood and had long been subject to “collapse” under any nervous strain so that for many years she had been a confirmed semi-invalid. She was frightened, apprehensive, tearful; averse to company or to effort. In speaking of the development of symptoms along lines of least resistance, whenever sick, this patient always exhibited a very pronounced group of stomach symptoms so that it was felt by her friends that there must be a serious digestive fault. Fullness, sensitiveness to pressure, the eructation of great bursts of gas with loud noise that could be heard all over the house; quivering, aversion to sweets and desire for acids, bitter taste–very slow and imperfect digestion, cutting pains and nausea.
Her sleep was indifferent and insufficient, waking, as if the habit of these cases, around 2 A. M., with only restless naps during the rest of the night! Frightened sensations in the night, perspiration, confused dreams. Menstruation regular and normal, followed by great exhaustion; some pain down the thighs on the first day.
The patient is warm blooded. wears light clothing and desires cool air and open windows. She was not as well at the seashore when a child. Her condition was a good illustration of that of many individuals who have a marked hereditary tendency to tuberculosis. Through the influence of good care and environment they never develop the disease itself, but they have a greatly diminished resistance to disease in general and the nervous system is especially susceptible to overstrain from causes that would mean nothing to a normal individual. This patient up to forty years of age had never had normal, sustained strength enough to enable her to undertake a permanent occupation.
The first prescription was Tuberculinum 1m., in an effort to correct in some degree the underlying constitutional tendency, and under which her general and mental condition improved considerably. Phosphorus was the net remedy and it exerted a very helpful influence. During the following two months she improved steadily and the more active symptoms were much modified. After the action of this medicine ceased she received two or three medicines that were ill chosen and accomplished little. Finally Nux vomica was selected and under its influence practically all of her acute symptoms gradually disappeared and she was able to leave the sanitarium by the first of June, 1905, after about eight months.
And now began the really interesting features of this case. For the next year the patient spent most of her time either in her own camp in the White Mountains or with relatives, not attempting constructive work of any kind. While free for the most part from her old symptoms and quite and quite comfortable, her general strength remained below what we have a right to expect in a normal individual. During this time I was in touch with her at intervals and in the summer of 1906 after further study, decided on Calc. phos. as a constitutional remedy and it was given in the 1m. potency with most happy results. Improvement began at once, slowly at first and with breaks from time to time yet her general strength increased constantly.
She spent the following year or two in the Middle West and through several trying periods in which her strength as tested to the limit in the care of friends. In spite of all this she began to develop initiative as well as strength, and life began to have a new meaning for her. She took up the study of domestic economy, and, to make a long story short, she has now been for some years at the head of this department in one of the well known Eastern colleges for women. In addition to this, she has, for the past two years, conducted a similar department at the summer school of Chicago University. During all these years, whenever a period of great anxiety or of some acute sickness has brought some of the old symptoms to the front a few doses of Calc. phos. have never failed to set things right.
Another case of a very different nature is that of a young woman of 32, Miss B., and individual of marked vigor and endurance and with a superabundance of energy, stout of body and fearless in mind. For years, in fact, for most of her adult life she had suffered periodically from chronic headache or migraine, occurring mostly at the beginning or close of menses, coming on during the night, dull aching, through temporal region, shooting pains, entering about the right eye; worse from loss of sleep or from overuse of eyes; nausea and belching but no vomiting; great desire for stool, bowels usually constipated. Formerly the headaches appeared only at the menstrual cycle, but now they occur after any unusual loss of sleep as well.
The patient is of an emotional nature, tense, emphatic. There is some posterior displacement of the uterus, and slight prolapsus; menses are scant, the flow coming for one day, stooping for a days then going on for one or two days longer.
Here we find a chronic disease of a more simple character then the former case, yet a condition not always easy to overcome as we all know from experience that these woman are quite prone to suffer on until the climacteric unless relieved by correct homoeopathic medicines.
Furthermore, this case will illustrate the fact mentioned a few moments ago of the necessity, in diseases of this nature, of paying chief attention to the symptoms which concern the individual patient, the “general” symptoms of Kent, rather than those pertaining solely to the disease. In this instance we have only the symptoms which are common to a large majority of such cases of chronic headache, they are almost meaningless. But we have here a strongly individual type of woman, stout, inclined to take in flesh as she gets older l her trouble begins or is at its height during the night; her menstrual habit is scant and short; she is emotional.
If we pay not attention to the particulars of the paroxysm itself we would surely select Graphites as the only possible remedy, a deep acting drug as are all the carbons; one capable of causing longstanding disturbance in the economy of the healthy individual and likewise of curing similar conditions in the sick. In this instance, a very few doses of the medicine repeated only two or three times over a period of several months has put an end to all manifestations of the trouble.
In closing let me say that these cases are not selected as showing anything unusual, but merely as illustrating again the wonderful help that simple medicines, carefully chosen according to the homoeopathic principle may be in the handling of our chronic cases.
I am sure most of you can call to mind many similar experiences with Alumina, Baryta, Calcarea, Carbo animalis, Kali carb., Lycopodium, the Natrums, Platina, Silica, Sulphur or Thuja. A few of the drugs which are capable of effecting deep and permanent improvement in cases that otherwise would drag out a miserable existence to the end.