THE CLINICIANS PROBLEMS


THE CLINICIANS PROBLEMS.
   [ Read before the Annual Meeting of The International Hahnemannian Association, Phil…


As believers in the art of prescribing homoeopathically for the sick it may be interesting to us all to consider briefly a few of the many problems which we as homoeopaths daily encounter in our work. One occasion of discouragement, even dismay to some of our immature but enthusiastic prescribers, lies in the fact that times arise when the most conscientious and orthodox matching of drug and disease fails to produce results. To stand by calmly and see such cases seek and obtain relief from measures other than homoeopathic, is disconcerting to say the least. When, however, we better understand that a variety of points more or less obscure often enter into the trying situations, our pride is somewhat restored.

I will mention one of these factors even at the risk of being reminded that a “poor workman always finds fault with his tools.” I refer to the fact that our materia medica is profusely studded with gaps so to speak, serious gaps that have to do with inadequate provings as well as no provings. After thirty years experience the marvel to me is still present, that we achieve the high ratio of success that statistically belongs to us, carrying even this one handicap. Another problem presents itself when patient and doctor hold different opinions as to what constitutes a cure of some given condition.

This problem sometimes narrows itself down to a toss-up of whether it is more expedient to relieve pain, hold the patient, and possibly postpone forever any eventful cure or to disregard immediate and pressing discomfort in an effort to secure effective and permanent removal of the same later as the case scientifically unwinds. This problem calls for expert management, the chief phase of importance in its solution being to win the confidence of the patient.

A prescriber who is incapable to inspiring this because, for one thing, he prefers to keep his plans and methods on a high plane of inaccessibility as far as the patients comprehension goes, in other words the man who deems it the patients part to take his medicine and ask to questions, will often be disappointed in results. It is well to remember right here that a patient afflicted with a chronic disease, who today agrees to be treated homoeopathically for his troubles, needs first a little re-educating, for the average individual has absorbed a lot of information which, as Josh Billings would say, “aint so.”

Indeed a whole paper might be written on this new relation between doctor and patient due to the trend of the times. Intelligent people are seeking first hand directions as to the best manner of running their physical machines. They are beginning to appreciate the wisdom of keeping it in repair. Expert advice here is soaring in price, while popular health admonitions crowd our magazines and papers. The noncommittal physician should recognize the situation and with no compromise of professional dignity meet the problem diplomatically.

Unquestionably this widespread health propaganda campaign is not unmixed with grave danger to the public. Putting aside the old- fashioned scare headlines in health articles, written to promote the sale of all manner of worthless nostrums, a vast amount of pathological misinformation is being assimilated by the innocent and ignorant seekers of knowledge. An accredited psychologist will indeed tell you tales of the bugaboos he snares from the subconscious of these victims.

Connected with this problem, in fact growing out of the same stem, is the popular modern mania for publicity, an excellent safe-guard against many ills undoubtedly but, once more, if pushed to the extreme, a propensity that readily becomes in uncomfortable not to say dangerous element for us to combat. The slogan, “no secret nostrums,” “a clear label on every bottle” of alleged medicine, such of course receives our support. It is when a prospective patient asks of us: “What am I taking, doctor?” “What am I to expect from this prescription?” that the incognito in our therapeutics bobs up– a question.

To people unacquainted with homoeopathic medicines and the time-honored method of their administration these are legitimate and natural queries and must be met. To hand such an inquisitive patient a small vial of alcohol saturated pellets of saccharum lactis and a growing one. I am aware that some prescribers today, as in the early years of homoeopathic practice, administer their one dose and scorn any follow up procedure. It is a question whether this method could succeed today. I am convinced, however, that the very simplicity and sameness of our office and bedside routine keeps a certain type of would-be investigator of homoeopathy from any honest trial of its virtues.

This reminds me of an instance that occurred in a fatal case of pneumonia in a member of an old homoeopathic family of the late Dr. C. W. Butler. I treated this patient for some years after Dr. Butlers death, then the young members of the ladys household, attaining years of wisdom, homoeopathy in their midst became conspicuous by its absence. The mother finally coming down with pneumonia, an elder daughter on being asked why they did not have homoeopathy for the patient, replied that she “just could not stand by and see nothing being done for our dear little mother.” Well, much was done and the undertaker finished the job.

Education is invariably offered as the permanent solution of social and moral problems. I suppose some sort of a comprehensible explanation is due the patient who seeks it, but here again we bump into a problem of just how far to go in this educational process. We are all regaled from time to time by regular Arabian Nights tales of what other doctors have told patients before they came to us. Nothing can be done here of course but catch these flights of the imagination and classify them in our case history under the head of mental symptoms, but the experience serves as a warning against over volubility.

Back and forth swings the pendulum. You are often damned if you do explain matters of diagnosis and prognosis to your patient, you damned if you dont. Within the last year I lost a family because I explained to a father that his young daughters slow progress towards health had its root in a tubercular taint. The ominous word terrified him. I supposed he concluded that if I knew what I was talking about the case was too serious for homoeopathy to cope with. Some other doctor with an itch to explain has probably reassured him ere this, and my explanation is now regarded as another doctors wild goose tale.

Such an experience of course illustrates not only the danger of saying too much but of saying it the wrong way and to the wrong individual. Retiring then within ones shell, reassured by the knowledge of the great value of our methods, again I sometimes wonder if some of us at heart are not in danger of becoming a trifle static in what for a better term I will call the mechanics of our professional ministrations. A principle must be stationary– its manner of ex-emplification may improve. Veering around once more I appreciate that just as this point looms up another danger, which may degenerate into a problem– a problem by the way more likely to confront the beginner in medicine than us older members of the profession.

I have reference, for instance, to the doctors office, of over elaboration of equipment, over emphasis on the ceremonial of approach. Where the patient as a patient is so invested with the ritual of scientific examination, that the simple illness for which he often seeks aid is swallowed up in the technique of its discovery. Just what constitutes a happy middle position in this relation? To be personal and mention my own surroundings, I dont believe I am ashamed to state that for more than twenty years my office, its rules, regulations, and appointments have undergone no perceptible change. A few modern implements of diagnosis have crept in and added remedies, of course, but Dr. Butler would be quite at home in his old chair with his beloved old vials close at hand. He might be mystified by the complexities of an up-to- date blood pressure machine; he might question just how much of a part the findings of such an instrument play in the grand total of our homoeopathic prescription, but in the main his teachings and beliefs would receive so little of a joint with the passing of the years, that I wonder again whether the inertia of the routinism, above alluded to, has me in its grasp? It is a problem.

In this age of intensive specialization I presume it behooves the homoeopathic therapeutist to cast about and find the niche in which he by rights belongs. He has a place in medicine and a vitally important one, so important indeed that in the whole wide range of the art of healing disease there exists no substitute for the homoeopathic prescription when correctly applied.

I suppose my mind is wandering and I am glimpsing Utopian days to come, but I believe the ideal environment of the specialist in homoeopathic prescribing, assuming that his clientele could be made to appreciate what they would be getting under such a plan, would be for each chronic patient to appear with a complete record or “health chart” compiled by experts in the various branches of physical diagnosis. The general practitioner is not an eye, or an ear, or a throat man. Why not extend the office of these specialists to include the entire physical organism and all of its functions? Great laboratories for such work are coming –one I could mention is here.

Suppose it is a commercial organization, in so far as mighty financial interests sustain it, the results accruing from it could be made worthy of genuine support. With such important and reliable specifications at hand, the specialists of final importance, the man to cure the case, could begin to get in his real work with the patient. Stripped of all named disorders, just a disturbed and suffering organism assailed by many ephemeral and apparently no consequential sensations, unnoticed in the laboratory or on the examination table but which often spells out a code of help to the homoeopathic prescriber, how many problems would melt away under such a regime.

In conclusion I want to present three cases, not because of any special interest in the cases themselves but because each contains specific points for discussion.

Case one, shows that the old dictum, ” a case well taken is half prescribed for,” can be reversed into a case half taken is worse than not prescribed for. Mrs. A., middle-aged, rather rotund, and of a gouty diathesis, evidence by chalky deposits around finger joints, family history negative, has had gall bladder trouble in the past for which she was operated upon. Present symptoms — fatigue, can hardly endure her weakness and her pains; craves heat; is constantly sighing; has had a series of shocks in recent years, notably the loss of a favorite son in the late war; is very sensitive and high strung but constitutionally reticent and difficult to approach.

I gave her Ignatia which brought some relief but did not hold –a change of potency in a repeated prescription gave no better results. I now reassembled my data and at the third conference chose Nat. mur. Failure this time nettled me, and Mrs. A. and I got down to business, in other words I took her case because and I got down to business, in other words I took her case because I overcame her disinclination to talk and induced several important revelations, chief of which was the admission that so strong was her fear of growing stouter that she was living on a diet so low in caloric value that it would not nourish a half grown pup.

It took some eloquence but I finally convinced her that she could not run such a sizeable engine on such fuel, also that her disagreeable sensations were directly traceable to her abstenaciousness in the matter of food. I now gave Ignatia and with her cooperation, it worked the miracle, relief such as she had not known for years.

Case two is interesting because it indicates to my mind the fact that we do meet cases of so-called deficiency disease where the need may be physiologically supplied and not interfere with the action of true medicine when such cases call for medication. Mrs. G., with a history of myxoedema of thirty years duration. Thyroidine has been constantly employed during the whole of this period with a loss of ninety pounds in weight. She now weighs 180. I was called to prescribe for a case of grip and found that her constitutional history clearly indicated that Nat. mur. had been her medicine since girlhood.

I overlooked the acute symptoms of the grip picture and followed the lead. Her recovery was so spectacular that it was widely commented upon in the boarding house where she lives. Did I imagine I could remove her Thyroidine? I did not. This was nourishment not medicine. Nat. mur. took charge of affairs but on a different plane. This may be just a flicker of truth regarding all the ductless glands, simple of course when compared with hypersecretion, but the end of human attainment is still some distance ahead of us.

Case three is more complicated and more problematical. I did my best for him but the old man is dead. The last ten years of his final total, seventy-three, was rather rocky going; an energetic stubborn will and a fibrillating heart provoked more than one crisis. Finally two grains of Dig. a day smoothed over some of our difficulties — (that rank misnomer physiological medicine again). Then storms broke, restlessness, peevishness, sweat, sleeplessness and many more discomforts. I enlarged to him upon the steadying of the heart beat, etc., but all to no effect, he held to the opinion that he was getting worse and his family agreed with him. The main functions of the body were apparently normal and there was no fever.

I may mention here that Lach. had been given early in the case with great relief. At this juncture a misunderstanding suspended my attendance on the case. My two successors maintained the Dig. and added massive doses of Bromide which did not give sleep, but their tenure of office lasted but twenty-four hours. I was hurriedly summoned to see Mr. C. die or prevent it if I could. The case was desperate and looked hopeless. The generals in the symptomatology now were delirium without fever, aggravation from sleep, and profuse sweating, this last being the most peculiar as it ceased when the patient went to sleep.

Of course the Dig. was diminished and the Bromide discontinued. My prescription was Samb. Nig. Seven hours of quiet sleep followed the first night, even the heart action fell under the benign influence of the remedy for a number of days. Then Dig. was resumed and continued for a full year before he died, as I predicted, suddenly. In the interim between these two attacks my prescriptions were always based on the symptoms given regardless of the Dig. He had one or two colds and an attack of grip, but the action of the dynamic remedy given for these was in no way as far as I was able to perceive influenced by the Dig. I invite your comments upon my conclusion.

Hahnemann very emphatically enjoined us to determine what was curable in disease and medicine. I do not now recall that he left any specific directions as to what to do with our incurable cases. Palliation may be but an expedient, but no man could practice medicine without employing such. Are we always sure that the homoeopathic prescriber has a full line of these makeshifts? Their correct and legitimate use is perhaps our problem of problems.

Philip Krichbaum