CLINICAL PATHOLOGY-AN AID OR HINDRANCE IN PRESCRIBING


Therefore the doctor again went over the case and discovered that the good woman has slipped on the ice, some months previous, had wrenched this knee but had not thought it worth while to speak of it. Clinical pathology, in the form of trauma to deep tissues, of long standing, pointed the way to a deep-acting remedy for bruised tissue, tincture of Bellis Perennis, as recommended by Dr.Burnett of England.


At first thought, clinical pathology has no part in the making of a homoeopathic prescription for the whole fabric of homoeopathy is based upon the proving of remedies on well persons, with a recording of the abnormalities and peculiarities, or so-called symptoms then produced.

But these symptoms were the result of changes produced in the bodies, organs or minds of the provers, and these changes were seen, therefore they were clinical. The provers were temporarily ill. Now illness is a departure from a state of health or regular function of the bodily economy; perhaps due to transitory pathological changes and the recorded symptoms might be evidence of pathological difference. If these premises are tenable, then clinical pathology should be an aid to prescribing.

To illustrate: A physician and an ambulance surgeon were sent for, post haste, late one summers afternoon, to minister to a fat Italian woman who spoke no English. Neither doctor spoke Italian.

The woman was gasping for breath, the face was alternately red and bluish, the chest filled with bubbling mucous rales and it was plain to both doctors that the woman had a broncho- pneumonia and was drowning in her own secretions. The ambulance surgeon turned on his heel and said, “Nothing can be done. I cannot take her to the hospital, she will die before I arrive and I will only bring censure on myself.” So the ambulance left. Here was a dying woman.

She could not give her symptoms, yet the clinical pathology wrote the symptoms so clearly that the ambulance left her to die. The frantic family begged that something be done. As Antimonium tartaricum seemed well indicated, the sixth was prescribed, rather for the sake of attempting something, than with the real belief that the remedy would save a life.

The physician left with the promise to look in again before bed time. Imagine his surprise when he called later to find, not a corpse, but a fairly comfortable woman. The prescription was repeated and next morning, in the midst of the smiling family, the woman decided that the doctor need not call again. “Me all wella, now”, she said.

Here the clinical pathology proved both a hindrance and an aid, just depending upon its interpretation.

So far as is known, the old masters of homoeopathy, with no laboratory facilities, had only a general knowledge of pathology and therefore their writings, as well as many of their close followers, verbally discourage the seeing of aught but the symptoms in the taking of the case. Their successes were and are phenomenal, and cure after cure has been reported, while today, even with all the added aids to diagnosis and treatment, more and more patient each year come to operation, many times for conditions which should be curable by medicines if prescribed according to the Hahnemannian law.

Yet, with modern requirements of teaching in our medical colleges today; with the lack of enthusiasm among our recent graduates to keep up the study of homoeopathic materia medica as laid down in the books; with the skepticism manifested by the medical student and even by the graduate in the action of the infinitesimal dose; if with their training in pathology, they can see symptoms as written by clinical pathology, it may lead to a keener interest in correct prescribing. As an illustration note the following case: Again it is an Italian woman, pale, emaciated, with suffering written all over her.

She had had a major operation, an abdominal section three months previous. As the woman spoke very little English it was impossible to learn what was done. Following her return from the hospital, she had been in almost constant pain. Several doctors had been to see her with no relief. The pain was sharp, confined to the left side, travelling from the abdomen up the side, through the heart and chest to the head. It was spasmodic and interfered with the heart. This description of the pain is supplied by the physician, for the woman could only murmur “Pain, pain, pain”, and sweep her arm from the pelvis to the head, and hold the hand over the heart.

What pathology had made necessary the operation, was not learned, for only the verbal symptoms of pain was given. the fact that an operation produces trauma to nerve as well as muscle tissue and that it was a left sided, spasmodic, clinical picture, suggested Spigelia which was given in 3x potency. The next day the woman looked happier, and while she said she had pain, it was less severe. three days later the family said the doctor need not come any more for the patient was well.

Because clinical pathology may aid in the selection of the remedy does not make it a scheme , per se, for prescribing. It is to be considered as one more plan to be tried when other modes of reasoning do not bring results. Again, a knowledge of pathology cannot be substituted for a knowledge of a materia medica, for no one can prescribe a remedy homoeopathically until he has some idea of its symptomatology, as well as sufficient knowledge or experience to make remedy homoeopathically until he has some idea of its symptomatology, as well as sufficient knowledge or experience to make remedy comparisions. For example, consider the following case of an intelligent, cultured American lady suffering from a tendency to neuritis, only manifest when she became over-fatigued or exhausted from long hours, or undue exposure.

She had been seen in a number of attacks and had soon cleared under Rhus tox., Bryonia, Cimicifuga, Anacardium and Sulphur according to the symptoms. The attack in question was a bit more general in location, in that it involved the hands and wrists, then the shoulder, and finally settled in the left knee. Here it remained and none of her accustomed remedies did any apparent good. Electricity yielded no better results. The knee was stiff though she could walk, yet it was painful to climb the stairs or get in and out of a car.

Pain and soreness were of only moderate degree. At last both doctor and patient became worried, the doctor because he took pride in relieving the patients attacks, the patient because she was soon to take an automobile trip, on which she wished to do some walking and climbing. Therefore the doctor again went over the case and discovered that the good woman has slipped on the ice, some months previous, had wrenched this knee but had not thought it worth while to speak of it. Clinical pathology, in the form of trauma to deep tissues, of long standing, pointed the way to a deep-acting remedy for bruised tissue, tincture of Bellis Perennis, as recommended by Dr.Burnett of England. This was prescribed and the patient took her trip and walked in comfort.

In conclusion, may it not be suggested that clinical pathology oftentimes comes as an aid in remedy selections. MONTCLAIR, N.J.

DISCUSSION.

DR. HUTCHINSON: The old teachers of homoeopathic art stressed very delightfully an interpretation of t he symptoms and frequently used as an illustration the infant who, of course, never gave any symptoms verbally. The homoeopathist was quite ready to interpret any action of the sick infant by his emotions, his appearance, his color, the history or complaint and other clinical symptoms.

It seems to me this delightful paper of the doctors brings us back to that important phase of things in estimating case, the analysis of the case just as it stands, with all its symptoms assembled and evaluated.

DR.KAVCIC: Sometimes we are obliged to prescribe only on pathology, because we have nothing else. I had very important case where I prescribed only on one pathological symptom. that was a cartilaginous sarcoma of the second right rib. It was as large as my fist, and was growing very rapidly,. The woman had already been treated allopathically with x-rays and with all sorts of external remedies, without success. I found that Argentum metallicum was the remedy. I gave it and it acted promptly. In three weeks the sarcoma was completely cured.

DR.GRIMMER: The doctor has stated clearly the tenets laid down by some of our leading masters from Hahnemann down. We study the Organon and the writings of Hahnemann. We find that he stresses the totality of the symptoms. He didnt mean just the totality of the mental symptoms alone; he included every symptom that he could get. hahnemann went over his patients; he examined them. Everything that he could learn about his patient was recorded. That formed his picture. And so it is with the use of pathology. Dr. Kent says it has a place, a relationship, it is in the schema; it has a valuable place sometimes. As the doctor here just stated, sometimes there is nothing left for us. How many unconscious cases of apoplexy are we called to prescribe for, often very successfully, only on what we can see?.

DR. KRICHBAUM: The totality of the symptoms very often is quite a confusing term. What is the totality of the symptoms? Often you get nothing but one pathological symptom. Is that symptom a fact or a condition? You will have nothing on which to base a prescription., There was a woman who had been to the Mayos, she had been x-rayed in Minneapolis, she was in New York, for a while, and I failed just as completely as the others on the two first attempts.

I went up to see her again but could get no definite symptoms, no new ones, at all. I sat and talked and laughed with her but I was trying to think. She had been losing her hearing for ten or twelve years and my conclusion was that the woman had suffered from grief and nothing else during this period.

I had no symptoms whatever to prescribe on, except the one of suppressed grief, I didnt find an Ignatia symptom about her. I gave her Ignatia, however, and she has never had the pain since, so I infer that Ignatia was her remedy. With pathology we get the same thing.

DR.STEVENS: In a good many of these cases that have been cited, it seems to me that the question is reduced to finding the cause, and that is one thing that we have to stress over and over again. If we find the cause, it may be part of the clinical pathology, but it certainly leads us to the remedy.

DR. FARR: There are one or two points which have come up in the discussion that I want to mention. I am glad that the point has been brought out relative to the totality of the symptom, because I consider that the whole story, and that was the thought that was in my mind when I prepared the paper. the whole schema of homoeopathic prescribing is to fit the totality of the symptoms to the similimum and anything can be used which will help to produce this result.

To attempt to detail the symptoms of all the drugs that cure catarrhs, I should have to read the materia medica from beginning to end; not only read the nasal symptoms of each drug, but detail the peculiarities of each, noting all accessory symptoms: for if a patient presents himself to us asking to be cured of the catarrh, he makes a great mistake; he wants to be cured as a patient, and we are bound to cure him as such. If he speedily dies of consumption, the catarrh disappearing, we have lost the patient even though the catarrh be cured.

Further, the local catarrh manifestations are of the least importance in finding our remedies. Six patients may, any day, come to us with organic changes in the nasal passages; the extent of change may be equally great and yet six different remedies will have to be given. The treatment must, in the highest sense of the word, be constitutional.-T.F.ALLEN, 1865.

We claim superiority homoeopathy in that it gives us the means of selecting our remedies with a reasonable certainty of their effects, and we rightly claim that medicine should not rest content with anything short of a method which, given the symptoms of a disease, points us to a certain remedy if our materia medica contains it; or, given the pathogenesis of a drug, indicates to us, a priori, the complex of symptoms which the drug will remove. – American Homoeopathic Review, 1864.

I L Farr