LIMITATIONS


There are those who, recognizing no limitations, try to bend all facts, even those which are of necessity directly opposite to their desires, to meet those desires. On the other hand there are those who would draw the limits so closely that their work is stultified and obstructed until they are driven to other methods, too often not only bad but even definitely harmful.


It seems to me that the members of every society should now and then stop to consider the limits of the action of the particular thing in which they are especially interested. Obstetrics is a very definite place in which to do this, because we are dealing with conditions which have very definite limits. In a discussion of the value of any method of treatment of disease there are two extremes of thought and a middle ground.

There are those who, recognizing no limitations, try to bend all facts, even those which are of necessity directly opposite to their desires, to meet those desires. On the other hand there are those who would draw the limits so closely that their work is stultified and obstructed until they are driven to other methods, too often not only bad but even definitely harmful. There are certain limitations which, if we are to treat our patient with the idea of cure in the safest way, we must recognize, and which Hahnemann himself recognized.

Let us assume for the moment, although it is never true, that the limitations imposed by personal knowledge and skill are not. What remains then in the practice of obstetrics to limit the homoeopathic method? In the practice of obstetrics there are two important factors to be considered, mother and child. To have normal labor it is necessary on the mothers part that the mechanics which cause the expulsion of the child be competent, and the passage through which the child must pass must be sufficient to allow the passenger to go through. On the part of the child it is necessary that it be not too large and that it be properly adapted to the passage.

Granting these premises, it seems to me there are some definite limitations to the power of homoeopathy in obstetrics. In general all those maternal conditions which are not dependent on changes in the birth canal itself are best treated by the homoeopathic remedy. That opens a large field, in fact the largest part of obstetrics, to the action of the homoeopathic remedy. All those conditions of pregnancy leading up to the actual time of delivery are particularly susceptible and particularly affected by the action of the homoeopathic remedy.

All those conditions in labor which are due to abnormalities in the action of the mothers vital forces, all those conditions which are characterized by irregularities of the pains, by irregularities of the pains, by irregularities of the forces, all those conditions which are not directly dependent upon obstruction of some sort or other on the part of the mother are conditions which the homoeopathic remedy will, in my opinion, handle better than any other matter; that is, on the mothers side.

Now, on the side of the child, on the other hand there is very little that is amenable to the action of the homoeopathic remedy. The homoeopathic remedy will not decrease the size of the child so it can go through. I do not believe that anybody can prove that you can actually change the position of the child by the action of the homoeopathic remedy. I have seen presentations of the childs position having changed, but I have seen them change without any medication, so that we have trouble proving that medication has anything to do with it.

I do not believe there is any excuse for any women having serious toxaemia or convulsions if she has a homoeopathic doctor. There is just one thing in the homoeopathic case under homoeopathic care that causes convulsions and that is neglect. That neglect may be, and usually is, on the part of the woman. You tell your patient to come and see you every so often and you take a careful history.

You regulate her diet and you say, “Come back every two or three weeks for careful checkup”. She comes back after her legs are swollen two or three times their normal size, after she has begun to vomit and have headaches, and after her blood pressure has gone up to 160 or 170. Then you are in trouble, but if you get co-operation and you get proper care you should have no trouble in taking your patient up to the time of labor, and you should have no difficulties which are not due to the irregularities and the abnormalities of the mothers mechanism.

If you have a case of fibroid in the canal you cant expect the homoeopathic remedy to take care of it. If you have a case with a twisted pelvis or a generally contracted pelvis, so small there isnt room for the child to come through, you cant expect the homoeopathic remedy to take care of it. If you have a child with hydrocephalus, with the head definitely larger than the inlet, you cant expect the homoeopathic remedy to take that child through the canal. If you have a child which has come into the pelvis with the chin posterior you cant expect the homoeopathic remedy to take that chin posterior through the pelvis, or to put back the prolapsed hand or arm that has come down alongside the head.

Practically what this means is that in obstetrics we must do that thing which is so often decried by some of the homoeopathists: We must make a very careful diagnosis, and we must make a very careful diagnosis because we must know first where this case belongs. Is this a case which is amenable to the homoeopathic remedy, or is this a case about which we must do something? It practically all goes back to the point of mechanical obstruction, and I think that that is the important thing.

I dont believe we are justified in letting a patient go into labor without trying at least to know all there is to know about the condition of that persons pelvis, and all there is to know about the position and size and presentation of the child. If we do, we are not going to let our patient go into labor and stay there and work and work and finally have an exhausted patient, a seriously ill patient, before something is done for her. That is the point I want to bring out. It is necessary in obstetrics to make the diagnosis to determine under what head the case belongs.

WASHINGTON, D.C.

DISCUSSION.

DR. E. UNDERHILL, JR.: I heartily agree with Dr. Custis that mechanical conditions, as a rule, will have to be handled by mechanical means, but, of course, we have all had the experience of expecting a very long, hard labor, of giving the indicated homoeopathic remedy, and of having to hurry back in no time to find the baby delivered before you get there. I recall one experience when I was a student in my fourth year in the University of Pennsylvania. Dr. Barton Cooke Hirst was about to demonstrate a Cesarean section before the class. He was a very fine gentleman and a very good advertiser. He said, “Gentlemen, this operation has only been performed nine times in the United States, and in the six cases I have had,” and so on. But in this particular instance while he was discussing the technique of the Cesarean section the nurse came in and told him the baby had been delivered. So sometimes the unexpected happens. In that case the homoeopathic remedy had not been given.

DR. W. W. WILSON: I remember well a paper that Dr. Hayes wrote on a Chamomilla case. She was one of these worrisome, fretful women, who are not satisfied to carry on. He told how he had given this patient Chamomilla and how well his case came through.

I think Dr. Custis covered so much territory and so truth- fully there isnt much left to discuss.

I have heard older men say that when a woman has aborted two or three times remedies have been given, and a successful birth resulted. Such, however, might be the history in syphilitic cases, that the first case aborted early, the next one a little later, until finally comes the birth of the child, but that child is apt to die. I sometimes wonder if the constitutional remedy might not help in such cases.

DR. E. B. LYLE: May I ask Dr. Custis if in a long, drawn- out, complicated, painful, posterior position case he believes, or has had enough experience with the homoeopathic remedy to believe that it works as well as the gas oxygen or some of the other anaesthetics might? Personally I dont believe it. I havent had any experience with the homoeopathic remedy in such cases but I dont believe it. The pain in that case is natures way, and I dont believe the homoeopathic remedy will lessen the pain or shorten the labor. It is a mechanical condition. I have very often been told that doctors dont have any posterior positions if they practice good homoeopathy. I dont believe it.

DR. BENTHACK: I believe in the homoeopathic remedies and I believe in good homoeopathists. I tell my patients that a good homoeopathist should be able to cure everything from a corn to a cancer. However, I have been practising for over thirty years, and I have never gone out on a call without taking my instruments with me, and my chloroform and ether. If it is to be a long, drawn-out case, I apply my instruments and I help my patient.

DR. J. B. GREGG CUSTIS: I dont want to decry homoeopathic medicine for a minute in the cases of irregular forces, and those are the cases that hurt largely and those are the cases that homoeopathic medicine can so brilliantly aid, but it is a different story when you have an improper adaptation between the child and the passage. That is another story. I remember I had a case last year that made a very great impression on me and taught me a lot. It was a girl about 19 years of age. She had been married three years.

Her pelvic measurements were all three centimeters below normal. The baby apparently was in a perfectly normal position, but because of the size of the mothers pelvis I was afraid. I thought she was going to have trouble. She went into labor one morning about three oclock. The baby was born about seven oclock in the morning with no more assistance than forceps to lift the baby over the perineum. She had no medicine, but she had a perfect adaptation between the passage and the passenger. If it had been a posterior position it would have been a different story.

I think, Doctor Lyle, you are right. I dont believe the homoeopathic remedy will carry a posterior case through as well as will the gas oxygen, or oxygen with ether and olive oil. I believe that as soon as the posterior occiput comes to the place in the pelvis where it is safe to do something with the forceps it should be done. You can bring that head down and you can do a Scanzonian rotation. You can save that woman much suffering, and you can save that baby a great deal of morbidity in itself by saving the pressure, and the necessity of a long, hard labor which may, after all, be unsatisfactory and unsuccessful. I have seen two or three cases where there was no necessity for anything, where the women, went through with practically no pain, where every contraction seemed to do just what it should do but we dont have that very often. In many of the other cases we can help with the medicine, but sometimes we fail.

I had a patient who went into labor with an apparently perfectly normal pelvis. The cervix dilated normally, but the childs head, which was as far as we could tell in a normal position, would not engage. That girl went from bad to worse. The remedy was apparently Aconite, and I gave her a dose of Aconite. That Aconite acted as though somebody had hit her on the head with a brick. She went to sleep immediately. She had no more pain, but she didnt deliver. Instead of her pulse going down where it ought to have been, it kept going up, and she had a little temperature. It was necessary to interfere and we had to do a version and extract that child. Eighteen months later that woman went to labor again and she did exactly the same thing. That time we did a Cesarean section, because the version had been terribly difficult, and although we had saved the child we were a little afraid to try it again. We thought it was easier for the mother to do the Cesarean section. I havent been able to find out why this woman didnt have perfectly normal deliveries.

DR. UNDERHILL, JR.: How long did you wait until you interfered?.

DR. J. B. GREGG CUSTIS: Until her pulse got up to around 120 and her temperature went to 992. She was becoming more restless all the time and was not in very good shape. I thought it was dangerous to wait any longer.

CHAIRMAN GREEN: How about giving such a case a deep remedy of some kind, such as she might need for a constitutional, if you can find out what it is, and see whether or not it would help?.

DR. J. B. GREGG CUSTIS: I think it was just because I didnt know enough to give the right medicine.

CHAIRMAN GREEN: A deep remedy might help that girl. Dr. Custis has had a very wide experience in obstetrics, being the physician in the Florence Christenden Home in Washington where they deal with numberless cases.

Strange as it may seem, breeding bacteria is a costly pastime for even a philosopher; naming them affords harmless occupation for bookmakers, and such breeding and christening is called “science”. Now there is both science and the art of medicine; let the philosophers have their fill of science, but in Gods name! let the sick have the art.–SAMUEL ARTHUR JONES, M.D., 1893.

These advances in pathology, great as they have been, have not altered the relation which the phenomena of natural disease bear to those of drug disease. These phenomena respectively, whether rudely apprehended or clearly and fully understood in all their relations and interdependencies, still bear the same relation to each other expressed by the law similia similibus curantur. And we can imagine no possible development of the sciences of pathology and pathogenesy which could alter this relation.–CARROLL DUNHAM, M.D.

Gregg Custis J B