Repose of mind and body, adequate sleep, suitable sensible and sufficient exercise in the open air, away from the noise and fumes of industry and traffic, in short a sane, intelligent daily routine of life is to be prescribed and insisted upon in the management of the chronic case. Optimum conditions can rarely be had but this is no excuse for failing to ameliorate circumstances in so far as possible for each and every patient.
When the apparently well indicated remedy fails to act or permanently relieve it may be that we havent given it a chance. If the conditions that brought about the disorder still obtain the best selected remedy–the similimum itself–may not bring about a complete and permanent cure. Causes are continuous into effects. It is our duty to break the chain of cause and to destroy as many links as we can or it will drag the patient down to the grave sooner or later. We have performed only part of our duty when we have given the homoeopathic remedy. Let us do our full duty and then watch results. If the patient will not co- operate the responsibility is his. If we do not prescribe some thing more than the remedy when that something more is needed the responsibility is ours and the failure to cure will also be ours.
At the risk of repetition permit me to briefly outline the essential factors to be considered in the management of the chronic case.
1. The inherent, individual constitutional bias and the ruling qualities, and aspects of the mind.
2. The totality of the environment.
(a) The psychological environment, personal contacts, etc., not only at home, but also in business and social life, with especial reference to any pronounced emotional complex.
(b) Intake of all kinds.
(c) Elimination of waste.
(d) Rest and sleep.
(e) Outdoor recreation and exercise.
(f) Habitual drains and depletions especially those of sex vice and excesses–if such were large factors in a given case how much curing can the remedy accomplish if the depletion continues unabated? Perhaps the remedy will check and correct the habitual tendency , perhaps it will not.
(g) Venereal, malarial and other infections. These we will pass over without comment save to state that the constitutional bias and the totality of the environment doubtless determine both the susceptibility to these infections and the virulence of the disease when once acquired.
PRACTICAL CONSIDERATIONS.
The urge to get busy and do something right away is almost overpowering to many physicians. In the average chronic case such haste is generally to be condemned. Let haste give way to sober judgment and thoughtful deliberation.
It is only exceptionally that it is either necessary or desirable, in chronic work, to prescribe at the first interview.
The old routine of at once giving Nux vomica or other antidotal medicine to a patient fresh from old school hands is generally unwise. In the first place over-drugging is only one indication and in the second place supposing Nux to be symptomatically called for we have not had the opportunity to find out and remove the obstacles to recovery and thus get the full curative effect of the homoeopathic remedy. The obstacles, in so far as possible, should be removed before, certainly no later than at the time of giving the remedy if the best results are to be obtained.
If the patients life is first untangled and intelligently simplified and harmonized with his individual needs the remedy at first apparently or only superficially indicated may be found to be unrelated to the essential symptom ensemble and valuable time may be lost in waiting weeks or months following the administration of an inadequate or unhomoeopathic remedy.
It is at times surprising how much a patient will improve and how much the symptoms will clarify in even a few weeks or a months time, when the contributory and perpetuating causative factors have been corrected or eliminated.
In addition to his medical knowledge what special sagacity and technique are required of the physician if he would undertake the removal of the obstacles to cure?.
Three things are absolutely necessary—.
First–A broad knowledge of human nature coupled with an understanding heart.
Second–A clear perception of the condition, environment and needs of the individual patient.
Third–An unlimited store of good common sense.
The patient must be pointed and guided away from the artificial and the complex toward the simple and the natural. The ideal, of course, can not be reached but we must nevertheless aim for it, travel toward it.
Now what shall we do at the first interview?.
The doctor or his secretary should first of all obtain complete and accurate data as to the patients name, address, telephone number, age, occupation, marital status, etc.
Method and painstaking accuracy in all these preliminary details are important psychologically as well as practically.
Next inquire very carefully as to the chief complaints giving the patient freedom to tell all he will (if not too rambling) before questioning him more closely.
We thus come quickly to understand in some measure the patients viewpoint in respect to his own case. The family history and previous medical history can be more understandingly investigated if the salient factors of the case as it stands at present are before the mind of the physician.
It is not necessary in this paper to go further into the important subject of the taking of the case.
One suggestion, however, may be well to leave with you.
Some patients can write out their case and their symptoms better than they can tell them, in others the reverse is true.
It can do no harm to request the patient or a member of the family to write out the symptoms and describe their case in detail.
No matter how well and how completely we may have taken the case every now and then peculiar and characteristic symptoms, veritable gold nuggets for purposes of remedy selection, can be picked up from such written statements.
Both men and women can be made to co-operative in this way and a little “home work” in behalf of their health or the health of a loved one will do them no harm.
Patients in general can be made to do almost anything within reason. If the physician cannot make his patients work and co- operate in their own behalf the fault is his, not theirs.
While we are on the subject of “home work” let each patient write out and bring in a complete list of all foods and drink taken for say two days time–breakfast, luncheon, dinner and anything taken between meals or upon retiring. Make no modification of the diet until after this list is turned in. When requesting the complete two day menu tell the patient you will make whatever corrections may be necessary in his present diet without disturbing him any more than necessary.
Often you will have a treat in store for you.
Let each member of the Association make this request of each new patient or old patient for that matter and the importance of diet in the management of the chronic case will soon be brought forcibly to mind, and furthermore we will all hear about it at the next meeting of the I.H.A.
Correct the diet as promised. Usually it will be necessary to add more raw fruits which can be taken between meals or upon retiring in place of the candy, cookies, soft drinks, ice cream, pastries, jellies, etc.–raw fruit between meals will not disturb the digestion.
Add more fresh raw vegetables to the diet and a larger variety of fresh non-starchy cooked vegetables.
Observing how restricted and habitual the patients diet has been you will advise a small variety of foods at any one meal, of course, but a very large variety over a week or a months time.
You will often find it necessary to restrict meats–using your judgment according to the needs of the individual patient and not being influenced by your own desires, prejudices, or aversions in respect to meat or any other food.
Often you will find patients overloading themselves with carbo-hydrates–some with starches, others with sweets, some with both. Sensible corrections in such cases are in order.
Right food combinations should take the place of wrong ones, but time will not permit any detailed consideration of these matters at present.
Habits of over-eating and fast eating must be corrected.
Excesses, deficiencies and perversions in respect to food and drink constitute some of the major obstacles to recovery. There are all kinds of diet fads and fadists and all kinds of diet insanities brought to the attention of the physician and the public, many of them bearing the scientific label. But there is sanity as well as insanity and the intelligent and discriminating physician will be able to choose that which is good for both himself and his patients.
Proper attention to diet alone has cured many patients of chronic constipation.
Suitable exercises persistently carried out have cured many cases.
The homoeopathic remedy alone and unaided has cured obstinate constipation of years standing.
1. Correction of the diet.
2.Suitable exercise.
There is little excuse for failure.
Eugene passed away at his country home on Spring Hill, Tuscarora Township, Bradford County, PA. He had been in ill health for several months. His wife, the former Caroline Davis, whom he had married in Philadelphia in 1910, had passed away in 1961. They spent most of their marriage lives in Swarthmore, PA.
Dr. Underhill was a member of the United Lodge of Theosophy, a member of the Philadelphia County Medical Society, and the Pennsylvania Medical Society. He was also the editor of the Homœopathic Recorder.