It seems to be the universal tendency for Hahnemannian to fall into the work of treating chronic diseases almost to the exclusion of acute work. There is hardly a Hahnemannian in practice thirty years who has not succumbed to the spell of chronic work, for the record of cures of the seemingly incurable diseases has been brilliant. This in itself is but a natural outgrowth of the consciousness that underneath all our chronic diseases is the miasmatic taint or tendency, whichever way we may wish to express it, which is the mainspring and the main instrument undermining the health of all people.
This tendency for homoeopathic physicians to largely ignore the acute manifestations is one we may well deplore, for there is no class of cases which loans itself to such brilliant results and leads the way to permanent cures of miasmatic tendencies as does the care of acute diseases.
The idea that the Hahnemannian does not care for acute diseases and must therefore be inadequately prepared to meet them is very prevalent among honest (but misguided) observers of the two systems of medicine. To illustrate: One of my patients was once told by an allopathic physician, in all earnestness, that the homoeopathic physician could not cure acute diseases, but their strong point was in the care of chronic diseases, because anybody could cure those.
It is this idea that I wish to emphasize and combat in every particular, for this same physician, when we came to investigate the vital statistics of the city in which he resides and practises, had signed forty-one death certificates of those who has succumbed during the course of acute diseases within twelve months, whereas the two Hahnemannian homoeopaths who had large practices, both acute and chronic, had signed but one death certificate between them for acute disease, and that was a case of malignant scarlet fever.
First we should understand and comprehend the characteristic differences between acute diseases and chronic states. I might give as a definition of acute disease that it is one that is self-limiting in its nature, either in the way of entire eradication or by overwhelming the constitution to the point where it is destructive of life itself; therefore it is limited in its sphere of action. The cardinal point of chronic disease, on the other hand, is that I never is self-limited, and can only be cured and completely eradicated by the administration of the dynamic similar remedy.
We all observe the tendencies in certain families and in certain individuals to be forever and constantly coming down with certain types of troubles, acute in their manifestations. One family is subject to bronchial troubles, another to disturbances of the upper air chambers and nasal passages. The members of another group are subject to sore throats. Later in life some of these groups show their peculiar propensities toward acute manifestations of the kidneys or the heart. Why is it that these tendencies to acute manifestations, which almost always follow the same course, constantly spring up in individuals and in individual families? Whatever these acute manifestations may be, they show their peculiar relationship to an underlying miasmatic condition in the inner recesses of the individual.
Usually the treatment of these acute disturbances requires a simillitude, or complementary remedy, to that called for in the chronic miasmatic manifestations. Seldom do they require the same remedy as the chronic manifestations, but rather one complementary to it. For instance, the patient whose chronic indications call for Silica will often show strong indications for Pulsatilla in his acute disturbances. The patient who requires Graphites in his chronic manifestations may often call for Pulsatilla in the acute conditions. One might point out many such instances where the deeper acting remedies are aided and abetted in the acute manifestations by remedies which are complementary.
In our study of the acute manifestations of disease we realize that these are an effort on the part of Nature to assist in throwing off some of the chronic miasms. It is an effort similar to that of the mill-pond or reservoir which foments and stirs itself to the bottom at intervals in its saprophytic action to purify itself. The acute disturbances are a saprophytic action on the part of Nature to stir the system in an effort to cleanse itself. It is at such times that the system is most susceptible to the action of the similimum, and it is at such times also that the most careful selection of the remedy should be made.
If it is possible, one should avoid giving much medicine during the acute manifestations, but the close of an acute attack is the time when the constitutional remedy can be made most effective, and will soon clear up very completely the miasmatic disturbances.
In these acute attacks, when a remedy is necessary, care should be exercised not to select a remedy that will suppress the disturbance. One should carefully avoid administering the constitutional remedy until the acute attack has subsided, but a complementary remedy may be used with good effect. However, following the acute attack, when the disturbance is completely ended, and the first indication of the constitutional symptoms appears, at that particular juncture the constitutional remedy should be administered. Practically, I have found that it is much better to use the complementary remedy in a lower potency than the constitutional remedy, the reason being that it is not on the same plane of activity.
I wish to urge the keener observation of these acute manifestations as giving us the clue and the opportunity to eradicate permanently the fundamental miasmatic basis in each individual case.
DR. E. UNDERHILL, JR.: Dr. Roberts excellent paper contains a good number of important points for our thoughtful consideration. Probably over seventy-five per cent of all physicians gradually come to prefer a relatively large office practice and a comparatively small outside calling list. Chronic work is much less subject to epidemic and seasonal fluctuations and is therefore more steady and dependable than the acute portion of ones practice. The more chronic work a physician has, the better able is he to arrange his schedule and apportion his time. The more acute cases he has, the more is he at the mercy of the unexpected. Time, energy, economic considerations all favor the drift toward chronic cases.
There is however, in good homoeopathic practice, another very large and legitimate factor ever at work. Acute diseases, as Dr. Roberts has pointed out, are efforts on the part of nature to rid the system of a portion of the chronic miasm. Correct homoeopathy can eliminate so much of the psoric or miasmatic dyscrasia as to no longer make acute flare-ups necessary. EVery correct homoeopathic prescription lessens the chances of the physician being called to take care of acute cases. If any one prefers acute cases to chronic he is perfectly welcome to specialize along such lines. If he is a good Hahnemannian his success is assured, but unless he fights them off, the old chronics will soon be found adorning his reception room.
The directional and family tendencies in acute diseases were very well brought out. The acute colds, throat troubles and respiratory ailments are the tendency with some, stomach and bowel disturbance in others, and so on, the acute manifestations showing the direction, to a large extent, of an underlying miasmatic disorder. The chronic remedy should have affinity for the region generally attacked by the acute diseases.
I heartily agree with Dr. Roberts that “if it is possible, one should avoid giving much medicine during the acute manifestations.” Why? Because of the danger of suppressing or perhaps diverting and partially defeating an eliminative effort on the part of the constitution. I also agree with him that the best time to step in with the constitutional similimum is just after an acute manifestation has subsided, when there is greater cleanliness in the organism than is the case under average or ordinary conditions of so-called health.
In closing this discussion allow me to especially emphasize the concluding paragraph in Dr. Roberts paper in which he urges “the keener observation of these acute manifestations as giving us the clue and the opportunity to eradicate permanently the fundamental miasmatic basis in each individual case”.
DR. P. L. BENTHACK: I agree with Dr. Roberts very much in this. In the old days I believed that pneumonia was only an outbreak of sleeping or latent tuberculosis, and that in families where there was a little tubercular condition, you could expect lots of pneumonia.
The higher the potency the stronger the remedy, but sometimes it is best to be careful, if the potency is too strong. We will say we have a case of pneumonia after the acute symptoms are over, it does not clear up, and we give Sulphur. We can kill the patient if we give it too high. Start it lower. I once killed a woman with 200th potency. She might have lived had I started with a lower potency. Higher potency means more power. What is true about pneumonia and tuberculosis is true about cancer. We must use the high potency. Sometimes if we want to do good work we often need the lower potency to prepare for the higher.