One of the finest things about keeping case records is, that in reviewing our failures we can visualize the whole ensemble and analyze each prescription separately.
I presume that we all function pretty much alike and that when I mention my weaknesses I am including the weaknesses of a goodly percentage of all physicians, yet I fear the men who do not keep adequate records, or do not take written reports on all cases, may not have the damning evidence before them for their own good.
It is a weakness of mine to spoil my case by impatiently breaking in on a perfectly good first prescription and prescribing for some symptom (or train of symptoms) that appears. Too often subsequent events demonstrate that they are old phases of the chronic ailments and are without a doubt due to my first prescription, working in an orderly manner to perform a cure, that is symptoms occurring in a reverse order of their appearing.
It is a hard lesson to learn not to go “symptom chasing”. Weeks, perhaps months after your first prescription has been given and there has been an appreciable letting up of the symptoms for which you were first consulted, enough to convince anybody conversant with the orderly way a clinic case is cured, that the remedy is reacting nicely. Along comes something unexpected and with it, the temptation to give relief by prescribing some remedy other than your chronic.
In such a situation I have failed my patient and my teaching many times, and this is the point I want to stress in this paper because I believe I am not alone in this type of blundering.
Sometimes I have the wisdom not to interfere and I want to cite one or two cases to illuminate the text. I will give you two cases, each of several years standing.
My first case is a young man, twenty-one years old, a student. I have had him under my care since 1919 at which time I took him through his third attack of pneumonia. I will not extend this paper to a length sufficient to show you how definitely this boy was a Sulphur case, sufficient to say that he was so intensely a Sulphur patient, that I was afraid to give him the remedy in a really high potency. He responded nicely to the 30th, and cleared up so much quicker and better than in his two former attacks of pneumonia that I won the confidence of the mother.
Since that time I have had him under my complete control, and have had to fight many psoric manifestations of various degrees of severity, most of them annoying rather than alarming. At one time when he was about ten years old, I think I crowded the remedy till he proved the drug for about six months. This is a possibility that must be guarded against and I know of no better way of safeguarding this, than to review your records.
This boy was backward in his studies, not through inability but through delinquencies. He was lazy and a consummate liar. He was a problem for his parents as well as for his physician. He is now twenty-one years of age and has developed a fine physique. He is six feet and weighs 180, strong of wind and limb. X-rays have been discontinued for past three years, as all lung tissue is perfectly clear. At 8 they showed evidence of his pneumonias in both lungs. He has developed into a good student, is honest and dependable, has started his college studies with a steadfast determination to make up his lost and wasted years in the grades and high school.
Five years ago he developed athletic feet, which I carefully nursed along without the antiseptic applications which are so satisfying to the patient, because suppressing an eruption may mean suppressing just the vent the psoric individual needs. Later he developed an eruption on his neck and scalp, and his physical development did not start until this eruption was established. Since that time he has developed in an orderly way, all his delinquencies have subsided, and not till then did I feel safe in raising the potency of his dose of Sulphur. The eruption on his neck and scalp still show when he experiences a cycle of exacerbation, and of course I am unable to say when it will be definitely at an end.
To me and to his parents, who have watched his development from a poor little sickly child to the fine specimen of young manhood, there is supreme confidence in what the future holds for this patient.
Critics may say, that it has taken too long, that the case has not been cured yet. To the first, I would answer that results show that the time was well spent, and to the second, I would say it wont be long now till it is all cleared, and that I trust I may be able to report ten years from now that I was right or better still, have the patient do his own reporting for by that time I expect him to be a practicing homoeopathic physician, as both he and his parents are devoting all their energies to start him on a medical training with the homoeopathic goal in view.
My second case is one in which I am just beginning to get order after several years of blundering along. I am sure I have blundered by not sticking to my program, for I have tried to cut corners by symptom chasing. I suspect we all have a few such cases. Good old faithful families that stick to us even when we do not cure them. Faithful old chronics. And when you go home carry this “tip” from me: Take out some of those old case reports that have been going on for years back, and see if you cant put your finger on that same old sore spot. You have given too many drugs, and have repeated them too often.
This case is a woman, now 68 years old. I have doctored her for ten years. For six years previous to my entrance into the picture she had attacks of indigestion and mucous colitis. She came to me from allopathic hands and all her life had been used to taking medicine in allopathic doses. Placebo was her remedy for several weeks, and it looked for a time as though it would cure her as a long train of nervous symptoms and her indigestion were showing decided improvement. However, I finally was able to chart her, and definitely establish Sulphur as her remedy. She made wonderful gains, the bowels moving every day without the aid of cathartic or enema and no mucus in the stool.
The patient is now up and actively engaged in caring for her household duties for the first time in six years. Quite needless to say, everybody is happy. Case dismissed, the doctor feeling a warm glow of smug satisfaction, which was of rather short duration. The family auto wrapped itself around a telephone pole and my patient emerges with a fractured rib, and numerous cuts and contusions. The shock was considerable, and she directed into another attack of her old colitis. I was not much worried because I thought I knew the answer, another dose of Sulphur. But she failed to react to the remedy, and I began to “symptom chase”.
As I review my case now I am convinced that this was the place where I began to drift. I should have been more patient, I should have waited longer for my dose of Sulphur to react, but I did not and in consequence she had a long, tedious recovery followed in a few months by other attacks.
It is not an easy matter for me to stand before you and admit that my patient then was just as bad as when I first was called in on the case, and that it was probably four years before I had the courage to resort to my old friend Placebo again and let the remedy ride until her system had a chance to clear up. Then I found that instead of a Sulphur case I had Psorinum, which is complementary, and in this case has proved very satisfactory. She has had no sick spells for nearly two years, and enjoys the best health she has had in sixteen years.
Having complete records for analysis and the courage to put my finger on the weak spot, I recognized my failure to follow my philosophy and finally won a victory for which I feel very grateful.
So my message to you today is: First, keep written reports on every case your take; second, take these records out and study them thoroughly before you change your first prescription, and, lastly, when you have the evidence before you that your first prescription was well selected, STICK TO IT.
CHAIRMAN UNDERHILL: We need a paper like that every now and then and I hope to hear some good discussion on it.
DR. ALFRED PULFORD: Dr. Dixon always writes a good paper. You know it is through differences of opinion that we gain our knowledge. Some say we should report our failures. I say we should report our successes. If I cure a case of diphtheria or a case of diabetes, and give a remedy, I know why I gave it and what the results are and I pass it on to Dr. Dixon. When he sees a case with the same condition and symptoms, he has some guide.
If I fail in those cases and I pass them on to Dr. Dixon, he has nothing, and even if he made a different prescription from mine, the patient is dead. What is he going to prove? He hasnt that same patient again. He may have made just the same mistake I did, but when he gets the same case, or the next case and it gives the same symptoms and condition and he gives the same remedy that I did and it continues to prove correct, we have all learned something.
None of us is infallible. We all make mistakes. I wish we were more perfect than we are, but we come here, as I said a while ago, to get the rough edges knocked off, that we may appear more polished to the outside world. We want to come here to be broadened educationally and it is only these conditions that bring us around and when we do get to the right thing, I claim, with Dr. Dixon, we grow.
DR. EUGENE UNDERHILL, JR.: I have in mind one case of a lady I had been treating about as constantly as anyone could, ever since 1919. For a long time she came once a week and now she comes once in two weeks. One day I got out her record and blushed for shame to myself at the number of doses of medicine I had given her and, I am sorry to say, the number of different remedies.
As Dr. Dixon has pointed out, when your good old faithful chronics come in every week or two, they are taking an awful chance and putting temptation in our way.
DR. CHARLES A. DIXON: That is just the point, folks. We know better. We all have those old chronics who come in and deserve the best we have and, bless their hearts, they dont get it often unless we do just go through this self-analysis and snap ourselves out of what really is routine, which is a bad thing for a homoeopath to get into. Another human element in it is we dont have enough of these stories come out where we have something to conceal.
These finer details and individualities, these shades of variation and modalities are the only bases upon which to obtain the requisite knowledge of drugs or of good prescribing. So in disease, we must know its objective and subjective symptoms, its method and manner of progression; then we must know the drugs that will produce such symptoms, conditions and modalities.
Symptoms that to the unaccustomed eye seem but shadows, as whether the patient is warm or cold; is better by application of cold or heat; what < the pains of this drug; what > them in another. You would hardly give a patient who was cold and anaemic such remedies as belong to a class that are always too warm, want doors and windows open, and have high degree of arterial excitation, if every symptom that had been developed was covered by the remedy. We can hardly know and be familiar with remedies in both their noxious and their curative power without a strong personal interest. My advice is, cultivate that interest. – J.T. KENT, M.D., 1888.