One of the obvious duties of the physician is to carefully observe the results of the treatment he prescribes. To intelligently observe there must be therapeutic simplicity. If several treatments or correctives are employed simultaneously or in rapid sequence accurate evaluation of each is difficult if not impossible.
Of course, in serious illness where life is threatened and there is no time to lose, the indicated remedy must be found and prescribed at once and correct case management immediately undertaken.
In the average ambulatory case, and especially in chronic work, let the various therapeutic measures be instituted in an orderly and scientific manner, giving each essential factor time to be observed in its modifying effect upon the progress of the disease.
In undertaking a new and perhaps difficult chronic case one should make an earnest effort while taking the symptoms to ascertain the apparent initial cause of the malady, the shock, grief, injury or illness, the occurrence above all else which set the ball rolling in the wrong direction and turned the constitution from order into disorder.
Prior to and underlying the apparent cause are the potent predisposing factors, the psoric or miasmatic background plus years of faculty eating and unhygienic routine. So habitual and customary is the modern mode of life that its etiologic and pathogenetic significance is apt to be overlooked by physicians who are themselves often the unhappy victims of erroneous living.
Latent in every child are tendencies, physical, mental, moral. Subject to more or less modification through training and environment these gradually unfold as the years pass and sooner or later the weak points begin to manifest themselves.
It is probably no mere coincidence that heart disease is so frequently associated with libertinism and perversion of the affections, that pulmonary lesions are related to mental and nervous disorders or that chronic gouty arthritis occurs so often in persons who have an acquisitive and miserly disposition.
Next in importance to the predisposing and determining causes are those factors, dietetic, emotional or whatnot which tend to aggravate the condition or which in some measure augment or perpetuate the disorder, furnishing thereby an unbroken sequence toward ultimate chronicity and incurability.
In all chronic cases with the exception of those that are really urgent, the first steps to be taken is to remove the exciting or perpetuating cause or causes, if discernible and removable. If long over-indulgence in coffee has resulted in nervous or digestive troubles common to coffee addicts, what folly it is to prescribe the indicated remedy and not remove the cause! Stop the coffee and prescribe placebo. Watch the case. Should the reaction be too violent, either taper off the coffee or prescribe the indicated remedy. Give homoeopathy a square chance and give sensible case management a like chance. Do not expect the remedy to work lasting good in the face of persistent disease causation. Remove first the obstacles to recovery and then prescribe the remedy. You will thus cure, not merely palliate and ameliorate, most of your chronic cases.
If the baking soda habit was resulted in symptoms of sodium poisoning, first stop the soda and, in order to prevent undue reaction, substitute liberal quantities of unsweetened lemon juice in water, using the juice of a half or preferably a whole lemon in a glass of water. Two to four lemons a day may e thus used to advantage. Give placebo if you deem it advisable and usually it is quite essential in controlling the psychological factors in the average case. Moreover it protects the patient against trying this or taking that, either on his own responsibility or at the urgent insistence of misguided relatives or friends. Correctly the intelligently employed the placebo is a mighty weapon in the hands of the physicians and one of the greatest protections against ignorant and meddlesome interference with the treatment prescribed.
You will seldom be disappointed and you will sometimes be amazed at the results of so simple a modification as in the two examples cited, assuming of course that you have correctly perceived the offending agent and have proceeded logically and sensibly to remove the cause and to control the ensuing reaction if necessary.
The average chronic case, of course, is not so simple. Many have been going the rounds of the doctors and the hospitals for years and have suffered all too much at the hands of fadists and cultists as well as at the hands of the more reputable and dignified practitioners and medical institutions. The original malady has been modified, wrapped, suppressed and complicated by many kinds of therapeutic endeavor.
In undertaking the care of such a case the following procedure is suggested:.
Take the symptoms as completely as possible and make all necessary examinations.
Stop all forms of treatment and medication and prescribe placebo for the most distressing symptoms or complaints.
Most definite and specific instructions are necessary if one is to avoid all possible interfering factors, as for example, the various drops and eye washes prescribed by the oculist, mouth antiseptics advertised over the radio, medicated soaps, antiseptic douches, pills, tablets and medicines for every little ache or pain, chemically treated foods and the innumerable pathogenetic products of our commercially inspired civilization.
As the cure is lifted improvement in the patients health is generally to be expected. Unfortunately the curse of modern living is not so easily waved aside. Persisting in the present are many unhygienic habits of the archaic ages and especially as regards eating and drinking.
Ascertain and correct any faulty habits of eating. Dietetic errors can be discovered by requesting the patient to bring or sent in a complete three day menu. Proceed to simplify and correct the diet, turning from the artificial toward the natural, wholesome, unprocessed foods and instructing the patient to observe the rules of food compatibility.
Having corrected the intake the problem of elimination will perhaps adjust itself. If not, enemata of plain tepid water, acidulated with lemon juice or alkalinized with a little baking soda may be used. High colonic irrigations afford a quick means of cleansing the bowel. Seldom indeed are laxatives of any kind to be advised. Almost without exception they have undesirable side effects.
Correct, simplify and improve the patients routine of life as much as possible. Does he retire unreasonably late? Prescribe an earlier hour. Is he or rather is she a house plant? Prescribe an adequate amount of out-door life. If necessary prescribe sun baths, conservatively of course. Fresh air and daylight baths with friction over the entire body are of tremendous value. Prescribe suitable exercises, including breathing exercises in the open air. Advise exercises for the abdominal muscles in cases of obstinate constipation. Establish as far as possible a normal, healthful mode of life. No matter how apparently hampered and restricted ones life may seem to be there is always at least some room and opportunity for betterment. Encourage the patient to make the very best of his situation, be it what it may.
Before prescribing the indicated potentized remedy, go over the symptoms in the presence of the patient and see just what sensible, scientific case management is accomplishing. What still remains after the obstacles to recovery have been removed will probably require constitutional treatment. Sometimes the case may have to be retaken and the new clarified picture, not the original tangle, is the basis for remedy selection. Carefully selected and prescribed on cleansed soil, curative action may be confidently expected. The similimum has been given a real chance and homoeopathy has been accorded a square deal.
Following the prescription of the correct homoeopathic remedy in suitable potency, the action of the medicine is to be carefully observed. A number of effects are possible, depending upon the type of constitution and the extent of the pathology. These effects have been outlined both by Kent and Bidwell. Their order and interpretation are here somewhat modified as neither of these authors stressed sufficiently the importance of case management nor did they insist upon removing the obstacles to recovery in chronic cases before prescribing the indicated remedy. Following the exhibition of the correct remedy the following effects may ensue:.
1. A RAPID CURE WILL TAKE PLACE. This indicates that both remedy and potency were correct and that there is no organic or structural changes to offer resistance to the remedial process.
2. A PROMPT, SHORT AGGRAVATION FOLLOWED BY SATISFACTORY CURATIVE ACTION. Either the symptoms have been magnified temporarily by a potency above the plane of the disorder or else some slight organic changes have already taken place.
3. A LONG AGGRAVATION WITH FINAL SLOW BUT PROGRESSIVE IMPROVEMENT. This means a moderate amount of pathology which is slowly overcome by the curative action of the remedy.
4. AMELIORATION COMES FIRST AND IS SOONER OR LATER FOLLOWED BY AGGRAVATION. This signifies still more, but not necessarily incurable, pathology. A slow, tedious recovery may be expected.
5. A LONG SEVERE AGGRAVATION WITH FINAL DECLINE OF PATIENT. Extensive and incurable organic lesions and advanced pathologic changes. (An antidote in such a case may sometimes be necessary.).
6. PALLIATION IN MANIFESTLY INCURABLE TERMINAL CONDITIONS. The remedy producing euthanasia but not in any way hastening the termination of life.
7. A PROVING OF THE REMEDY OCCURS. Either the patient is exceedingly sensitive or there is perhaps a tuberculous or a sycotic background. A suitable nosode if indicated, or a deep antipsoric, may be required to arouse the vitality and turn the case in the right direction.
8. A NEW REMEDY PICTURE SOON PRESENTS ITSELF WITHOUT ANY ESSENTIAL PROGRESS TOWARD RECOVERY. Such cases often have a tuberculous background and a suitable nosode or antipsoric remedy may be required to steady the picture and stop the oscillation.
9. CURATIVE ACTION FOLLOWS ONE OR MORE OF THE THREE NORMAL DIRECTIONS:– from above downward (e.g., complaints shifting from head to back), from within outward (e.g., skin eruptions substituted for digestive symptoms), and finally the disappearance of recent and the return of old, perhaps even long- forgotten symptoms. Full recovery is indicated by any or all of these curative directions following the prescription of the wholly similar remedy.
10. THE SYMPTOM PICTURE CLEARS IN THE WRONG DIRECTION. Physical improvement with progressive mental warping, always unfavorable and unless checked may lead to insanity, sometimes occurs in tuberculous, syphilitic, and sycotic cases and the suitable antipsoric, antisyphilitic or antisycotic remedy should be presented. The corresponding nosode will sometimes turn the case even in the face of confusing and apparently conflicting symptomatic indications.
11. TOO SHORT RELIEF OF SYMPTOMS. This may mean any of several things: — (a) Too low a potency of the remedy; (b) A similar but not the exact similimum may have been prescribed; (c) Poor case management, failure of the physician to discover the obstacles to recovery, or failure of the patient to cooperate with his medical advisor and to actually live up to his part of the necessarily mutual undertaking.
In observing the action of the indicated remedy the kind of improvement is worthy of consideration. If the remedy is acting as it should there will be objective evidence unmistakable to the watchful physician, something in the step, the tone of voice, the manner of greeting, the expression and color of the face. Something has happened, a change has taken place.
The statement of the patient may or may not agree with the objective symptoms and signs of betterment. The chief complaint, the particular outstanding symptom, may perhaps be no better, may even be aggravated; and with his attention focussed on this the general constitutional change may be more or less overlooked. In such a situation, if the patient is questioned regarding each recorded symptom there should be ample evidence of remedial action, enough to satisfy both physician and patient.
Improvement that is general is of tremendous value, that which is particular is much less encouraging. The kind of improvement desired must include betterment in the mental sphere, more ambition, more energy and at least some of the objective signs and symptoms as noted above.
Remedial action which does not include several of these essentials must be regarded with some misgivings as to the actual homoeopathicity of the remedy prescribed.
After the first prescription in chronic cases three very important questions generally sooner or later present themselves:.
When should the remedy be repeated? When should the potency be changed? When should a new remedy be prescribed?.
Much of success and failure in homoeopathic practice is involved in the correct or incorrect solution of these problems.
There is undoubtedly a very strong tendency to make all three errors: to repeat too soon, to change the potency without rhyme or reason and to prescribe a new remedy prematurely without adequate symptomatic justification.
If the first prescription was in error the sooner the mistake is recognized and corrected the better. But suppose the similimum has acted favorably, when will it cease to act and require repetition?.
Any table to list the duration of action of a list of remedies is to be regarded with suspicion. Such a time table fails to take into account the wide potency range employed in homoeopathic practice, the varying degrees of pathological resistance which the remedy must encounter and the constitutional reaction of each individual patient.
Improvement under the action of the remedy in chronic cases is almost never a straight shot up a hill or inclined plane. As day alternates with night so does amelioration alternate with aggravation during the recovery process. This oscillation or rhythm is a normal and natural phenomenon and careful observation will enable the physician to detect it in the vast majority of cases coming under constitutional treatment. Do not allow the ebb and flow of the tide to confuse you as to the general direction the case is taking.
Careful observation along these lines will act as a check against hasty action which might cut or divert the remedial process.
The Hahnemannian who employs the single remedy in the single dose and in moderately high potency, having removed the obstacles to recovery, is in a most fortunate and opportune position to truly observe and accurately evaluate the results of his labors.