This is the practice of one of our outstanding Philadelphia surgeons, Dr. Desiderio Roman. He recognizes the need of good homoeopathic prescribing in surgery and he does not neglect it. If the case can be better cared for through a prescription made by a homoeopath he looks about for the best and generally calls on Dr. William B Griggs.

This question in one form or another has been repeatedly put by both specialists and out-and-out homoeopaths.

At one time it was not unusual for a homoeopathic body, as large as the Institute, to have appear on its program an outstanding surgeon presenting a paper on his particular subject. These gentlemen were by no means narrow-minded; on the contrary they were capable, broad-minded homoeopathic physicians.

The growth of specialism brought with it an ever increasing number of specialists. In the course of time they became so crowded at Institute meetings that they were compelled to form separate bodies; however, they continued their membership in the A. I. H. With progressive improvement in surgical technique our specialists began to take advanced courses which were available only at “old school” post-graduate colleges in this country and abroad. The more ambitious of our specialists drifted toward those influences which had helped them to become more efficient. Most of them felt that they could learn more about their specialty through affiliation with the “old school” special societies than with the homoeopathic.

The strict adherents to Hahnemannian homoeopathy and the specialists springing up from our ranks spoke different languages. They became foreigners to one another. Both the specialists and the homoeopaths were honest in their beliefs as to the cause and cure of disease. The homoeopathic eye, ear, nose and throat specialists typified one of these special groups that formed a separate organization (The American Homoeopathic O.O. & L. Society).

Twenty-five years ago this society prospered with a membership of over 200 active, wide awake men. It held three day annual conventions, the average attendance of which exceeded 125. The meetings were real treats, equal to the best the “old school” could put on and with considerable homoeopathy thrown in. The Society ran its own journal of 84 printed pages of scientific matter with a liberal distribution of illustrations. The American Homoeopathic O.O. & L. Society flourished but gradually died down. There were several contributing factors:.

World War Number One hit us hard, when many of our members went into the service. Their dues were remitted. The cost of paper for our journal increased as well as that of half-tone illustrations. The net result of these two factors were sufficient to bring about the discontinuance of the journal with more than 600 paid subscribers.

Another contributing factor leading to the diminution of the attendance of the O.O. & L. Society and the Institute was the welcoming of homoeopathic specialists into the ranks of the national “old school” special societies. The majority of the homoeopathic eye, ear, nose and throat specialists were admitted into the Academy of Ophthalmology and Otolaryngology, one of the largest special societies in the world with an average attendance of 800 at its regular annual conventions. Then followed the certification boards, for instance, the American Board of Otolaryngology. It granted certificates according to the following formula:.

The American Board of Otolaryngology.. . .

Thereby certifies that Dr. John Doe has pursued an accepted course of graduate study and clinical work and has successfully passed the examinations in Otolaryngology conducted under the authority of this Board, May 5, 1925.

Those who applied for examination did so for no other reason than the desire to see the day come when those who were certified in their specialty would be recognized as capable specialists, reducing those not qualified to a lower grade. The certification of specialists “went to the head” of some of our homoeopaths with the results that they failed to keep up their activities in our own homoeopathic medical societies.

Our O.O. & L. Society continues to exist but appreciably reduced in membership and in attendance at the annual meetings. To their credit let it be said that many members of this and other special societies continue to lean heavily on the homoeopathic principles. This loyalty, however, is not strong enough to stop them from joining “old school” special societies. Quoting from a letter by one of the members of the Homoeopathic O.O. & L. Society whose name need not be withheld:.

Dear Dr. George:.

I have felt that the Society has been heading for oblivion for some time, sorry as I am to see it. The great difficulty in getting papers for the annual meeting goes back for a good many years and the meetings have been more and more poorly attended as you know. Never has a Society appealed more to me than this one. I enjoyed it to the full and never came away without feeling it had been worthwhile to attend its meeting.

Unfortunately, times have changed and the younger men crave something else and there is so much to be gotten at the Academy and College of Surgeons meetings that it is but natural they should prefer to spend their time and money to go to them.

I am sorry to say that homoeopathic remedies do not seem to figure much in the average O.O. & L. specialists work. Having used them both in my general practice as well as in O.O. & L. work for over 40 years, I feel sorry for those who do not know what they miss in not using them. But the men of recent years, be they graduates of Hahnemann or the N.Y. Medical, are more impressed with chemotherapy and vitamins than with the homoeopathic remedy. It is only here and there that we get an intern from either of these schools who has an interest in homoeopathic prescribing.

As regards the meeting of the O.O. & L. with the Institute I cannot help but feel that it would be a mistake. . . . Sincerely,

(Signed) Dudley A. Williams.

The better rated specialists as a class are not as liberal as Dr. Williams. They prefer the local palliative treatments to the homoeopathic remedy. They obtain results sufficiently satisfactory to themselves and pacifying to their patients as to result in their neglect of the homoeopathic principle. In the long run the over-use (abuse) of palliatives does more harm, locally and generally, than would have resulted if the patient had never had special treatment.

The worship of false gods has decimated our ranks. What is to be done about it? Think it over!.

Then there is the lower type of specialists, those not qualified to operate even an emergency mastoid with sinus thrombosis or other complications. They do not recognize the existence of an emergency operation. They know nothing about diagnosis. Furthermore, they do not want to know. To them it is unessential, for the homoeopathic remedy acts favorably, independent of the diagnosis. Yes, it does, but there are cases in which a diagnosis is essential. May I cite a very simple instance?.

A patient in the course of a heavy infection of the nose and throat begins to develop a pain in the ear. Otoscopic examination reveals a red swollen drum-head. Belladonna is prescribed in a “sufficiently small dose” since it had previously worked satisfactorily in other cases of the kind, but in this particular case it failed.

The drum-head is unusually thick and resistant. While waiting overly long for spontaneous rupture and drainage to take the place the infection spreads to the mastoid cells. The mastoid is not operated, in the hope that the carefully selected homoeopathic remedy will accomplish the impossible. The mastoiditis passes from the acute to the chronic form. The bacterial toxins in the middle ear and mastoid spaces find their way into the labyrinth through the perivascular lymphatics.

Congestion follows, resulting in the development of vertigo accompanied by spontaneous rhythmic nystagmus directed toward the affected side. What does the incompletely trained specialist do in such a case? He neglects to give the patient the local attention that is necessary. He neither operates nor calls in another more capable specialist to operate. The condition goes from bad to worse. The inner ear that was at first merely congested develops an inner ear abscess (labyrinthine suppuration). This at best destroys hearing permanently. More than 50 per cent of the cases of labyrinthine suppuration terminate in suppurative meningitis and death.

When the course of middle ear suppuration the patient develops vertigo with rhythmic nystagmus directed toward the affected side, the mastoiditis calls for an immediate operation in order to thwart the more dangerous complications noted above.

What is true of labyrinthine congestion followed by labyrinthine suppuration is true of all complications of middle ear suppuration. The irritative lesion precedes the destructive; spasmodic myosis precedes paralytic mydriasis; spasmodic tic occurs in the muscles of the face before paralysis; excessive restlessness precedes stupor; convulsions precede paralysis; which make it rather easy to foretell in advance what is going to happen if the provocative factor is not removed in time to abort the more destructive complication.

One mistake is possible at the hands of a too restricted homoeopath. He is going to lose lives now and then if he depends entirely on his remedies. There is positively a place for the carefully selected homoeopathic remedy, but hardly as much room for them in those cases I have been called upon to operate in a moribund state that could have been saved had the otologist been called earlier.

George W. Mackenzie