The fourth, and certainly not the least important, point to be brought forward in considering the management and treatment of eczema involves the question of how much, or how little, to tell the patient concerning the homoeopathic principles which will guide both himself and his physician along the hard road to cure. Obviously there is no rule by which this question can be answered; it is a matter to be decided by the individual physician alone. It is my own custom to make a point of discussing the entire situation in regard to the homoeopathic conception of eczema as a constitutional disease. The time spent in this way will pay dividends later on, I can assure you. My experience has been that the patients love it.
They feel that you are really interested in them and their sufferings and are grateful for it. Moreover, such instruction increases their confidence in you and makes them more ready to cooperate in any measures deemed necessary to their ultimate cure. The entire process of history-taking and instruction in most instances in wholly foreign to their previous experience with physicians. Frankly, I fail to understand how any homoeopath can expect to hold his eczematous patients unless he imparts to them a working knowledge of the principles underlying his art, emphasizing at the same time the differences that exist between homoeopath and allopathic treatments.
Indeed, I would hesitate to undertake the care of eczema without first spending time in laying the groundwork for a mutual agreement as to the technique to be followed. My observation has been that the patient will acquire an enthusiasm for homoeopathy even before he has had an opportunity to experience its beneficial effects, once he has become convinced of your own sincere belief in it.
As an appropriate ending for this discussion of eczema I append the following case history :.
A 17-years old schoolgirl presented herself on May 4, 1938, with a history of eczema since the age of four months. The eruption first appeared on the head as the old-fashioned crusta lactea. Then it came out on the backs of the hands and in the popliteal spaces. At the time of her first visit the eruption covered the following areas: forehead; malar region of cheeks; chin; anterior neck and region of seventh cervical vertebra; upper chest anteriorly; both arms, forearms and hands; and both popliteal spaces. The eruption was dry on a red base and covered with find branny scales.
There was a great deal of itching which was worse at night, when studying and from 2 to 3 a.m. Scratching to the point of bleeding produced an amelioration, as did bathing in very hot water. In the cool morning air the eruption smarted and there was soreness in the skin when moving the parts. The eczema was worse in the fall and spring; also when overheated, in hot weather, when sweating, and in a warm room. After scratching, moisture oozed forth, soon formed scabs beneath which pus developed. In the palms the skin was hard and dry and she stated that washing tended to increase this dryness. There was a tendency for the skin to crack, especially on the fingers. The only symptom obtained concomitant to the skin manifestations was “a hollow feeling in the abdomen” during menses.
As to past treatment, this had run the gamut from salves to x- ray, but all to no purpose.
I do not intend to cite all the minutiae attendant upon the cure of this case. To do so would only try your patience. Suffice it to say that in a little over three years the eczema had practically disappeared and to date there is only a little roughness of the skin on the hands remaining. My chief purpose in bringing this case to your attention is to show you the mistakes that were made in its management.
The first of these is evident in the incomplete history. You will note that almost all the symptoms obtained refer to the skin and almost none to the patient herself.
The second mistake lies in the fact that no attempt was made to obtain information concerning the family history, especially with respect to chronic conditions.
A third error, and a most important one, occurred with the first prescription, Rhus tox., which was not based upon a repertorial study of the symptoms.
Fourthly, I had not learned the value of patience. The result was that in the first year the following remedies were given at intervals of from two weeks to one month : Rhus tox. twice, Sepia, Sulphur, Graphites, Sulphur again, Calcarea carb., Petroleum twice, Bryonia twice, Silica, and Rhus tox. again.
If you know anything about homoeopathic principles in prescribing, and I assume that you do, you can visualize how badly mixed the picture was by the end of the first year of treatment. Disease symptoms and remedy symptoms were so inextricably tangled as to require the skill of a master to unsnarl them, and to him should go all the credit for the eventual cure. His prescription was a nosode, Tuberculinum 20M. Four doses of this remedy at intervals of two months clarified the situation so that the true similimum gradually became apparent. Sepia infrequently repeated in ascending potencies has successfully given this girl a health which she never previously had. BRATTLEBORO, VERMONT.
DISCUSSION.
DR. WAFFENSMITH : This paper was interesting to me, because specially in my earlier practice in the southwest I found many cases of eczema, psoriasis, etc. I am pleased Dr. Sutherland paid due attention to Sepia. It usually comes into the picture some time or other, becoming the necessary tri-miasmatic remedy to bring about a favorable termination of the disease.
DR. MILLER : I have been doing a lot of study on allergy, in the eczema class, beginning in the early months of the childs life. I have found that cows milk is one of the factors which we should consider in every case of eczema. The inherited tendency is born in the child but the feeding of cows milk only antagonizes the predisposing factors. We should make a drive to feed children with mother;s milk. It is the natural milk. While we wont cure the inherited tendency, we wont develop a more severe from of allergy, whether it is asthma, eczema, or what- not. When I take these children off cows milk, in many cases the lesions clear up immediately, by just removing that exciting factor. It is not curative; it is only palliative. Then you can study the case with a lot more comfort.
DR. ROBERTS : It gives me a great deal of pleasure to know that Dr. Sutherland has his lessons well learned even through bitter experience. That is where we all get it, and we all have to come back to the idea of the fundamental dyscrasias that are abundant in almost every one of us.
Years ago I had eczema very severely myself. i went to one of the leading dermatologists in New York. He said, “Doctor, why dont you go into dermatology ? It is the greatest profession on earth, for the reason you dont cure your cases but you keep them for three years. The other fellow doesnt cure his, then they get mad and come to me. After three years mine go to the other fellow. It is an exchange all the way back, but we dont pretend to cure”.
That is not true of the homoeopath. Eczema is curable, but it represents the fundamental miasms of the human race. Until we come to that basis and look at it from the constitutional angle, we will never cure it. I do not believe that avoiding the ordinary food elements is cure. You have cured your patient when he can eat what others do, milk included. The trouble with milk is that we dont get the right kind of milk. If one can get good clean Ayrshire milk, you can still feed milk and cure eczema. Ayrshire milk has a curd that is very different from the curd of other breeds, and it is much easier to digest.
Allergic conditions that you have to run away from are not cured. If you can live in one place and cant live in another, there is something wrong. There is a constitutional basis for the trouble. In these skin troubles there is a combination of all three miasms, and until you lift one layer after another you have not cured your patient.
DR. MACKENZIE : I would like to speak of this subject from the standpoint of the ophthalmologist. Taking into account the fundamental dyscrasias, not one but a combination of them, has been known for many years, not only by the homoeopaths but by leading “old school” authorities. May I mention first Ernest Fuchs, the man who wrote the standard textbook on ophthalmology. It has been translated into many languages, including Chinese and Japanese.
Those of you who have done any eye work will recall that class of patients, children who come to the clinic with their eyes protected with dark glasses, eyes partially or completely closed, tears running down their faces, and they frequently have eczema of the face. It has been known that when the eczema is more profuse on the surface, the eyes are better. When that has been suppressed, the eye condition becomes worse.
Now Fuchs, Fisher, Charles H. Thomas, former professor at Hahnemann College on the subject of the eyes, stressed these points that I am bringing out. In other words, their conclusion was that eczemas together with what was known as scrofulous keratitis and conjunctivitis, was due to the toxins of tuberculous lesion in some part of the body, generally a latent one in a lung or in a joint or somewhere else.
Allan D. Sutherland was born in Northfield, Vermont in 1897, delivered by the local homeopathic physician. The son of a Canadian Episcopalian minister, his father had arrived there to lead the local parish five years earlier and met his mother, who was the daughter of the president of the University of Norwich. Four years after Allan’s birth, ministerial work lead the family first to North Carolina and then to Connecticut a few years afterward.
Starting in 1920, Sutherland began his premedical studies and a year later, he began his medical education at Hahnemann Medical School in Philadelphia.
Sutherland graduated in 1925 and went on to intern at both Children’s Homeopathic Hospital and St. Luke’s Homeopathic Hospital. He then was appointed the chief resident at Children’s. With the conclusion of his residency and 2 years of clinical experience under his belt, Sutherland opened his own practice in Philadelphia while retaining a position at Children’s in the Obstetrics and Gynecology Department.
In 1928, Sutherland decided to set up practice in Brattleboro.