SINE QUA NON OF GOOD PRESCRIBING


In modern ages, Homoeopathic practitioners may be divided broadly into two groups: (a) Those, that can be called Physician first, and Homoeopaths later, and (b) Those, who are homoeopathists first, last and always. Practitioners who after graduating from an Allopathic institution, take up homoeopathy as their professions, are often (of course, not always) seen to belong to the first group. In going through a case, they often study it with an eye of an allopath first, in order to come to a definite diagnosis-thus trying to put a nomenclature of the patients suffering or finding the organ or organs of the patient suffering or finding the organ or organs of the patient which are at fault- and so on and so forth.


In modern ages, Homoeopathic practitioners may be divided broadly into two groups: (a) Those, that can be called Physician first, and Homoeopaths later, and (b) Those, who are homoeopathists first, last and always. Practitioners who after graduating from an Allopathic institution, take up homoeopathy as their professions, are often (of course, not always) seen to belong to the first group. In going through a case, they often study it with an eye of an allopath first, in order to come to a definite diagnosis-thus trying to put a nomenclature of the patients suffering or finding the organ or organs of the patient suffering or finding the organ or organs of the patient which are at fault- and so on and so forth.

In this way they often prejudice themselves and invariably err in prescribing the proper remedy. which seems to them to be of secondary importance. This reminds me of an interesting anecdote, occurred some years ago. In the early thirties, when I was but fresh from the Calcutta Medical College and getting a training in the science of Homoeopathy at the feet of my revered father (the late Dr. D.N. De) one afternoon, a doctor, one of fathers pupils, came to our house to consult my father regarding his ailing wife, said to be suffering from some Heart disease for sometime. She had been undergoing homoeopathic treatment in the bands of a physician, (also a medical graduate of the Calcutta University, who was also an author of a book on Homoeopathic Therapeutics) without any marked improvement.

After having investigated the symptoms of the case thoroughly and after a careful evaluating with Knerrs Repertory, the patient was prescribed “Cicuta Virosa” (I am sorry I do not quite remember the symptoms of the case now), which alone cured the patient completely and that in no time. On hearing of this cure, the first physician and therapeutist came to my father to give him his compliments, and remarked that he was going to include “Cicuta” under Heart disease in the next edition of his boom. My father only smiled, and afterwards warned me not to be a blind therapeutist, as they can never be a successful homoeopath in the long run; of course, this is only by the bye.

I am free to confess that I started out in the first group, but after about 15 years of practice in close touch with my late father in his vast practice, I have slowly moved towards the latter. Every man is rightly expected to follow the trend of his own thought and reasons, and if I have slowly changed my methods of practice, it is because I have read up carefully the Philosophy of Homoeopathy and Hahnemanns special instructions as laid down in his “Organon” and have thought it out.

I would specially request my friends who are juniors in their practice to master throughly the Organon of the great master and that with an open mind, so that they may become homoeopathist in thought, word and deed. A good practitioner must study patient and drug images, and read his case from the stand point of individuality. He must always have in his front the maxim in bold types Treat the patient and not the disease. Thus, in selecting a remedy, the homoeopathist should pay no attention to the diagnosis but should treat the patient as a whole and in its individuality.

The technique of diagnosis and the technique of prescribing are quite different, as they involve quite different mental processes, and have different ends in view, different methods of approach. Of course, I do not intend so belittle Diagnosis in a case, as it may often help so allay anxieties of the patient and the relatives, or it may aid in giving a prognosis of the case in question. Sometimes also it may be helpful in giving instructions as to diet, nursing etc. etc.; But what I want to impress upon is that Diagnosis is of but very little help in the proper selection of the remedy, which is essential for the cure and which is really the physicians sole purpose. Besides, as has been pointed out earlier, the physician is often prejudiced by his diagnosis and is thus led to err in prescribing.

Prescribing without any knowledge of diagnosis makes an incompetent physician; on the other hand, a pure diagnostician is no physician at all. The practice of thoughtfully and intelligently making homoeopathic prescriptions has the invariable effect of improving the power and accuracy of perception of the diagnostician, but the practice of diagnosis, however carefully and conscientiously performed, does not tend in the least to improve the ability and accuracy of the prescriber.

The first of the process of prescribing is to get an understanding of the case from the homoeopathic standpoint, which seems at first sight an easy thing to do, but in reality it presents a number of difficulties;: (i) some of which are due to ambiguities of the language of the provers and are therefore inherent, (ii) some added by our patients and (iii) some by the peculiarities of the doctor himself.

(i) The first difficulty in prescribing for the sick lies in the ambiguities of the language, and the lack of precision in translating the language of the prover, as we read in our texts, and the difficult may only be overcome by experience.

(ii) The difficulties that arise from the patients themselves, lie in the fact that the heads of our patients are often full of notions as to what has actually occurred with him, or as to what organ or organs in his system have been at fault. Also, they often come to us with stock phrases, e.g. Heavy cold”, “Disordered Stomach.” “Biliousness”, “Constipation”, and so on and so forth, which are often absolutely meaningless to a homoeopathic prescriber, as neither head nor tail can be made out of them.

Again, I have often met patients, who think themselves to be intelligent par excellence, and so they try to describe their sufferings as “Inflammatory”, “Congestive” and the like, but alas! they do not know that these are of very little value in prescribing our remedies, if not misleading and harmful. It was only the other day, that an Anglo-Indian walked into my clinic to place himself under my treatment. He told me that he had caught a very bad cold, which he wanted to get rid of, very quickly.

Now, that was too much general, and when further questioned he replied very energetically that “it was making him feel like a hell”; Although that was somewhat more definite, yet not at all satisfactory, as I have not yet acquired any personal experience of a “hell”. Such patients are often very tedious, and the difficulties in obtaining proper symptoms out of them can be aptly compared to those experienced in pumping water out of a dry well, and hence we are often forced to do guess work in treating such difficult patients.

(iii) On the doctors side, difficulties often arise, where there is an instinct of trying to make a diagnosis-(putting a name in classical and often bombastic languages) and thus overlooking the essential points that are helpful and essential in prescribing; or sometimes, and specially with junior practitioners, it happens that the doctor has got a tendency of twisting the patients symptoms to suit a particular remedy he has in his mind or that has come to his head.

To avoid this, one must never put a leading question to his patient and must take every peculiarity of the case and its individuality-as if it had never occurred before. It is always wise never to give any thought to a remedy until after a thorough and careful investigation of the patient.

After having recorded the symptoms of a particular case in detail, the practitioner should try to make an analysis of the case from the homoeopathic standpoint, and not from the diagnostic point of view. The symptoms that lead us to a proper diagnosis are but common symptoms, and as they are found in all patients suffering from that particular disease, they are almost useless in prescribing, because in that case all alike patients would get the same remedy (which is often the case in old school practice).

High temperature, dyspnoea and oppression of breathing, movements of alae nasi, cough, crepitant rales under the stethoscope, rusty sputum may, all together, lead to a diagnosis of Pneumonia no doubt, but these symptoms alone can never lead us to any proper remedy for a cure. These are the symptoms that can be noticed in all patients suffering from that disease, which is called in the next as Pneumonia and if they would be taken as the basis for prescription, all Pneumonia patients would get the same remedy. In order to arrive at a remedy, one must elicit some Peculiar, uncommon, characteristic symptoms from his patient, which belongs to the patient alone and not to the disease.

There are different methods of homoeopathic analysis, as instructed by different authors, but what I do is as follows.

After noting down the chief complaints of the patient in his own language, and the chief seats of the patients sufferings, I try to get the modalities i.e. how the symptoms are affected by various external and internal agencies, time, temperature, rest, motion etc., the causative factors if there are any, the generalities of the patient himself irrespective of the local suffering, and last but not the least, “Peculiar, Uncommon and Characteristic symptoms”, and then try to select some remedy which covers all these, that is the Totality, and which at the sometime must cover the Peculiar and Uncommon symptoms that has been elicited in the patient.

From time immemorial, mankind had been subject to ills, and with the advancement of civilisation, which brought in its train much more artificial mode of living, divergent to the laws of nature, the disease expressions have become so complex and multifarious, that with the best method of analysis, there may still remain plenty of room for the exercise of skill and judgment. I have, however, endeavoured to present before the readers in a nutshell, the procedure I have found helpful in making a true prescription and this may be of some help for at least the junior practitioners.

I am afraid to prolong my discourse any farther lest it may tax the patience of my readers, and I wish to close my article with a few typical illustrations from my own case book to show how helpful in curing care the “Peculiar, Uncommon and Characteristic symptoms” in a given case:

(A) Last year about this time (November) I was called to treat a young gentleman at Bowbazar, who had been suffering from an intermittent fever (malaria?). He had been to his native village at Santipur, about a fortnight previous to the first day of his illness, and when I was called to see him, he had already been in bed for about 10 days.

On enquiry, I learnt that every day at about 9 A.M. in the morning, he was having a chill, a sort of shivering all through the body, but specially marked over the back, preceded and accompanied by violent thirst for cold water. This would last for about a couple of hours and was followed by in intense heat all over the body, specially marked over the hand and face, when the patient would prefer uncovering.

In the heat stage also, thirst continued, although sometimes ending in vomiting of a better fluid, and there was an intense pain and aches in all the limbs, along with a hammering headache, worse on motion. The temperature generally rose to 104*-105*F. Towards evening, the temp. would gradually come down till it reached below normal, during the course of the night. Sweat was generally absent, and when present, it was but scanty, and found chiefly not the face and palms. Pains and aches, as well as headache subsided with the fall of the temperature.

Tongue – Dry, with a brownish yellow coating.

Bowels – The pt. was constipated.

Urine – a little high-coloured; quantity satisfactory.

Prescription – Eupator Perf 200, one powder, when the temp. would be normal, and Sac, lac. every 4 hours.

Next two days, report was almost same, except that the pains were slightly less, and the temp. did not exceed 104*F. Being on the guard not to spoil the case by a hasty change of prescription. I continued Sac. lac. for another 48 hours. On the fourth day of my visit I found the conditions almost the same, with an additional symptom. “Extreme nausea and vomiting on the least movement and even at the sight or thought of food.”

This peculiar symptoms at once reminded me of Colchicum, but still I hesitated and repeated another dose of Eupator, and waited for two more days; But the symptoms continued, the paroxysms came daily with same violence. Then basis on the peculiar and uncommon symptom, although after much hesitation. I left a powder of Colchicum 200, to be taken in the early morning. To my utter amazement, and to much relief of the patient, from the next day after administration of Colchicum, the patient became fever free, with no further recurrence of the paroxysm and was cured almost in no time.

(B) My second case is that of a Hindu widow, aged about 25 years, who had lost her husband about six months back, and who had been suffering from a chronic diarrhoea, since about a couple of months. I am sorry, I do not quite remember the details of all the symptoms, but what I remember is that the symptoms of the case apparently pointed to “Sulphur” which I was about to give to my patient when casually I enquired if the stool were Hot, (to verify Sulphur.). She instantly replied not only in the negative, but remarked that they were rather cold. This at once struck me to be very Peculiar. After a careful search in “Bells Diarrhoea”, I found out “Cold flatus” under Conium, and analogically I gave her a dose of Conium 2c. There was no more loose motions and this patient was almost immediately cured.

N C Bose