I am coming before you this afternoon totally without others on my program. There are two reasons for this, one of which is probably my fault in that, although I had short notice, I could not persuade any of my surgeon friends to write a paper for this bureau. The other reason is probably yours because you are not interested in things surgical and your criticisms too often are those of unfriendly critics who only tolerate the surgeon as, at most, a necessary evil to be called upon only after all other measures, often too long persisted in, have failed, and then use his failure to support the alibi that nothing could have been done in any event.
Hahnemann, in an age where the scientific approach to medicine had not even begun and in which medicine was a conglomeration of theory and supposition unsupported by any relation of fact, observed in his work as a translator, the similarity between the poisonous effects of malaria and the cinchona bark, a resemblance between these effects and the symptoms suffered by those affected by the disease which they seemed to benefit.
Starting form there he began to collect data on the effect of medicinal substances on people and to give to the sick like-acting remedies. After years of experiment and observation he announced his discovery. Here is the first record of a really scientific approach to the treatment of the sick man.
This method was presented, except for minor papers, in his Organon which was brought out in a world of medical bigotry, theory and polypharmacy, and without more that 10 percent of the medical knowledge of today.
In that day there were no instruments for diagnoses, no knowledge of pathology or true physiology; surgery, except for the crudest kind of traumatic and battlefield surgery, was practically non-existent. In such an age medical treatment is some form was used for at least 95 percent of all ill people and usually, poor crutch that it was, was all they had.
Hahnemann offered much more efficient treatment with much less mumbo-jumbo and torment and with the success of his method, and I may say largely because of it, the scientific approach to medicine began and grew and medical knowledge spread. With this spread the decline of drug treatment and the extension of other agents of care became more important.
The physicians sole duty is to heal the sick person by the surest, gentlest, safest way. It is not to indulge in theories, etc. In other words, the treatment must fit the patient. The patient must not be fitted to the treatment, whether it be to homoeopathy if it is not so amenable. That diagnosis must be made; or, if it cannot be made, it must always be remembered that the safest treatment in the light of the medical evidence present must be carried out.
It seems to me that it is of utmost importance for us as homoeopathic physicians to make a diagnosis – a homoeopathic diagnosis – before undertaking the treatment of a case. This homoeopathic diagnosis, as Hahnemann pointed out, has to do not with the name of the disease but with the discovery of the exciting cause and its removal, if it is removable; and he gave examples adequate in the light of the medical knowledge of his time before instituting homoeopathic treatment. Today these examples are not enough, for there are other measures which in some cases are more effective and safer than the homoeopathic remedy.
From the surgeons standpoint it seems to me that all physicians should be not only aware of, but quick to recognize and to act upon, the signs of the surgical emergency such as severe haemorrhage, ruptures or perforations of the organs within the abdomen, intestinal obstruction from any cause, mechanical obstruction of the bile ducts and increasingly severe appendicitis, to many probably the most common.
You, as specialists in the homoeopathic treatment of sick people, are not interested in the technique of surgery or in descriptions of operations. You should be interested, in addition to the homoeopathic pre- and post-operative care where your special knowledge is often of a decisive nature, in those signs and symptoms of conditions such as I have mentioned which should lead you immediately to feel that surgery may be needed and promptly to call for consultation and advice in the interest of the safety of your patient.
I know that often under good homoeopathic treatment surgical aid will often not be necessary, but none of us are always successful and many times the crisis is present and must be met immediately when you first see the patient.
LEt me illustrate:.
About four weeks ago my nephew, who is associated with me in practice, was called about midnight to see a woman, 85 years old, who at about ten P.M. had been suddenly taken with pain in her abdomen and persistent vomiting. She had an old incisional hernia following an operation for perineal abscess 19 years before but it was not swollen or tense and the ring was not tight.
He sent her to the hospital and called me. On examination I found an old incisional hernia with some abdominal distension. She was vomiting every few moments and there was severe abdominal pain. There was no history of dietary indiscretion, no fever, pulse about 90, face showed suffering. Bowels had moved about 18 hours before. Hernia was not strangulated.
Thru the thin abdominal wall two distended loops of dilated bowel could be seen. Those loops showed spasmodic peristaltic action but did not change their position. Diagnosis – intestinal obstruction. Operated at 1:30 A.M. Bowel was obstructed where a loop of intestine had gone thru a ring formed by adhesion of a loop of bowel to itself. Obstructed intestine was swollen, somewhat reddened. The white lines of the empty arterioles of early obstruction were present. The ring was destroyed and the obstruction relieved.
Because of the prompt operation the obstructed bowel was not permanently damaged and recovery was prompt and even. You can easily imagine what a delay of even 6 or 8 hours would have meant to the condition of the bowel and the welfare of the patient. SAFETY FIRST!.
About 4 weeks ago one of our members called me and said that she had a patient who might have acute appendicitis and that if I thought so I was to take her to the hospital and operate on her. On examining the patient I found a woman in the sixties who accompanied of some pain in the lower right quadrant. Her pulse, temperature and bowels were normal. She had no nausea. There was some tenderness in lower right abdomen and also some in back. I told the patient I could not make a diagnosis of appendicitis or other surgical condition and to call her doctor again. That afternoon her son and daughter took her to the hospital to be operated.
Next day I was more certain there was no surgical condition, except possibly a stone in her ureter, and I advised X-ray of abdomen. This was negative – the appendix filled with the barium. The family was still not satisfied and wished further consultation. Another physician examined her and after rectal examination suggested a proctoscopic examination because of a fancied lump in her pelvis.
The next morning before the proctoscopic examination I saw the patient who still had some right-sided pain, and saw that during the night she had broken out with Herpes Zoster which explained all her symptoms. In spite of this the proctoscopic examination was unnecessarily done and later, at the insistence of the son and daughter, an unnecessary catheterization of the bladder was done. No surgical condition. No surgery. I am sure the son and daughter were much disgusted with me for not rushing in.
I could go on and on reciting cases. I could tell of the young woman who in spite of no pain but because of the way she held her abdomen tight, her rapid pulse, her anxious face and her two months pregnancy, was operated immediately because we felt that there was an internal haemorrhage, probably from the rupture of an extra-uterine pregnancy, and the patient was saved because of prompt action. I could tell you of the woman of 80 with gall- stone colic with beginning duct obstruction who had many attacks and who, in spite of advice, waited so long that she died during a last-hope operation; whereas had she been operated 10 years before, when I first began to advise it, would probably be alive and well today.
The point of this too-long paper, and its sole reason for appearance, so to impress upon you that you must make a diagnosis not of the name of the disease but whether this special case is, first, one which can most effectually and safely be treated with the homoeopathic remedy, or whether other help is needed, whether it is infectious for the protection of others, and if it is incurable, what is the best way to bring about the best adjustment of the sick person so that he may be carried along though his remaining life in the best possible condition as to comfort and happiness.
In conclusion let me say that surgery should not be treated as your unloved step-child, but as an unobtrusive friend who, in time of doubt or need, may pull you out of a mean jam.
