WASHINGTON, D.C.
DISCUSSION.
DR. ELIZABETH WRIGHT HUBBARD: I want to thank Dr. Custis for his very salient and wise and also, as always with him, very charming paper. I will not have him say that no kind words are said about surgery here. I am also extremely interested to hear about the lady whose family wanted her to be operated on for appendicitis which turned out be shingles.
Two weeks ago I was called in a great hurry to see an old gentleman of eighty, with all sorts of heart conditions, emphysema, and asthma, and he thought he had appendicitis. He had right lower pain, no fever, but a fast pulse. I poked around and finally I said to him, “Have you been awfully nervous lately and under great strain?”.
He said, “Why, yes!”.
“You havent got a few eruptions down around your right hip?”.
“Why, you know, Doctor, I have!”.
“Do they itch?” Do they burn?”.
“No, they dont”.
But, sure enough, there was a beginning of a herpes zoster right on his right hip. A dose of Ranunculus bulbosus fixed him in short order. The first symptom of pain they thought was appendicitis and it turned out to be shingles, and here the past master found the same thing.
I want to thank him especially for the term “homoeopathic diagnosis.” I am one of the homoeopathists who insists we must have a regular diagnosis as well, if it is possible to make it, and I get into all sorts of battles with my colleagues from Boston and Connecticut about that. I want that in addition to the homoeopathic diagnosis, which can be come at in a curious way sometimes through the remedy the symptoms call for, and sometimes in other ways. It is a very important concept and one all us should bear in mind.
DR. HARVEY FARRINGTON: Mr. Chairman, you know I cannot remember these criticisms. It is true some of the old war horses that look down on surgery may have said something, and they included Hahnemann; but it seems to me that in general we Hahnemannians have taken a more rational view of things, and we perceive the fact that medicine as a whole is ours, and we add to it only our knowledge of materia medica, and the special way in which we prepare and give our medicine.
Surgery is necessary, and this short, petit paper gives us the line that we should have in mind all the time.
Now, there is another view. What is a homoeopathic diagnosis? We all know it is according to what Hahnemann taught, but cant we enlarge on that and say a true homoeopathic diagnosis includes everything in the patient? You know, we look back over the history of some of the chronic cases and occasionally there is in something that a patient has had correctly diagnosed a little clue to the remedy that may be only partially indicated by the symptoms present at the time.
We talk diagnosis all the time. Here is a man with tonsillitis. That is making a diagnosis, and Lippe once cured a man in consultation who had arthritis because several years before he had a throat that alternated sides. He cured him with Lac caninum.
I could tell you a number of case, too, that would confirm the doctors contention in regard to this – the one I mentioned last year, the old man seventy, operated on in emergency for strangulated hernia, when I was called by my friend who had him in charge, he had omentitis and a flickering heart and was almost comatose. He could talk if you roused him, but he was so sleepy, he would fall asleep while you were talking to him. He had a dry mouth.
Nux moschata was plainly indicated. At nine-thirty he got a dose of the 10M. At two oclock I got a call. “The patient is worse, cussing and swearing around here, and the nurses cant do anything to please him.”.
I said, “That is all right. He is coming to life again. His bile went down and his dander went up”.
Now, if we learn even the rudiments of diagnosis in surgical cases, it will help us out. If there were a beginning herpes zoster involving the lower right quadrant of the abdomen, there wouldnt be that tenderness of the muscles there that you find if there is appendicitis – a few little simple things like that, and as we were told in college, look out for pain in the knee, because it may be the beginning of hip disease, and one of the biggest surgeons in Chicago, to my knowledge made a mistake in that.
He had a tubercular case in a girl and even got her father to build a gymnasium on the back of the house and kept her exercising for nearly a year when he suddenly woke up to the fact that he had a case that should have been immobilized.
Many papers have been read about homoeopathy and surgery. I thought the subject was darn near worn out, but our doctor here has given us a new view of it.
DR. WILLIAM B. GRIGGS: I think it is criminal negligence to neglect good surgery when needed. I had an infant brought in to the Childrens Hospital, which had been vomiting for three weeks. It was dehydrated, eyes sunken, vomiting everything, even a teaspoonful of water; no history of stool except a little starvation stool. The doctor prescribed everything he knew for “vomiting immediately on taking liquid” – I think Arsenicum, Bismuth, Cadmium. The first think I did when I examined the childs belly was to go carefully and I felt a little lump. I watched the childs stomach and observed a reverse peristalsis. We operated for pyloric stenosis, which was present. The child was almost dead, and it took a great deal of case post- operatively to bring it along. The child should have been operated on early.
DR. A.H. GRIMMER: I think the paper is well-timed and cannot be reminded too frequently of the necessity for every physicians at least recognizing a surgical case when it is present to him, and it will help us a great deal to win the respect of those outside of our own circles. I want to thank the doctor for an excellent paper.
DR. ALLAN D. SUTHERLAND: The proper use of surgery will also win respect within our own circle.
DR. J.B. GREGG CUSTIS [Closing discussion]: As I said in the first place, I wasnt talking about elective surgery, which can be done any time, the surgery of the end product of the disease, the surgery of the descent of the uterus, which has to be done for the comfort and safety of the patients – I was just trying to talk about the necessity for the quick diagnosis of the surgical emergency, the case which is not amenable to homoeopathic treatment and is acute.
You take the surgery where the tumor becomes so large that it is practically a mechanically obstructive object, where the cyst gets so big that it is in the way, where the hernia persists – that is all necessary surgery for anybody, for any doctor, but the thing I want to bring to your attention is the necessity for a prompt diagnosis of surgical emergencies where the waste even of a short few hours may mean the difference between having a live patient and a dead one.
You take this case of intestinal obstruction in old lady, eighty-five or eighty-six, and six hours or eight hours might mean a gangrenous bowel, and a necessary intestinal anastomosis, and a person that age probably wouldnt get over the intra- abdominal haemorrhage for hours. The woman would have been dead of haemorrhage. That is the sort of thing I want particularly to call your attention to.
Now I am going to go over in discussion a few of the symptoms which make up the surgical emergency, just to refresh your memories on that subject. First I want to recite to you the acute symptoms of a few of the surgical emergencies in the abdomen particularly. The first one is haemorrhage. In an internal haemorrhage, of course, you dont see any blood. YOu see an anxious face, pallor, difficult breathing, a rapid, weak pulse. If you have time to do it, you find a lowered haemoglobin, a lowered cell volume, an increased blood sugar, and increased non-protein nitrogen. If you have time for a blood examination, it is very well to know that.
In bowel obstruction you have vomiting, pain, distention, no passage of gas, no bowel movement, and often you can see a ladder-like arrangement of the intestinal folds, unless the abdomen is so fat that you cant perceive the intestinal obstruction at all, and, if you cant, an x-ray picture will often show that ladder-like arrangement.
If you have a strangulated hernia, unless it is one of the internal hernias, you find the hard, tense lump sticking through, and I want to make a plea for very gentle and short attempts at reduction because I have seen one or two cases which had been reduced without any difficulty and the patient kept on getting worse and, on operation, a gangrenous kink of bowel was found which had been pushed back when it was too late, and the patient died, so you want to be very careful about trying to reduce a strangulated hernia – very careful.
Of course, we all know the symptoms of appendicitis, with the vomiting, the tenseness and distention, the tension of the abdomen, which is common to all intestinal-abdominal inflammatory conditions, the more or less feeling of tension.
In internal haemorrhage, especially from the ruptured extra- uterine pregnancy, you feel an abdomen almost like a board, from attempt to guard it, and examination shows a very tender cervix. Any pressure on the cervix causes very much pain, even though with no inflammation.
