Eczema is the Oliver Twist of the medical world. It is booted about from general practitioner to dermatologist, from dermatologist to allergist, from allergist to roentgenologist, and even the physiotherapist gets a “crack” at it. From all of these specialists it takes what is known in the vernacular as “an awful shell-hacking.” But the eczema sufferer is glutton for punishment. He emerges from each set-to, if not smiling, at least willing to go another round. And, believe me, brothers, it is a round-around and around in a vicious circle which can only be broken by the patient himself. This fortunate fracture occurs when the pruritic has either (a) become “flat broke” or (b) awakened to the fact that he is being “sold down the river” or (c) convinced himself that while the average doctor may know a great deal about eczema, he doesnt know enough to cure it, so why take any more treatments from him ?
By this time, of course, the patient himself has learned as much about the treatment of his disease as his various physicians and, from here on, figures himself perfectly competent to stand in local doctors. All he has to do, anyway, is to paw around among the old ointment jars, find the one that held the stuff that made him most comfortable, have it refilled, and he is “all set.” If he needs any further advice he can listen to his radio or read the advertisements. If his doctor knew what he was about, he would cut him dead, little realizing that his former patient is getting along just as well under this self-instituted regime as under the medical one.
The above quasi-satirical description of the manner in which the eczema patient is “taken for a ride” represents a fairly accurate outline of what has happened to a great many of these sufferers who eventually present themselves to the homoeopathic physician for alleviation of their distress. I use the word “alleviation” purposely. These people have long since given up all expectation of cure; they hope only for relief.
Not infrequently patients give an eczematous history over a period of fifty years during which time every resource of orthodox treatment has been tried and found wanting. It is easy to understand, therefore, why cure is not expected. One marvels at the persistence with which they have followed the ignis fatuus of promised cure when by the simple expedient of turning to homoeopathy they might, years before, have been set upon the straight path to health.
The management and ultimate cure of eczema presents a problem which often taxes the patience of both patient and physician. The solution, however, is easy-I say it in all humility-if the physician, and through his influence the patient, will rid himself of the idea that he is dealing with a sick skin. He is not dealing with a sick skin, he is dealing with a sick person. This conception of eczema requires that the physician discard as useless and untrue all that he has gleaned from standard texts in dermatology concerning the etiology of this disease. One may go so far as to say that the sole etiological factor of any importance is a constitutional one. Once the physician becomes aware of, and accepts, this he has put himself in a position to be of real benefit to his patient.
The very fact that one;s patient has already “made the rounds” should be an indication to the wise that there is some-what more than meets the eye in eczema. If this is merely a sick skin, why has it not already been cured ? If, as is claimed, a percentage of eczema is due to an allergy, why are these cases not cured by desensitization or by removal of the offending substance from the patients environment ? The physician must rid himself of the notion that in discovering an allergic relationship between a certain substance, or substances, and the patients eczematous manifestations he has uncovered the cause of this condition.
Such is not the case. Allergy is a symptom, not a cause. It has no more significance than any other external manifestation of disease. The question must be asked, “What makes the patient allergic ?” The answer to this query lies in a recognition of the deep-seated constitutional fault. Psora undoubtedly underlies all cases of eczema; and, while it may not be the sole miasm involved, it is the principal one.
Heredity has been assigned a role in the causation of eczema and it is a fact that many patients suffering from this eruption will be second or third generation pruritics. But close study of these people indicate that what is inherited is not so much a sensitive skin prone to eruption, as a constitutional dyscrasia conditioned upon one or more of the chronic miasmata. A thorough inquiry into the family background of any case of eczema should be considered a must; the physician can scarcely hope to be of service without the aid this procedure will bring.
One is struck by the frequency with which asthma, hay fever and eczema appear in the genealogy. Such a family history indicates, of course, that the eczema under consideration is not a pure psoric manifestation but a combination of psora with one of the other miasmata. Although such a merger makes the road to cure a little longer and a little harder, both for patient and physician, the facts gained make it possible for the physician to set foot on the right path at the beginning of his treatment.
If, after carefully probing the family background of his eczematous patient, the physician still believes he has to deal with a severe skin condition alone, a searching cross-examination of the patient will clearly demonstrate the constitutional nature of the disease. Patient persistence in questioning pays well by bringing to light many signs indicating disturbances in the spiritual and mental planes as well as the physical.
If this is merely a skin disease, how explain the concomitant symptoms the leucorrhoeas, the tendency to asthma, the sensitivity to heat or cold, the frequency of respiratory infection, the mental peculiarities and personality defects, to mention a few ? Man is a living unity; only as a unity can he be affected by disease, the disturbance manifesting itself through one or more of the parts composing the whole. Without the conception of man-disease relationship one can scarcely hope to attain “the highest ideal of cure” either in eczema or in any other of the ills to which flesh is heir.
Having established by thorough anamnesis the constitutional nature of eczema, the physician is now in a position to institute proper treatment according to homoeopathic principles. In considering this phase several points should be emphasized.
First, do not prescribe for your patient at the initial interview. This admonition is especially for the tyro in homoeopathy; the skilled Hahnemannian has already learned his lesson through sad experience ! “Snap-shot” prescribing has no place in the treatment of chronic disease, least of all in eczema; nothing but the similimum will do. There is a much potentiality for harm in the apparently indicated remedy as there is potentiality for good in the similimum. The thoughtless prescription will so tangle the thread of cure that months may be required to untangle it. I know this to be true; I have done it and I have regretted it. Placebo is quite effectively harmless and gives time to the physician for further study before prescribing.
Secondly, repertorial analysis is essential to successful prescribing in eczema. Were skin symptoms the sole manifestation of disturbed dynamis the remedy could more easily be found. Rarely, however, are these the only evidences of a diseased state. Commonly, other evidences of ill health present themselves, as might be expected considering the constitutional nature of eczema. The proper e valuation of each symptom in relation to the totality can only be attained through the intelligent use of a good repertory. By this means one is enabled to narrow the choice of remedy from among four or five. Thus the similimum is more accurately determined. One must bear in mind that only the most similar remedy will do good in any chronic case and this is equally true in eczema.
Thirdly, local applications are entirely out of place in the homoeopathic management of the eczema patient. The statement refers to any form of external treatment-from unguents to x-ray; none of them are curative, all are suppressive. Itching may often be allayed by cold normal saline which has no suppressive action at all. In cases presenting a dry, cracked skin, an ointment made of lanolin containing ten drops of fluid extract of calendula to the ounce may be allowed It doesnt cure, but it doesnt suppress; often it helps to prevent severe rhagades.
I will admit, however, that according to some criteria the use of this innocuous preparation may be regarded as a mildly heretical deviation from the dictates of the strictest homoeopathic practice. These two harmless procedures may be thought of as in the same category as the placebo; they please the patient. At the same time they offer no impediment to the action of the carefully chosen remedy and in addition help to bridge the wide chasm which separates the orthodox from the homoeopathic management of eczema.
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.