THE CLINICAL APPROACH

  Read before the

Annual Meeting of the International Hahnemannia Association, New York, June, 1925.

Guy Beckley Stearns, M. D.

 

If a patient be represented as occupying the center of a circle and the radii converging from all parts of the circumference represent the various approaches to a study of his case, such a circle forms a round table around which can sit in harmony healers of all schools and opinions.

There are two general directions or approach; one is from the diagnostic and the other from the therapeutic side. All useful therapeutic efforts embrace the homoeopathic principles because they are directed toward the stimulation of curative reactions along the lines upon which the organism is automatically working. For the purposes of this paper we can speak of the approach from the diagnostic side as the clinical approach, and the approach from the therapeutic side as the homoeopathic approach. Understanding “homoeopathic” to mean not a sectarian method, but, as was originally intended, a basic therapeutic principle.

To one who understands the homoeopathic principle and how to prescribe remedies in accord with it, it is amazing that there can be a group of physicians who know nothing about it and, what is worse, do not care to know about it. Yet it is a fact that the physicians who approach only from the clinical angle are oblivious to the fact that there can be a science of therapeutics more difficult and comprehensive than the clinical science with which they are familiar.

The most desirable thing that can happen in medicine is that these two types of physicians get together, for they are both in possession of invaluable knowledge. People who think the same language are not apt to have any great differences of opinion. The problem is to get them to think in the same language. There are two major inhibitions that prevent mutual understanding: one is the exaggerated ego; and the other is the inferiority complex. If a few of the leaders in medicine on both sides who are free from these two inhibitions could gather around this round table and change places occasionally, it would not be a great while before the differences between them would be cleared away.

The clinicians approach is based on the concept that a patients illness must be understood from the angle of cause with all contributing factors, the organs and tissues affected and the nature of the effect, including all pathological changes; that is, there must be a thoroughly established diagnosis. His therapeutic efforts are largely based on this diagnosis and are directed along the lines that lead to it. These include the removal of the cause, a rational hygiene, and the discovery and use of some specific related to the causative agent. To this is added various palliative measures, such as stimulants, tonics, anodynes, etc.

Since there are but few so-called specifics, none of which are perfect, and since no physician believes that palliatives are curative, the clinical approach leads to drug nihilism. The homoeopathicians approach is based on the concept that a patients illness must be understood from the angle of what his organism is trying to do to combat the illness. This leads to the observation of the individual peculiarities in contradistinction to the diagnostic symptoms and is unique, inasmuch as it does not necessarily comprehend the factor, which is the clinicians sole basis of treatment, namely, diagnosis. Not that diagnosis is not essential, but it is secondary, for remedy indications are found, not in the diagnosis but in the totality of the symptoms.

The clinicians effort is based on the mechanism of disease; the homoeopathists, on the natural reaction of the organism. The homoeopathic concept leads to the understanding of drugs and, because of uniform curative results, to confidence in their use.

The clinician embodies the science of medicine. The homoeopathician embodies the science of therapeutics.

Although, because homoeopathic prescriptions are made mostly on other evidence than the diagnostic, many of the best homoeopathic prescribers gradually neglect the diagnostic side of medicine, yet the comprehending of all that pertains to diagnosis is part of the homoeopathic concept. Thus, in the matter of diagnosis the two sides have a common approach.

After the diagnosis is made, the clinician clings to his diagnostic evidence for his therapeutic guide, while the homoeopathician seeks the therapeutic approach from another part of the circle. The homoeopathician, therefore, understands the clinicians approach much better than the clinician understands the homoeopathicians approach. Each side can learn from the other. But as one side has a language unfamiliar to the other, they must, in order to get together, use whatever common approach they have.

At a recent symposium, composed of both homoeopathists and old school physicians, a patient was presented of a highly- strung, nervous type, having, amongst other conditions, acne rosacea. She suffered from backache, always felt the approach of a storm, craved salt, was debilitated and had a headache if she missed a meal. One of the old school physicians suggested phosphorus from the clinical aspect alone. One of the homoeopathists, who was demonstrating homoeopathic prescribing by symptomatic analysis, arrived at the same remedy. A single dose of the 200th caused marked and continued improvement. It was illuminating to both parties to find that they could exchange approaches and arrive at the same prescription.

Of course, the two groups of physicians had entirely different ideas as to the action of the remedy, as well as of the dosage. The discussion of these two points was a mutual interest and benefit. It is a problem how to utilize this common approach for the benefit of the medical profession in general. One method is by the study of acute diseases. It has been said that any remedy may be indicated in any case. This is true, of course, for chronic diseases and it may be true, although not probably so, for acute conditions. For example, most cases of pneumonia require remedies from a comparatively circumscribed group.

This group is composed largely of remedies which cause the pathology of pneumonia. By knowing the natural history and pathology of the acute diseases and by knowing a few drugs that cause a similar onset and a similar method of development of symptoms, together, if possible, with the pathology, one has a good working foundation for quick prescribing in acute and emergent cases.

Thus far the clinical approach serves for the homoeopathic prescription. While on this common ground, the two sides think in the same language.

This clinical understanding also leads to prophylactic prescribing. There is no doubt about antibody formation induced by drugs.

The drug that most closely stimulates the disease in all its clinical aspects is more likely to be a prophylactic than one less similar.

Of course during an epidemic the “genus epidemicus” is the best prophylactic.

Frequently a case can be cut short by a remedy before the symptoms have revealed the characteristics, if the remedy covers well the developing pathology.

Both the homoeopathician and the clinician recognize the need of increasing the patients reaction against the disease. The difference between them is in the principle that shall be utilized for stimulating physiological activity. The clinicians concept being mechanistic, leads to a direct method of stimulation; that is, to direct action. This concept, through the natural course of medical progress, is gradually changing toward the indirect method of homoeopathy. The important problem in medicine is the improvement of therapeutic methods, and this will take place through the dissemination of the homoeopathic application of remedies.

This must come from those who understand the method and who are purists in its use. In my own twenty-five years of experience I have never known any but a purist to make a convert. The first step is to demonstrate the cure of a supposedly incurable case where the diagnosis has been properly authenticated. Anyones attention is arrested by an unexpected or unexplained fact. Once interest is aroused, the next question is, “How is the cure brought about?” If the homoeopathist thoroughly understands his own approach as well as the approach of the clinician, opportunities constantly occur for disseminating the homoeopathic method of prescribing.

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