Read before the February, 1923, meeting of the Homoeopathic Medical Society of the County of New York.
The expression “chronic cases” is so very indefinite from the general medical point of view that I feel some hesitancy in using it before this body physicians.
Yet to those of us how are familiar with the works of Hahnemann and are accustomed to homoeopathic methods of prescribing, the term is intelligible and carries a certain rather unique definition.
By the term “chronic disease” Hahnemann meant not merely a disease extending over a long period of time; or necessarily a definite disease entity such s cancer or eczema, but rather an individual state of ill health resulting usually from some deep seated condition, perhaps an hereditary matter, or the result of suppression of some external or paroxysmal state.
The manifestation of the “chronic disease” may even assume different forms during the life of an individual. Be that as it may, one who studies disease from the Hahnemannian point of view soon learns that success in dealing with his chronic cases is likely to be proportioned to the keenness of his powers of observation and his ability to understand his patient as an individual exhibiting characteristic a little different from every other individual and this regardless of the classification of his immediate group of disease symptoms, for symptoms arise in the human body along lines of least resistance and the especial group that a given individual may be afflicted with at some period of his life is determined largely by the state of an organ or group of organs at that time.
Consequently in selecting remedies for sick individuals the important thought is not whether a medicine may be valuable in nephritis or tibial ulcer or what not, his present group of symptoms. In other words, there must be a homoeopathicity (harmonious relation) existing between drug and patient as individuals as well as between symptom groups.
A curative remedy must be one that has a certain homoeopathicity to the patient and that will develop in the healthy human being a condition similar to the existing state of illness as determined by the above tests.
With these preliminary thoughts in mind, let us inquire into the practical application of our principles – how are we to determine what remedies may be suitable for certain individual cases and what results may we expect?.
Through the influence of traditional medicine it is hard not to fall into the habit of grouping in our minds certain drugs as having especial value in the treatment of certain diseases: Arsenic in cancer, Mercury syphilis, Iron or Arsenic in anemic and so on; while it is true that these medicines are perhaps more frequently indicated than others in the mentioned diseases it is also true that if we attempt to treat our cases as they come in this routine manner we shall find very little satisfaction in the handling of chronic cases.
It must continually be borne in mind that while the diagnosis of the diseases from which our patient is suffering is important the diagnosis of the homoeopathic remedy with which we propose to attacks his illness is even more important and that the two may best be kept entirely separate in our minds.
It is imperative that we homoeopaths should be expert diagnosticians, our training in observation should make this a natural expectation, but once having made a correct diagnosis, of the disease and thus forearmed ourselves in matters of procedure, physical care and prognosis we may then put aside this knowledge, so to speak, and proceed in an unprejudiced and orderly manner to study the patient as an individual entirely apart from his pathological state with a view of determining what medicine may offer help in the rebuilding of his body and the consequent amelioration or eradication of his disease. Before proceeding far we shall be confronted with two questions that are of considerable moment, viz:
To follow Hahnemann-what is curable in disease and what is curative in medicine? For instance, it would be a bold physician who would claim o have cured a case of epilepsy because the patient had had no seizures for one or two months after coming under treatment, for is it not a well known fact that a large majority of these cases show improvement for a time after beginning any new treatment? Four or five years should elapse before one would feel that a cure had been made.
No one would claim to have cured a case of manic-depressive insanity on the passing of the stage of exhilaration and the appearance of a temporary normal state. No more should one consider malaria to be cured after the suppression of the paroxysms of chill and fever by Quinine, for does not the disease reappear year after year under favorable conditions in various forms until eradicated by correct individual homoeopathic medicine?.
Thus before we may essay to achieve desirable results we must know from experience what is disease in curable. Again, what is curative in medicine. The answer to this question presupposes a knowledge of the relative value of drugs from a homoeopathic standpoint, of their provings and what they may reasonably be expected to do both in the healthy subject and in disease.
Thus we may not expect to cure a long-standing, chronic case with remedies of very limited scope such as Cepa, Lobelia or Cocculus, even though the symptoms may agree with the immediate picture of the case. It is imperative that we extend our vision in order to take in the whole life of the patient and note down carefully the various manifestations of his sickness and his personality as they have developed from the beginning.
We must know our drugs in the same way that we know our friends, as individuals, as definite personalities each with its especial characteristics. Here is the explanation of Hahnemanns remarkable success as a prescriber, his intimate acquaintance with his tools; through the many provings that he made on himself and others, he got at his drugs first hand and knew exactly what they might be expected to do in sickness because he had tested their reactions on the healthy.
Very few physicians of today have done much proving; in fact, we could hardly find the time for it were we so inclined, though it is a great misfortune that we cannot.
In its place many of us have substituted repertory analysis of cases, a poor substitute though under present conditions indispensable. Hahnemann had no repertory. He did not need one. He knew every drug he had occasion to use as he knew his neighbors and he knew just what they could be depended on to accomplish.
The next generation of homoeopathic physicians, beginning with Boenninghausen began to make repertories and they have been at it ever since. There has never been a perfect one; there never will be; however, a few of these books, especially those of Boenninghausen and, greatest of all, that of Kent, ar monumental works, almost as great as the materia medica itself. We could hardly practice without them today.
It goes without saying that if one knows his chronic patient intimately, in other words, if he had “taken the case” accurately and thoroughly and if he is equally familiar with his drugs it is not especially difficult to prescribe well and obtain good results, but what one of us is really able to measure up to such a standard? If we were, homoeopathy would soon sweep all before it, for we all of us have occasional brilliant results that seem to the uninitiated little short or miraculous.
Practically, however, only the rare man–the Hahnemann, the Boenninghausen, Hering, Lippe, Kent–is ever able to achieve wholly satisfactory results in more than a small percentage of his cases, but these are so very satisfactory that we must continually strive to approach in some measure the records of the greatest of our predecessors.
In view of the practical aspect of our art at the present time it is hard to see how any one can expect to get results without preliminary repertory analysis in practically every case of any importance, otherwise our materia medica is a closed book.
I will pass over the “taking of the case,” which really means the careful and painstaking investigation of the life of the individual and his intimate personal characteristics. This matter is elaborated in the “Organon” and in Hahnemanns “Chronic Diseases,” and has recently been restudied and presented in a most helpful manner by Dr. Stearns, of this city. Suffice is to say that the foundation of all success in this field is largely dependent on the care with which this initial study is made.
Of all the repertories that have ever been published only two are suitable for such analysis–Boenninghausen and Kent–and the latter is by far the more comprehensive of the two and is used exclusively by most students today.
We can do no better than to follow as accurately as possible the plan of Dr. Kent, to first study through the aid of the repertory the individual in his most intimate aspects, what are his personal reactions to his environment as shown by mental symptoms, temperature symptoms, sexual or menstrual function, idiosyncrasies of food, and so on. These great general symptoms being ascertained, it will usually be found that the minor, passing and particular symptoms will be included in the anamnesis of any medicine that covers the case.
