Read before the I.H.A., Bureau of Homoeopathic Philosophy, June 1931.
H.A. ROBERTS, M.D.
It seems to be the universal tendency for Hahnemannian to fall into the work of treating chronic diseases almost to the exclusion of acute work. There is hardly a Hahnemannian in practice thirty years who has not succumbed to the spell of chronic work, for the record of cures of the seemingly incurable diseases has been brilliant. This in itself is but a natural outgrowth of the consciousness that underneath all our chronic diseases is the miasmatic taint or tendency, whichever way we may wish to express it, which is the mainspring and the main instrument undermining the health of all people.
This tendency for homoeopathic physicians to largely ignore the acute manifestations is one we may well deplore, for there is no class of cases which loans itself to such brilliant results and leads the way to permanent cures of miasmatic tendencies as does the care of acute diseases.
The idea that the Hahnemannian does not care for acute diseases and must therefore be inadequately prepared to meet them is very prevalent among honest (but misguided) observers of the two systems of medicine. To illustrate: One of my patients was once told by an allopathic physician, in all earnestness, that the homoeopathic physician could not cure acute diseases, but their strong point was in the care of chronic diseases, because anybody could cure those.
It is this idea that I wish to emphasize and combat in every particular, for this same physician, when we came to investigate the vital statistics of the city in which he resides and practises, had signed forty-one death certificates of those who has succumbed during the course of acute diseases within twelve months, whereas the two Hahnemannian homoeopaths who had large practices, both acute and chronic, had signed but one death certificate between them for acute disease, and that was a case of malignant scarlet fever.
First we should understand and comprehend the characteristic differences between acute diseases and chronic states. I might give as a definition of acute disease that it is one that is self-limiting in its nature, either in the way of entire eradication or by overwhelming the constitution to the point where it is destructive of life itself; therefore it is limited in its sphere of action. The cardinal point of chronic disease, on the other hand, is that I never is self-limited, and can only be cured and completely eradicated by the administration of the dynamic similar remedy.
We all observe the tendencies in certain families and in certain individuals to be forever and constantly coming down with certain types of troubles, acute in their manifestations. One family is subject to bronchial troubles, another to disturbances of the upper air chambers and nasal passages. The members of another group are subject to sore throats. Later in life some of these groups show their peculiar propensities toward acute manifestations of the kidneys or the heart. Why is it that these tendencies to acute manifestations, which almost always follow the same course, constantly spring up in individuals and in individual families? Whatever these acute manifestations may be, they show their peculiar relationship to an underlying miasmatic condition in the inner recesses of the individual.
Usually the treatment of these acute disturbances requires a simillitude, or complementary remedy, to that called for in the chronic miasmatic manifestations. Seldom do they require the same remedy as the chronic manifestations, but rather one complementary to it. For instance, the patient whose chronic indications call for Silica will often show strong indications for Pulsatilla in his acute disturbances. The patient who requires Graphites in his chronic manifestations may often call for Pulsatilla in the acute conditions. One might point out many such instances where the deeper acting remedies are aided and abetted in the acute manifestations by remedies which are complementary.
In our study of the acute manifestations of disease we realize that these are an effort on the part of Nature to assist in throwing off some of the chronic miasms. It is an effort similar to that of the mill-pond or reservoir which foments and stirs itself to the bottom at intervals in its saprophytic action to purify itself. The acute disturbances are a saprophytic action on the part of Nature to stir the system in an effort to cleanse itself. It is at such times that the system is most susceptible to the action of the similimum, and it is at such times also that the most careful selection of the remedy should be made.
If it is possible, one should avoid giving much medicine during the acute manifestations, but the close of an acute attack is the time when the constitutional remedy can be made most effective, and will soon clear up very completely the miasmatic disturbances.
In these acute attacks, when a remedy is necessary, care should be exercised not to select a remedy that will suppress the disturbance. One should carefully avoid administering the constitutional remedy until the acute attack has subsided, but a complementary remedy may be used with good effect. However, following the acute attack, when the disturbance is completely ended, and the first indication of the constitutional symptoms appears, at that particular juncture the constitutional remedy should be administered. Practically, I have found that it is much better to use the complementary remedy in a lower potency than the constitutional remedy, the reason being that it is not on the same plane of activity.
I wish to urge the keener observation of these acute manifestations as giving us the clue and the opportunity to eradicate permanently the fundamental miasmatic basis in each individual case.
DR. E. UNDERHILL, JR.: Dr. Roberts excellent paper contains a good number of important points for our thoughtful consideration. Probably over seventy-five per cent of all physicians gradually come to prefer a relatively large office practice and a comparatively small outside calling list. Chronic work is much less subject to epidemic and seasonal fluctuations and is therefore more steady and dependable than the acute portion of ones practice. The more chronic work a physician has, the better able is he to arrange his schedule and apportion his time. The more acute cases he has, the more is he at the mercy of the unexpected. Time, energy, economic considerations all favor the drift toward chronic cases.
There is however, in good homoeopathic practice, another very large and legitimate factor ever at work. Acute diseases, as Dr. Roberts has pointed out, are efforts on the part of nature to rid the system of a portion of the chronic miasm. Correct homoeopathy can eliminate so much of the psoric or miasmatic dyscrasia as to no longer make acute flare-ups necessary. EVery correct homoeopathic prescription lessens the chances of the physician being called to take care of acute cases. If any one prefers acute cases to chronic he is perfectly welcome to specialize along such lines. If he is a good Hahnemannian his success is assured, but unless he fights them off, the old chronics will soon be found adorning his reception room.
The directional and family tendencies in acute diseases were very well brought out. The acute colds, throat troubles and respiratory ailments are the tendency with some, stomach and bowel disturbance in others, and so on, the acute manifestations showing the direction, to a large extent, of an underlying miasmatic disorder. The chronic remedy should have affinity for the region generally attacked by the acute diseases.
I heartily agree with Dr. Roberts that “if it is possible, one should avoid giving much medicine during the acute manifestations.” Why? Because of the danger of suppressing or perhaps diverting and partially defeating an eliminative effort on the part of the constitution. I also agree with him that the best time to step in with the constitutional similimum is just after an acute manifestation has subsided, when there is greater cleanliness in the organism than is the case under average or ordinary conditions of so-called health.
In closing this discussion allow me to especially emphasize the concluding paragraph in Dr. Roberts paper in which he urges “the keener observation of these acute manifestations as giving us the clue and the opportunity to eradicate permanently the fundamental miasmatic basis in each individual case”.
DR. P. L. BENTHACK: I agree with Dr. Roberts very much in this. In the old days I believed that pneumonia was only an outbreak of sleeping or latent tuberculosis, and that in families where there was a little tubercular condition, you could expect lots of pneumonia.
The higher the potency the stronger the remedy, but sometimes it is best to be careful, if the potency is too strong. We will say we have a case of pneumonia after the acute symptoms are over, it does not clear up, and we give Sulphur. We can kill the patient if we give it too high. Start it lower. I once killed a woman with 200th potency. She might have lived had I started with a lower potency. Higher potency means more power. What is true about pneumonia and tuberculosis is true about cancer. We must use the high potency. Sometimes if we want to do good work we often need the lower potency to prepare for the higher.
DR. R.E.S. HAYES: I would like to make one exception – I might call it an addition – to Dr. Roberts statements. We do not usually give the constitutional remedy in acute diseases, but there are cases of acute diseases, where the constitutional symptoms are quite prominent and the constitutional remedy will act and act better than at any other time. There will be no other remedy needed afterwards either.
DR. E. UNDERHILL, JR. : I wish to endorse that statement.
DR. C.M. BOGER: It has been mentioned this morning that we are told to remove all the external influences, outside causes, and so on, and then treat the causes with the indicated remedy. In that, Hahnemann does not differ in any sense from our modern allopathic friends at all, only after the causes are removed, bear a distinct relationship to the constitution of the patient, and therefore are likely to correspond to one of Hahnemanns remedies. That brings us down to the crux of what I want to say. The patient who is under a chronically acting constitutional remedy and is taken down with an acute disease is not being affected by your constitutional treatment. In other words, he has not gotten his indicated remedy, because if the constitutional remedy does anything, it so stabilizes the vital force so that one will not be subject to acute diseases.
How far we may allow the patient to apparently go down before our eyes before resorting to the complementary remedy is sometimes a difficult question to answer, but by being patient, waiting for your reaction, watching the concomitant symptoms very carefully, and not being in too great a hurry, you will see your reaction come in due time without the interference of the acute remedy, even in low potency.
When we look back and think of the demonstrations made in the Vienna Hospital, by comparing the results of the Homoeopaths in Homoeopathic treatment of pneumonia with the allopathic, homoeopathic death rate 16 per cent, allopathic 25 to 40 per cent, we can hardly have a more conclusive evidence of the truth of this statement. In my own work in pneumonia, I have frequently seen a case of pneumonia entirely through without giving a single remedy. And the same has been true with typhoid fever. It requires close attention, but the patient is better off afterwards, much better off. Your remedy, if chronic afterward, goes right along doing the work you are not able to do beforehand. In other words, the acute disease was simply a new exposition of a disordered vital force.
DR. A. H. GRIMMER: I am in accord with what Dr. Boger has just stated, providing we are all as competent to select the deep constitutional remedy as Dr. Boger is. Some of these cases with acute conditions really are alarming to patients friends and even to the doctor himself. Unless you are absolutely certain that you have that patients constitutional remedy, it might prove dangerous to leave some acute condition, such as pneumonia, untreated and you may have to interfere with the best indicated acute remedy at that time. I believe that in those vicious cases, with this exposition of psora, we have indications for a remedy that will aid nature in her attempt, but as has been stated by other essayists and commentators, there is danger of suppression if the exact remedy isnt given. It is a hard question, a question that will make us all think. Dr. Bogers idea is really the ideal Hahnemannian way, wherever you are certain of the constitutional remedy.
DR. J.M. OVERPECK: A question comes to my mind. If you have a case of pneumonia or some other acute trouble, and a good, thorough prescriber of Homoeopathic remedies finds symptoms pointing to a chronic remedy, why not give it?.
DR. C.M. BOGER : This question opens up a whole new subject. I dont want to start talking on it. The acute disease is still demonstratively caused by the reacting constitutional remedy. The most careful evaluation of the patients vital force and strength and power of reaction will enable you to decide whether you are justified in giving it or not. The examination and conclusion has to be very carefully made and weighed.
DR. W.J.S. POWERS: There is one point that has not been emphasized enough, the constant recurrence of acute conditions, despite careful homoeopathic prescribing. Why is that? I believe, in a case of that kind, it is very essential that we go into the psychical relationship of the patients, the family relationship, the psychical atmosphere under which he is living. Very frequently by straightening out this outside causes, our homoeopathic prescribing is much more effective.
DR. R.W. SPALDING: It seems to me that the discussion has really brought out two angles to the acute and chronic proposition, as I understand it. The discussion has mainly brought out the assumption that people who are coming down with acute disorders are already under a constitutional remedy, whereas I think Dr. Roberts brings out, in his last paragraph, particularly the point that these cases may first be seen by us as acute cases, not having previously been observed, and therefore great care is necessary in the observation to later point out the proper constitutional remedy.
DR. J.M. GREEN: Let us remember that Hahnemann treated first acute patients, and had one acute case after another, the same patient returning with a different acute manifestation, which made Hahnemann puzzle as to the cause. The very collection, for years and years, of these acute cases was what led him to his theory of chronic diseases. Therefore, the chronic patient should, with good prescribing, not come down with an acute manifestation very often, and when he does, perhaps his chronic remedy is the one to be prescribed. At least we ought to think of that before giving a more acute or temporary remedy.
DR. R.E.S. HAYES: It seems there is one thing more that should be said. The suppression of the acute disease with acute remedies is not always such a serious thing in the end, if the patient is handled carefully afterwards. I have found that where the acute condition is cleared up with an acute remedy and several prescriptions are given afterward of a constitutional nature, the patient did not have the best of health until he got around to the remedy that he had before the acute trouble. He goes right around in a cycle. But when he gets the cycle completed, and gets around to the original remedy, the remedy that he had before the acute trouble. He goes right around in a cycle. But when he gets the cycle completed, and gets around to the original remedy, the remedy that he had before the acute trouble, he will be vastly improved.
CHAIRMAN DIXON: I have noticed so often, through the grippe epidemics, that the chronic cases do not come down with grippe or influenza, or if they do, it is so mild that I seldom find it necessary to take them off their chronic remedy. I suppose that has been the result with their men who have a list of chronics, but I thought, in connection with what Dr. Boger said, I would like to make that remark.
DR. H.A. ROBERTS: I feel very pleased indeed to have had you discuss this paper as thoroughly as you have, because it is just what I wanted you to do. for that reason I did not write much myself. We should emphasize more and more the opportunity the homoeopath has in observing acute diseases. By so doing we are going to learn much. If we only see them in the chronic state, we have missed out. I feel that very strongly.
Now in regard to the carrying through, on the basis that we should never interfere with acute diseases, there are so many times when the system is so overwhelmed with acute manifestations that unless there is interference you are going to lose your patient. I think it takes a great deal of patience and a great deal of judgment to know just where that point is.
Above all, dont forget that acute diseases give us the opportunity that we long have sought, of finding our constitutional remedy better, because it is more manifest. It will come out just at the close of the acute diseases. Very often we homoeopaths, who treat only chronic cases, do not have the opportunity we ought to have. I beseech each one of you to take pains to court the acute diseases instead of confining yourselves entirely in your own office to chronic work.
DR. C.M. BOGER: In a neighboring city there is a family that nearly always needs Mercurius. They are too far away for me to see them, except as chronic patients. One of the children was taken with a serious trouble with the middle ear, tonsils, and so on, and the local homoeopath, who was a very good prescriber, did not seem to be able to get her over it. He finally brought her back to me. I looked her over for a little while. I could not decide which one f the Mercurius group she needed. She had been broken down and was not coming back. I finally concluded that she needed Mercurius cyan. and the response came right away.