THERAPEUTIC AND PATHOLOGIC DIAGNOSIS THE PHYSICIAN’S RESPONSIBILITY

  “Homœopathic physician”—what meaning should this title convey?

  The physician who, to the complete equipment of his university studies in medicine and surgery, adds also a thorough acquaintance with Homœopathy and puts its principles into practice, only has the right to the title “homœopathic physician”.  He will have made himself especially familiar with the work of Dr. Samuel HAHNEMANN, founder of Homœopathy, with the Materia Medica, with the repertories and the laws related to the administration of remedies to the sick.

  The study of Homœopathy exacts of the neophyte a definite effort; for he must lay aside prejudices acquired during his university studies.  But the method of considering any given case proves to be so different from that which he has hitherto known, that soon he sees the importance of this new method.  Now he sees in the “cases” who come to consult him, not merely diseases which he must diagnose, but sick individuals, for whom he must find the similar remedy in his homœopathic Materia Medica; a particular remedy for each, individually.

  Also he must avoid routine; he may not remember other cases resembling this one, which he has already treated; he must isolate the distinctive difference in the sick person whom he now considers, must find out his peculiarities, his individual characteristics.  This is a theory essentially and indispensably homœopathic.  Among the tangle of symptoms resulting from his examination, he must distinguish with care those which pertain to the sick one himself, as a thinking and suffering human being, because of which he is burdened with illness, from those others which concern only a portion of his physical organism - a single organ, or group of organs.

  The practical result is fully inherent in this great secret of nature, discovered by Samuel HAHNEMANN:  To determine the symptoms representative of the individual himself who is ill; and not make the blunder of noting alarming symptoms to any organ which is the point of least resistance where the illness finds for itself an exit, through which it utters its cry of pain.

  A true homœopath finds his task to consist first, in establishing a therapeutic diagnosis according to the fundamental laws of Homœopathy discovered by HAHNEMANN and developed by LIPPE, HERING, ALLEN, KENT, NASH and so many others.

  This is which makes Homœopathy a method not to be surpassed, this “therapeutic diagnosis”, or I may call it “homœopathic diagnosis”, which leads to the remedy immediately without waiting for a “morbid diagnosis”; which treats a patient without having to determine his exact sickness!  Observe that I say “exact sickness”, for such general terms as hysteria, nervousness, rheumatism, dyscrasias or cryptogenic state, idiopathic, and what not - these do not deserve the noble term, “diagnosis”.  This fine and learned terminology readily covers the ignorance of the doctor giving treatment, an ignorance not as to his science but as to the case he deals with in a very different matter.

  The word “diagnosis” alone connotes a pathological diagnosis, with verdict of morbidity.  It is time to show to those who have not yet learned the fact, that there is a far more practical diagnosis:  that is, one indicating from the very outset the necessary remedy.  This is what Adolph LIPPE meant when he said: “Here is a person of the Phosphorus type: here, one of the Arsenic type; here, ofPulsatilla”.  And he uses the terms consecrated to these meanings by HAHNEMANN in the Organon, 1810.  KENT also tells in hisLectures on Homœopathic Philosophy, of a patient who asked him: “Doctor, what is the matter with me?” and he replied: “Why, you have Nux vomica,”  that being his remedy.  Whereupon the old man said: “well, I did think I had some wonderful disease or other”!  That is a therapeutic, a homœopathic diagnosis.

  I do not enlarge further upon the point; such diagnosis is clearly the first duty of the homœopathic physician.  Frequently it leads to a prompt, mild and permanent improvement, to a cure of the patient.

  But we are not at the end of our task; we face two other heavy responsibilities: one of these concerns the patient, and the other, the future of medical science.  Upon us rest both of these responsibilities.

  As to the patient - our task is not only to relieve but to Cure.  Now, a true cure rests not solely on a disappearance of existing symptoms, but equally on advice given the patient, that he need not again fall into such a state.  Such counsels, of hygiene, of directing work and time, of morale, of reading, of the whole attitude and control of life - these also presuppose a diagnosis.  And here, at this point, the nosological diagnosis becomes not only serviceable but indispensable to the doctor.  (KENT’s Lectures on Homœopathic Philosophy, 1919, p. 143).

  The whole idea of diagnosis, in relation to the task of the physician, is it not just the discovery of that famous causa occasionalisof which HAHNEMANN discussed in such detail? (See Organon, paragraphs 7, 73, 77, 150).  The homœopathic doctor must not simply prescribe pills or drops, but he must be a minister of nature, a “naturist”, in addition to a homœopathist, whose first purpose is, after securing the symptoms, to give them a diligent, interpretative analysis covering their last detail, a complete semeiologic examination.

  There are homœopaths, alas! who do not sufficiently examine even their patients, and who thus bring discredit upon the name and value of that medicine called homœopathic.  That certain clever men may omit such a procedure in examination as we  have described, and still by a judicious interpretation of symptoms, cure their patient, is of course possible; but certainly such is not a method which could be generalized.  Perhaps a few instances may clarify this thought yet further.

  A young man of 18 years of age sought consultation regarding frequent attacks of angina, which settled as often on the right side as on the left, and followed almost regularly exposure to cold.  Painting with various collutoria and frequent cauterizations and pulverisations in no way affected his condition and he asked my advice.  The symptoms, as he gave them to me, pointed explicitly to Tuberculinum or Sulphur. Yet I gave neither of these remedies, because after further questioning I found that he wore low slippers and silk stockings, and that he took cold especially after dancing, or when his feet were cold.  Accepting some simple hygienic advice, he wore thicker socks, shoes with rubber soles, gaiters in winter - and he had no more angina.

  I acknowledge that possibly the remedy, had I given it, would have removed his tendency to the symptoms, in the bad conditions to which he exposed himself so often; but it seemed to me wiser to show him the mistake he was making, and to correct his state by simple hygienic measures.  The therapeutic diagnosis was Tuberculinum; the morbid diagnosis was angina from exposure to cold; the prescription was hygienic advice.  Result: a cure.

  A young woman in domestic service, aged 20, came to consult me regarding rheumatism in the legs.  She had been treated allopathically for three months, but the salicylate was making her deaf and producing vertigo.  She found herself increasingly weak, walking with difficulty, vague pains and great weakness in the calves of her legs.  Questioning led to a clear indication ofLycopodium, but I did not give that until completing the full examination.  On reaching the throat, I found a curious condition of the pharynx; it looked as if painted with a yellow orange varnish.  Taking a culture, I found a large number of  Klebs-Loeffler bacilli, of the short type.

  Evidently here there was paretic trouble sequelae of diphtheria, of which the angina had not been observed apart from a faint dryness of the throat, the sick girl had no other local symptoms.  This diagnosis enabled me to isolate her and to take the measures necessary in this disease.  Naturally, I made no serum, but for symptoms which I need not detail here, I gave one dose ofLycopodium  200,  without observing any result in the following 15 days.  The throat remained the same; weakness was still there; no improvement was perceptible.  Such total failure of reaction to the indicated remedy led me to give her a dose Diphtherinum200, to which the condition responded very well.

  In ALLEN’s Nosodes (1918, p.40) there is the following comment upon this remedy:

Painless diphtheria,

Symptoms almost entirely objective,

Patient too weak to complain, and apathetic

Prostration,

Highly susceptible to diphtheritic virus,

Post-diphtheritic paralysis

Remedy suitable when the most carefully selected remedy fails to relieve or permanently improve.

  The girl’s throat cleared up and resumed its normal aspect and at the end of a fortnight, another examination (made by the Inst. Off. d’Hyg.) showed not a single bacillus.  Since the weakness remained, I gave then one dose of Lycopodium, of which the effect was surprising - the patient got up, began to walk, and in ten days was able to return to her position.

  Would Psorinum or Tuberculinum have had an equally good effect?  How could one determine the suitable nosode in a case which does not react save only by determining most carefully the exact nosological diagnosis?

  A young man was treated by a homœopath for submaxillary swelling.  The homœopathic treatment was changed frequently during several months, but without result.  The doctor examined his neck each time, believing that here was a ganglionic condition.  The patient consulted another physician who found in his face, head, and chest no remarkable signs; but on examining the spinal column, the physician found evidence of Pott’s disease.  The swelling was only a cold abscess arising from the third cervical vertebra.  It was a tuberculosis of the bones of the spine, causing a suppuration which descending, went between the inter-aponeurotic spaces and settled in the submaxillary  region.

  The patient followed hygienic advice and suitable treatment until completely cured.  Rest, mountain air, diet in accordance with the morbid diagnosis, a remedy based on the therapeutic diagnosis, made possible this desired result.

  A patient, 55 years of age, was subject to colds in the head, was neurasthenic, and had suffered for six months from sudden attacks of suffocation.  He had been treated by various allopathic physicians with all known anti-spasmodic and vagotonic medicines with no improvement whatever, but rather an increasing decrepitude.  The patient walked with head bowed, had frequent loud eructations, spat continually, was afraid to swallow even his saliva.  Eating was a veritable tragedy for him, for he remembered that his first attack had occurred while eating and he refused to take any liquid food, since this affected him more than solids.  Finally, he gave up his doctors, for they but told him he was nervous, that he must make an effort to recover his health for himself, and that his attacks should be treated with contempt.  A first examination revealed nothing obviously abnormal.  For a time psychotherapy seemed to alleviate his fears.  But neither Mephitis, Ignatia nor Lachesis could stop the attacks which though less frequent still did recur too often.  But after taking  cold, one time, laryngitis set in, causing a husky voice. However, remedies indicated had no effect.  According to all homœopathic principles the case was incurable.  Examination of the larynx showed a paralysis of the right vocal cord; external examination revealed a thyroid tumor, very hard, and as large as a tangerine on the right side.  This was the cause of the constriction of the recurrent nerve.  His loss of weight, age, and complexion, and the development of symptoms, authorized the belief that here was a case of thyroid cancer, primary or metastatic it could not be determined.  The prognosis was clearly not that of mere laryngitis.  But the diagnosis indicated a very serious prognosis. Unfortunately the patient found Homœopathy too slow, and returned to an allopathic physician, who applied radium needles to the tumor which reduced but ulcerated and within eight days, the poor patient died under terrible sufferings.

  And again it is clear that the physician must know what he is treating quite as well as whom he is treating.  What can be said of those who, not comprehending the case, called it “nerves”, and ordered the sufferer to cure himself?

  A young man of 20 had been treated for two years by a homœopath with Aurum, Calcarea, Ignatia, Pulsatilla.  He was in a neurasthenic state caused by frequent sudden attacks of vertigo which came upon him while working.  He became so distressed, and depressed as actually to weep hot tears.  He worked in a bank, but his condition forbade his remaining there any longer.

  The remedies hitherto prescribed had been given for mental symptoms, symptoms chosen somewhat at random, without regard to their due significance—for mental symptoms have also their hierarchy, and must be known in their relationships.  A complete examination showed that Natrum sulphuricum, was the indicated simillimum, thorough physical examination revealed an advanced myelogenic leukaemia with probable tuberculosis of the bone marrow.  A homœopathic prescription, an immediate sojourn in the mountains, with suitable diet, transformed this young man in a few months. Blood tests enabled me to follow the course of his steady gain and to control scientifically and objectively the course of subjective improvement as this followed.

  But it was the two-fold diagnosis, therapeutic and nosologic, which enabled the physician to direct this unhappy youth toward the health from which he had so widely strayed.

  A Boston physician told me of being called by a homœopathic colleague in whose care was a young man injured by being impaled.  He had fallen sitting upon a wooden paled fence and suffered excruciating pains in the rectum.  The pain had been somewhat relieved by doses of homœopathic Arnica administered by a homœopathic doctor called in the emergency.  The sensation as though there was a splinter in the rectum, suggested to the doctor Nitric acid., Hepar., then Silicea.  But the young man still suffered.  After a few days of continued pain, the family insisted upon a consultation.  The second homœopathic doctor, summoned, recalling section 7 of the Organon, made an examination of the “site of pain”, and found indeed a splinter deeply imbedded in the rectum.  The simple extraction of this splinter, and a diet for a few days, completely restored the patient.  The wound closed without treatment.

  Here evidently was an accident, not a sickness.  Hence the physician should in such cases establish immediately the pathological diagnosis and not prescribe before he is sure whether there is a “local cause” or not.  Had the mistake been made by a young practitioner, by a beginner, I should not comment upon it.  But it was an occurrence in the experience of a man of long practice, over several years in general practice.  And this seems to me to call for attention.

  I beg that the ideas presented in this brief paper may be understood exactly as I intend them.  Far be it from me to sermonize, or to give undue emphasis to nosological diagnosis.  But it is indispensable that the conscientious physician be familiar with the interpretation of symptoms, with all that goes to insure a complete pathologic diagnosis, so that he shall not be in danger of making such blunders and oversights as those just cited.

  Our responsibility demands that we establish a therapeutic diagnosis, but not less, a pathological one, as well.  For the definition of a homœopathic physician is, a physician who had added something special to his/her education. So that we must not, once entered upon practice, curtail this new special information, and neglect physical examinations.  And it must be added that very often minute study of symptoms reported by the patient, will lead the doctor to conclude that there is a local cause which at first did not seem apparent.  And the doctor must never forget to develop the essential quality:  Good sense.

  Nevertheless, whether in case of accident, or in case of illness, the distinction must be observed from the outset.  As a homœopathic physician he must make his therapeutic diagnosis; for if he prescribes for names of things, and not according to Hahnemannian rules he must be responsible for the failures that will result.  Pathological diagnosis will claim his first attention in cases of accidents or indispositions.

  We trust that in this study we have given each method its due place, insisting that we cannot omit either one or the other kind of diagnosis.

  We always must have those two paragraphs of the Organon in mind (paragraphs 3 and 4):

  The physician is likewise the guardian of health when he knows what are the objects that disturb it which produce and keep up disease and how to remove them from persons who are in health.

  If the physician clearly perceives what is to be cured in disease, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly  perceives what is curative in medicines, that is to say, in each individual  medicine (knowledge of medicinal  powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient so that the recovery must ensue - to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated) as also in respect to the exact mode of preparation and quantity of it  required (proper dose) and the proper period for repeating the dose; if, finally, he knows the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent, then he understands how to treat judiciously and rationally, then only can he merit the title genuine and true physician or a master in the art of healing.

  (Courtesy: The Homœopathic  Recorder, March 15, 1929)