“The request of some friends, halting half-way on the road to this method of treatment, to detail some examples of its success, is difficult to comply with, and no great advantage can attend a compliance with it Every cured case of disease shows only how that case has been treated. The internal process of the treatment depends always on those principles which are already known, and they cannot be rendered concrete and definitely fixed for each individual case, nor can they become at all more distinct from the history of a single cure, than they previously were when these principles were first enunciated. Every case of non-miasmatic disease is peculiar and special, and it is the special in it that distinguishes it from every other case, that pertains to it alone, but that cannot serve as a guide to the treatment of other cases. Now if it is wished to describe a complicated case of disease consisting of many symptoms, in such a pragmatical manner, that the reasons that influence us in the choice of the remedy shall be clearly revealed, this demands details, laborious at once for the recorder and for the reader.
To 2. Stramonium and Nux vomica cause vomiting of sour and sour-smelling mucus, but, as far as is known, not at night. Valerian and Cocculus cause vomiting at night, but not of sour stuff. Iron alone causes vomiting at night (61, 62), and can also cause sour vomiting (66), but not the other symptoms observed here. Pulsatilla, however, causes not only sour vomiting in the evening (349, 356), and nocturnal vomiting in general, but also the other symptoms of this case not found among those of Iron.
To 7. Pulsatilla produces the same state (995), and it also causes oversensitiveness of other organs of the senses, for example, of the sight (107). And although intolerance of noise is also met with in Nux vomica, Ignatia and Aconite, yet these medicines are not homoeopathic to the other symptoms and still less do they possess symptom 8, the mild character of the disposition, which, as stated in the preface to Pulsatilla is particularly indicative of this plant.
This patient, therefore, could not be cured by anything in a more easy, certain and permanent manner than by Pulsatilla, which was accordingly given to him immediately, but on account of his weakly and delicate state, only in a very minute dose, i. e., half-a-drop of the quadrillionth of a strong drop of Pulsatilla.This was done in the evening.
The preceding extract from the writings of our great master, Hahnemann, will serve to show not only the care with which he examined a very slight case of disease, and his mode of choosing a remedy for it; but it will exhibit in a clear light, the opinion he held in regard to the uselessness of reporting cases which have recovered under treatment-a custom which prevails at the present day to a pernicious extent. We have a strong proof of the tenacity with which he adhered to this opinion, in the fact, that he has published but few cases comparatively; and those have been given to the world with a view to guide his followers into the right path as to the true method of administering medicines, or to prove the truth of his doctrine; and not with any desire to make a vain-glorious display of his own success. Doubtless, if he had been so disposed-if it had accorded with the Homoeopathic doctrine-he could have given us hundreds and thousands of cases of cure, which would have been very valuable to those who depend mainly on clinical experience, instead of giving their whole attention to pathogenesis. But he declared, and with a laudable persistence maintained, the doctrine, that each case of non-miasmatic disease is in itself a speciality, and that its cure ought not to be and cannot be a guide to the cure of any other case. It is worthy of remark that his most successful followers, with but few exceptions, have adopted this opinion.
It cannot be denied that clinical reports may be, and frequently are, very instructive in confirming pathogenesis. Considered in this light they are very interesting. But to be either interesting or instructive, they must conform to the following rules:-
It is quite useless, for instance, to report as one of the symptoms of a case, “ headache,” without stating the precise locality and character of the pain and the circumstances which increase or relieve it. More than half the medicines we use are capable of producing some form of headache. One causes shooting, stinging pains; another, throbbing and fullness; another, dull, heavy, pressing pains; another, piercing as if a nail were driven in, and so on. One produces pain principally in the left temple, and another in the right temple; in the pathogenesis of one, pains in the forehead predominate; in that of another, in the occiput, and in that of yet another the headache is principally in the vertex. Which shall we choose for this symptom (?) “ headache." It is equally useless to report diarrhea as a symptom, without the color and appearance of the discharge, the time of day when the evacuations are most frequent, the nature and locality of the pain accompanying them, and all other concomitants. Yet how often we see these and other generalities in the reports of cases of cure! Of what possible benefit can such cases be to the profession ?
II. The name of the medicine administered must be clearly stated in the ordinary Homoeopathic nomenclature, together with the potence used, the manner of giving it and the frequency of repetition of the dose. Such terms of “Tr. Nucis,” ” Silex,“ ” Carbo Animal,“ etc., etc., are inadmissible because incorrect. They serve only to display an affectation of superior learning on the part of the reporter.
Many cases are reported, in which it is impossible to trace any relation whatever in the detailed symptoms, to the pathogenesis of the drug used. And again, it is not uncommon to read reports of cases which are said to have been cured by medicines given empirically. And these cases are reported by men calling themselves Homoeopathic physicians! Thus we are told that a case of ” Intestinal hemorrhage“ was cured by Hamamelis virg., and the report is closed by the following remarks: ” Its use was of course empirical, having been recommended by different authorities as of service in Hemoptysis and Hematemesis. In order to decide intelligently whether or not it is adapted to any given case with or without hemorrhage, we should know its pathogenesis more fully. It is probable we shall then learn that the cases where its action has been so marked are those where the totality of the symptoms corresponds with those of the remedy.“
It is possible we may learn this, and it is quite as possible that we may not. Until we have a well conducted and arranged proving, we have no right whatever to experiment on the sick with this or any other drug; especially when we have, as in the case under consideration, medicines already in our Materia Medica, which are so clearly indicated by their pathogenesis. It is this very empirical source, and use, of the Allopathic Materia Medica, this jeopardizing the lives of the sick by experiments, that we as true Homoeopathists, most strongly condemn. We profess to be governed by a great law of cure which is universal, and when we so clearly depart from it and publish our departure, we not only proclaim our want of faith in the fundamental law, and bring discredit upon the cause of Homoeopathy, but we subject ourselves to the ridicule of our opponents, and the criticism of our colleagues.
It is very much to be regretted, that this disposition to try drugs on the sick in accordance with the suggestion of old women, or the suppositions of our Allopathic brethren as to their virtues, is becoming daily more common, such a course is a complete reversal of the doctrine, Similia similibus curantur. Instead of endeavoring to discover the use to which a drug may be applied in curing a disease by proving it on the healthy organism, those who adopt this course are making a vain effort to discover its pathogenesis by its effects in disease. They willfully blindfold their eyes from the bright light which is shining upon them in this nineteenth century, and grope in the darkness of the middle ages.
To be certain that any pathogenetic symptom or group of symptoms is confirmed by our practice, we must use but one remedy at a time, and that should not be repeated oftener than is absolutely necessary. If we give medicines alternately, we cannot know decisively to which the relief is attributable; and if we repeat the dose too often, we have pathogenetic and curative effects mingled, and the whole case is apt to become confused. The plan of alternating remedies is almost always a proof, either of the imperfection of our Materia Medica or of the inefficiency of the physician. Doubtless most, if not all, Homoeopathic physicians find themselves sometimes under the necessity of alternating medicines in their daily practice; but cases in which this plan is adopted ought not to be reported, because they do not teach us anything very decidedly, except that a case has recovered under treatment; and the great object of all published reports should be, the confirmation of the pathogenesis of the remedy and the consequent establishment of the fundamental law of Homoeopathia.
We not unfrequently see reports of cases in which benefit is attributed to so called ”juvantia.“It is scarcely necessary to say, that this plan of using medicated adjuvants is totally opposed to the very spirit of the Homoeopathic doctrine. One case is reported in which, while using two medicines alternately, the reporter applied a “liniment of Chloroform,” under the use of which, a distressing symptom (“trismus”) was relieved. Does it not seem highly probable that this result would have followed the use of the Chloroform without the internal remedies ? How could the latter produce any effect while the patient was constantly inhaling the powerful anesthetic? Even supposing that it did not counteract their curative power, which of them relieved the symptoms? In this connection, it may be well to notice that a case of traumatic tetanus is reported in a recent Allopathic Journal, in which the spasm was relieved by inhalations of Chloroform.
Another case is reported in which a cutaneous eruption was cured by the use of Rhus tox. internally and Calendula externally; and we are asked to believe that this is a valuable course of treatment. Is it in accordance with the Homoeopathic Law ? Perhaps the gentleman can tell us which of the medicines cured the case, and which might have been dispensed with? Perhaps he can tell us which symptom, or symptoms, of the disease, corresponding to the pathogenesis of Calend., indicated the employment of that medicine? But more probably, he can expound to us the theory in conformity to which, Calend. was applied. That theory may safely be pronounced in advance, as anti-homoeopathic, as the application was empirical.
In commencing this article with a case reported by Hahnemann, it was not intended to suggest that case as a model for ordinary clinical reports. The examples of cure referred to in the extract, if well pondered by the student and young practitioner of Homoeopathia, would impart to them knowledge of the most important character as to the Homoeopathic and only true method of choosing a remedy. But, although it is not necessary or desirable, in ordinary reports to consider each symptom in its relation to the pathogenesis separately, it is of the utmost consequence that the characteristic symptom or symptoms which led to the selection of the remedy administered, should be definitely stated.
In conclusion, it cannot be too strongly urged, that the confirmation of pathogenesis should be the only object in making clinical reports, and that the pathogenesis of remedies can never be discovered by their empirical use in disease. Reports made with any other object, may sometimes be curious, but can seldom, if ever, be useful to the true Homoeopathist.
|The AMERICAN HOMOEOPATHIC REVIEW Vol. 01 No. 09, 1859, pages 411-418
|Value of Clinical Reports.
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