Adolph Lippe

Clinical Reflections

The Clinical experiment is our ultimate test. If we violate any (even the least well-known) rules which should always guide us in our therapeutics, we have no right to expect that favourable success which is promised us if we strictly apply these rules; and if this is true, then it is also obvious that want of success generally depends upon a violation of these rules, and not, as is generally claimed, on the unreliability of them.

We propose to relate here a case in which some of the strict rules for the proper application of our Law of cure were inadvertently violated, and how the discovery of this mistake led to a stricter application of them, with the usual good results which must necessarily follow the strictest homoeopathic practice. We shall first give a plain relation of the case, and follow it with our comments.

Mrs. B., aet. 45, had for many years suffered from a very delicate and irritable stomach, from cancrous sore mouth (cured by Phytolacca), all in consequence of what is mis-termed scientific treatment; she had also suffered from hay-fever, regularly returning every year on September 16th.

Mrs. B. returned from Europe, after an absence of several years, on July 26th last; the voyage had been a very unpleasant one; she had been very sea-sick all the time. From the time she left Liverpool till she was visited by me, on July 27th, she had taken literally no nourishment; broken ice was the only thing that had passed her lips. I found her sitting up, occasionally straining to vomit, very weak, pulse 110 per minute, she complained of violent pain in the occiput, with great heat, which she had tried to relieve by applications of broken ice; urinary secretions suppressed; mouth dry and hot; she had not slept for a fortnight, and could not lie down on account of a great nervousness, as she expressed it, which compelled her to change her position and her chair so very often; she wandered about all night from chair to chair; taste very disagreeable; perfect loathing of food, and for a few days had a watery, very offensive, and black-looking diarrhoea.

The choice of the remedy was easy enough; I gave her one dose of Arsenicum album 50m (Fincke) on her tongue (July 27th, 10 a.m.). July 28th, had slept in her bed from 10 p.m. to 1 a.m., then became nervous and restless, but says that she feels better. No medicine. July 29th: Has been in bed all night, slept, and no return of the diarrhoea; urinary secretions re-established; the hot water applications to her head have much relieved the pain; has taken some milk-toast, and relished it; pulse below 90; is cheerful and hopeful. July 31st: Had a still better night, is better in every respect, but complains of severe pains in a bunion on the left foot; it is much inflamed and stings (1). I gave her now one dose of Nit. ac. cm. (Fincke). August 1st: The bunion is less painful, otherwise there is not much change perceptible. August 2nd: Bunion still improving, and on August 3rd no more pain or inflammation in it. On the evening of August 3rd I was again summoned to see her; found her (7 p.m.) quite ill; the diarrhoea and vomiting had returned with great violence; pulse over 110; the same headache as on July 27th had also returned, also the great restlessness (2). Gave her one dose of Arsenicum cm. (Fincke) dry on her tongue. Found her better next day, and the improvement continued; on August 6th (3) her bunion began to pain her again as on July 31st. Gave no medicine (4) The improvement continued satisfactorily; when September 16th came, she had that night, about 1 a.m. some oppression of breathing, which remained her of the terrible asthmatic attacks she had had years ago; she had to sit up for half-an-hour. No medicine. She fully recovered, and traveled for some weeks; had no hay fever; really has had nothing to complain of since; enjoys better health than she has had for years.

COMMENTS ON I. When the bunion appeared, no medicine should have been given, because all the other symptoms for which Arsenic was clearly indicated improved under its salutary action, clearly showing that the effects of the dose administered was not yet exhausted, and because this new symptom appearing on a less vital part of the body; also showing a moving downward of the disease, did not indicate a progress, but a diminution of the disorder. Here were two important rules violated. The remedy must be allowed to exhaust its effects before another dose of the same remedy, or a new remedy, shall be administered. If the appearance of the painful bunion had demonstrated a progress of the disorder, a new remedy indicated by this last appearing symptom would have been in order; and , above all, do we know that if a less vital organ becomes affected, and if the symptoms move from the centres to the extremities, or from above downwards, such symptoms do not indicate a progress of the disorder, and therefore no new remedy should be given, and especially not if the general or previous more serious condition of the patient improves.

COMMENTS ON 2. Nitric ac. had removed the symptoms for which it was given, viz., the stinging pain in a bunion on the left foot, but as soon as this symptom had disappeared the first symptoms for which Arsenic had been beneficently administered returned with great severity; this fact was a convincing evidence that the bunion should have been left alone, and that the improvement of the first symptoms would most likely have continued if there had been no interference. As a rule, the last appearing symptoms are of most importance, and must guide us in the selection of the next remedy, but it is obvious that we must first determine whether such a new symptom, or symptoms, require a new remedy. Our knowledge of pathology comes here to the rescue, as well as other well-known rules. If, for instance, in a case of encephalitis, a profuse secretion of pale urine appears, we know well that we have a dangerous symptom added to the other symptoms, and that it must guide us in the selection of a new remedy, and must be promptly attended to; if the same increased discharge of pale urine appears in a case of rheumatic fever, we would look for a diminution of all the former symptoms without giving a new remedy. If the symptoms of a patient begin on the extremities, and if they improve, but symptoms appear in internal organs, then it becomes necessary to be guided by them in the prompt change of the remedy; if the reverse occurs, no new remedy should be administered. If the symptoms descend, we may safely wait and give no medicine, but if they ascend, every progress upwards shows us that we have not yet conquered the disorder, and reminds us of the necessity of re-examining the sick, and choosing the more similar remedy. In the case related, the symptoms left the internal organs, went to the extremities, and descended, it was therefore wrong to interfere with the beneficial action of the remedy.

COMMENTS ON 3. The previous symptoms returned, and the same remedy in a higher potency again controlled them. A higher potency was given, following one of Hahnemanns important injunctions, given in his Chronic Diseases, that the potency must be changed if the same remedy has to be repeated in a given case. Now again, after this remedy had acted very beneficially for three days, there returned exactly the same symptoms. There is still another lesson to be learned from this case, and that is, that we should again pay as much, nay more, attention to the artificial days than did Hippocrates of Cos. There is open to progressive Homoeopathy a very large field. We must continue to develop the Healing Art, guide by the well-established fundamental principles (the science) and the established rules (the art) left us as a legacy by Samuel Hahnemann. Forms of disease have had their critical days, and as Hippocrates points it out very clearly, days for medication and days for non- medication; the Materialists of the common School of Medicine could no more see the critical days, and set them aside as useless; they could of course not see them because they so violently and blindly interfered with the natural course of disease that these days could no longer be observed. When the sick were treated homoeopathically, and this blind and violent interference gave way to a mild and humane treatment, those old, long-forgotten critical days were again observed, and were by the true Healer utilized. And when proving drugs fro the purpose of learning their sick-making, and, therefore, curative virtues, we again find this same periodicity of the critical days. A well person exposed to a contagion shows the infection after a certain lapse of time; for three days generally the organism remains undisturbed; then or later, but invariably on an uneven day, the disease develops itself. A well person taking a single dose of a medicinal substance (and why should he take more if he expects a satisfactory proving?) will, with rare exceptions depending on the character of a few sudden-acting substances, like Glonoin, Camphora etc. not feel any disturbances in the organism before the third day, when the effect of this health-disturbing medicinal substance begins, develops progressive symptoms, and shows all its sick-making powers for a certain length of time. In the case here related we find an illustration of these propositions; Arsenicum so clearly indicated in the case caused, after three days, twice, the same new symptoms not known to belong to Arsenicum. When it appeared the second the time it was not interfered with, and disappeared with all the other symptoms belonging to the case. To the thoughtful Healer these observations present a number of questions. Shall we add this new symptom (inflamed and stinging bunion) to the pathogenesis of Arsenicum? Shall we wait in each individual case for the exhaustive action of the single dose? And if a single dose, as it is illustrated in this case, can fully restore health, why should we give repeated doses to the sick till we have ascertained it to be necessary, because the action of the single dose is very soon exhausted. How can we bring the critical days to guide us in our therapeutics? .

COMMENTS ON 4. The greatest and most important question arising in a given case, is, whether a new remedy should be administered, or the former one repeated, or no medicine should be given, and we should wait. This is surely very often a perplexing question. In the case here stated an error was committed, and we have already dwelt upon it; but in a great majority of cases such an error is not so easily remedied. It will very frequently happen that the disturbance created by this erroneously-administered remedy interfering with the action of a health-restoring and truly homoeopathic medicine, will be followed by a new combination of symptoms not having any similarity with the first symptoms observed; and we then generally find a grave case before us. This being so, the importance of the question of medicine or no medicine becomes apparent. When we are not quite certain whether the dose before administered has exhausted its effects, or whether new symptoms presenting themselves, and not known to belong to the medicine then acting, are indicating an improvement or a progress of the disorder, then we should give the benefit to our doubt, and decide on no medicine. If the new symptoms belong to the remedy administered then it is evidently acting beneficially and we decide on no medicine.

In an epidemic of croup here, many years ago the children who always gave a hoarse barking cough in the early morning hours, were comparatively well during the day, but were attacked the following night with malignant membranous croup. When a single dose of Belladonna was administered in the morning, they full recovered; but at 4 p.m., a violent fever, with headache and drowsiness, would set in. When no medicine was given for these symptoms characteristic of Belladonna this fever would end by 6 or 7 p.m. in a perspiration, and without any more medicine the child would recover; when medicine was given, and especially when Aconite was administered, which from the absence of its characteristic restlessness, was unsuitable, then the child became very ill, the membranous croup became fully developed, and presented a very grave case. Such cases were hard to manage. No medicine in this case was the proper decision.

To-day, October 22nd, Mrs. B., above referred to, reported herself unusually well. She has not taken any medicine since the evening of August 3rd.