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Chronic Disease (Important)


Chronic Diseases.  In the treatment of cases of chronic disease homoeopathy has very great advantages over the old school, but in my experience there are few homoeopaths who take full advantage of it. It is necessary, in the first place, for the practitioner to understand the conditions of success, and in the next place it is necessary for the practitioner to make the patient understand. The first condition is  TIME. A constitution cannot be radically changed for the better in a week or a month, and it is seldom accomplished in a year. Hahnemann demanded at least two years case. It is well when such a case comes for the cure of a chronic treatment for the first time to refuse to undertake it unless the patient will promise all the time required. Or a patient may be told that his immediate condition may be ameliorated, but he must not consider himself cured, and must not be surprised by a return of the symptoms at some future time. The young homoeopath will be saved much disappoint- ment if he understands this. A case comes to him, and the first prescription answers admirably. The patient thinks he is cured, and if the doctor does not understand the real nature of the case, he is apt to think so to. If he is aware of the chronically operating cause, he is prepared for the backward swing of the pendulum, and knows how to meet it.  Another point to be remembered is that cases of this kind do not need to be seen frequently (except for intermediate acute phases). As a rule, once a month is quite often enough. If they are seen too frequently, there is not time to properly apprehend the evolution of the medicinal action, and the practitioner is in danger of changing it too frequently and spoiling his case. The true nature of chronic disease was first pointed out by Hahnemann, and his elucidation is most helpful in practice. The term " chronic disease " in his sense has a different meaning from the same term in ordinary medical writings, and though both schools would apply the term to the same case in many instances, it is necessary to clearly understand the difference in the signification. In ordinary medical language a case of acute rheumatism which fails to clear up properly, but goes lingering on for months or throughout the rest of life, is said to have become "chronic"; or a case may never have had an acute stage, and having a slow, non-febrile course, it is also •' chronic rheumatism." Arthritis deformans is always a " chronic disease " from first to last. These, in the language of ordinary medicine are " chronic diseases." With Hahnemann a chronic disease is a condition of chronic constitutional poisoning analogous to an acute disease due to poisoning with an acute poison. Typhoid is an acute disease due to an acute poison which has an evolution ending in recovery or death. Psora is a chronic poison having a chronic evolution, and if not cured lasts throughout life, manifesting from time to time in some form or another, in the intervals subsiding into latency. Most of the " chronic diseases " of ordinary medicine are phases or manifestations of one or other of the chronic poisons or " miasms " of Hahnemann. Hahnemann took a larger view of the history of a patient. He saw in these skin affections, asthma, intestinal catarrh, neuralgias, tumours, or what , not, manifesting in the same patient at different times, not so many different diseases, but only so many different manifestations of one continuously acting chronic poison. Thus it happens that the term "chronic disease " as understood by him would apply to many cases of chronic disease as understood by old- school writers ; only, with him it would apply not to the particular manifestation then present, but to the entire pathological history of the patient. It was not until Hahnemann recognised the unity underlying diverse disease-manifestations that he was able to treat these cases successfully ; and it is the short sighted view of modern medicine in regarding every manifestation of disease as a separate and independent or local affair that has given surgery its present tremendous vogue.

      The treatment of chronic diseases is the test of a homoeopath. It cannot be described in detail in a treatise like this. The treatment of the active manifestations of the chronic miasms will be found, indeed, throughout the work under the appropriate headings. As in the case of intermittent fever, in which the best time to give the curative remedy is after the paroxysm, so the best time to treat a constitutional state is after an acute manifestation is over.  The chronic miasms act in a direction from without inward. This is evident in syphilis and sycosis and in the initial skin affections of psora. But all three may be hereditary, and, in my experience, psora, as at present seen, generally is hereditary. But, in any case, as Hahnemann pointed out, in order to cure it, it is necessary to find remedies whose action is from within outwards. Hence, in the process of a constitutional cure, it frequently happens that an eruption appears on the skin or an old eruption reappears. This is to be regarded as a favourable indication, and by no means is the skin affection to be treated as a local affair.  In diagnosing the constitutional remedy for any patient, the totality of symptoms will always rule, but there are some points which are of more importance than others. I have dealt with this subject in the Introduction, but it will be useful here to take by way of illustration the Sulphur type, as Sulphur is the chief of antipsorics. It is so by reason of its own symptoms corresponding more closely and extensively to psora than those of any other remedy. The typical eruption of Sulphur is a crop of itching and itch-like pustular vesicles, the itching being relieved by scratching. The most characteristic organismic symptom is the "sinking," all-gone sensation at the epigastrium, occurring in the forenoon, and more especially at 11 o'clock. When patients say they cannot eat breakfast, but must have something to eat at 11 o'clock, Sulphur must be thought of. The characteristic mental type of the Sulph. patient is somewhat melancholy, with a turn for theological and philosophical speculations. The head is hot and the feet cold. Often we have only to shake hands with a Sulphur patient to learn his remedy : the hot,sweaty hand of Sulph. is very characteristic. The feet may be cold, but more generally they are hot and perspiring. The symptoms are < by washing,< at night, and < by warmth. When patients complain that all their sufferings are worse as soon as they get warm in bed, Sulph. is most likely
required.  In connection with Sulph. it is necessary to study Calcarea, as it is in many ways the antithesis of Sulph. The Gale, patient has irritability of temper, chilliness, cold, perspiring head, cold, clammy hands and feet, the legs feeling as if damp stockings were on. The Calcarea patient seeks warmth. Lye,Nat. mur., SiUc., Psor., all the nosodes, and many others must be studied in this connection.

      In prescribing for constitutional states it is well to give remedies in the attenuations. I prefer the 30th. The repetition must depend on circumstances. I sometimes give one dose a day or onea week. A placebo may be given in the interval according to circumstances. In treating chronic cases, it is almost essential to success for the practitioner not to reveal the name of the remedy to the patient.