Chronic Diseases

Case History

§ 82

Although, by the discovery of that great source of chronic diseases, as also by the discovery of the specific homoeopathic remedies for the psora, medicine has advanced some steps nearer to a knowledge of the nature of the majority of diseases it has to cure, yet, for settling the indication in each case of chronic (psoric) disease he is called on to cure, the duty of a careful apprehension of its ascertainable symptoms and characteristics is as indispensable for the homoeopathic physician as it was before that discovery, as no real cure of this or of other diseases can take place without a strict particular treatment (individualization) picoof each case of disease - only that in this investigation some difference is to be made when the affection is an acute and rapidly developed disease, and when it is a chronic one; seeing that, in acute disease, the chief symptoms strike us and become evident to the senses more quickly, and hence much less time is requisite for tracing the picture of the disease and much fewer questions are required to be asked1) , as almost everything is self-evident, than in a chronic disease which has been gradually progressing for several years, in which the symptoms are much more difficult to be ascertained.

1 Hence the following directions for investigating the symptoms are only partially applicable for acute diseases.

§ 91

The symptoms and feelings of the patient during a previous course of medicine do not furnish the pure picture of the disease; but on the other hand, those symptoms and ailments which he suffered from before the use of the medicines, or after they had been discontinued for several days, give the true fundamental idea of the original form of the disease, and these especially the physician must take note of. When the disease is of a chronic character, and the patient has been taking medicine up to the time he is seen, the physician may with advantage leave him some days quite without medicine, or in the meantime administer something of an unmedicinal nature and defer to a subsequent period the more precise scrutiny of the morbid symptoms, in order to be able to grasp in their purity the permanent uncontaminated symptoms of the old affection and to form a faithful picture of the disease

§ 93

If the disease has been brought on a short time or, in the case of a chronic affection, a considerable time previously, by some obvious cause, then the patient - or his friends when questioned privately - will mention it either spontaneously or when carefully interrogated.1)

1 Any causes of a disgraceful character, which the patient or his friends do not like to confess, at least not voluntarily, the physician must endeavor to elicit by skilfully framing his questions, or by private information. To these belong poisoning or attempted suicide, onanism, indulgence in ordinary or unnatural debauchery, excess in wine, cordials, punch and other ardent beverages, or coffee, - over-indulgence in eating generally, or in some particular food of a hurtful character, - infection with venereal disease or itch, unfortunate love, jealousy, domestic infelicity, worry, grief on account of some family misfortune, ill-usage, balked revenge, injured pride, embarrassment of a pecuniary nature, superstitious fear, - hunger, - or an imperfection in the private parts, a rupture, a prolapse, and so forth.

§ 94

While inquiring into the state of chronic disease, the particular circumstances of the patient with regard to his ordinary occupations, his usual mode of living and diet, his domestic situation, and so forth, must be well considered and scrutinized, to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may by prompted.1)

1 In chronic diseases of females it is specially necessary to pay attention to pregnancy, sterility, sexual desire, accouchements, miscarriages, suckling, and the state of the menstrual discharge. With respect to the last-named more particularly, we should not neglect to ascertain if it recurs at too short intervals, or is delayed beyond the proper time, how many days it lasts, whether its flow is continuous or interrupted, what is its general quality, how dark is its color, whether there is leucorrhoea before its appearance or after its termination, but especially by what bodily or mental ailments, what sensations and pains, it is preceded, accompanied or followed; if there is leucorrhoea, what is its nature, what sensations attend its flow, in what quantity it is, and what are the conditions and occasions under which it occurs?

§ 95

In chronic disease the investigation of the signs of disease above mentioned, and of all others, must be pursued as carefully and circumstantially as possible, and the most minute peculiarities must be attended to, partly because in these diseases they are the most characteristic and least resemble those of acute diseases, and if a cure is to be affected they cannot be too accurately noted; partly because the patients become so used to their long sufferings that they pay little or no heed to the lesser accessory symptoms, which are often very pregnant with meaning (characteristic) - often very useful in determining the choice of the remedy - and regard them almost as a necessary part of their condition, almost as health, the real feeling of which they have well-nigh forgotten in the sometimes fifteen or twenty years of suffering, and they can scarcely bring themselves to believe that these accessory symptoms, these greater or less deviations from the healthy state, can have any connection with their principal malady.

§ 96

Besides this, patients themselves differ so much in their dispositions, that some, especially the so-called hypochondriacs and other persons of great sensitiveness and impatient of suffering, portray their symptoms in too vivid colors and, in order to induce the physician to give them relief, describe their ailments in exaggerated expression.1)

1 A pure fabrication of symptoms and sufferings will never be met with in hypochondriacs, even in the most impatient of them - a comparison of the sufferings they complain of at various times when the physician gives them nothing at all, or something quite unmedical, proves this plainly; - but we must deduct something from their exaggeration, at all events ascribe the strong character of their expressions to their expressions when talking of their ailments becomes of itself an important symptom in the list of features of which the portrait of the disease is composed. The case is different with insane persons and rascally feigners of disease.

§ 97

Other individuals of an opposite character, however, partly from indolence, partly from false modesty, partly from a kind of mildness of disposition or weakness of mind, refrain from mentioning a number of their symptoms, describe them in vague terms, or allege some of them to be of no consequence.

§ 98

Now, as certainly as we should listen particularly to the patient's description of his sufferings and sensations, and attach credence especially to his own expressions wherewith he endeavors to make us understand his ailments - because in the mouths of his friends and attendants they are usually altered and erroneously stated, - so certainly, on the other hand, in all diseases, but especially in the chronic ones, the investigation of the true, complete picture and its peculiarities demands especial circumspection, tact, knowledge of human nature, caution in conducting the inquiry and patience in an eminent degree.

§ 103

In the same manner as has here been taught relative to the epidemic disease, which are generally of an acute character, the miasmatic chronic maladies, which, as I have shown, always remain the same in their essential nature, especially the psora, must be investigated, as to the whole sphere of their symptoms, in a much more minute manner than has ever been done before, for in them also one patient only exhibits a portion of their symptoms, a second, a third, and so on, present some other symptoms, which also are but a (dissevered, as it were), portion of the totality of the symptoms which constitute the entire extent of this malady, so that the whole array of the symptoms belonging to such a miasmatic, chronic disease, and especially to the psora, can only be ascertained from the observation of very many single patients affected with such a chronic disease, and without a complete survey and collective picture of these symptoms the medicines capable of curing the whole malady homoeopathically (to wit, the antipsorics) cannot be discovered; and these medicines are, at the same time, the true remedies of the several patients suffering from such chronic affections.

§ 104

When the totality of the symptoms that specially mark and distinguish the case of disease or, in other words, when the picture of the disease, whatever be its kind, is once accurately sketched,1 the most difficult part of the task is accomplished. The physician has then the picture of the disease, especially if it be a chronic one, always before him to guide him in his treatment; he can investigate it in all its parts and can pick out the characteristic symptoms, in order to oppose to these, that is to say, to the whole malady itself, a very similar artificial morbific force, in the shape of a homoeopathically chosen medicinal substance, selected from the lists of symptoms of all the medicines whose pure effects have been ascertained. And when, during the treatment, he wishes to ascertain what has been the effect of the medicine, and what change has taken place in the patient's state, at this fresh examination of the patient he only needs to strike out of the list of the symptoms noted down at the first visit those that have become ameliorated, to mark what still remain, and add any new symptoms that may have supervened.

§ 206

Before commencing the treatment of a chronic disease, it is necessary to make the most careful investigation1) as to whether the patient has had a venereal infection (or an infection with condylomatous gonorrhoea); for then the treatment must be directed towards this alone, when only the signs of syphilis (or of the rarer condylomatous disease) are present, but this disease is very seldom met with alone nowadays. If such infection have previously occurred, this must also be borne in mind in the treatment of those cases in which psora is present, because in them the latter is complicated with the former, as is always the case when the symptoms are not those of pure syphilis; for when the physician thinks he has a case of old venereal disease before him, he has always, or almost always, to treat a syphilitic affection accompanied mostly by (complicated with) psora, for the internal itch dyscrasia (the psora) is far the most frequent fundamental cause of chronic diseases. At times, both miasms may be complicated also with sycosis in chronically diseased organisms, or, as is much more frequently the case, psora is the sole fundamental cause of all other chronic maladies, whatever names they may bear, which are, moreover, so often bungled, increased and disfigured to a monstrous extent by allopathic unskillfulness.

1 In investigations of this nature we must not allow ourselves to be deceived by the assertions of the patients of their friends, who frequently assign as the cause of chronic, even of the severest and most inveterate diseases, either a cold caught (a thorough wetting, drinking cold water after being heated) many years ago, or a former fright, a sprain, a vexation (sometimes even a bewitchment), etc. These causes are much too insignificant to develop a chronic disease in a healthy body, to keep it up for years, and to aggravate it year by year, as is the case with all chronic diseases from developed psora. Causes of a much more important character than those remembered noxious influences must lie at the root of the initiation and progress of a serious, obstinate disease of long standing; the assigned causes could only rouse into activity the latent chronic miasm.

back to entrance