How not to do it
by Margaret Tyler, M.D.

With thanks to Julian Winston for the use of his archives, and for the annotations

This article was originally published in "The Homoeopathician," February 1912. It was reprinted in the "Homoeopathic Recorder" October 1929.

Dr. Kent, Dr. Gibson Miller, and others, can tell you, from long years of successful work and experience, how to do it. I feel that I am equally well qualified, from some years of poor prescribing and much failure, to tell you how not to do it. I used to get brilliant flashes of light and joy - when I hit the drug - and that was just often enough to keep up the enthusiasm of an optimist like myself; but, take it all around, it was failure; and, because it may help some of you, I will try to tell you why.

Homoeopathy, as you and I know, would work, and did work. But I had not properly mastered it; my ideas were too crude, my methods too lawless and untrained, for it would work only fitfully for me. The power was there, right enough, for the illuminating flash testified to its presence; but I could not draw on it with confidence at all times, or make it work quietly and surely - as power will work for those who understand the forces they harness, and can recognize their laws and limitations, and the peculiarities of their manifestations. In short, I had not learned my philosophy .... to tell you the truth, I did not know that there was any philosophy to learn. And, without its philosophy, one may use homoeopathic medicines, even homoeopathically, but one is no homoeopath, and one will never get uniform nor satisfactory results. One will never even recognize the significance of the results one does get, nor know how to deal with them.

TO MASTER THE FIRST THING IS TO OBEY

Remember that the one thing that power exacts is obedience. Electricity is a great power; no man has doubted its existence; for the roar that has followed the flash since the dawn of time has proved too much for the stoutest skeptic. But, to utilize this power, man must court it in its own way, obediently, guiding it through its own channels, conforming to its idiosyncrasies one by one, as he makes its better acquaintance and discovers them. It is only by faithful obedience to the master-power that it may be bent to work for man, obediently, as his slave. So with homoeopathy. There are no rough-and-ready methods. A child can stroke a cat's back and get sparks; but for a steady, useful current, to drive engines, or light a city, or girdle the earth, it requires rigid conformance to all the known laws. No great power works without definite laws and limitations; and with these we have to reckon, or fail. And in homoeopathy, as in electricity, you have either something - or nothing! Both are giddily intangible - only to be recognized by results. And in both there are no half measures. All has to be in order with your method if the steady current of healing is to flow. A spark here and there - even devastating - is not business. It is convincing in its way, and may even hold a promise of better things if you can better your methods of dealing with it.

PRESCRIBING FOR THE DISEASE

For a homoeopath, I suppose the often fatal first step is to label diseases, and then to label drugs to match.
To ticket Rhus and Bryonia "rheumatic remedies", and practically make your choice between them, and to fling it in the teeth of homoeopathy when they fail to cure a case that required Sulphur or Tuberculinum, or - the dentist;
To regard Sulphur and Graphites as "skin medicines", and utterly fail in the cases (and they are not few) that demand Pulsatilla;
To set Sepia aside as "a remedy for women's complaints", and scorn the person who dares to give it to babies.
Whereas, if you are to work your homoeopathy for all it is worth, you will have to cure individual cases
Of tubercular dactylitis with Sepia, of all medicines!
Of goitre, even with a mass in the right lobe - not even the left - with Sepia (I showed such cases recently to the British Homoeopathic Society);
Constipation with Rhus, or Variolinum (as did Dr. Burnett);
Or (as did one of our men recently) a nocturnal gastralgia accompanied by wasting with a single dose of Syphillinum.

If you are to do it, and to do it often, you just have to let the disease alone and go for the patient. You have to say, not "this is a case of rheumatism, and I might try Rhus, because Rhus is a very good medicine for rheumatism", but "this is a Sepia patient, and, whatever ails her, it is Sepia she needs, and no other medicine". My goodness! if I had known that from the beginning.

And, for your own sake, don't be too ready to say, "I tried homoeopathy for such a case, and it failed". Remember, it was you who failed; and the very fact that you failed proves that, whatever it was, it was not homoeopathy. The power was there all the time, only you failed to apply it. Say this to some one who knows, and he regards you pensively. You have merely betrayed your own limitations.

TOO FREQUENT REPETITION

Now, the second fatal stumbling-block is the cabalistic sign "t. d. s." - ter die sumendum (which the knowing ones reserve for Placebo). I suppose that that has blighted more brilliant homoeopaths in the bud than one can imagine. And next to that, in its self-stultifying mischief, comes the atrocious formula, of those who fondly imagine that they are doing high class homoeopathy indeed, "once weekly". When I started on my career of failure and bad prescribing, I saw every one giving drugs "t. d. s." - for chronic cases anyway; think of it ! And, never having learned to prescribe, I fell headlong into the pit. In vain my mother protested - she had learned good homoeopathy in the early days of better work.

"It is quite wrong", she said, "to give medicines like that, and for weeks at a time. It is not homoeopathy at all. Directly there is improvement, you must stop; and only repeat later, if the symptoms return unchanged".

But "t. d. s." was everywhere the rule, on which I proceeded to improve. For, knowing that potencies worked, I gave 30s and 200s thrice daily - or once or three times a week, as the spirit moved me; not divining that, if one must play the "t. d. s." game, it is well to employ the drug in its highest state of im-potency - perhaps about the 3x, where you have not enough quantity for crude effects, or enough penetrating power for deep and lasting mischief. Men do get excellent results in some superficial cases, in this way.

Worse than all, I led others into the same error, inducing them to try the high potencies. I was always thrown back on myself to wonder why, when I had made a good prescription, the patient, after a few days' splendid betterment "Why, I thought I was cured for the first three days" - relapsed and came back worse than ever, or with new tales of woe, for which a new prescription went down - with like result. Always better - and then worse, perhaps in a new way; but never, never, never cured.

Gentlemen, you can go on in this way for years, curing your patients till they die. They will forgive you the relapse each time for the good hope of the first three days. In fact, that will go down to your credit, and the rest to the credit of the disease. You can ring the changes with a regular sequence of amelioration; drug effect; new prescription - symptoms wiped out; new drug symptom; new drug to meet them - fresh amelioration; fresh mischief; and again another remedy of like symptoms which, like all its predecessors, ameliorates promptly, and then proceeds (if persisted in in this idiotic way) to set up its own train of symptoms, for which you again drearily prescribe - while homoeopathy sinks lower and lower in your estimation, and the younger men wonder that you have lost all enthusiasm for its cause. Even in those days of little knowledge, I could often have done brilliant work had I used my mother's words, and adjured the patient: "Directly you are better you have to leave off your medicine, and never touch it again, unless you are really worse".

I am afraid I spoiled several men's work by inducing them to try the higher and highest potencies. I know that I am giving myself away badly, but perhaps that is necessary. For, gentlemen, every evil that I have done in my ignorant flounderings after better things lives on in some corner of L. H. H., and I am always meeting my sins at odd moments and around unexpected corners - "hinc illce lachrymoe!"

I have seen Calc. carb. CM prescribed thrice daily for a month by a man who was, as he expressed it, "giving the high dilutions a trial". And my evil suggestions as to giving Tuberculinum weekly, while one gave, say, Silica 30 t. d. s. (Silica, that deep-acting drug of 40-60 days' action ! ), are still haunting the place like evil spirits, to lay which it will take more of the holy waters of repentance and confession than I can manage this afternoon.

USE OF REPERTORY

But it was not all imagination and daring experiment. I did try to work out my cases, believing that when I failed it was because I had the wrong drug - which by no means follows. I did try to work out cases, with hours and hours of labor - generally in vain ! For I had never been trained.

Till our first scholars came back from America, no one had ever taught me how to recognize the few symptoms of inestimable value in the equation. NO one had ever shown me how to eliminate drugs and minimize labor by starting with certain general symptoms well marked in the patient. I had no faintest idea how to work economically as regards labor.

I would start by writing down that terrific list of drugs producing constipation - if the patient complained of that trouble; and so on through all his symptoms, important or unimportant, even mechanical, and probably altogether misleading, giving to each drug its value according to type, and never once considering (what is most important) whether the type coincided in patient and drug; then rounding up with an arithmetical calculation. Sometimes the drug came out: but the labor was hideous, monotonous, and not even remunerative in results.

I was not easily beaten; if there was anything in repertorizing, I was determined to master it, and more, to make it practical with a minimum of labor; for I went so far as to devise a card-trick system, every card a symptom, and all drugs that produced that symptom punched out. I deafened myself punching one thousand such cards. I have them still, a great cabinet full. But even this could not help, because the system was wrong.

[NOTE: Tyler mailed a copy of this card-repertory to Kent for a critique. He was scathing. He said, in part: "...Your card system is like ready made shoes that must fit everybody, regardless of the misery they cause. The first and highest thought in Homeopathy is the individual. OUR WORK IS INDIVIDUALIZATION. Your cards will destroy the highest ideal of Hahnemann, and my teaching as it aims to fit and adjust remedies to the masses instead of to each one. The card system destroys growth and progress that must come form working out the case, every case, in the work of every beginner. Give a beginner a card system and that will be the end of him. He will not grow. He will not learn or master the materia medica. I once planned a similar scheme, but I soon saw that I must work out every case, making use of the fullest repertory accessible; curtailing nothing less I miss something important, and this meant a life charged against my conscience... Your card system will make mediocres out of good men as it will pervert advancement, growth, maturity in our pupils. There is no way but to continue to use the repertory in each case..." --JW]

When one knows how to repertorize, a choice from some 80 cards of "general" symptoms in a small portfolio is all that is needed to start a case - often to work it out in five minutes with a glance at the materia medica - had I known ! But I have learned one thing from all this, and that I am competent to teach any one, viz., how not to do it.

Another way to insure failure, in some cases, is to start your repertorizing (by way of weeding out useless drugs and lightening labor) not with generals, but with some list of drugs that has the patient's ailment. Say it was my case of goitre, where Sepia cured - one dose of Sepia.

In my days of fruitless repertorizing, I should have begun work on a case like that by writing down all the drugs that have been found useful in goitre; then, as there was a mass in the right lobe, I should have eliminated all the drugs, by the help of another list, that did not affect the right side of the body, or neck. And I should have failed - absolutely and inevitably have failed; because Sepia is in no list of drugs known to affect the thyroid gland. And again, though Sepia is among the drugs that pick out one side of the body, it happens to choose the left side for its operations, in the general way; so, again, I should have inevitably missed it. She received Sepia because she looked, and was, a typical Sepia patient, with Sepia symptoms, and because I simply could not give her anything else - then; my absurd intention being to cure her first and then to tackle her goitre.

But if (and it is a large if) you cure your patient, the odds are that there will not be anything left to cure. Your business is to cure her; the rest is her affair. Make her normal, and she will have no further use for acquired abnormalities. Healthy nature makes short work with superfluous details; for she can waste, as well as develop. Given the irritant, and she will sprout "ultimates", and in vain you prune them away. Put her right, and she starts clearing them off and setting her house in order. Be well assured that 8nothing continues to exist without cause! And learn a lesson from the tadpole's tail; it has taught me much. I used to think it dropped off ! We have a great deal to learn about absorption !

HASTY PRESCRIBING

Another way not to do it is to be too ready with your prescription. If you take a lot of trouble with a case (when you know how), it will give you very little trouble afterwards. Conversely, if you take a very little trouble to begin with, it will give you endless trouble, many times repeated. You have fouled the clear waters with a wrong prescription, and how are you going to peer into the depths? You no longer have a true disease picture to match. One bad prescription leads to several, perhaps to a hopeless mixing-up of the case. "Curses and chickens (and bad prescriptions) come home to roost". If you are not sure give a Placebo and wait. Hahnemann says, "A week's Placebo to start with, anyway" !

PRESCRIBING DURING AMELIORATION

And when you have worked it out, and actually found your drug, there are still several ways of how not to do it. One of the most catastrophous and heart-breaking is to repeat while amelioration holds. Two cases have bitten into my memory, though hardly understood at first; and yet I go on doing the same thing again and again, for it is the hardest lesson in the world to learn, to hold your hand and do nothing. One catches at the excuse of any little recurrence of symptoms to repeat, and often spoils the case - pro tem., anyway.

A glaring instance, which in those early days I did not even understand, was a chronic typical Aloes-diarrhea. (I have hunted in vain for the notes so speak from vivid memory only). He got Aloes CM (either one dose or two at a week's interval). He came back so much better, practically cured, that I hugged myself, and hugged homoeopathy as a very wonderful thing. I had found his remedy right enough, and I would keep him on it for a bit, lest he should relapse! Of course, he came back less well. Then I gave it more often (it was the right remedy, for the first dose had been magic). I piled it on - homoeopathy was a less wonderful thing (my homoeopathy, that is, which ought to have been written in inverted commas); and presently he came no more.

That case has rankled ever since. I came to the conclusion, at that time, that the first prescription was a comparatively easy matter; but what to do with patients when they came back better was beyond me! The very obvious "do nothing" was also beyond me for ages.

That is where the philosophy comes in. That is where, in homoeopathy, we perish for lack of knowledge. That is where the young men, who have been trained score. They will never know so much about "how not to do it"; but they have been taught when not to do it ! For there is one rule, and one only, that meets the case: So long as amelioration holds, let it be; and only repeat, or reconsider the case, when you are sure that it is quite at an end.

Why, Wright has proved that recently, under the microscope, for Tuberculinum; though Hahnemann laid down the law more than a hundred years ago. And we who call ourselves his followers sneer at "the eternal Hahnemann'', and do not even take the trouble to master his teachings.

Never repeat while amelioration holds. It will be from minutes to hours (Hahnemann says so) in acute cases, and from days to weeks or months, according to drug and case, in chronic diseases. But, unless you want to see your work always going back on you, unless you want to be one of those who have "tried homoeopathy and failed", let your ameliorations severely alone, and keep your enthusiasm for scientific medicine.

The other sharp lesson was a case of heart failure in a woman of 29, mitral incompetence, etc., that I got permission to treat after admission to the L. H. H. Here I have the house physician's notes and measurements. She worked out Arsenicum, and I gave a dose of Ars. CM two days running (as she had been given a dose of Spig. low in the intervening night, and it might have interrupted). The effect was magical. Three days later (only four days after admission):

The heart had contracted, and was now only one inch, instead of two, to right of the sternal margin.
The liver had also contracted, and now, in the nipple line, measured 6 1/4 inches instead of 8 3/4
inches. One hundred heart beats out of one hundred and forty-four now reached the wrist, instead of sixty-two out of one hundred and sixty.

She was sleeping quietly at night, instead of the suffocating spells when she dozed, and the frequent vomitings all night that had been a feature of the case.

She felt very much better. Every one was amazed at the improvement, and, in my joy and desire to hasten matters yet more, I gave her, a week later, another dose of Ars. CM. And that ended the case - in all senses! She grew worse. Lyc. was given, and failed to relieve. All her fearful restlessness returned; she could stay nowhere. She demanded to go home, where she died very soon after.

You who know realize that it was risky even to give a CM to such a case, but that it was madness to repeat it while the patient was doing so well. You see that it is not enough to spot your drug; it is not enough to make a successful prescription, even. You need all the philosophy if you are to carry your work through every time, if you are to get nearly all there is to be got out of homoeopathy. I was like an electrician who, having proper wires and a lamp of just sufficient resistance to glow its brightest, wantonly doubles the current, fuses the filament, and earns darkness. The greater the power, the more carefully must it be handled, to avoid disaster.

HIGH POTENCIES IN ADVANCED CASES

Another way not to do it., a case that emphasized the fearful risk of giving a high potency of the indicated remedy to advanced disease, was a case of malignant tumor of the breast. The woman had been doing well on unit doses of Scrof. nod., had lost pain and swelling of the arm, and inconveniences of the disease, though it was steadily progressing. She was a healthy looking, robust old woman of masculine appearance.

I worked her out and gave Lach. 200, and then a dose of Lach CM. This was promptly followed by alarming collapse, hemorrhage, rapid greenish fungations, and intolerable odor (all relieved, by the way, by a dose of Ornithogalum a few weeks before she died). This Lach. CM aggravation pleased me, rather than otherwise - showed that I had hit the drug. A second dose, later was followed in half an hour by collapse; and, again, a horrible aggravation of all symptoms. But I still fondly hoped that the reaction might carry her a long way toward clearing up the case. It never came. And I have learned my lesson now.

In advanced disease, malignant or tuberculous, with much tissue change or lowered vitality, philosophy teaches that the most terrible that you can give your patient is the indicated remedy in high potency. Give her anything but that!

Some of you are fidgeting with impatience, not believing this, or vowing that if you did believe it you would quit homoeopathy. But others in the discussion, by and by, will more than confirm it from their own experience. You will find that it is the men who know their work, and can handle their power, and get results, who are not only the most keen and enthusiastic, but who develop at times a positive terror of their drugs - in the potencies; for they know how potent they may be for evil as well as for good; that when the disease mass is large, or the reaction poor, the most harmful drug you can give to a patient is the simillimum unless very cautiously and low.

INTERFERENCE

Another brilliant way not to do it (you see that I have tried them all) is to have your cases in common, and to work with some one who knows little, and cares less, for the philosophy of prescribing. It is late; there are a heap of patients to be got away in a short time. He sees a case on which you have expended much labor and thought; hears a tale of woe - a medicinal aggravation perhaps (your poor prescriber does not believe in aggravations, for in the nature of things he gets few, and never spots one when he does get it ! ); or old symptoms returned; or a diarrhea or rash or excessive sweating that may be critical, mean a sharp leap towards the cure of some serious condition, if left alone; or even symptoms worse and patient better (if he inquired), which should call a halt. But, at the first word, down goes a new drug; and the case is off at a tangent - perhaps beyond recovery. This is how not to do it, with a vengeance! For this is to throw your very life, your energy, and your success, to the moles and the bats - and without compensation. You and your patient have both suffered for the victory that has been snatched from you, and suffered in vain! We all have plenty of chances, unless we walk warily, of spoiling another's work.

But enough of how not to do it! There has been plenty of that in the past; but the past is beyond our reach. Old things are passing way, rapidly! Our concern is with the present; and the future, living or dying, is ours! Let us only diligently train the younger men, and the great cause is safe in their hands Those who can wield power can be trusted never to betray it. And to you who have learned your homoeopathy under a master; who know its philosophy by heart; who have been trained to work out your cases, to respect and fear your potentized drugs and to use them only safely; who have learned to recognize and understand and deal with results - to you I would say: Be patient, be gentle and courteous, be tolerant and forbearing. You have no idea how those who have not had your advantages have struggled and do struggle, in a heart sickening way, and without your results to buoy them up and reward their labors. They can look back, many of them, to the time when their enthusiasm was as great as yours; when they knew their drugs, from diligent study, as well as you do, and with far more labor than you have bestowed, who have had them presented to you in an attractive way - who have been taught.

And, above all, be good stewards of the gift that was given to you, and be ready to impart. Each one of us, working by himself and for himself, has only a limited life work, a limited fund of hours and energy, and then comes the "whisper out of the darkness" that says "the end is forbidden"; that says, "thy use is fulfilled'' - and then, silence. But think how enormously we can multiply our life work, our influence, the sphere of our energy and usefulness, by helping and inspiring others. What an enormous mass of work may at last be laid to our account. Think of the work that Dr. Kent is doing in the world today, through his scholars, through the men he has kindled and inspired, and taught, and the men that they, in their turn, have taught and are teaching. Believe it, there is no greatness in the world but through service.

He that would be great among you, let him serve. Teach! Help! Strengthen! Hearten! Inspire! Freely ye have received freely give - and of the best that is in you.

In reading this over, every sentence is a gem. If we pay attention to this we should be doing it OK. The L.H.H. is the London Homoeopathic Hospital. - JW





 
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