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Before /discussing the problems of actual homeopathic practice let me show you some of the difficulties in the ordinary practice of medicine which led me to an interest in homeopathy.'When I was a student at Columbia: Medical School, 'P & S' as we called it, in the war time, I was much disappointed at the paucity of therapeutic information. There was pathology. and bacteriology galore, and fascinating dri!l in diagnosis, but being a woman, and therefore a practical soul (I see some of you smiling at women you have met) I hankered after means of cure. Most of what we were taught in therapeutics was hygiene, nursing procedures, diet, hydrotherapy, etc. A large proportion of my class, who had intended to go into general medicine, took up surgery or the specialities because in those fields there was something definite to do for the patients. From medical scheol I W€l1t . to Bellevue Hospital for two years' rotating interneship, and there again I met the prevailing therapeutic nihilism. Our chief of service was a wizard at diagnosis, but I always felt that an autopsy was fully as acceptable as a cure and much more frequent. One class of patients in the hospital particularly distressed me; those who had abundant subjective symptoms and on whom the diagnostic and laboratory pronouncement was, 'There is nothing wrong with you'. I remember one saying, 'Well, doctor, I may be perfectly well, but I know ! am sick.' And then there were the chronics, not only those with marked pathology but life-long sufferers from 'indigestion' or migraine, who had been passed around from doctor to doctor with nothing but temporary relief. Two ,other problems puzzled me particularly in those days

Besides the apparently functional cases and the chronics~ One of these was the pa,tient with a classically recognizable disease who did not respond to the usual 'specific' . treatment for that disease. For instance, a young sailor with a severe malaria which no' amount of quinine influenced in the least, to the const~rnation of all the' visitings. The other matter which set me thinking was the wide variety of types of a single disease. I used to, wonder why the pneumonia in the second bed who was such a' strapping specimen, and had come down suddenly at midnight on the date of admission, was in such mortal terror of dying by noon the next day, (which I may add, he did, to the surprise of all of us), and why the besotted looking fellow in the next bed, lay on the affected side with his hand under his chest, motionless' gulping two or three glasses of water at long intervals,. complaining of the light and snappiqg your head off when spoken to; and why the pneumonia on the other side of the ward thrashed about so incessantly, especially in the evening, calling for cold milk. Now I know that although these three had the same disease and received the same treatment, they would have responded to three different remedies, Aconite, Bryonia and Rhus tox. But that is getting ahead of our story. My puzzles, then, in my training, were the appa.:ently functional cases, the chronics, the patients who did not respond to the classical treatment of a: clearly marked disease, and the varied types classified and treated according to one diagnosis.

. Underhill' has told you most graphically and humorously how he was led into homeopathy. So I will omit my initiation except to say that a,fter working at the Allgemeine Kranke,nhaus in Vienna in the usual way, I was apprenticed for nine months to a homeopathic physician in Geneva where I studied, literally, from 12 to 16 hours a day.

Before he was willing to take me as a pupil he gave me a stiff examination in ordinary medicine, including anatomy, fractures, surgical diagnosis, pathology, bacteriology, and chemistry, and gave me slides to diagnose under the microscope, etc. He then asked me certain questions as to what I thought life was about, why I went into the practice of medicine, what were the chief duties of a physician and so on. These questions perplexed me, as I did not then understand their bearing on the philosophy of homeopathy. He then put to me a leading question to see if I already had any background of homeopathy. It was, "What do homeopaths give for rheumatism?" Having read somewhat in homeopathic literature I answered that homeopaths do not give a remedy for rheumatism or for any disease name or diagnosis (although, of course, certain remedies are more frequently indicated in rheumatic conditions). They give a remedy on the symptoms of the patient who has the disease, in other words on the reaction of the individual in question to any given disease entity. This defines one of the fundamental differences between the homeopathic approach and regular medicine.

Until the physician's mind has compassed the differences between the viewpoints of ordinary medical training and homeopathy he cannot even begin to prescribe homeopathically. Let me enumerate, for clarity wherein these differences lie. First, as above mentioned, he must grasp the principle of individualization. Modern medicine lays a good foundation for this through its interest in endocrinology and psychiatry, but except for obvious glandular imbalances it offers, as yet,. no therapy commensurate with the refinements of differentiation. What does individualization mean to the homeopath and how does he arrive at it? It involves a silbsidiary new method of case-taking. After you have your classical history, elicited largely by asking questions, you can often make a diagnosis but rarely a homeopathic prescription. For the latter you need to know the mental ~tate of your patient, and what the. homeopaths call his "generals", which mean the things which apply to the patient as a whole-his reaction to heat and cold, wet and dry weather and storms, motion' position, food, etc. You need to know how these same factors affect the specific complaints of. your patient, iri other words the modalities of his particular disease symptoms-whether his headache is better from hot or cold applications, from motion or rest, from lying or walking, from pressure, or food, and at what time of day it is worse. ('Modalities', in other words, mean aggravations or ameliorations of specifi.c symptoms, just as 'generals' mean aggravations and ameliorations of the patient as a whole). There is a fourth type of thing that you must knoW' about your patient in order to prescribe homeopathically and that is his rare, peculiar, or characteristic . particular symptoms. These often appear trivial idiosyncrasies to the patient, things that .he has always had, or that no doctor to whom .he has told them, has ever been interested in. These often serve as keynotes to guide you to a remedy. But of what use is all this additional information about your patient? How does this picture of his personality aid you? You have individualized, but of what use is such differentiation, if you have only a standard treatment for the condition that you have diagnosed?

This brings us to the second great difference between homeopathy and regular medicine. The law on which homeopathy is based, or, if you prefer, the hypothesis, is to be found in the statement of Hippocrates, 'similia simililum Cure'fltur,' which Hahnemann revived and amplified. Dr. Stearns has told you how Hahnemann came to apply this la,w and made the first socalled 'proving' of quinine. A 'proving', in the homeopathic sense, is experimenting with a drug in minute doses on a relatively healthy human being. The record of symptoms so produced, on a large number of provers of different ages and sexes, constitutes the basis of our homeopathic materia medica. The object of proving a drug is to delineate the drug personality. Each of our remedies is to us a living individual, they are like friends whom one recognizes whenever seen, not only by their grand characteristics but also by their mannerisms and tricks. We now have on the one hand, the drug personalities, and on the other the picture of our patient in his present state. It follows, if like cures like, that we must match pictures and fit the personality of a drug to our patient, administer it, and watch the results. After one has grasped this ingenious theory and learned to put it into practice, it remains only to see it work. I, for one, being a natural sceptic, was slow to believe the evidence- of my senses. Could the astonishing improvements and cures have been coincidence or suggestion, or faulty diagnosis?

One of the knottiest problems for the beginner is the different concept of pathology and bacteriology. Homeopaths accept the facts of these branches of medicine. The difference lies in the interpretatIon. Pathology is an end result of some morbid process. The homeopath is not nearly as interested in the diseased tonsil, the haemorrhoid, the ovarian cyst, the cancer, the tapeworm, or the psoriasis, as he is in the constitutional dyscrasia behind these. He is not eager to remove the ultimates of disease at once, but rather to cure the underlying cause. In the course of this cure the ultimate will cften disappear, as in the case of diseased cervical glands or fibroids. If not, it can be removed when it has become merely a foreign body, and when the constitution is so changed that it will not ultimat~ itself in further pathology in a more deep-seated organ. Similarly one is taught to consider that bacteria cause disease. The homeopath is more interested in the individual's susceptibility, than in the bacteria themselves. Instead of poisoning the malarial plasmodia, with quinine or the syphilitic spirochaetae with salvarsan, the homoeopath prefers to stimulate the body to make itself uninhabitable for these organisms, and he does this by means of the similar remedy. To give another instance, instead of killing off head lice with delphinium and leaving the patient susceptible to further invasions, the homeopath gives a chronic constitutional remedy which removes the susceptibility and the lice seek better pasturage.

A fourth stumbling-block for the medical mind is the cluestion of suppression .. Discharges and eruption are ordinarily classed with pathology as something to be gotten rid of by local measures. are taught to use argyrol in coryzas, to paint cervices with mercurochrome in leucorrhoea, to stop a gonorrhoeal discharge with protargol, to check a diarrhoea with opium or bismuth, to clear up skin eruptions with ammoniated mercury' or sulphur ointment or other applications. The homeopath holds that this is suppression, and not cure, that these outward manifestations are not primarily local but an expression of deep disease the body trying to throw' off impurities. They have watched the incidence of more deep-seated troubles following such 'suppression.' The chronic constitutional homeopathic remedy given to a case which has been so treated, will often bring back the original eruption or discharge with concomitant relief of recent grave symptoms and ultimate clearing up from u:ithill of the original discharge or eruption. Let me illustrate with a case from my practice recently. A woman of 45, came to me for suicidal depression, for which she could give no emotional cause. She dated .her mental symptoms definitely from the time when she had had a foul, lumpy, green leucorrhoea 'cured' by local vaginal .applications, a few months before. I gave her a dose of Sepia (a remedy ma~ from cuttlefis.h ink) on her mental symptoms. A week later she returned exuberant, all the depression for which she had been doctoring being gone, and said, 'By the way, doctor, I have that awful discharge back again just as it was before'. I was .delighted, warnep her against suppressing it a second time, and gave Placebo. The discharge has since lessened and improved in character and she continues, as her husband says, a changed woman. So much for the fundamental differences. Another problem which confronted me· was whether the homeopathic remedy could influence definite chronic pathology. A girl of 19 came to me for severe intermenstrual' bleeding. On examination I found a nodular fibroid bigger than my fist. A well-known New York specialist, she told me later, had diagnosed it and advised merely general health measures, as he did not want to X-ray so young a girl. Her chronic case worked out on mental and general symptoms to Phosphorus, which happens to be one of the main remedies useful in fibroids. Three months after I gave her this, I sent her to be checked up by the same specialist. He . ;vas amazed at the decrease in size of the fibroid and asked her what she had been doing. Six months later ?e pronounced her normal and sanctioned her marrymg. A further difficulty I experienced was. in believing the current statement. that homeopathic remedies can do no harm. THEY CAN! Another problem which one frequently meets in general practice is that of prophylaxis. Strict homeopaths believe that vaccines and inoculations are harmful. It took considerable experience for rile to be convinced that the chronic constitutional remedy is the best prophylactic. The whole subject of the chronic consti­tutional remedy is a fascinating one, but beyond the scope of this paper. As a last problem comes the practical one which is such a stumbling-block to students, as to whether one can make a living on homeopathic general practice. Certainly more than half of my patients were not believers in homeopathy, many of them dead' against it, but I have found that by up-to-date examination and laboratory procedures, by the actual accomplishment of the remedies, and by adroitly 'selling' to the patient the principles of homeopathy without the name, they are intrigued, send you their friends, and become staunch believers in the method.

To all of the puzzling problems outlined above, a satisfactory solution can be found, if one is willing to do the hard work involved in learning enough to get results. I am completely 'sold' to homeopathy. When I fail, I know that the failure is 'mine and not homeopathy's, and when I can see a similar remedy for a case, I have, even before giving it, a perfect certainty that good results will be forthcoming.

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