Malaria is a prolific cause of persistent pain. Browague is its common expression. Periodicity, of course, is another of its manifestations. Arsenic, Cedron, Nat. sulph. and Chin. ars. are our remedies to be considered. Then comes syphilis as a very frequent cause of violent, crushing, persistent pains. These are often due to the pressure of thickened periosteum and may yield only to Iodide of Potash.

NORMAL healthy life manifests its functional activity with pleasure to the subject if he is conscious of it at all. The sense of pleasure accompanying the performance of every function is one of the best evidences of perfect health, and so discomfort or pain is one of the most common, one of the earliest and most persistent evidences of disease. Pain may be looked upon as the physical conscience of the bodily life, the monitor of wrong done or endured.

Pain is a symptom always; true, at times, one of much dignity with imperious demands for immediate consideration, but nevertheless a mere symptom of mischief somewhere, and it behoves the wise physician to discover, whenever possible, its pathological basis, as it does the careful prescriber to analyse its character and conditions. Since its aid in diagnosis is frequently of higher value than that of any other single symptoms, it becomes evident how important the recognition and study of pain as a symptom in every case of disease becomes.

How futile, too, to cover it up by some painkiller and thus not only deprive ourselves of much valuable information as to the disease, but moreover load the system with some foreign intruder and possibly lay the foundation for some drug habit, but no means an imaginary fear.

We are told that pain is the cry of hungry nerves for healthy food and, unquestionably, impoverished conditions of the general system on account of deficient supply of nourishment to the part may give rise to pain which nothing will relieve until this cause is met. Here belongs the dull vertical pain with sense of weight and depression of cerebral anaemia, very common with women. Phosphor. acid produces and helps to cure such a condition.

Malaria is a prolific cause of persistent pain. Browague is its common expression. Periodicity, of course, is another of its manifestations. Arsenic, Cedron, Nat. sulph. and Chin. ars. are our remedies to be considered. Then comes syphilis as a very frequent cause of violent, crushing, persistent pains. These are often due to the pressure of thickened periosteum and may yield only to Iodide of Potash. It must be remembered that the prognosis of neuralgia depending on both malaria and syphilis is quite favourable.

It is too late in the day to deny the efficacy of the anti-kamnic properties of Syphilinum given in the highest potencies. Many pains are due to the diathetic power of gout, rheumatism, and diabetes, which states must receive attention before a cure is possible. Here the influence of uric acid as an etiological factor is of paramount importance, and before homoeopathic remedies can act satisfactorily suitable regimen and hygienic habits must be enforced.

The same holds good of those undoubted cases of auto-intoxic conditions where long neglect of the state of the bowels has brought these on. Rational cleansing process of the tract primarily with all other extra homoeopathic aids may be necessary before the chosen similar remedy can effect a cure.

With us in California, a very prolific cause of pain of all kinds in certain patients is the north wind. This insidious, dry, irritating atmospheric factor is responsible for many a manifestation of “nerves” among our patients. I know no remedy that possesses much modifying influence over it, although, theoretically, Aconite ought to be of benefit, and whatever good results I have seen from its use have been with the higher attenuations.

The successful treatment of pain unquestionably includes its reference to the pathological basis. The pathology and symptoms expressing this must form part, and a most valuable part, of the totality of symptoms that must guide us to our remedy. For instance, it is not immaterial, therapeutically, whether pain is caused by impoverishment of blood, or by encroachment of new growths, or by ulceration of tissues giving rise to exposure of nerve fibres, or to malaria or syphilis or some other toxic influence.

In order to prescribe successfully for pain, the homoeopathic physician must bear in mind that pain is but one symptoms whose peculiarity he must study; and its relation to all the morbid states of the patient must be considered. In short, it is the patient always and his totality of symptoms that must form the basis of the prescribers art. Practical application of our therapeutic method has long ago taught us that every complete prescription has as its elements consideration of symptoms pertaining :.

1. To the locality involved.

2. To the kind of sensory disturbances, i.e. character of pain or altered sensation.

3. To the modalities, 01 accompanying modifying factors, i.e. conditions of weather, times of day, rest and exercise, warmth and cold, etc.

Every complete symptom is made up of these three elements and whenever possible ought to be so analysed in order to utilize it for a homoeopathic prescription. In the treatment of pain another factor is of importance in determining the curative remedy and that is the immediate etiological factor, if known.

Whenever we can cover with our medicine these conditions, a speedy curative response is certain; quicker perhaps with the higher attenuations higher in proportion to the great similarity, although this is not an absolute rule. But even if only one condition is well marked experience teaches that often the remedy so indicated is capable of helpful curative service of a high order.

The Materia Medica is full of valuable suggestions, but my object is to call to mind such as I have personally verified in practice or seen so verified by others.

Taking the first division, locality. Our Materia Medica furnishes us with many well-tried and frequently verified remedies, adapted to and acting especially upon certain parts of the body.

In certain cases this is so pronounced and the elective affinity of certain drugs for certain organs so plainly evident from the provings and from ultimate lesions as testified by pathological anatomy as to be truly wonderful.

While the seat of pain may have comparatively little relation to the true location of the disease excepting gastric pain which usually locates it, yet for homoeopathic therapeutic purposes the seat of pain as experienced by the patient is always important and often leads to the right remedy.

The reason, of course, is evident. Our provings are simple records of symptoms produced independent of their pathological interpretation, and in passing we see how wisely the builders of the homoeopathic Materia Medica worked by keeping the record pure of all pathological speculation and making the outward expression of the morbid condition produced, namely the subjective and objective symptoms, the only legitimate basis for recording drug action and for guidance in drug selection.

What homoeopath does not associate Cactus with the heart, Podophyllum with the duodenum, Argentum with the joints, Oxalic acid with the spine, Belladonna with the brain, Aloes with the rectum, Ceanothus with the spleen, etc. ? But aside from this general organopathy, our remedies seek certain parts of organs and tissues by preference and the careful prescriber will seek to utilize this more minute affinity.

Thus we all think of Chelidon. for pain under right shoulder blade and Cedron for supra-orbital pain; Gelsem. and picric acid for occipital pain; Spigelia, when pain centres around left eye; Coffea, pain in the parietal bone as if a nail were driven in ; Bellis per. for pain in the coccyx; Mezereum, when it seats itself especially in the malar bones, etc. Every practitioner soon gains from his own observations knowledge of some of these localities, which become always suggestive, and offer certain guides to curative remedies.

So Myrtus became associated with the upper left chest about the third rib, and Illicium with the corresponding place on the right side. Kalmia for all sorts of flying pain in region of the heart; Ulmus for pains in the wrists; Zinc, aching in the last lumbar vertebra; China, for sensitiveness of scalp; Mel cum sale, hypogastric pain, and so on indefinitely. In this category belong sensory hyperaesthesias, which are characteristic of certain drugs: for instance, the olfactory hyperaesthesia of Carbolic acid and of Phosphorus; the acoustic hyperaesthesia of Belladonna and Acid salicylic; the ophthalmic of Oxalic acid and Conium; the cutaneous of Ergot, etc.

In the treatment of pain such changes in the functional integrity of the senses, whether increased or decreased or perverted, become helpful indications.

In regard to the second leg of our therapeutic stool, upon which our prescription must stand, the kind of pain, this, also furnished decisive aid. My own experience corroborates that of the whole homoeopathic school as to the value of, for instance, the burning pain of Phos., Arsen., and Carbo., and we know that burning pains are usually associated with morbid condition of the mucous membranes and skin and these tissues determine the form of pain more certainly than does the character of the morbid process, although as a rule burning pains are effects of passive states or incipient decomposition. So pain in bones, is of a gnawing, boring character, is worse at night and influenced by changes in the weather.

Remedies presenting similar conditions will be found to act on bones, as is known of Aurum, Mercury, etc. Serous membranes give us the sharp, Sticking pain, as is also produced by Bryonia and Kali carb., which experience teaches, have a direct relationship to serous membranes. Throbbing, beating, hammering, point to movements of the vascular walls, congestion and inflammation, and Aconite Belladonna, Glonoin and Verat. vir. are of course the pathological similars.

Drawing and tearing and sore pain occurs in muscles, tendons, and fibres and is usually rheumatoid in character, with remedies like Arnica, Rhus, and Cimicifuga as types. So the stinging pains or herpes call to mind the corresponding sensation and remedies Apis, Theridion, Natrum mur. To this category belong the erratic shifting pains of Puls. and Kali the plug-like sensations of Anacardium, the hot needle sensation of Arsenic, the corresponding icy needle sensation of Agaricus, the general coldness of Veratrum and absolute refrigeration of Keleioderma.

Constricting pains are met with. A feeling of the trunk, as if the clothes were too tight or as if a cord were compressing it,is often present in spinal affections. Plumbum produces a similar sensation. Local constrictive sensations are certain indications when present. Such are the constriction around the heart of the Cactus, around sphincters of Apis, etc.

The opposite sensation of expansion points to Cannabis indica, if in the head; to Medorrhinum if located in the eyes, these feel as if staring; and to Argentum if in other parts of the body.

Thoracic pain is marked in case of pleurisy and pericarditis during the stage of friction; a similar respiratory distress is met with in pleurodynia, but the friction sounds over the heart easily differentiate, the former calling for remedies of the type of Bryonia, the latter being easily vanquished by Ranun. bulb. and Borax. Remember that intercostal pain is often caused by ovaritis.

I meet with much thoracic pain of severe type due to poor digestion with loads of flatulence that becomes incarcerated. Here I cannot be too enthusiastic about the efficient service of Argent. nit., and in women of Nux moschata.

The pain of angina pectoris is intense. It is not always centred in cardiac region, but it always tends to the left side of the chest. A mortal terror accompanies it, with pain shooting down the left arm or darting from heart to elbow. I can conceive but one humane treatment during the attack palliation. Amyl nitrite is the only drug I have any experience with in this dreadful pain. Spigelia and Oxalic acid have in their pathogenesis very similar symptoms.

Epigastric pain coming on suddenly points to appendicitis. It is reflex and associated with moderate bloating and muscular tension of the right side of the abdomen. The rapid pulse and rise of temperature here are very important, but both are apt to be erratic in this disease. Belladonna, with its rapid onset of pain, Colocynthis and Lachesis certainly correspond to the symptoms in great part at least.

Abdominal pain, with tenderness to deep pressure, points to enteritis and peritonitis, colic being rather relieved thereby, and the temperature, usually, normal.

Persistent colic with constipation looks like lead colic. If vomiting is added always examine the hernial region.

Pain associated with defecation, aside from the tenesmus of dysentery, ought to lead to examination probably inflammed piles, fissures, ulceration, etc., will be found to exist. Homoeopathy possesses two remedies of extraordinary value in rectal pain Ratanhia and Sanguin. nit.

Pain on urinating is often a symptom in fever, due to a highly acid and concentrated urine. It may be due to anal fissure and other rectal disease. In pelvic peritonitis acute pain on urinating is frequent, but there is other pain as well. Pain during and some time after, points to the bladder and urethra.

I wish to sing the praises of Berberis as a general remedy for pains centering in the region of t he kidneys, radiating thence in every direction, especially down the ureters.

Another important aid in selecting the remedy is the side of the body affected. There is no question of the predominant left- sidedness of Lachesis and Spigelia; of the right-sidedness of Belladonna and Chelidon.

The method of invasion of pain is important also. Remember the sudden violent onset of Aconite; the equally sudden coming and going of Belladonna; the absolutely certain gradual decrease of pains of Stannum; the gradual increase to unbearable height with a sudden snap of release characteristic of Puls., etc.

And even greater certainty in the choice of remedy is obtained from the third factor the modalities. Given these clearly cut, you are enabled to decide the curative remedy often even if the special pain is not found in its pathogenesis.

First in importance in the treatment of pain, I consider the aggravations, according to time. Here belong the early morning aggravations of the Kalis and of Nux, remembering that many nervous affections are worse in the morning; the forenoon aggravation of Natrum mur. and Stannum; the afternoon aggravation of Pulsatilla; the early evening aggravation of Lycopodium, remembering here that many congestive and vascular affections are worse in the evening; the night aggravations of many remedies, Aconite, Mercurius and Syphilinum; the after midnight aggravation of Arsenic than which nothing is more characteristic.

These can be utilized in every form of disease and so can the remarkable aggravation of Lachesis after sleep and the equally remarkable temporary improvement after a nap of Nux. The aggravation from dry cold air of Aconite, the amelioration from fresh air of puls. the aggravation from exposure to cold damp surroundings of Nat. sulph. the California winter storm antidotal powers of Dulc. and Rhus. Each one of us could from his own experience multiply examples of unquestionable modalities that he has learned to class amongst the certainties of medicine.

There is nothing more satisfactory than to see the wonderful restorative and quieting effect of a well-chosen homoeopathic remedy in cases that have passed through the gamut of all sorts of treatment and palliative measures with the disease more firmly established and fastened upon the patient, plus discouragement, if not despair. But it can be done but in one way, not in any haphazard fashion, but only by following out the principles of our art faithfully and patiently.

I think it is not an exaggerated statement to make that Homoeopathy can take the incurable cases of the old school, the victims of mere palliation, the candidates for narcomania and cure a good percentage. How ? Just in this way, make our diagnosis according to the most approved methods of the up-to-date physician; bring in all our pathological theories and lore, apply all hygienic and dietetic aids.

But then for purposes of homoeopathic prescribing, forget for the time being most of this interesting knowledge, take the patient as a morbid symptomatic being take account of his stock of symptoms subjective and objective, arrange this totality according to location, sensation and modality, fit the remedy to this organized morbid human form and the curative response will come just as sure and as long as there is re- active vitality left.

William Boericke
William Boericke, M.D., was born in Austria, in 1849. He graduated from Hahnemann Medical College in 1880 and was later co-owner of the renowned homeopathic pharmaceutical firm of Boericke & Tafel, in Philadelphia. Dr. Boericke was one of the incorporators of the Hahnemann College of San Francisco, and served as professor of Materia Medica and Therapeutics. He was a member of the California State Homeopathic Society, and of the American Institute of Homeopathy. He was also the founder of the California Homeopath, which he established in 1882. Dr. Boericke was one of the board of trustees of Hahnemann Hospital College. He authored the well known Pocket Manual of Materia Medica.