Cases Illustrating Repertory Work.
Case 3. – Boy, age 14; epileptic attacks for three years. First attack followed fright caused by other boys’ make believe to hang him. Attacks increasing in frequency until at this time they occur every two weeks. The following symptoms were given: Attacks begin by running round in circle, the falls down unconscious. Attacks are more frequent in cold dry weather and during new moon. Involuntary urination during the attack. Boy complains of always being cold; wants to keep warm both summer and winter. He is very touchy; everything makes him cry; seems depressed all the time. Appetite either ravenous or wanting. Aversion to all kinds of sweets, of which he was previously very fond.
Under complaint caused by fright we find thirty-six remedies. Of these the following twenty-one have the symptoms in the first and second grade: Aconite, Apis, Argentum nitricum, Art. v., Aurum, Belladonna, Causticum, Coffea, Cuprum, Gelsemium, Gloninum, Hyoscyamus, Ignatia, Lachesis, Lycopodium, Natrum mur., Nux v., Opium, Platina, Pulsatilla, Rhus t.
Sadness and depressed. – Aconite, Argentum nitricum, Aurum, Belladonna, Causticum, Gelsemium, Ignatia, Lachesis, Natrum mur., Platina, Pulsatilla
Worse cold dry weather. – Aconite, Causticum
Aversion to sweets. – Causticum.
We have arrived at the solution of the case by four steps and have used all general symptoms. Now you may ask, why did we start with the rubric complaints caused by fright? First: this is a general symptom and we are working from the generals to particulars. Second: This condition was caused in this boy by fright. This mental shock was so profound that it caused the whole condition of this patient to be changed. It not only produced the epileptic seizure, but affected his desires as well. One of the remedies found under this rubric will be the one which will cover the totality of the case.
The second symptom we will take is another general – sadness and depression. We take this rubric from the fact that it is a mental condition produced by a derangement of the patient’s most internal condition, the mind. Now if we hope to cure this case we must have a remedy which has produced this symptom in the provers, so among our first twenty-one we find eleven with this symptom in the first and second grade.
Another general condition is the modality that attacks are worse in cold dry weather. Among the eleven remedies found in the first two rubrics we find only two which are worse in cold dry weather.
In order to decide which of these two will cover our case we will take the general aversion to sweets. Here we find that Causticum must be the mathematically correct remedy, and turning to our materia medica we find that the pathogenesis of Causticum not only contains the rubrics we have used in our analysis, but the remaining symptoms of our case as well.
Therefore, Causticum is the remedy we will give. Our records show that two doses of this remedy were administered with the following results: The attacks lessened during the first month to one; the second attack, a very slight one, did not follow for seven weeks, and now, after an interval of a year and a half, there has been no sign of a return, so we may safely say the boy is cured.
Case 4. – Mrs. A. S., aet. 28; married four years; menses have always been irregular, but during the first year of married life were more regular but always profuse. The third year married gave birth to a seven-pound child; labor normal, no lacerations. Since labor has never been well; the menses would appear every two weeks; then every five or six weeks, with no regularity. The would be profuse and weakening. Had had curettages and various treatments without relief. The condition of the patient at the time of first prescription was as follows: Menses irregular and profuse; great weakness when walking; the walk from the car to office completely exhausted her. Cannot sleep; what sleep she gets is unrefreshing. No appetite; does not want to think of eating. Craves beer, of which she had never tasted but once, and then it was repulsive. Sweats easily; is in a perspiration most of the time and has to be very careful about getting in a draft, as when she becomes chilly she is nauseated.
Menses irregular and profuse – Apis, Argentum n., Art. v., Benz. ac., Calcarea c., Carbolicum acidum, Causticum, Cimi., Cocc., Conium, Digitalis, Ignatia, Iodium, Ip., Iris., Kreosotum, Lycopodium, Murex, Nux v., Nux moschata, Secale, Sepia, Staphysagria, Sulphur, Tuberc.
Worse from warmth – Argentum nitricum, Calcarea c., Cocc., Conium, Ignatia, Iodium, Ip., Lycopodium, Nux moschata, Sulphur
Extreme weakness from walking – Calcarea c., Cocc., Conium, Iodium, Lycopodium, Nux moschata, Sulphur
Great desire for beer. – Calcarea, Cocc., Sulphur
Nauseated when chilly. – Cocculus.
Just a word of explanation of our selection of rubrics in this case. Why did we start with the symptom, menses irregular and profuse? In the first place, it is a general symptom; then it is the symptom above all others that has proved the change in the patient’s general condition; it we expect to cure this case we must have a remedy that has in its symptomatology this condition. On the other hand, if we took any of the remedies we find in the first and second grades under this rubric we would have a remedy for this local condition that so many and various lines of treatment had been used upon with no results; so not only must we take this symptom, but must take the other symptoms, which make this case of irregular and profuse menses different from every other case of the same condition; in other words, that makes of it an individual case. Therefore, we proceed with the other symptoms.
One word more, about our fourth rubric – great desire of beer. Ordinarily this symptom would be of little vale, but we find a patient that before she was affected with this change of internal conditions did not like beer; in fact, she had never tasted it but once and then it was repulsive to her, but now she is sick; some change in her desires has produced a condition of her economy whereby she has a craving for beer. Now the condition has changed and a symptom which in other cases would be of little or no value deserves a prominent place in our record analysis.
This case also has another interesting peculiarity, in that if the keynote prescribers had been working at it they might have reached a correct solution, for in this case we find that the particular symptom, nauseated when chilly, is found under only one remedy, Cocculus.
Our selection of Cocculus in this case was justified, for the case was cured. The menses became regular and normal; the weakness disappeared; the craving for beer vanished; the excessive perspiration and nausea left, until after four months she was discharged stating that she never felt so well in her life.
There are some cases where we cannot individualize closely enough to work our case down to less than two or three remedies. When this occurs we take the remedy which has the symptoms in the highest grade and if the pathogenesis of the drug justifies we give that. To illustrate, I will give the analysis of a case without the history.
Menses copious and dark. – Ammonium carb., Ammonium muriaticum, Antim crud., Arsenicum a., BELL., Bism., Bovista, Bryonia, Calcarea c., Calcarea p., Carbo a., CHAM., China, Cimic., Cocc., CROC., Cyclamen, Ferrum, Graphites, Ignatia Kali n., Kreosotum, Lachesis, Lilium t., Magnesia carb., Acid nitricum, NUX M., Nux v., Phosphorus ac., PLAT., PULS., Sabin., Secale, Sepia, Sulphur
Worse riding in a wagon. – COCC., Ignatia, Nux moschata, SEPIA, Sulphur
Worse before menses. – Nux moschata, SEPIA, SULPH.
Aversion to milk. – Sepia, Sulphur
Sadness in evening. – SEPIA, Sulphur
Vertigo looking down. – Sepia, SULPH.
Here we find by giving a numerical value of two to those of the first grade and of one to the second grade that we have Sepia having a value of nine and Sulphur a value of eight.
Absolute reliance cannot be place on numerical superiority on points for any one remedy; that is, a remedy not having so many points as another will yet have a better correspondence with the vital features of the symptom picture, and be the curative drug to select. This selection must be made from a final comparison of the drug’s pathogenesis as given in a complete materia medica.
In closing the cases for analysis I wish to conclude with the following case to illustrate two points. 1st. That, as regards our prescription, diagnosis has little or nothing to do. 2d. That if we could all forget our diagnosis while taking our case for a prescription we should all be able to do better work. This case will be given as taken by a young lady who had never studied medicine; in fact, all she knew concerning that subject was that when she or her friends were sick she wanted a homoeopathic remedy to make them well. I have never this case personally, but know she is well from reports that I have received through the mail.
Mrs. H. C., aet. 42; widow. Has eruption on legs, which burns and itches, and is worse from warmth of bed. She cannot keep her legs quiet at night. Is worse from warmth of stove, which causes creeping sensation over whole body. Feet are icy cold during day, but soles burn at night in bed.
Lameness of left shoulder, which has lasted since rheumatism four years ago; this is worse when lying on it. The hands go to sleep and feel numb, more specially the left one. The wrist pains as if sprained when awakening. All pains are of burning character and change locality often and suddenly.
Sometimes, there are small ulcers on inner side of left thigh, from which there is a thin offensive discharge; walking will cause them to smart, become red and puffy. Stiffness in small of back on bending or beginning to move. The pains go down the thigh. She has dry cough, which is worse after sleep and is caused by a tickling in the throat. This cough has always come the last of March or the first of April, and would last until real hot weather had come; with this cough she is quite hoarse and has sensation of lump in the throat. Menstruation is dark and scanty and offensive; has not been regular since last child, twelve years ago; she says all her aches and pains are better during her flow, and she never feels so well as when flowing freely, although it is sometimes accompanied by a painful diarrhoea. At other times she is always constipated; has to closet and try several times before she has stool. There is sensation of weight and pressure in bowels with much rumbling of gas. Abdomen is sensitive in the morning on awakening. Complains of burning, stitching pains in left ovary when constipated. Appetite one time is good, then she may have none at all. She says she cannot get enough to drink; has constant thirst and drinks a great deal of coffee. The mouth and tongue are dry; has feeling as if the skin was peeling from the roof of mouth. Sour taste in mouth all the time; tongue cracked, brown center and red tip.
Does not sleep well; has had work to get to sleep before midnight and then she wakens frequently with shock in pit of the stomach and a tight suffocating feeling in the chest. Lately she has complained that her heart feels too large for her chest when she walks fast. This oppressive pain is sometimes relieved by belching. For past few weeks face and lips are bluish; has flushes of heat, but only one cheek gets red; the other is pale. For last year her hearing has been failing; she complains of noise like a tea kettle boiling. There has been scarcely any wax, and what there was would be hard and white. Riding in the cold has always given her earache. She fears to go to bed during this last attack, as she thinks she may die, and she says she dreads to die so much.
There has always been more or less headache, at different times, but the one which has been most troublesome is one that begins on the right side of head and goes through to the left until it aches all around. With this there is a drawing in the back of neck and burning pains back of the eyes; some dizziness with sensation as if she were going to fall to the left side. She has an irritable disposition and everything seems to be worse in the morning when she awakens.
Now what is the diagnosis in this case? I do not know. Have never made one. We do no care about the diagnosis, as it is not a disease we wish to treat, but rather this sick woman we are going to try and cure. We have a well taken case, and from this mass of symptoms we must select some that will individualize this case and make it different from all others. Let us look at the record and see which symptoms we will select for our repertory analysis. We find the following general symptoms:
Worse after sleep, thirsty, burning pains, left side and better during flow. Making a repertory analysis of these we find under:
Worse after sleep. – Aconite, Apis, Arnica, Arsenicum, Camp., Carb. s., Carb. v., Causticum, Chelidonium, Cocc., Conium, Euphrasia, Ferrum, Hepar, LACH., Lycopodium, Opium, Phosphorus ac., Pulsatilla, Rheum, Sabad., SEL., Sepia, Spongia, Staphysagria, STRAM., SULPH., Veratrum
Thirsty. – ACON., Arnica, ARS., Camp., Carb. v., Chelidonium, Cocc., Conium, Hepar, Lachesis, OP., PHOS., STRAM., Sulphur
Burning pains. – Aconite, Arnica, ARS., Carb. v., Conium, Lachesis, Opium, PHOS., SULPH.
Left side. – Arnica, LACH., PHOS., SULPH.
Relieved during flow. – LACHESIS.
Here you see we have worked our long case down to one remedy with five rubrics. We will now turn to the pathogenesis of Lachesis and see if our selection has been justified. In the Guiding Symptoms we find under Lachesis not only the five symptoms we have used, but also each and every one of the other symptoms; so this remedy must be homoeopathic to the case.
Lachesis, two powders, was sent with the following results: For thirty-six hours after the administration there was an aggravation of all the symptoms, which was followed by rapid improvement that has continued ever since until the last report, when she wrote that every symptom had disappeared and that she felt as well as she had ever been in her life.
Let us look at the analysis of constipation, the great bug-bear of our prescribers, who say that constipation cannot be affected by the homoeopathic remedy. The reason for this statement is that constipation, in the common, per se, cannot be cured, for we have no one remedy for the disease condition.
Even when we bring our case of constipation down one step in individualization we are no better off; taking for example, constipation with hard stool, under this common general we find eighty-three remedies listed under this rubric (page 635, second edition, Kent); any one of these remedies might be curative in such a general condition, but if we do not have something to individualize our case further we are at sea.
Taking the character of stool as:
Stool Dry (page 634). – We narrow our list to thirty-one remedies, which are as follows: Aesculus, Ammonium c., Argentum m., Argentum nitricum, BRY., Calcarea c., Cimex., Conium, Cuprum, Hamamelis, Hepar, Kali bichromicum, Kali carb., Kali sulph., LAC. D., LYC., Natrum mur., NIT. AC., NUX V., OP., PHOS., Platina, Plb., Podophyllum, Prun., Sanicula, SIL., Stann., Sulphur, ZINC.
With this condition is often associated inactivity of rectum, i. e., not having a desire for stool for three or four days.
Inactivity of Rectum (page 619). – We find fourteen of the above thirty-one remedies, in the first and second grade, which allows us to narrow our group of curative remedies to the following: BRY., Calcarea c., KALI C., Lycopodium, NAT. M., NUX V., OP., PHOS., Platina, PLB., Podophyllum, SANIC., SIL., Sulphur
The stool may crumble, and if such is the case it will help you to further particularize the above fourteen remedies in order to find the one curative remedy in this individual case.
Crumbling (page 634). – This rubric gives us only five out of the above fourteen which have crumbling stool, and are as follows: Natrum mur., Opium, Platina, Podophyllum, Sulphur
The best we have been able to do with the symptoms that refer to the constipation, per se, has been to narrow down to five remedies, and one of these five will be curative. You say we might give all five at once in a gun-shot prescription, and that is what some men do, and then say that Homoeopathy will never cure constipation. Or that you might give first one and then the other in rotation, but you would never cure the case that way, although one of these five remedies will be curative if given alone. We must look for other symptoms of the patient, and you will always be able to find some in every case that will help us to individualize this patient so we may find the one remedy.
Suppose Burning pain after stool. (p. 624). We find that this rubric only contains Natrum mur, and Sulphur of the above five remedies. We are now down to two remedies either one of which may be curative. Look at the tongue, and see if you cannot find some symptom there which will help you out. Let us suppose that this patient had a heavily coated tongue, but along the edges there were spots which were clean. This would be known as mapped tongue. Look under this rubric, Tongue mapped in circles on sides (page 411). We find that of our two remedies only Natrum mur, has this symptom, so if you have no marked generals to rule out Natrum mur, it would be the remedy and would cure the case, unless there was some tissue change or growth which from pressure was causing an occlusion of the bowel. In taking these old cases of constipation do not expect to give one dose, or a dozen doses, in rapid succession, and expect the constipation to disappear over night or in a week. These cases are usually long standing, they all have the constipation habit, and most of them the cathartic habit, and have to be carried along with your remedies in series, mayhap for several months, before a cure will be established.
In order to cure your case you must insist upon the cathartics being stopped at once, and until your remedy has changed conditions so as to establish a normal stool you must depend upon diet and an enema of warm water to empty the lower bowel.