After having dealt with that, one takes up the patient’s general reactions, starting off first with the time, day or night, or season of the year, during which there is an aggravation. Then any general reaction to weather, temperature, atmospheric disturbances.
Then any general reaction of the patient to activities on his own part. Then any general reactions to external stimuli, for example, sensitiveness to noise, to music, to touch, etc. And lastly and general sensations such as weariness, faintness, giddiness, chilliness.
Then one rapidly runs through the various organs or systems, in every case enquiring for any alternation of function or any disturbance of sensation. For instance, under the digestive system one enquires into alterations of appetite, alterations of sensation of taste, hunger in general, effects of eating, or fasting, disturbances of the bowels, and their effects on the patient as a whole. Under the generative organs one asks into any disturbance of function, any general reactions that take place in connection with sexual relations, or menstruation, and the character of menstrual flow. Under the urinary organs, again, it is a question of enquiring into any difficulty that there is, pain or discomfort, and any alterations in the appearance of the urine. Under the respiratory organs one enquires, again, into the disturbances of respiration, the type of disturbance, what is liable to affect it, any cough, with the modalities modifying it, and its character, any alteration in the voice, again differentiated by when and how these disturbances take place, and the character of the sputum if present.
Similarly, under the circulation one enquires into any sensation which the patient experiences, such as precordial pain, palpitation, sensations of general heat and cold, and again the circumstances which modify them. Then taking up the special senses, one enquires into any increased sensitiveness, and loss of sensation, any disturbances of function, again with the modalities which modify these symptoms. Under the nervous system one enquires into any hyperaesthesia, paraesthesia, or anaesthesia, any loss of power, or paralysis, any tendency to tremor, spasm or pain, in each instance enquiring carefully into the modalities of the individual symptoms.
Under the heading of the skin one enquires into the state of the skin and any tendency to sweat, whether it is general or local, the character of the sweat, any effect produced by sweating, any tendency to eruptions or suppuration, and any disturbances, of appearance, such as colour, or local redness, or swelling. Finally in this in this group of symptoms one considers any disturbances of sleep, sleepiness occurring at definite times or under definite circumstances, sleeplessness caused by mental over-activity, pain, or any other physical disturbance, and the effects or any other physical disturbance, and the effects produced by sleep. And under the same group one considers any dreams which are constant in character.
Lastly, one takes up the examination of the mental symptoms of the case, First of all one enquires as to any change of the patient’s character, next into any disturbances of his primary instincts, or his intellect or understanding, and then as to any sign of alteration of his general mental capacity or his memory.
Having run through these various points, one then carries out a very careful physical examination. There are two important objectives one has in so doing. First of all, it is essential to make an accurate diagnosis, otherwise it is impossible to know what would be the normal progress of the disturbance from which the patient is suffering, of to advise the patient what regimen to adopt in order to help his recovery. Secondly, without an accurate physical examination it is impossible to decide what medicine can be prescribed not merely with benefit but even with safety to the patient, and in what potency the medicine should be administered.
When recounting such a scheme of case taking it sounds as if it would be impossible to apply this in ordinary practice. As a matter of fact, after a very short time working on these lines becomes purely automatic, one simply thinks one has checked this, that and the other essential. Where the reply to our queries has been negative the time taken is negligible, whereas if the query does elicit some positive information, that positive information must be taken into account in deciding on one’s treatment and may well prove to be the deciding factor between success and failure.
Some such scheme must be followed in detain in the treatment of any chronic case. The more acute the disease the more one finds that the acuteness of the disturbance tends to limit the field over which one gets any positive record. For that reason, in the treatment of acute disease it is seldom necessary to record much more than the symptoms of the actual locality, with the modalities which control them. But even in acute disease one finds that there is a very marked tendency for a change to take place in the patient’s mentality, and also in his general reactions to his surroundings. For that reason, even in acute disease these ought carefully to be inquired into.
For instance, take a case of pneumonia, one will find the patient with a certain amount of pain in the chest, one enquires into the character of the pain and the circumstances which modify it. One finds that at certain times of the twenty-four hours the patient tends to be better or worse, one finds that since the onset of the disease the patient has developed a thirst, then one enquires into the character of the thirst and the nature of the fluid desired.
With the developing of the pneumonia the patient will show some characteristic appearances of the tongue, which again have to be recorded and considered. And then one finds that every pneumonia has its own reaction to heat and cold, fresh air and stuffiness. One finds that some pneumonias are intensely restless, while others are toxic and sleepy. One finds that some cases desires to be left undisturbed while others are never at peace unless someone is about. One patient will be worrying about his business, while the next will be made ill by any mention of business responsibilities. One patient will tend to sweat profusely, while another is hot and burning. Lastly, certain remedies have a tendency to produce more pneumonic disturbances in one part of the chest then another. All these actors have to be taken into consideration. By having a general scheme at the back of one’s mind these points are run through and noted in no time at all, whereas without a scheme of this sort on which one always works one is at a loss to note the individualizing characteristics of the case which one is attempting to treat.
Having obtained a complete record of a patient’s symptoms one has next to consider the problem of matching the symptom picture of the patient with the recorded symptoms produced by some homoeopathic remedy. It is quiet impossible for anyone to memorize all the symptoms recorded in the Materia Medica Medica, and to attempt to examine the records to provings in order to find which drug will most accurately correspond with the patient’s symptom picture is like hunting for a needle in a haystack. That, however, is the problem one has to face.
This difficulty has been faced since the earliest days of homoeopathic practice, and has resulted in the production of Repertories of various types. A Repertory if simply an index to the Materia Medica. Just as the symptoms in the Materia Medica have been grouped as mental, or referring to one or other organ or system, so the Repertory, or the index has been arranged on a similar plan. In the earlier Repertories sufficient care was not taken to distinguish between modalities which affected a patient as a whole and those which applied to one specific symptom. It was not until the time of Kent that a clear differentiation between the two was attempted in the Repertory. For that reason Kent’s is the most accurate Repertory we possess to-day.
There has been considered disagreement as to what symptoms should be including in the Materia Medica and so in the Repertory. Some homoeopaths maintained that only symptoms which have been experimentally brought out by the administration of the drug to a number of healthy people, and which appeared in a majority of those people should be accepted as reliable.
Other maintained that it was permissible to include in the Materia Medica, and hence in the Repertory, symptoms which had been cured by, or had disappeared after, the administration of the drug to a patient. Others, again, maintained that symptoms developing in patients after the administration of the drug might also be included as evidence of the drug effect.
An attempt has been made to show the extent to which any particular symptom was characteristic of an individual drug, and also to show that the accuracy of this drug effect had been repeatedly confirmed. This has been done by the employment of different types in the printing of the Repertory Where the heaviest type is employed this is meant to convey that the symptom recorded under the particular drug has been produced experimentally and has appeared many times in the healthy persons to whom the drug was given. Where the second type is used it is meant to convey that the purely experimental evidence is less conclusive, but that the record of the curative value of the drug is absolutely convincing. Where the lowest type is used it implies that the evidence of the action of the drug is much more restricted, it may rest on an individual experiment, or it may have appeared in the course of treatment, or again it may be entirely clinical.
From the practical point of view the important thing to stress is that the first and second type drugs cab be relied on absolutely. When employing the lowest type drugs one has to use a certain amount of discretion.
When a patient is being treated with a drug that patient is certainly sensitive to that particular stimulus so it is not surprising that in response to the drug administered he should produce fresh symptoms of the drug which has been given. Among the provers it was the sensitives who produced the most valuable symptoms. It is obvious that anyone giving well-marked indications for a drug will automatically be in a sensitive state. Theoretically, therefore, those symptoms appearing in the course of treatment should be valuable. Again, where one is considering local symptoms these low type drugs re immensely useful. In the majority of cases provings have not been pushed to the extent of producing all the effects of which the drug is capable, and in the case of many of the less well-proved drugs the evidence of their ability to produce, or remove, these local symptoms is a most entirely clinical.
If follows from this that where one has well-marked general, or mental symptoms in a case one’s tendency is to seek for the drugs which are recorded in the first or second types, but where one’s case record shows only local symptoms one does get great help from the lower type drugs which are recorded under the appropriate headings.
It must always be clearly understood that a Repertory is nothing more than an index to the Materia Medica. To confine oneself to the study of the Repertory and to neglect the study to the Materia Medica is just about as sensible as to study the catalogue of a reference library and never to look at the volumes to which the catalogue refers.
Having considered how to arrive at a decision as to the most appropriate drug for any given case, the next problem, with which one is faced is in what form, and how frequently the appropriate medicine should be administered.
There are several factors which govern one’s choice of the form in which the medicine should be administered, or in other words, be potency which should be used. Hahnemann’s experience was that actual material doses administered to a sensitive patient produced an undue aggravation, he therefore diminished his dose, and finally discovered that by his special method of preparing his medicines he could reduce the dose to infinitesimal proportions and still keep the specific action of the drug constant in his day potentization was not normally carried beyond the 30th centesimal since his day there are practically no limits to which potentization has not been carried. My personal experience is that all ranges of potencies have their uses, but that in certain instances one potency is to be preferred to another.
Where one is endeavouring to treat a purely local condition one’s tendency is to consider those drugs only which have a definite affinity for that organ or tissue. There is no doubt that very beneficial effects can be produced by working along these lines, and when the is done only the lower potencies are found to be effective in the vast majority of cases. When a higher potency has been found to be effective in such a case it has always been found that in addition to the local similarity there has also been a general similarity present, even if it has not been recognized.
By a lower potency what I intend to convey is a potency from the mother tincture to the 12x or 9th. centesimal.
Where treatment is based on a general similarity in addition to the local indications my experience has been that the medium or higher potencies are much more efficacious. By the medium potencies I intend to convey anything from the 9th centesimal to the 200th.
There are certain well-marked guides which I have found to be very helpful in deciding when one of the medium potencies should be employed and when one can sagely and with benefit use one of the higher potencies. The first and most important of these is the gravity of the pathological condition from which the patient is suffering in the more chronic cases. Where there is danger which may result from any receive process set up by the medicine it is advisable to commence treatment with one of the lower of the medium potencies, say a 12 or 30 centesimal. A second type of case in which the administration of the higher potencies is undesirable, although not perhaps dangerous, is the one in which one is treating a very sensitive, highly strung, finely balanced patient. In such a case the administration of a high potency does produce a very marked reaction which is needlessly painful and from which the patient may take weeks or even months to recover. If in such a case one starts with a lower potency – in my experience a 30 is perfectly safe-one avoids these unnecessary and very undesirable reactions and starts the curative process right away.
A striking contrast to this is the case in which one is dealing with the lethargic, phlegmatic patient, of slow reaction time, as in these one finds that little or no effect is produced by the lower potencies and only the higher produce any satisfactory curative reaction.
There is another lead as to the most desirable potency to employ. This is the acuteness of the disease from which the patient is suffering. It may be taken as a reliable rule of practice that the more acute the disease the higher should be the potency which is administered. From experience I can say that this rule is of universal application, and my opinion is based not on theory, but on actual personal experience.
Finally. let us consider the question of administration, in other words, having declared on the potency, how often the medicine should be given. There is one universal rule which can be applied to every case, namely, allow the dose of medicine to act as long as it will.
When dealing with chronic cases the duration of action of the medicines is a very variable quantity and one’s success or failure chronic cases depends almost entirely, apart from selecting the right medicine, on one’s capacity to assess whether the reaction to the initial dose is still continuing or has ceased. In my experience, no harm ever results from waiting too long, but many, many, cases are spoiled by too early repetition. When repetition has been too early it is exceedingly difficult to straighten out the case again and it will often take months, during which one may have to wait for the harmful reaction to subside or may have to attempt to counteract the unfavourable reaction which has taken place.
The same principle of letting the drug act as long as possible applies in every case. In the subacute one finds that the duration or improvement will be materially less than in the chronic, lasting only a week or two at the outside, whereas in acute disease the duration of action, again, is very much shortened, the length of time during which the action will continue being proportional to the acuteness of the disease from which the patient is suffering. In the average acute febrile condition one finds that one has to repeat every hour or two hours, to begin with, increasing the interval as the curative reaction improves. In very acute conditions, such as biliary or renal colic, one may have to repeat every ten or fifteen minutes; in cases such as acute ptomaine poisoning one may have to repeat at first, every quarter of an-hour, or every half-hour, then as the duration of action lengthens one spaces out one’s administration. In all these cases it is obvious that one is working on the same principle, of letting the drug act as long as possible.
There is one other practical point which is of great importance, namely, what to do when the action of the first dose in coming to an end in a chronic case. In my experience it is in advisable to change the potency of the drug at the time of the second administration. If the symptoms of the case are still covered by the original prescription one should repeat the same drug in the same potency. A very important practical point arises here. If a patient comes back and reports that he is suffering from some fresh symptoms which have not been noted in the original case record and if these symptoms which are covered by the original drug, even if they have not been present at the time of the first prescription, the indications are that the original drug was correct, and is still acting so no further medication is required. Of course, where the symptoms have changed entirely a fresh prescription will have to be made. In the event of the indications still pointing to the same drug, how often one can with benefit repeat the same potency depends very largely on the time over which the drug is acting. Kent says that one can repeat once only without changing the potency. In my experience, if the drug is holding for a long time one can repeat much of tener than once and each time the same potency holds longer and longer, If a repetition of the same potency does not produce such a marked improvement as the first prescription, or it the duration of the improvement is tending to lessen, then it is advisable to raise the potency.
My experience of prescribing for local pathological conditions with low potencies is very limited, the reason being that it is only in a very small minority of cases that one is unable to find any symptoms in addition to those of the local condition on which to prescribe. In the vast majority of cases the local pathological lesion is covered by the remedy which is selected on general principles and will respond to the administration of the remedy. From such experience as I have had of pathological prescribing I conclude that one has to administer several doses over some days and then stop. It would appear that where one is prescribing in this way there is not a general symptom similarity and that by the administration of several doses over a length of time one sensitizing the patient to this action of the drug, very much as the insensitive prover eventually produces symptoms if the drug administration is kept up long enough. The difference is that in cases requiring treatment one particular organs has been rendered to some extent sensitive by the disease processes, therefore the drug tends to pick out this sensitized organ before it begins to produce constitutional symptoms.
As I said at the beginning of my paper, the practice of Homoeopathy is a combination of art and science. There are certain fixed rules which govern homoeopathic practice. The application of these rules to practice is an art. Just as there are certain laws which govern all musical production and yet the playing of any musical instrument is an art which can be acquired and developed only by practice, so it is with Homoeopathy. I have tried to show how, over the years, I have come to employ the tools of Homoeopathy ad to use them in accordance with the homoeopathic principles. It has been said that ” There are nine and sixty ways of constructing tribal lays, and every single one of them is right” so I am sure that every one of you has his or her own method of putting into practice the principles on which we are all agreed.