ONE of the most useful chapters in Boenninghausen’s “Therapeutic Pocket-Book” is that which comprises the modalities, the conditions of aggravation and amelioration.
But unfortunately they are not sufficiently individualized. They are rather treated as general characteristics, applicable to the entire range of action of the drugs.
When the book was being written, Dr. Hering urged its author to state just what symptoms or group of symptoms were affected by a given condition. For instance, instead of writing “worse from motion, Bryonia”, Dr. Hering desired that it should be stated what symptoms were worse from motion.
But Boenninghausen refused to comply with this request as reasonable as it was; so his book was crippled, and we have lost probably irreparably, the particulars of his vast clinical work.
This is greatly to be regretted for many reasons, one of which is the aid such work might give in the construction of a systematic Materia Medica.
Symptoms are, as it were, threads of one fabric, which fabric is the entire drug. Hence symptoms must possess certain common relations, to discover which, is to discover the woof of the whole cloth.
Now very few of the modalities have a universal application. They rather belong to definite groups of symptoms. To clearly discriminate in such cases, requires not only a general knowledge of drug-effects but a particular knowledge; and just here, Boenninghausen’s clinical studies would be of the greatest service.
But since we are not so favoured, it should be the agreeable duty of each practitioner to make observations for himself, and communicate the results to his colleagues. Let me illustrate what I mean.
An oft-confirmed condition of Sepia is amelioration from violent exertion of the body. The full symptom reads : “The complaints disappear during violent exercise such as walking in the open air, fencing, etc. (horse-back riding excepted), and appear most frequently, and severely when sitting quiet, forenoon and evening.”
How far is this modality applicable, and what is its explanation? We find as well-confirmed, aggravation from walking quickly and less frequently, worse from exercise; worse from motion. Also, relieved in a recumbent posture; better lying down, etc.
Examining particularly into its symptoms, we observe that the headaches, sacro-lumbar pains, heaviness in the abdomen, and faint, weak state, are all emphatically aggravated from motion. Bearing-down in the pelvic region induces a desire to remain sitting or lying, with the eyes closed. Prolapsus uteri, better sitting with the limbs crossed or lying on the right side.
One from of pelvic distress seems to necessitate motion. It is described as a distress in the hypogastrium as from a distended bladder, worse from continued sitting and lying, better on walking about. But this same patient was also relieved momentarily by lying on either side, with the thighs fixed on the abdomen.
Another prover complained of pain across the lower part of the bowels, relieved by passing urine; felt only on lying down.
On the other hand, we notice that palpitation of the heart is diminished by “walking a long distance and walking fast.” And if the nervous weakness is not too great, if the patient is tired, languid, feels bruised, parts laid on go to sleep, she feels worse while sitting; and although stiff and sore on beginning to move, walking soon relieves.
It is well-known that Sepia affects the nervous system and causes, through vaso-motor relaxation, venous congestions. The connective tissue all over is likewise relaxed. From this arise : “fullness, venous fullness, in various parts; empty, gone, sensations; feeling, as if the joints were slipping out of place; prolapses of the viscera; and, through overfilled veins bruised sore feelings in the muscles, numbness, paralytic weakness, etc.”
Now exercise, by favoring venous return and stimulating lax tissues, tends to relieve just the pathological state upon which many Sepia-symptoms depend. But horseback riding since it jars the sensitive parts, and even tends, like the motion of a ship, to retard venous return, necessarily aggravates the Sepia patient.
This, I submit, is the explanation of the modality under consideration.
Confusion sometimes arises from modalities which are opposed to each other; as Magnesia Muriatica better from pressure, worse from pressure-Calc, Carb., worse from washing; better by cold bathing-Bryonia, worse from motion; better from motion-Sulphur, worse or better on an empty stomach-Petroleum, better or worse when stretching out the diseased limb, or when drawing it up.
These apparent contradictions may spring from the two fold action of the drugs. But they also may arise from the fact that nearly all modalities have but a limited range belonging to the same remedy.
How, then, can they be discriminated, if the plan of Boenninghausen is to be continued?
If we consult the provings of the above-cited remedies we find a solution to our difficulties. Mag. Mur. has relief of headache from pressure, but aggravation of hepatic symptoms. In general the Calcarea Carb. patient is made worse by bathing, but in colic and Peritonitis, cold-water applications give prompt relief, and so on.
Still another defect in Boenninghausen’s method arising from generalization, is his imperfect presentation of a symptom.
Thus, under Alumina we read : “Inclination for open air.” But the complete symptom requires the further statement that, nevertheless, neither cold nor warm can be borne well.
There is an underlying system, according to which modalities can be arranged, and we should find it. We know that complaints involving muscular tissue are increased by motion, while affections of fibrous structures are improved by continued motion. Many variations of symptoms accord with diurnal, weekly, and annual changes, barometrical vicissitudes, etc., all of which are acknowledged to be exhibitions of natural laws. For instance, Natrum Mur. has its acme at 11 A.M.-just the hour of daily maximum electric tension; Lycopodium has its acme from 4 to 8 p.m. -Just the hours of minimum electric tension; Nux Vom. has arousing at 3 A.M.-an hour when Bryonia, Arsenic, Sepia, Sulphur and other remedies, which act on the intestinal contents, also offer symptoms. Rhododendron, Natrum Carb., Petroleum, Phosphorus, etc., are worse before a thunder-storm, when the air is poor in Ozone, and when constitutions needing an abundance of this form of Oxygen, must necessarily suffer.
A west wind, in our latitude, is, in Winter, frequently cold and dry; a south wind warm and relaxing; and an east or north-east wind cold, raw and damp. Consistently herewith, we have one set of remedies, Aconite, Hepar, Spongia, Causticum, in exacerbations from one wind; Ipecac., Bryonia, Carbo Veg., for the next; and Sepia, Allium Cepa, Dulcamara, etc., for the last.
Gelsemium, Bryonia, and Quillaya, picture a cold which is the effect of a relaxing atmosphere; Nux vomica, Aconite, Belladonna, catarrh caused by cold, crisp weather. Ipecac. portrays a wheezing, rattling bronchial catarrh, with loose but difficult expectoration, just such a cold as a debilitated lax-fibred patient might contract under the depressing influence of a southerly, warm, thawing wind. Hepar, on the contrary, displays the rough hacking cough or the croupy rattle which one might expect to follow exposure to piercing cold winds.
Many more instances might be cited, tending to prove the harmony of the effects of provings with the numerous accidents and contingencies of our checkered existence.
Try to investigate them thoroughly.