REPORT OF AN UNFINISHED CASE ILLUSTRATING
TWO IMPORTANT FACTORS IN
(a) the taking of the case;
(b) the technique of finding the remedy.
The business of the physicians is to make sick people well, an axiomatic statement which will be agreed to by physicians of any or all shades of opinion. Next to making sick people well, the finding our of what ails them, is the most important step. Patients do get well without the aid of medicines or physicians and they frequently of importance in bringing about recovery or cure, but is the object of all intelligent physicians in the treatment of their cases.
Among homoeopathic physicians there has been much discussion as to what constitutes the totality of the symptoms and by many, a totality of the subjective symptoms alone, has been understood. A moments reflection will show such a conception to be false. The true symptom totality includes anything and everything which can be predicated as abnormal of the patient. Hence nay departure from the physiological normal standard of health, whether organic or functional in character, becomes a part of the symptom totality of the case.
That its counterpart may or may not have been recorded in the provings of drugs, does not detract from the truth of the statement. As a matter of fact, a true totality is seldom obtained in any case. Further more, the provings of drugs have but in a few instance been carried far enough to produce objective organic changes. But even in those cases where such changes have been recorded if by no means follows that the drug producing them will be the remedy to cure them, when found in the clinical case.
Disease results or pathological end – products are arrived at after a longer or shorter period of physiological disturbances, but the latter takes different courses in various individuals. This explains the reason why certain pathological states, e.g., hypertrophied tonsils, cannot always with certainly be cured, by the internal remedy. Unless the underlying constitutional bias of the patient be revealed, therapeutics endeavors in such cases will be futile. Prescribing becomes a matter of guesswork.
It is a matter of common knowledge among us that Baryta carbonica is a good remedy in the treatment of hypertrophied tonsils; but it is also the experience of all of us that the remedy fails again and again. And it will do so unless we have a true Baryta case, which means one in which the constitutional symptoms as well as the local conditions correspond. To treat a Lycopodium child with Baryta, simply because the presence of enlarged tonsils suggests the latter remedy, is wrong in principle and non – productive of results.
The case to be reported is presented with the purpose, first, of demonstrating a properly taken case from the prescribers standpoint. No matter how elaborately a case may be presented from the pathologic, bacteriologic, diagnostic and pathognomonic stand – points. it is impossible for the prescriber to select the needful remedy for the case, unless it has been presented from the homoeopathic side also. This means not only the numerical totality of the symptoms, but also and of far more importance, a totality of quality. The symptoms of the patient himself rather than those of the disease itself, are to be considered. In a word, the patient behind the disease be treated, rather than the disease itself.
Secondly, the case is presented to show the futility of successful prescribing in many instances, of which this one is an example, without repertory analysis and study. A surgeon would be lost without his cutting instruments and clamps. They are his tools with which he works. His theoretical knowledge is useless without them. So with the careful homoeopathic prescriber. He is lost many times, without a knowledge of and the ability to properly use the repertory. The latter is his most important tool.
The great storehouse of the vast materia medica cannot be penetrated without it. Upon his ability to correctly analyze for repertorial study, the difficult cases presented to him, depends the amelioration or cure of such cases, for without such analytical study, he too often is left to flounder aimlessly about in a sea of therapeutic uncertainty and bewilderment.
After much treatment of various kinds at the hands of several physicians Miss X, age 32, was referred to me by her last physicians in the hope that her curative remedy might be found. The symptoms are here given precisely as originally taken, after careful interrogation, with an avoidance of leading questions as far as possible:
Father died of paralysis at 52, following a stroke. Mother alive, is an invalid, has had two strokes. One sister, age 38, has nephritis. Patient, as a child, had a weak stomach always. Had measles, mumps and scarlet fever at 12 years. Not well for a year after, suffered from dropsy and heart trouble. First menses during 15th year. At 27 years had trouble with the 1. knee, diagnosed as a possible tubercular arthritis. This lasted 3 years, and at the present time gives her little trouble. At 30 years began to have corneal ulcers, treated by Dr.L.E. Hetrick; has had these appear off and on since.
Within 15 to 30 min. after dinner or supper, a distress in stomach appears, causing nausea and faintness and cold sweat all over. This distress gradually works down into bowels and causes a diarrhoea of mushy, dark, almost black almost with much flatulence, but not offensive. Usually has three stools in close succession. After the attack is physically weak.
These attacks come on at intervals, after any solid food, and last 2 to 3 weeks. Then an interval follows, during which she has normal stools, Cant eat breakfast, gets sick if she does. Drinks a cup of weak coffee only. No appetite. Much flatulence, up and down. Easy eructations. During her bad attacks of distress and diarrhoea eye slight is poor and at night the lights have colored circles around them. Thirsty for cold drinks, never vomits. Craves salt, uses much salt in her food, like acids, prefers them to sweets.
Mouth dry, also teeth. Tongue coated whitish. Attacks of throbbing headache in temples and throat < 1.side. Attacks excited by worry, mental strain, excitement, conversation, usually last three days. Pain < lying down with the head low; > hot applications. Pain, during an attack, comes and goes suddenly, is < at night, waking her from sleep. Sensitive to cold weather, like plenty of heat. Languid and generally < mornings. Always feels > in the evening. Had grip and tonsillitis last winter. Skin dry, never perspires. Hands dry and hot. Cant fall asleep at night, lies awake for hours. Nervous excitement < diarrhoea.
Menses very profuse, last six days, and inclined to be 2 or 3 days too soon. Before the menses in nervous and generally <. Sadness and mental depression < from consolation. During menses aching of limbs and body for first 2 days, then feels >. Has an aversion to fats which disagree. At present a hacking cough, since a cold in throat some few weeks ago. Spells of exhaustion during day, when she must lie down. Falls sleep for about 5 minutes and feels very much refreshed on waking.
From this anamnesis it will be seen that several remedies suggest themselves, yet on one of them appears, even upon superficial examination, to be the correct one. From this fact alone the deduction is simple that careful study of the case is required if results are to be obtained. Of this mass of symptoms, those only are to be chosen, which characterize the patient herself and thus we may note as characteristic the following:
Thirst for cold drinks.
Craving for salt.
Sensitiveness to cold.
Amelioration after a short sleep. It will be noted that in this analysis the special symptoms referring to the head, stomach and intestine are not recorded for the reason that these must be included by and in harmony with the more important symptoms of the patient in general. If the patient in general be covered, so to speak, by the simillimum, her organs will also be covered. The lesser must be included by the greater.
Commencing with the broad general fact that this patient is aggravated by cold, we may feel certain that the remedy to be sought must be found in a group corresponding to this modality. The group is a large one, even omitting, as may safely be done for the sake of brevity, the remedies of lowest rank. Hence, using Kents Repertory, 2nd edition, on page 1311 we have the following:
Cold in general <- Acon., agar., am.c., aran., ARS., aur., bar.c., bell., bor., bry., calc., calc. P., CAMPH., CAPS., carb. an., CAUST., CHIN., cic., cist., cocc., coloc., con., cycl., dig., DULC., ferr., hell., HEP., hyos., ign., kali bi., KALI C., kreos., led., lyc., mag. c., MAG. P., mang., merc., mez., MOSCH., nat., m., NIT. AC., nux m., NUX V., petr., PHOS., PSOR., puls., ran. b., rhodo., RHUS T., rumx., SABAD., sep., SIL., SPIG., STRAM., sulph., zinc.
Taking the next important observation regarding the patient and in passing, it may be stated that, much thought and discrimination are often required in the determination of the order and value of these deciding symptoms, we find by rapid elimination of the remedies which are not common to both rubrics, this list on p. 1304.