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.
General < mornings – AUR., BRY., CALC.C., CARB. AN., KALI BI., NAT, M., NIT. AC., NUX V., PETR., PHOS., PULS., RHODO., RHUS T., RUMX., SEP., SPIG., SULPH.
Of this very much smaller list, but two remedies have a decided craving for salt, viz.:
NAT. MUR. and PHOS., and this symptom will be found under the list of desires, among the stomach symptoms, on p. 488.
The desires and aversions of a patient are general to the patient and not predicated of an organ or part. In the same manner, the desire for cold drinks, while common to a large number of remedies, will be found on page 486 under both Nat. mur. and PHOS. with the latter leading in value most decidedly.
Now taking the last symptom of the analysis, the general amelioration of the patient after sleep, we have PHOSPHORUS alone to consider. Hence, if the analysis be correctly performed, the technique without a flaw, this remedy must be the proper one. Reference to the materia medica, confirms the choice. For the purpose of this demonstration it is unnecessary to go into the details of the administration and repetition of this remedy. It is sufficient to say that marked improvement had followed, no diarrhoea has occurred, headaches are slight and much less frequent, three good meals are eaten daily and all abdominal pain is gone. Cure seems assured and the improvement thus far has occurred within a few weeks time.
It my be objected that in the recital of this case no diagnosis has been stated. The objection to a certain extent is valid one. The difficulties of a correct diagnosis in such a case will be appreciated by all. The patient had been in the hands of careful physical and various possible causes eliminated. The case was referred to me as a materia medicist, and it became a duty as well as a problem to search for the key to the case.
After all, the homoeopathic physician is really a specialist in therapeutics. He cannot be expected to possess the same degree of skill in diagnosis as his brother physician who concerns himself almost solely with this department of medicine. If homoeopathy is to survive, the art of applying it must be better known and more generally practiced. In this art, case taking and repertory analysis, together from the keynotes.
Compared with them, the questions of potency and repetition of the dose are decidedly inferior in importance. The sooner we recognize that there is such a thing as the technique of prescribing, the better for us as a body of men and women entitled to recognition as scientific physicians. The science and art of homoeopathy are very real and virile, and we should strive to make ourselves masters of them.
Repertory analysis carried out in the manner outlined, offers a rapid method of finding the remedy. There is no secret about it and no difficulty, provided that the analysis is based upon careful case – taking. The latter seem to be an almost unknown art, if one is to judge by the slipshod prescribing done by the average hospital interne.
Syphilis and the Wassermann Test.- We recently were called upon to treat a patient who some five years ago had been unfortunate enough to become infected with syphilis. His initial and secondary symptoms were mild and apparently yielded readily to the classical treatment given by his physician. Arsphenamin, or one of its earlier forerunners, played a prominent part in the therapeutic drama. Symptomatically negative, the patient, now after a lapse of five years, presented himself for examination to the Life Extension Institute. The only finding of significance was the presence of a positive Wassermann. Nothing else.
Here, then, we have a patient in whom syphilis still exists, shall we say, in a latent or quiescent state, but who shows no active symptoms of any kind. An interesting problem forsooth, the solution of which we shall await with interest. In the meantime, along comes Wurtz, of Pittsburgh, and shows that the administration of the red iodide of mercury to a healthy subject, is capable of producing a positive Wassermann in that subject. Is he syphilitic? Hardly; but the homoeopathicity of the red iodide of mercury to syphilis would appear to be proven.
Anyway, the ultimate result will be awaited with interest.
Gall Stones and China Officinalis.- Many years ago Thayer, of Boston, recommended China as a cure of gall stones. Homoeopathy has no specific for any disease, each case must be considered from the symptomatic standpoint of the patient himself; yet it is apparently a fact China has put a stop to recurrent attacks of gall stone colic in many cases. Our own experience would seem to bear this out, in some instance at least. On the other hand it must be remembered that gall stones have a childish habit of indulging in names of hide and seek and frequently hide so successfully that no one finds them until autopsy has been performed.
We should not, therefore, be hasty in claiming powers of solution for China or for any other remedy. The olive oil treatment continues to have many firm supporters, though Osler states that the concretions passed with the stools and supposed to be partly dissolved gall stones, are in reality small masses of inspissated fat. True it is that at the autopsy table gall stones are often found which during life gave rise to no symptoms.
After all each case must be treated upon its merits, and wise judgment will frequently be necessary in determining whether a case of cholelithiasis needs medical or surgical care, or both. Here the X-ray is of course invaluable as an aid to correct diagnosis; the latter should never be neglected in any case.
Pituitary Gland.- A potentized preparation of this gland is now to be had in potencies above the third and sixth decimal. The 30th, 200th, 500th, 1,000th and 10,000th are available, made from the 30th potency up, on the Skinner machine. In several cases marked by high blood pressure, vertigo, difficult mental concentration, confusion and fulness deep in the frontal region, the 30th and the 200th have brought about decided improvement.
Frankly, our use of the drug has been entirely empirical, since there is of course, no proving in existence; but we have been guided by such meagre information and experience as is at present available. We hope to prove this undoubtedly important drug within the next few months. The knowledge of its action upon unstriped muscle fiber is to be sure helpful; its use by obstetricians and surgeons, in physiological doses, is also illuminating.
Succinic Acid.- To Carl H. Rust, of Cleveland, Ohio, we are in debted for practical knowledge and use of this remedy in hay fever. The drug was mentioned by him in his article on hay fever, published in the March, 1920, number of THE HOMOEOPATHIC RECORDER, and in our hands has produced brilliant results in several cases. The 6th and 30th potencies have been used. Cases marked by paroxysmal sneezing, itching of the eyelids and canthi, itching in the nose and aggravation from drafts, without marked general symptoms, have responded well.
Remedies to be compared are Arundo mauritanica, Wyethia helenoides, Sabadilla, and Sinapis nigra. Where marked constitutional symptoms are in evidence, such remedies as Carbo veg., Arsenicum album and Iodatum, Psorinum, Silica, Sanguinaria, nitrate, and others, are to be studied.
What Is Disease?- Well, one definition might be, “disease is what the patient thinks it is.” Asinine you say; yes, and no! It all depends upon the point of view. We are not now thinking pathologically or diagnostically; we are thinking in terms of therapeutics only. Quite apart from diagnosis, whether this be right or wrong, the patient remains to be treated and we must fit the remedy to the patient, not the patient to the remedy. Hence all that the patient thinks he feels into be considered – how he feels it, where he feels it, when he feels it, and so on. Even what he thinks, is to be regarded – his fears are often valuable indications.
A diagnosis may be tentative only or even impossible, the most acute clinicians and diagnosticians fail most woefully at times, yet diagnosis or no diagnosis, the patient demands relief, and so we are obliged to photograph him symptomatically, if we would do him any real good. If he thinks he is sick in certain way, that very fact should serve as a guide in our selection of a remedy. Take, for example, the treatment of neurasthenia, that symptom complex which so generally defies us all and which stands out as a menacing rock upon which many a gayly painted therapeutic bark is wrecked. Here we surprise ourselves occasionally by the remarkable cures we make, when we have been able to get a clear symptom picture.
But for every brilliant cure there are at least a dozen failures, as the neurotic wanderers in and out of any physicians office will testify. What is neurasthenia after all? Its pathology is by no means certain, though further knowledge of the ductless gland secretions promises to unravel much of the mystery. There is, however, no standard treatment for neurasthenia, and so we are best off when we fall back upon the good old Hahnemannian method of treating the patient and not his disease. The latter is what he thinks and makes it, no more no less.
This was forcibly borne in upon us not so long ago. A middle aged woman, single, whom we had treated over a long period of months, presented herself after an absence of several years – for observation. Originally a neurasthenic, neurotic in the highest degree, she had presented all the usual and unusual manifestations of this condition, much to our discomfiture and perplexity. No doubt we had often wished her miles away from the office sanctum – in fact, we are quite sure that we did – still, we were obliged to keep on and prescribe to the very best of our feeble ability, until we finally saw her no more.
Judge of our surprise then when her reappearance presented a plump, well nourished and rounded woman in the best of health, bereft of all her old time neurotic vagaries. Here then was a patient in whom no pathology could ever be found, but who had been the rounds of German health resorts, had been bathed inside and out with Europes most potent mineral waters, who had gone through elaborate “Luftkurs” and “Molkenkurs,” and incidentally, had been milked of numerous American dollars, all to no purpose.
Geheimrat This and Oberstabsartz That had held awe – inspiring conclave over her, and professors of the universities had looked wise and done their best – or worst. So it remained for the simple Hahnemannian method, by taking account of what the patient thought she had, to cure this tedious and obstinate case. It is all too simple for the Her professor to accept; it lacks the theatrical; the dramatic beating of the medical tom – toms is absent; the press agent is missing; the skillful newspaper write – up is nowhere to be found; but the poor, deluded, simple patient gets well at last, at the hands of a trusting disciple of homoeopathy. Really it is all too simple – it is to laugh.