Generally stated, the nosodes are indicated where we lack individualistic symptomatology. This lack of symptomatology plus the chronic taint or diathesis which we can ascribe to our patient will help us prescribe the nosode. For example, let us say we have an old suppressed gonorrheal case, having been treated by injections, and now ten years later he suffers from rheumatoid affections.

After four years of contact with the intimate personalities of homoeopathy and homoeopathic prescribing, it is but due time to express some personal views and opinions in the treatment of cases. I shall confine myself solely to the treatment of the chronic case, for in this alone, I have been most fortunate to observe and carefully study the patients presented to me.

To treat a case properly, it is of course essential to know ones patient-and this at once brings us down to case history and case taking. These have been so carefully mapped out before that there remains little I can add or subtract. It is well, however, for the sake of continuity of essay, to briefly review a few of the fundamental facts. Make your history as complete as possible, permitting the patient to tell all he or she can. This allows you the opportunity of not alone learning the patients ailments, but also gives you insight in the study of your patients mentality and psychology. These latter are most significant in every case and often are the clues to your remedy.

Having obtained this, one should proceed to gain other information, depending on what the patient has already said what is brought to the mind of the prescriber during the course of the history taking. It is well not to place direct interrogations to the patient. In dispensary work, however, direct interrogations to the patient. In dispensary work, however, direct questioning may be resorted to, for we are here often in contact with aliens and they cannot appreciate psychologic pointers made by the examiners.

In those unaccustomed to homoeopathic ways, direct questions are often also essential. After having obtained all this try to determine individualizing symptoms of the patient-as regards weather, time, season, emotion, hour of day or night, ameliorations and aggravations, heat and cold, and numerous others depending on what the patient has told us. These latter symptoms are most often our very background to the case, as we usually choose these as our rubrics. Secondly, these symptoms are truly indicative of this patient alone. Homoeopathy treats individuals, not the name of a disease.

An anatomical survey is then necessary. After which a past personal and family history should be elicited. Physical examination, I may add, should be done in all cases-though, to be sure, in the chronic case, with which we are here most concerned it often offers us quite little.

Now we are prepared to proceed and make our prescription. It is well here to state a broad general principle announced primarily by Hahnemann-base all your prescriptions on the “totality of symptoms,” regardless of how you expect to find your remedy. This must constantly be borne in mind when the final prescription is made. I shall now attempt to describe means of finding ones remedy under various conditions and circumstances. As is well known, the simplest method or easiest task is the offhand prescribing of remedies as practiced by Lippe.

That which is simplest, of course, leads most often to greatest disaster, and so it is with this. Offhand prescribing in the acute case is quite permissible and tenable, and it is my belief that Lippe used it only in such cases. In the chronic case, it is quite impossible and should never be attempted. Intuitive desire to give certain drugs under ostensibly the same conditions may be considered, but again I must emphasize that the “totality of symptoms” alone should act as ones guide.

Another method involving greater consideration and probably the best we now have is the Repertory. Easily stated, we may say that it is a purely mechanical means of arriving upon a certain group of remedies (never a single remedy as some believe), among which, in the average case, we can be reasonably certain our remedy lies.

Of course, before using our Repertory, the greatest task must be performed. A general thoughtful consideration of the patients symptomatology is made and what I may term individualizing symptoms are outlined. By this I mean that, in every patient, one will find certain symptoms which are not generally characteristic of all persons and these symptoms are inherent to this patient alone-thus individualizing symptoms. These symptoms belong to our patient and we can be assured that these characteristics will lead us to out remedy. These symptoms should be carefully tabulated and then we can resort to our mechanical Repertory.

Of late years, the Repertory has been constructed in various card index systems and these have greatly diminished the work of the homoeopath. After this has been done, we are confronted with a number of remedies and now a very important problem is presented, to wit, the ultimate selection of the remedy.

To obtain our remedy, a number of other means should be considered for the perfect prescription. These aids should be used wherever possible and will greatly enhance ones personal ability in prescribing. All these aids, of course, cannot and need not be considered; individualization again should be our guide.

We now must turn our eye to the Materia Medica, for the final selection. It has been customary with me, and many that I have observed, to give especial emphasis to the mental sphere of our patient. This is highly illuminating and especially individualizing, for the mind is the consummate reaction of every physiologic and pathologic process of the body. The nervous system is the dominant organ of action and its reactions are exclusive.

Read the mental symptoms of the remedies in question and note which is most exact to our patient. Then, due to our previous intercourse with the patient and often from what the patient will tell you-a fairly good idea of the mental attitude will be known. In some cases, I may say, this is quite difficult to elicit. As a rule, everything being equal and mental symptoms comparing, a prescription can now be made. I am quite positive that many men have found this to be so. However, we should go on, for we are now seeking the ideal method of prescribing.

A most satisfactory and most useful and really scientific means is offered by what we see–namely objective symptoms. These are really most reliable, and such symptoms as hectic flush, vermilion red border of lips, eruptions on the skin, indented tongue, triangular red-tipped tongue, are most invaluable and should always be utilized in making ones prescription. In fact, I cannot conceive of a prescription which would be contradictory to these objective signs. In the chronic case, however, objective symptoms are usually lacking, and this valuable guide to our remedy is lost. In every case, however, try to discover these signs and, if present, you will more easily find your remedy.

Objective symptomatology, of late, has been refined and really made quite scientific by certain morphologic considerations and various body dimensions. This helps us to determine most precisely the patient we are dealing with, and should very materially guide one in the difficult case. For instance, if in a given case we find that the nervous system dominates the individuals activity we know that a certain group of remedies alone can touch or dynamically affect such an individual. Morphologic studies reveal physiologic reactions and thus truly reveal another step in our forward progress to the correct remedy.

Still another refinement in homoeopathic prescribing is the consideration of the hormonopoetic system of each patient. This is a comparatively new thing in medicine, but can be made especially helpful to us. Each endocrine gland produces certain definite reactions in the body. When these glands work harmoniously we are in perfect endocrine balance. Hyper-or hypo-action of dysfunction of any of these glands will give rise to a train of symptoms. Individualization of patients, according to the endocrine gland which dominates their system, should help not alone in explaining symptoms but can help in the selection of remedies. It is already known that certain remedies act only in individuals of a certain endocrine balance; for example, bryonia and iodine are typically thyroid in action, lycopod. is pituitary in character, as is phosphorus. Ant. art is suprarenal.

In certain cases, the patient lacks entirely a distinct symptomatologic group to help select our remedies. A determination of such a patients endocrinologic balance should tell us his or her type and then administration of the gland in minute doses will help to bring out more definite symptoms and a more perfect selection will be tenable.

One of the greatest difficulties encountered by homoeopathic prescribers are patients who possess genuine ills but lack a distinctive or sufficient symptomatologic group- complex. Such cases are quite common and need especial consideration. The beginner must differentiate these cases from the many he will encounter who will fail to give symptomatology because they are alien to our methods of prescribing, and those cases from whom the beginner cannot obtain a good symptom complex because of his “greenness.” The latter cases simply need further questioning and an acquaintance of our methods. The beginner in homoeopathy will overcome this by constant practice. What I wish to present now are the truly difficult cases which lack definite symptomatology.

In one of my previous paragraphs, I have already alluded to such cases and presented one of the means of overcoming this difficulty. Careful study of the endocrine dysfunctions of your patient is essential. Once we know the nature of the pathologic gland or, better, the dominant gland of the individual, we can hope to solve our problem. This determination is often not a simple task; nevertheless, a broad general comprehension of the endocrine balance will help in the classification of your patient.

This determination having been made, we now proceed to give the patient small doses of the gland. Personally, I would prefer the lower potencies, as the 30th, for this class of patient. After a period of week, longer or shorter, the true basic symptomatology of your patient will develop. After this we can prescribe our remedy. It is interesting in this connection to note that with a small minority of these cases, the endocrine prescribed will clear up the entire case for you. In most cases, however, a true similimum is necessary to obtain a complete cure.

Another invaluable means of treating chronic cases lies in the use of the nosodes. With these, I have had a limited experience. I have, however, been fortunate to observe the actions of Tuberculinum, Bacillinum and Psorinum. The action of nosodes is based upon present-day conception of Vaccine and Serum therapy. Like the latter it has been proven, that they increase the opsonic index of the body, but unlike vaccines, it is unnecessary to poison the body by injecting deadly germs into the system. The homoeopath has a further advantage with the use of his nosodes, in that he can individualize the cases in which the nosode is necessary and not indiscriminately inject poisons into everyone. These nosodes are very valuable when properly indicated and must be borne in mind by the chronic prescriber.

Generally stated, the nosodes are indicated where we lack individualistic symptomatology. This lack of symptomatology plus the chronic taint or diathesis which we can ascribe to our patient will help us prescribe the nosode. For example, let us say we have an old suppressed gonorrheal case, having been treated by injections, and now ten years later he suffers from rheumatoid affections. The patients no definite symptomatology and we are sure that his present complaint is based on this old taint. Such a patient, given a dose of Medorrhinum, will quickly respond. Often the old G.C. flow will return and recovery ensues or else we can then properly prescribe for our patient. Similar examples can be given, using Psorinum, Syphilinum, and Tuberculinum.

In view of the last few paragraphs, in which I have especially alluded to some of our more modern ideas in homoeopathic practice, in relation to the chronic case, it would here be worthy to mention the old Miasmatic theory propounded by our founder. Briefly stated, according to this, each true chronic case is based upon three general dyscrasia or taints which inhabit us. These are Syphilis, Sycosis and Psora. Hahnemann claims that all true chronic diseases are possessed of these miasms. Such a conception, though archaic of expression, still holds sway today. We moderns speak of the Chinese as being a syphilized race, meaning a luetic dyscrasia is inherent to the entire race.

We often state that the white race will, in the near future, be tubercularized. And such a conception of disease was announced by Hahnemann. He, however, allowed of three great diseases and no doubt they are still our dominant diseases, with Psora holding the greatest sway of all. We immediately concern ourselves with these miasms when we remember that a remedy, to cure a truly chronic case, must not alone comprise all that I have already mentioned, but, in order that the cure be a true and lasting one, the remedy must bear a definite relation to the individuals miasmatic background.

In some of our very difficult cases, especially that type of patient who has made the rounds of many physicians, including homoeopaths, and in whom most everything has failed, another method of approach may be made. This is not new, in fact , very old, but it is through this that some of our old brilliant prescribers made their most successes, almost fabulous in its very essence. Men of the type of Hering, Boenninghausen, Allen and Lippe stand out primarily here. These careful old prescribers noted what I should choose to term the peculiarities of symptoms group complexes of individuals. For instance, they noted that certain people were peculiarly affected by the tides, others by proximity of certain stars, others by the moon.

There is no doubt that such tremendous forces as tides, stars, sun and moon must bear a relation to each individuals reaction. This, however, is not always demonstrable or observed, but in the more sensitive of our brethren such symptomatology can be observed. I have been fortunate to observe and hear discussions of such symptoms during the past year by an example in our dispensary work. When such symptomatology can be elicited in the chronic case, utilization of the symptom may bring you untold success. Silicea, Bufo, Argentum nitricum, all contain such symptomatology and careful study will reveal the presence of many more. Brilliant cures are reserved for the searching prescriber.

A prescription is now ready for our patient. The old question of potencies arises. Personally I have observed excellent results with the higher potencies and these alone I would choose to use. The higher the potency the more dynamic its reaction, and since homoeopathy cures only through its dynamic activity, the potencies alone should be used. Low potencies, as the 6th, can and may yield the action of the crude drug and may not arouse a curative reaction in chronic cases.

I always start the patient with a single powder of the drug in the 200th and supply the patient with sufficient placebos to carry him on during the intervals of visits. Upon each visitation, careful memoranda of the case should be made. It will be noted that the last symptoms improve first. We will also note that symptoms previously suppressed by palliative means will return. When such is the trend of our case, we can be reasonably certain that the case is on the road to a true recovery.

In conclusion, I can only re-emphasize the principle stated by Samuel Hahnemann in the guidance of a true prescription in every case-“in short, the totality of the symptoms must be regarded by the physician as the principal and only condition to be recognized and removed by his art in each case of disease, that it may be cured and converted into health”.

Samuel Rosenfeld