REPERTORY STUDY FROM A THESIS PRESENTED IN COMPETITION FOR THE DARNELL PRIZE


Still this does not disturb our choice. To understand the scope of our treatment we must be able to discriminate between disease as a morbific process within the organ and the material results or products in which this process terminates. Homoeopathy has to do with the former and is not essentially concerned with the latter. The application of Chelidonium in this case will not result, primarily, in the return of normal activity of the uterus.


CASE II.

Mrs. L.P., aged 50, married. No children, never pregnant. Complains of a soreness over the region of the liver, a burning, referred to the right scapular region and from thence downward. Frequent headache, preceded by blindness of the right eye, with nausea but no vomiting. Has no modalities. Is an aspirin fiend. Generally she feels better lying down. Most of her attacks begin in the morning. She has a sweetish taste in her mouth. She is fair and stout, has many gold teeth and has a chronic nasopharyngeal catarrh. She may be said to be of the lymphatic constitution. Her bowels are regular but there is a frequency of urination.

Some years ago she was subject to eczema. She is sore to touch in the region of the gall-bladder and clothes annoy her here. She is better in the open air. She has periodic nosebleeds. Ten years age she was operated upon for polypi of the nose. On several occasion she has had a cessation of menses which returned after some months with a severe uterine haemorrhage. Examination of the uterus shows it to be large and baggy, adnexa normal. There is a small, red teat in the cervical orifice. She was advised against operation and a drug was given. This produced a haemorrhage of dark, watery fluid from the uterus, old stagnant blood, and the teat from the cervix proved to be a polypus. She remains well to date.

PHILOSOPHICAL DISCUSSION.

Throughout this thesis the reader will constantly be confronted with psora and its secondary manifestations. Underlying the disease process in this patient, we are able to ferret out this universal disturbed, and gradually we come to realize that perhaps Hahnemann was not far off when he stated that this was a prime factor in eighty per cent of all chronic diseases, the remaining twenty per cent being traceable to syphilis or sycosis. It might be well to further broaden our knowledge of this prominent factor in disease. What is it? Where did it originate? How is it spread?.

Psora, as defined by Hahnemann, is a morbific process within the human organism which, in its active form following its primary skin manifestation as the itch-pustule, distorts the normal function of the body and predisposes t visible symptom- manifestation of this dysfunction. Its end products we call disease. Its latent form is found when the vital resistance and the morbid process counterbalance each other.

The origin counterbalance is by no means distinct. Psora or its analogue in mentioned throughout the Bible about the time of Moses. At that time and for centuries following it was marked by cutaneous eruptions. Since then the transmission of the ancient miasm through countless numbers of organisms in the course of hundreds of generations has brought about a distortion of the original manifestations so that today the condition is marked by not one but a multiplicity of complaints. Suppression has played a prominent part in this distortion and the resultant secondary manifestations are tabulated over thirty pages in Hahnemanns Chronic Diseases.

Association and contact, according to Hahnemann, caused its spread. Its universality today is the result of its distortion. When the lesions were prominent upon the skin people avoided the afflicted and did not become similarly affected but since the lesion has been suppressed many unsuspected exposures and contacts have been made.

But it was noted that frequently secondary manifestations of psora appeared in which there could not be elicited any history of the initial lesion. Admitting of the unreliability of he patients word, many cases continued to crop up where the above explanation did not seem to apply.

Charles Julius Hempel, M.D., noted this and attempted an explanation. He contended that the presence of the psora within the body antedated its cutaneous manifestations and further stated that any abuse of the organism which has a deleterious effect upon the normal vital process should be considered a causative factor of the miasmatic process. He wrote:.

Man is ignorant of the true laws of life; he eats improper food.. inhabits smoky, dark rooms.. is deprived of fresh air, is without cleanliness, is doomed to hard and enervating labor.. inhaling the same death-harboring stench (with his fellow men); bellowing, roaring, sweating, together, in the same horrible discord; it is to such influences that we must trace the first immediate or proximate cause of disease, and not to the suppression of the cutaneous symptoms of a miasm that was itself a result of mans primitive deviation from the divine laws of life.

Lastly, there came th theory of inherited taint and predisposition to morbific processes, one of its advocates being J.H. Allen.

Taken as a whole we have before us a picture of distorted life processes and a plausible explanation of the foundation of disease. We are at liberty to accept them for what they are worthy and by observation confirm them, or we are at liberty to reject them and continue without any semblance of an idea of what disease is all about.

Once the miasmatic process is incorporated into the body it never dies out of its own accord. In the words of Hahnemann “it is more aggravated from year to year, through a transmission into other and more serious symptoms until the end of mans life, like every other chronic miasmatic sickness”.

The connection between this paragraph and the case before us is obvious. Reading the history we are able to point out the early manifestation of the psora. Though married, the patient has never been pregnant. This could hardly be called the result of normal functioning (although we must remember also the possibilities of sterility of the husband). The history further states that some years ago she was subject to eczema. This might be the first external manifestation of the internal disorder.

There is no mention of maltreatment of this condition but then that is not essential. Hahnemann has said that the external eruption may not only be driven in by faulty practice but unfortunately it not infrequently of its own accord withdraws from the skin. The after effects in either case are the same. The psoric process continued its activity within the body and the distortion of normal function results so that we are confronted today with a patient having a multiplicity and complicacy of complaints.

One thing we must remember about this case. When the history is taken all symptoms are noted but we must learn to recognize the symptoms dependent upon the disease process per se and those resulting from the effects of the condition. Primarily homoeopathy has nothing to do with the tangible or physical products of disease. Effects of disease and the associated dysfunction will remain after the cause has been removed in most cases. Indirectly, the homoeopathy remedies many exert a favorable influence upon the products of disease by restoration of the normal vital function and resistance.

This thought is to be kept in mind when we note the presence of the uterine polypus and also when we consider that the age of this patient makes highly probable the deduction that not a few of the symptoms of uterine dysfunction might be the result of an impending menopause.

CHOICE OF SYMPTOMS FOR ANALYSIS.

Repeated attempts to organize a group of symptoms which would give us satisfactory results has met with only continued failure. Fortunately several general symptoms were found in the case. They consisted of, first, amelioration or general feeling of betterment in the open air; second, a morning aggravation; and, third, better lying down. Of the integrity of the first two symptoms there seem to be no misgivings but the third choice still leaves us with a feeling that the point could be brought out more clearly if we were questioning the patient personally.

From her we fell we would be able to elicit information which would bring out whether the act of lying down was really necessary for the amelioration of her complaints or whether the truth was that motion aggravated her symptoms. There is a difference. Further there may be a general debility or lethargy which might prompt her to lie down. The way the point is expressed “generally she feels better lying down” seems to indicate that the latter conclusion is the more probable. We do not feel that under the circumstances we would be justified inn readjusting the symptoms to fit our opinion so we will repertorize the symptom as it stands.

From the mass of Particulars we next attempted to build up our totality. We are inclined to the opinion that the seat of the trouble is the liver. the headache and the uterine symptoms are easily explained from this point of view. Consider an hepatic inflammation, catarrhal congestion or diffuse hepatitis with engorgement and enlargement of the liver, and the bogginess of the uterus is explainable upon a basis of portal congestion and venous stasis. The polypus is a natural sequence and its appearance would aggravated and perpetuate the condition.

Likewise the nasal polypus is explainable upon a basis of chronic irritation from a chronic nasal catarrh (most frequently from an anterior ethmoidal sinusitis). The age of the patient and the realization that she most likely is passing through her change of life might be partially the cause of the menstrual irregularities and the peculiar concomitants thereof. The headache gives us an extremely peculiar symptom, a headache preceded by blindness of the right eye, and is to be remembered.

Being of the opinion that the primary upset is in the liver our next and fourth symptom is the right hypochondrium. Modification of this general rubric is made with the rubric internal soreness which is chosen as number five. A final differentiation of this condition is made when we take as symptom number six the fact that the condition is worse to external pressure.

From this point on general rubrics are considered exclusively. There is a chronic nasopharyngeal catarrh in this case so we include this rubric in our analysis as symptom number seven. For the headache we take only the internal nine and menses, late, is the; menses, profuse, is chosen as number eleven thus covering all the fields.

We feel justified in regarding the symptoms chosen as sufficient to cover the case since they embody the Generals and, in part, cover the most important phases from an anatomical standpoint. By so doing we hope to avoid the complicacy of symptoms which impeded our progress heretofore.

We set aside as important the two very peculiar symptoms of the case, the peculiar headache and a point that has not been mentioned, a burning referred to the region of the right scapula. Inexperienced as we are the fact remains that having these before us we surely should be able to locate our remedy without further complicating the repertory work.

We hope to gather all the drugs applicable to this case and then to follow the example of Kent by trying to select from among them the one which contains these peculiar symptoms. Our guide will be the advice of Kent: “We must not expect a remedy that has all the Generals must have all the little symptoms. It is a waste of time to run out all the little symptoms if the remedy has the Generals. Learns to omit the useless Particulars.. get the strong, strange, peculiar symptoms and then see to it that there are no Generals that oppose or contradict”.

As for the sweet taste in the mouth, it too is peculiar but we have chosen what we consider strong symptoms. As for the nosebleeds, we are content to wait and see.

THE REPERTORY ANALYSIS.

Scanning the case, one would expect to build a concrete picture in a comparatively short period of time. Reflection upon the case taught us that the direct opposite was true. The General symptoms were quite definite; the Particulars, as pertained to the liver, were also definite and acceptable. The uterine symptoms were definite enough but we were forced to admit that the results were influence first, by the liver; secondly, by the possible interposition of the menopause, and thirdly, by the presence of the polypus.

An attempt was made to extensively repertorize the case using Kents REpertory. Repeated failure, as evidenced by our complete dissatisfaction with the remedies brought out, leads us to decide upon the course outlined on the foregoing page.

Even with this modification of our usual method we still felt inclined to use Kents Repertory but when we further considered that we were going to base our analysis almost entirely upon general symptoms and the larger rubrics we felt an urge to try our hand with Boenninghausens Pocket Manual. This we found fitted our case admirably and in view of the fact that we would be able to use practically all symptoms without undue distortion of meaning we made this our final selection. The terminology of the symptoms was changed to suit the repertory and is expressed as given on the previous pages.

THE REMEDY.

We will begin by considering the two strange symptoms we have selected. First, the headache; the symptom reads “frequent headaches preceded by blindness of the right eye, with nausea but no vomiting. Investigation brings out the fact that four remedies show this prominently, Kali bichromicum, Iris versicolor, Podophyllum and Stramonium (Pierce).

A consideration of Kali bichromicum brings out the following interesting facts. This drug, in addition to having the peculiar symptom mentioned, is especially indicated in fleshy, fat, light complexioned persons subject to catarrhs or with syphilitic or scrofulous history (Boericke). A study of the materia medica and the repertory brings out the fact that this remedy is better in the open air and worse in the morning. Although not brought out in the repertory, this drug is classified in the materia medicas as having pain in the right hypochondrium, a soreness, which is referred posteriorly to the spine.

There is fatty infiltration of the liver with increased fibrous tissue. There is painful retractions, soreness and burning. This drug has a marked effect upon the mucous membranes, especially those having columnar epithelium (as is found in the uterus). But lists its fields of action under five headings, the first being the mucous membranes, the second the liver and the third the kidneys. Internal soreness is prominent in the repertory analysis as is also the rubric “worse to external pressure”.

Further, there is marked periodicity of some of the prominent symptoms of this drug. All these considered with the fact that there is a chronic catarrhal condition of the drug almost constantly, leads us to hold it in very good light. One point, and unfortunately a General, is unconfirmed. Here again rises the point whether we have correctly interpreted our case or not. Had the symptom been expressed “worse to motion” Kali bichromicum would have been our foremost thought of remedy. Under the circumstances we are not justified in too freely interpreting our symptoms. Further interrogation of the patient is the only thing that would permit it so we are discarding a very good remedy for a rather weak reason.

Iris versicolor, since it is contrary to all the Generals in the case, is set aside as unworthy of consideration.

Podophyllum, the vegetable mercury, is especially adapted to persons of a bilious temperament. Suppressed menses form a part of its picture also, but in the liver region the existing pain is better to rubbing of the part. In the Generals, this drug features but one symptom, the morning aggravation, although the menstrual pains are relieved by lying down (Minton).

The entire force of Stramonium seems to be expended upon right scapular region and from thence “a burning referred to the Chenopodium anthelminticum and Chelidonium majus (Pierce). The former seems to have nothing in common with this case. Its characteristic pain is lower than the angle of the scapula and nearer the spine than Chelidonium (Farrington).

Chelidonium majus deserves considerable thought. This remedy has all the the general symptoms and, in addition, is one of the most prominent liver remedies with symptoms of congestion, inflammation and jaundice. It also has disturbed function of the bowels and kidneys and sympathetic affection of the right lung. Pierce states that it is a right-sided remedy and that in the majority of the cases in which it is indicated one will find more or less hepatic disorder and referred pain beneath the right scapula. Dr. Garth W. Boericke states that the two prominent indications for this remedy are pain in the right hypochondrium referred to the right scapula and (second) lethargy. Millspaugh attributes this lethargy to Chelidoniums narcotic action on the nervous system”.

Lethargy, and the fact that the patient is generally better lying down go well together. Pierce further discusses this point and states that the patient is indisposed to make any effort. A pathogenetic symptom reads “horror of movement.” Here then is a remedy which seems to cover both sides of the undeveloped phase so often discussed in this case. Continuing the analysis of the drug we discover that the headaches are usually right-sided and, as a rule, are associated with hepatic symptoms. One type of headache is the violent neuralgic one in the right side of the head affecting especially the right eye (which is an interesting point). From Burts Physiological Materia Medica we derive the information that the main action of this drug is upon the vagus nerve.

Through it and its branches it produces congestion and active inflammation of the liver (and the lungs). It also has an action on the fifth nerve with severe neuralgias (of the eye). Its three fields are listed as first, the vagus nerve; second, the digestive organs, and third, the liver. A review of this drug brings to light the fact that it stands quite high in the repertory analysis, but by no means among the highest. The head symptoms are fairly well balanced and the main field, the liver, is completely and satisfactorily covered. The uterine phase of this case is extensive while the same field in the drug is comparatively meager.

We might think nothing of this and set it aside excusing ourselves with Kents words that we must not expect to find all the little symptoms. Boerickes Manual simply says “menses too late and too profuse”. Neither Farrington nor pierce make any mention of the female phase of this drug. Burt makes no mention of it is either his physiological or therapeutic discussion. Jahr and others also avoid the subject. This more or less emphatically indicates that the field is either absent or undeveloped, the former being the more probable when we consider the age of the remedy and the men who have worked on it.

Still this does not disturb our choice. To understand the scope of our treatment we must be able to discriminate between disease as a morbific process within the organ and the material results or products in which this process terminates. Homoeopathy has to do with the former and is not essentially concerned with the latter. The application of Chelidonium in this case will not result, primarily, in the return of normal activity of the uterus.

But it will certainly restore the normal functioning of the liver (provided it is the truly indicated remedy) and in so doing we believe that we will be readjusting the patient as a whole, that we will be removing the cause of many of the uterine symptoms and that therefore we will be placing this patient upon the road to cure. Our limited knowledge prevents us commenting upon the outcome of symptoms dependent upon the change of life, if there is any truth in our belief that this also is a factor in some part in the menstrual distortions.

Additional remedies which were strong in the General symptoms and which continued to carry through the repertory analysis to a degree worthy of mention were, Mercury, Natrum muriaticum, Nux vomica and possibly Sepia, Sulphur, and one or two others which came in strong when the Particular were run after making a poor or doubtful start with the Generals.

Mercury is worse at night, worse to warmth or coolness. The type of patient and the foulness and the burning of the discharges are prominent features. Natrum muriaticum has a blinding headache but lacks the peculiar sequence. This drug also acts upon the mucous membranes and we find it indicated in catarrhs which are almost a constant feature. There is also marked distress in the region of the stomach which is relieved by tightening the clothes. While this drug is brought out by the rubric “better to lying”, further study shows that the majority of the complaints are aggravated. Nux vomica in general is better to warmth as is also Sepia. The action of the former drug is more gastric than hepatic and its prime etiological indication, abuse, is not a prominent feature in this case. Sepia, besides being better to warmth, is, to a greater degree, worse in the afternoon instead of the morning. The temperament of the patient does not fit here either.

Bryonia seems to have a special affinity for the lungs and serous membranes. Its headache is more apt to settle in the occiput although it may begin in the occiput or the forehead. It is true these are rarely neuralgic in type, but instead are usually associated with gastric derangement. In such gastric disturbances there usually is, besides the thirst, a bitter taste, coated tongue, nausea with possibly vomiting and sensitiveness of the epigastrium to touch. This drug is useful in affections of the liver especially where there is associated constipation, the stools being large, hard and dry and with little or no inclination to movement.

Frederick A. Riemann