As a guiding light we take a statement by Stuart Close: “It has come to be a maxim among experienced provers that the last appearing symptoms are the most valuable and characteristic. In the same way the last appearing symptoms in a disease,especially chronic diseases, are of the highest rank in selecting the remedy”. We will, therefore, in this case and those to follow heed his advice, at the same time keeping in mind the value of the symptoms as brought out in he general discussion of the interpretation of symptoms.
Considering each symptoms separately we find only a few that are positive and distinct. These we will take and set the others aside for consideration when we have completed our repertorizing, their chief value being confirmatory. Two mental symptoms present themselves at the start. Since mental symptoms are of the highest order we them first place in our analysis. Here they serve also as eliminative symptoms. The general attitude of the patient, being a manifestation of his will, is ranked first and cheerfulness is taken as symptom number one.
The other mental, his suspicious attitude, being a perversion of understanding is chosen as the second symptom. Because there is the possibility that his slowness of speech is due to cerebral complications this was chosen as the third symptom. In this symptom we have our first particular. We next consider the terminal organic manifestation and the patients complaint, his paralysis. We find this to be right-sided, that is confined to one side of the body so we take this general rubric of one-sided paralysis as symptom number four.
Since many of the patients complaints are traceable to weakness of the affected parts (for example, the difficulty in walking and the inability to use his right hand while eating) we chose as our fifth symptom paralytic weakness. Lastly, we chose the general rubric ulcerations of the skin not because of any intrinsic value but because we feel that in the course of the disease this symptoms played a prominent part, therefore we would like to have as our final group of drugs, those in which ulcers made up a part of the picture.
while considering the rubric” Paralysis” in Kents Repertory we came across the statement “heat in the paralyzed parts”. This fits in with our picture, but because of the peculiarity of the symptom we are more inclined to keep this in mind and use it after our drugs have been definitely limited to a few.
the symptom of “burning heat in the skin”, while it is the patients chief complaint, is not to be taken as our chief symptom. We prefer to place it as symptom number seven giving it a place in our analysis but not too prominent a one. In value it is equal or perhaps a little above “Ulcers.”.
REPERTORY ANALYSIS.
As stated in the general discussion of the repertories to be used, James Tyler Kents Repertory of the Materia Medica is our choice. Its scope is the widest and our symptoms were easily found therein. Boenninghausen;s Hand Book was given considerable thought and scrutiny. On the whole the case seemed applicable to this book but investigation brought to light the fact that in order to use our chosen symptoms it would be necessary to distort the terminology and to some extent the meaning of them.
It was feared that the real significance and value of the individual symptom would be lost in the effort. Examples of this distortion are, mistrustful for suspicious, and, in the absence of a speech rubric “tongue affected” for “slow speech”. This last example shows clearly what might happen. We cannot point to any definite lesion of the tongue which is responsible for the slow speech nor can we emphatically say that this symptoms is purely a disorder of this organ. Rather than invite error and increase our chance of failure we are content to rely upon the more accurate and better understood repertory, Kents.
As a result of the procedure already outlined using the previously discussed symptoms, three remedies stand out. They are Lachesis, Phosphorus and Causticum.
This case is certainly deep seated. It might be well to consider whether or not one of the nosodes might be needed to uproot the condition. After reading kents opinion regarding the use of nosodes we are inclined to be less hasty in prescribing them unless we can satisfy ourselves that they are really indicated. He says:.
The nosode tendency is becoming altogether too extravagant. I have known Medorrhinum to be given and fail where Thuja would have promptly, because the symptoms were predominantly Thuja and not Medorrhinum. I have known Psorinum to be given because a case was supposed to be due to psora, where Sulphur was well given indicated. It is a great error to prescribe for the miasm instead of the totality of the symptoms.
Nosodes may be of use when the symptoms are scanty or distorted or where the picture of the condition has been smothered beneath a series of complications thus rendering definite selection of the indicated remedy impossible. If these conditions are present and we have a definite history of one of the miasmatic disorders, Kent states that is a good “experiment” to resort to a nosode.
In this case the symptoms are not distorted. Those given are not hazy nor has the condition as a whole been subjected to frequent or radical distortion as evidenced by the fact that his present complaint is off fifteen years standing. In other words we do not feel that we would be justified in prescribing a nosode in this case when we are able to derive the truly indicated remedy from the totality of the symptoms given.
As has been previously stated, Lachesis, Phosphorus and Causticum seem to be the remedies from which we are to make our choice.
First let us consider the general modality of right or left- sidedness in these remedies. Lachesis is predominantly a left- sided remedy. Dr. Garth W. Boericke in speaking of Lachesis stated that it is exclusively left-side or at least the initial symptoms must make their appearance on the left side. This point is also emphasized by Willard Ide Pierce. Phosphorus, although also frequently mentioned as a left-sided remedy (especially in the respiratory field0 when paralytic symptoms are concerned seems to be less pronounced on this point. It will be noted that in Gross Comparative Materia Medica mention is made of the fact that paralysis of Phosphorus (especially of the lower extremities0 is frequently right-sided. Of the third remedy, Causticum is prominent right-sided drug.
The pronounced left-sidedness is a strong point against Lachesis. While one of its main actions is upon the brain and the cerebro-spinal nerves, its principal action seems to be upon those nerves which take origin at the base of the brain or in the medulla, especially the pneumogastric. The after effects of this involvement is more congestion, coma, convulsions or sudden prostration rather than paralysis as is found in this case. What is more, long and chronic as this case, is there is not mention of two very prominent features of this drug, namely, the extreme sensitiveness of the affected part to touch or light pressure and the almost universal distress that comes on during and congestion and disintegration are not prominent in this case.
Of phosphorus, we recently found (in the handwriting of Dr. Clarence Bartlett) on the margin in Farringtons Clinical Materia Medica the following notation: “Paralyses are characterized by itching and formication, numbness, trembling, muscular contractions and increased heat in the affected parts. Phosphorus is useful in mental decay especially if premature old age occurs.
The paralytic symptoms and mental weakness of cerebral softening disappear under its use”. Further, we find in Clarkes Dictionary of the Materia Medica these statements: “Phosphorus: walk less strong; often stumbles on a smooth road. As a leading constituent of nervous tissue Phosphorus has a deep action on the organ of mind and sensation”. All this nicely fits in with our repertorizing and when we find that the peculiar symptom “heat in the affected parts” in Kents Repertory applies to phosphorus and alumina) we might be tempted to rest our oars and consider the work completed.
We are given an incentive to look further when we find that Causticum, the lowest numerically of the drugs brought out by the repertory analysis, is recognized universally as the right-sided Phosphorus. Farrington states that although the two remedies (phosphorus and Causticum) do not follow each other well, they are, nevertheless, indicated in the same class of disease. Further, he points out that the main power of this drug pies in the paralytic weakness which the drug exhibits.
This paralytic tendency is a genuine potash weakness. We are amazed that slowness of speech did not bring out this remedy in our repertory study when we consider that its paralytic effects are very pronounced upon the organs of deglutition and speech, upon the tongue, upon the lips and in glosso-pharyngeal paralysis. These paralyses, states Farrington (among other causes) may be the result of a deep seated nervous disease. In the end, this point is valuable in that it very clearly demonstrates the fallibility of our efforts and the dangers from misinterpretation of symptoms.
