The title of this paper may appear puzzling. Some of you will wonder what connection there could exist between these two topics. No other connection than that they both are exemplified in this paper by one and the same case history.
About ten years ago I was asked to treat a boy then seven years old and who had been suffering from convulsions of hystero- epileptic nature. At first, these convulsions came on in the night, yet gradually established themselves also in the day. They were characterized by loss of consciousness, clonic jerking in the limbs, blue lips, foam before his mouth and were followed by a temporary paralysis of tongue and throat.
He was mild-natured, generous, considerate, affectionate and not a quarrelsome boy. He was a good friend, liked children, liked strangers, liked company, but these positive qualities were more than counter-balanced by the following very negative symptoms of cerebro-spinal origin. He was indifferent, not dependable, did not care and was very sensitive.
He was indifferent, not dependable, did to care and was very sensitive. he was easily offended, could be very contrary, mad and stubborn if not handled right. He was afraid of the dark if alone and would not go to sleep alone. On the other hand, he could not go to sleep if lights were on, and noises woke him up easily. He was afraid of dogs, chickens and almost all the other animals; was immature for his age and grew too slowly though he ate much.
Despite his being almost in constant motion, he was otherwise slow, phlegmatic and awkward in everything, in fact so awkward that he could not tie his shoes and that his mother had to peel apples for him. He stumbled easily and was also clumsy in talking while his restlessness found its expression in his constant picking of fingers and nails.
He had an aversion to raw eggs, craved candy and ice-creams and drank much cold water. He liked to wash his face with cold water but not his body. After bath he chilled easily. He hated hot sun but liked personal magnetism. The time after midnight was better for him that that before midnight. Rx. Phosphorus 10M.
Two months later came the report which was thoroughly disappointing. The remedy did not improve the bodys condition in any way.
After a pause of a year another prescription was requested. This time Phosphorus cc was given. Its result was no better than that of the 10M potency.
Another year elapsed after which time Phosphorus 1M was prescribed but, alas, with the same negative result. This produced so much discouragement in the boy and his parents that for five years they did not want to try homoeopathy again. however, after five years their discouragement was forgotten and they let me try again.
In order to be sure of the remedy I subjected the boy to another thorough questioning and secured the following additional symptoms:.
He now fancies seeing things. He also hears imaginary noises and thinks someone will attack him. He has developed a changeable mood and lacks ambition. His memory which was good before is now quite poor and he is slow to grasp and to coordinate ideas. He is lazy, discontented, tired and hates to study. He sits, broods, is not gregarious any more and has no boy friends. His movements which had been quick in the day have now become slow, while in his sleep he is moving constantly. His feet especially are in perpetual motion during sleep, partly because they get hot and he wants to find a cool spot for them.
In convulsions his whole body jerks, his face twitches and his lips become purple. These convulsions come slowly and with fear of something indefinite, as well as with a sensation of chilliness which starts in the head and goes down to the legs. He is ravenously hungry near an attack but has a poor appetite otherwise. He also vomits water in spells and is often car sick. At all times his eyes are sunken, have no lustre and are surrounded with blue rings. The pupils are contracted, his speech hesitating and stuttering. His chewing is unsatisfactory and his swallowing difficult. He is constantly picking his nose, lips and fingers.
He laughs little and when he laughs, it is a silly laugh over some trifle. He is dizzy, his head is heavy and at the table he supports it with his hand. His legs are tender and have developed aching and shooting pains, if he stands or walks much. His knees are sore and stiff if he runs too much, while slow and short walks limber them up. His feet perspire and the skin on them peels.
There is a crawling sensation on his face. He uses more covers than other people and feels chilly when he does not feel well; however, when he has a cold, he does not developed any fever. he is a poor sleeper, falls asleep late and in the morning he thinks he did not sleep at all. His face and his legs itch. He often has headaches which are worse in P.M. and grow with the day. He occasionally has cold sores and a kink in the neck, meaning a sensation as if sprained.
This time again the prescription was Phosphorus, only the potency was raised to MM and it did not disappoint. Six weeks later his parents reported in a letter, saying, “The boy is much improved, his nerves are better, he is much easier to get along with and we now have more faith than for years that you will cure him”.
In all, the MM potency was repeated three times at longer intervals. Its second dose was given three months after the first, and six months after this second dose a report was received which expressed great satisfaction with the results obtained. Even the boys strabismus seemed to be cured and he was taking so much more interest in school work that he graduated from high school during that time. He did not need any more medicine for a year and a half. The cure, however, did not prove permanent because after one year and a half the attacks returned with a severity which was almost the same as a few years before.
The third dose of Phosphorus MM was then administered. This dose was efficacious again but held only about ten months. While earlier the boy thought that his attack relapsed on account of physical over-exertion, this last time he alleged an entirely different cause. He had just become interested in a girl when the convulsions returned, so he concluded that the feeling of love – as he expressed it – caused them. He felt himself confirmed in this opinion because when one day he got mad at the girl, he started to feel better.
This last relapse finally made me suspicious and I started t doubt the correctness of the prescription. What if Phosphorus was not his similimum? I re-studied the case and prescribed Agaricus muscarius 1M. The fact that after an apparent cure the spells returned twice made me think that they were only palliated. Besides, there was another reason prompting this doubt. I, namely, had the opportunity to treat also this boys father who was a difficult chronic case, too. If there ever was a patient having strong Phosphorus symptoms, it was this man. He was afraid of death and disease, of darkness and water, of storm and wind, of loneliness and insanity.
He hated nights and cloudy days. Darkness, storm, wind, excitement depressed him. He was very affectionate, very sensitive and very excitable. He was jealous, vain, talkative, quickly angered and quickly discouraged. He was thirty when waking up in the night and his skin was easily abraded and he bled freely when shaving. He was extremely clairvoyant and maintained that all his dreams came true. He received Phosphorus, not one dose but the whole gamut of potencies from the 30th to the MM without any appreciable benefit. He surely was a puzzling case. In spite of presenting more Phosphorus symptoms than any of my Phosphorus patients, he failed to respond.
This not because of lack of reaction, but he evidently was not a Phosphorus case but at the time of treatment he suffered from a chronic lumbago which was of gouty etiology not of Phosphorus nature and with no definite symptoms to prescribe upon. He developed this gouty constitution in his later years and the conclusion is justified that it was in no way related to the Phosphorus pathogenesis. His system was harboring two different constitutions, his original Phosphorus constitution and the therapeutically undefined gouty constitution.
This last one developed over the first, covering or enveloping the first so tightly that Phosphorus even in the highest potencies could not penetrate through it and reach the deeper-seated Phosphorus constitution in order to afford relief. It is evident that the gouty constitution should have been removed first before Phosphorus could have been expected to act. His symptoms were of such a nature that at that time I did not even suspect that I had to deal with two different totalities requiring two different remedies.
Double totalities do exist, sometimes even triple. For the most part we encounter only one. Usually a mans constitution does not change much in the course of his life except if unusual and deep acting causes supervene. E.g.: Somebody may have a Calcium constitution in his younger years but, when 18 years old, he suffers from a violent and prolonged typhoid fever which will make a Psorinum case of him. A farmer may be a Sulphur case but one harvest season he works exceedingly much and strains himself excessively so that he produces a chronic passive congestion of his venous, as well as portal, circulations which makes him a Carbo veg. patient.
Or a silica boy becomes a miner and in the mining camps he lives almost exclusively on cooked meat and potatoes, a diet which will make a Sulphur patient of him. Or a woman who may have been a Pulsatilla case in her first 20 years of life but in the subsequent 20 or 30 years, by partaking excessively of chicken, turkey, ham and cakes, all of which foods contain devitalized proteins and cause gout, high blood pressure and hypertrophy of the heart, becomes an Aurum met. patient and later, running around for years with hypertension she finally exhausts her circulatory system, becomes decompensated and in consequence of this long lasting decompensation she develops into an Antimonium tartaricum case.
You may find Pulsatilla, Aurum and Antimonium tartaricum symptoms intermingled in such a case, but only the administration of Antimonium tartaricum will afford substantial relief; the other two will fail. After Antimonium tartaricum has done its full duty, Aurum met. will come in and, after this has restored the circulation to normal, Pulsatilla will be indicated. Pulsatilla or Aurum, if given first, wound not work or would work only partially and temporarily, would only palliate.
In the case of this epileptic boy, only the MM potency had the power to penetrate through the outer shell of the Agaricus constitution, to improve the Phosphorus constitution and remove the convulsions temporarily, while in the case of his father the gouty shell seems to have been too dense even for the highest potency. It is known that chronic gout is the most difficult trouble to treat even for the most experienced homoeopath.
In order to prescribe for cases with more than one totality, it is extremely important that their symptoms be correctly evaluated. It is more decisive to ascertain the chronological incidence of a symptom as far as this is possible than to determine its quality. Mental symptoms, no matter how strong, must be disregarded, if they do not belong to the totalities which we have to treat first. Of the greatest value are those generalities, either mental or physical, which have cropped up last.
They should be taken as key-notes. In multiple totalities, therefore, mental symptoms belonging to the uppermost totality are of first importance while mental symptoms seemingly just as strong, yet belonging to other totalities, are not important at all but will become important later. For years I have been making mistakes in complicated chronic prescribing because I did not know this rule.
In spite of all ones personal experience with the remedies, gathered over many years of hard and tiresome work, it is not possible to distinguish between the different totalities in chronic cases without constant referring to the Materia Medica. To consult the repertories alone is insufficient. The symptoms must be compared with the help of the fullest reference books, such as the Guiding Symptoms of Hering, Encyclopaedia of T.F. Allen and the Dictionary of John. H. Clarke. Nor is hurry allowed in taking the case history. The whole past of such cases from the cradle must be scrutinized, pitfalls lurk everywhere, omissions are costly, constant digging, searching and reviewing are necessary, only thorough work brings permanent results with respect for homoeopathy as a deserved addition.
DR. ROGER A. SCHMIDT [San Francisco, California]: This is a very thought-provoking paper. It brings up a number of problems that are not entirely solved and that need further discussion among ourselves.
The question of constitution, for example: We use terms that might have a different meaning among ourselves. My definition of “constitution” would be somatic condition of the body and the inherited factors that are imposed by the parents upon the being. Constitution is carried from the cradle to the grave. You cannot alter the somatic features that develop.
Things that are motivated are called temperaments. Temperament is an expression of the functional changes that occur with age. Possibly what Dr. Bellokossy referred to I would have called temperaments, and the person described in his paper developed different pictures as he developed throughout his youth into adulthood.
“Totality” being such a “total” term, if we take it to mean what it seems to mean, how could we have more than one “totality”? It would be rather a contradiction. We should not call it “totality,” if it is not something that is a total.
You stated that we should discard a number of mental what it seems to mean, how could we have more than one “totality”? It would be rather a contradiction. We should not call it “totality,” if it is not something that is a total.
You stated that we should discard a number of mental symptoms; yet, according to our rules, mental symptoms should be considered as the most important in the case. I quite agree with you, however, that such should be the case, because we have common symptoms and peculiar symptoms. I believe neurotic individuals (and the man whom you described seemed to be a perfect example of a neurotic individual) have many symptoms that are common among all neurotics whom we see. If there is one that is different from what we find in other neurotics, that one might be picked as the one that fits into the totality of the picture for prescription consideration.
What potency was the MM potency? Was it a Fincke, a Jenichen or centesimal?.
DR. BELLOKOSSY: It is really not possible to say, No matter who made those potencies, it is impossible to say whether they were exactly MM. I made the potency myself and it was approximately MM.
DR. SCHMIDT: It is another of those approximate things that we should sometimes, I believe, bring up for earnest consideration. We have to establish something exact. Science is progressing tremendously along the line of classifying things in such a way that you can compare them and evaluate them. If something is approximate, how can one evaluate it? An MM potency Jenichen is certainly entirely different from Korsakov or Hahnemann MM, isnt it? Mathematically I am sure there is a tremendous discrepancy.
DR. BELLOKOSSY: I made it out of CM according to my judgment, and I thought it was MM.