The Language of the Repertory – J T Kent

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This Article originally published in The Homoeopathician, A Journal For Pure Homoeopathy, Vol. III January,1913 No. 1, from page no. 8 to 10.

The Language of the Repertory
By James Tyler Kent, A.M., M.D., Chicago, III.

Introductory Note: To many who have not been thoroughly trained in repertory study, the practical value of such work remains uncomprehended. The following article has been prepared to shed light on some of the difficulties that confront those who have not learned to appreciate the immense value of such an index as is afforded in the modern Repertory, and how familiarity with it unlocks the store-house of our materia medica in the future to that rubric or symptom.
Many fail to use the repertory because they think of symptoms in pathological language or because they look for expressions in the language of tradition. It must be remembered that symptoms come to us from lay provers; that sick people are lay people. Both of these express sicknesses in the language of the layman and the repertory must be an index of the materia medica. Every effort to convert either the materia medica or the repertory into the language of traditional medicine must result in total failure. Technical language condenses the thought of a given sickness. That is all that is needed to convey all there is knowable from one physician to another until the question of the remedy comes up, and there the new question comes up: What is the remedy? The answer comes by asking another question: What are the symptoms? The symptoms are the speech of the Patient.
THE physician must study the homoeopathic principles until he learns what it is in sickness that guides to the curative remedy. He must study the materia medica until he learns what is needed to meet these demands.
He must then study the repertory until he learns how to use it so that he can find what he wants when he needs it. It must be admitted that many do mechanical work and fail to realize that any other kind is possible. The physician must read over and over the rubrics in the repertory in order to learn what is in it and how symptoms are expressed. Often he will see a rubric or a symptom that he would not have thought of seeking in that place; he should then settle in his own mind where he would have looked for it; then he should make one or several cross-references to guide him laity and of nature: uneducated nature—simple nature—appealing to an educated physician. The symptoms of a patient have no meaning whatever to an untrained physician—to a physician untrained in the significance of symptoms of the patient, of the prover—hence the repertory is meaningless to him. This explains why so many try to use the repertory and fail: they have had no teaching in our so-called homoeopathic colleges.
All who know how to use a repertory succeed, and not one has ever discarded it. It appears strange that all do not try to find some one to teach them to use it when there are so many willing to do it; it appears strange that they do not desire to know how to use the repertory; it appears strange that they have not learned to note the precise language of the patient, the language of the materia medica, and the language of the repertory.
Physicians who are ignorant in these methods see no difference when the same symptom appears in three different patients in the same family, though one has this symptom at 10 a.m., another at 1 a.m., and another at 4 p.m.; one is better from heat, another from cold, and the third not affected by either, and I have known them to ask very promptly: "What has that to do with it?" Three patients suffer from a similar headache: one is better in the open air, one is better from applied cold, and the third, from applied heat; and again comes the question: "What has that to do with it?"  Yet these are only the first and simplest differences to be mentioned.
The inexperienced physician in our art trains his mind to lump and condense and concentrate and this leads in the opposite direction to what is required. We have large groups or rubrics but these are next split up into conditions, circumstances and modalities until every least difference in time, place, degree and manner is brought before the mind so that distinction and individualization may appear. "What has that to do with it?"
I will mention the word "weakness" and even our own students may say: "What a common general symptom to mention," but if he is weak—after eating, must lie down for a while, in hot weather, after stool, after mental and physical exertion, after sleep, who would not wonder if Selenium would not cure such a case? When such a group of circumstances is associated in catarrh of nose, throat and larynx, or carcinoma, and there are desire for open air, lack of vital heat, emaciation in advanced years, extreme sensitiveness to drafts—even warm drafts, there is nothing left for the homoeopathist but to give Selenium.
How can the inexperienced physician work this out without a repertory, properly used? The proper use of the repertory will lead to correct offhand prescribing in simple cases, in from ten to twenty years. The mechanical use of the repertory never leads to artistic prescribing nor to remarkable results. Certain mental characteristics go hand in hand; some characteristics of mind are necessary to good, artistic repertory-work, others are equally prohibitory.
Some minds cannot comprehend that potentization of any given drug is possible in proportion to the homoeopathicity of that drug to a given group of symptoms, and that when the drug is not similar, only attenuation is present. When attenuation becomes potentization is a question that the healing-artist alone can comprehend otherwise than theoretically. The physician who can clearly comprehend this can learn to comprehend the value of symptoms and therefore learn, by the aid of a repertory, to compare the symptoms of his patient; otherwise repertory-work is purely mechanical.
Perhaps a clinical case will best illustrate the subject.
Mrs. S., aged 47, a very excitable—almost hysterical—woman, for many years has suffered—  violent occipital headaches.
Compelled to take strong medicines for years.
Occur every few days; never passes a week without one. Continue three days.
Heat and pressure give most relief.
Bowels constipated; for a week has no desire; then takes cathartics.
Says: "I have taken everything."
Stool hard and small, resembling sheep-dung.
Craves open air; cool air.
Heat flushes.
Menstruation absent lately.
Urine scanty and strong.
Eyes have sensation that they do not belong to her.
Cold knees and below knees.
Very tired and excitable.
Over-sensitive; extremely sensitive to touch over entire body.
What are the strange, rare and peculiar symptoms in this patient?
The remedies that have stool in round, hard balls resembling sheep dung that also have strong craving for open air are: 
Alum., bar.-c, carb.-an., carb.-s., caust., graph., kali-s., mag-m., nat-m., nat-s., op., sulph.
No desire for stool for many days;
Alum., carb.-an., carb.-s., caust., graph., kali-s., mag.-m., nat.-m., op., sulph., and many        others not related to the case.
Occipital headache: Alum., carb-an., carb-s., mag-m., nat.-m., op., sep., sulph.
jarring agg.: Carb-s., mag-m., nat.-m., sulph.
pressure amel.: Mag-m., nat-m., sulph.
heat amel.: Mag-m.
March 4th. Mag.-m. 10m.
April 9th. Mag.-m. 10m.
May 20th. Mag.-m. 50m.
There has been no headache since and she has been in good health. In this case the headache is a common one, but it was what she came to have cured. The peculiar symptom is the one difficult to explain, viz.: stool in hard balls resembling "sheep dung."
It is certainly uncommon; it is not the stool natural to healthy human beings; it is not a diagnostic symptom of any disease. One might wonder what kind of commotion in the intestine could break up a hard stool into lumps so small and tumble these around until they were flat, oval and round and small as sheep's dung; the normal stool and the common stool are quite different Then it must be "strange, rare and peculiar." Now as she so longs for the open air it will be best to eliminate with the above rubric from remedies that have craving for open air; this gives the start. Then taking the next most important rubric, viz., inactivity or no desire for a week what remains can be seen in the anamnesis above. So proceed to the end, taking the symptoms in the order of their importance. The result is a cure.
Most all recent discoveries are verifying what Homoeopathy has been trying, for more than a century, to have the medical profession realize. All Hahnemann has ever asked his enemies to do is to "put the law to a test and publish the failures.
Why do they not do it.

SYMPTOMS, THEIR STUDY; OR, “HOW TO TAKE THE CASE.” - Dr C . Dunham, M.D.

If you've come to this page directly via a search engine, please note this article is mainly for homeopaths and students of homeopathy, so assumes a certain level of understanding of homeopathic concepts and terminology.

Taking a case is an art. Success of homeopathic prescription is very much depending on true picture of patient. So case taking is a very important subject in homeopathy. Dr. Carroll Dunham, MD ,Editor of "The American Homoeopathic Review", has written an article on case taking.

SYMPTOMS, THEIR STUDY; OR, “HOW TO TAKE THE CASE.”

BY

DR. CARROLL DUNHAM, M.D.

In my “Lectures on Materia Medica” I endeavored to define the scope, nature and limits of the science of therapeutics, and to show that homoeopathy constitutes this science. I tried to explain to you how it is that, by analysis, every natural science may be reduced to two series of phenomena, connected by law or formula which express the relation of these two series of phenomena to each other; and how the practical problem which the science enables us to solve is this: Given one series of phenomena and the law of relation, to find the other series of phenomena; and that, in this problem lies a test of the soundness of whatever claims to be a natural science, viz. : that it furnishes as a means of prevision or foreseeing and predicting that which is to be observed or discovered; points which I illustrated by a reference to the history and structure of the simplest and most complete of the natural sciences, astronomy or celestial mechanics. Finally, I explained that the two series of phenomena which are the subject of a natural science, must be each capable of independent and indefinite expansion and development as a separate department of natural history; and that no expansion of either must destroy the applicability of the law of relation. I then showed you that in the science of therapeutics or homoeopathy (as it is more familiarly called) the two series of phenomena are respectively the phenomena of the patient on the one hand, and the phenomena produced by the drug upon the healthy, living, human being, on the other hand; while the formula which express the relation between these series of phenomena is the well-known therapeutic law, “Similia similibus curantur,” “Likes are to be treated by likes.”

            I showed in the book that, in our practical application of the science of therapeutics, the constant problem before us is that which is the problem in every natural science, viz.: Given one series of phenomena and the law, to state the other series. Given the phenomena of the patient and the law, to find the phenomena of the drug which bear to the phenomena of the patient the relation expressed by the law. Or if we are studying a drug, and have the phenomena which it produces in the healthy, living, human being, then, having the law, to find the series of phenomena in the sick which, bearing a certain relation to the phenomena of the drug, will be canceled by the latter in the terms of the law. In other words, our constant problem is: Given the symptoms of a case, what drug known to us will accord the law, or what must be the effects of such a drug, not yet known to us, as will cure such a case. Or, conversely: Given the effects of a drug, what case, as yet seen or never yet met with, will that drug cure?

            Such prevision as this homoeopathy has again and again in notable cases enabled us to exercise; and by this test she has justified her claim to be entitled the science of therapeutics.

            After this general view and analysis of the subject, it remains for us to study in detail the elements of which the science is composed, viz.: the two series of phenomena respectively and the law.

            I shall therefore ask your attention now to the first series of phenomena, those of the patient; or briefly to the subject of “Symptoms,” or how to take the case.

            And, here, at the very beginning of the subject, let me say that much unnecessary confusion exists in the minds of our own school, and of our opponents, because we have not agreed upon the meaning we shall attach to the word symptom.

            By the old school and by some homoeopathists who have gone astray after the “strange gods” of the physiological school of medicine, a very restricted meaning is given to the word symptom; and this being done it is made a reproach to homoeopathists that they take note only of symptoms, as though we disregarded some important phenomena presented by the patient. Assuming that homoeopathists understand by symptoms only the subjective phenomena or sensations which the patient experiences and describes, “How, then,” exclaims Prof. Bock, “can they prescribe for a typhoid patient who neither hears, sees, tastes, smells nor feels, and who could not express his sensations if he were conscious of them, but lies in a passive apathy, as indifferent as a long!” Well, the fact that he lies there and cannot express his sensations, if he have any, and that the avenues of communication between his brain and the world about him, his special senses and the general sense namely, are closed, constitutes a most important series of symptoms. For, gentlemen, in accordance with Hahnemann’s instructions, no less than with the common sense of the matter, we include under the term “symptom” every phenomenon presented by the patient which is a deviation from or an addition to, his condition which in average health.

            Whatever we can ourselves observe by careful scrutiny of the patient, bringing to our aid every instrument of observation which the ingenuity of man has contrived; whatever the patient can tell us as the result of his observation of himself or of his sensations; whatever his friends and attendants have noticed concerning his appearance, actions, speech, and condition, physical or mental, which differs from his condition and actions when in health – all these phenomena together constitute what we call the symptoms of the patient.

I conceive that it would be a waste of time to examine the alleged distinction between symptoms and “the disease.” Since we have made the term symptom cover every phenomenon, whether it be felt by the patient, it is manifest that we can know nothing of any disease except by the presence of symptoms; that when the symptoms have all disappeared we cannot know that any disease exists, and that therefore by us, for all practical purposes, the totality of the symptoms must be regarded as equivalent to, and identical with, “the disease.” Let, then, the bugbear of a disease a distinct from the totality of the symptoms never more haunt your path – way in practical medicine.

Hahnemann directs us to acquaint ourselves with every deviation from the patient’s normal, healthy condition which we can observe; to gather from the patient’s friends and attendants; to listen to the patient’s statement of everything of the kind which he has noticed, and of all unusual sensations and pains which he has experienced, and all unusual phenomena of which he has been conscious, whether of body or mind.

You will perceive that here are two classes of phenomena referred to, viz.: such as may be observed by the physician or attendants and friends, and such as are perceived and can be stated only by the patient himself. The former, which may be objects of study and observation by the physician, are called objective symptoms. The latter are the subjects of the patient’s own consciousness, and are styled subjective symptoms. We may notice and study the spasmodic twitching of the facial muscles, the alternate flushings and pallor in a case of facial neuralgia, but the patient alone can make us aware of the sensation which he experiences simultaneously with those twitchings and flushes. In a case of pleurisy we may detect a friction sound denoting dryness or roughness of the pleura, or the dullness denoting effusion; we may observe the deviation from the natural symmetry of the thorax; the labored and hurried breathing, the short, dry cough and the expression of suffering which accompanies it, but the patient alone can tell us that he suffers from a stitch in the side, where it is, what direction it takes, what provokes and aggravates and what relieves it.

The physician and attendants may notice and observe the accelerated yet unsustained pulse, the dulled perceptions and sluggish or perverted intellection, the red, or dry, or cracked and trembling, tongue, the elevated and uniformly fluctuating temperature of body, the tympanitic abdomen, the tenderness about the coecum caput coli and the enlarged spleen which characterize a typhoid fever; but only the patient could have made known to us the failing strength of body, mind and will, the peculiar headache and the desolate sense of illness which, perhaps many days preceding the commencement of the doctor’s attendance, began to take possession of him.

We meet with few cases which do not present throughout their course, or at least in some portion of it, both subjective and objective symptoms. If there be an exception, it is that of some chronic affections, consisting exclusively, so far as our observations enable us to speak, of pains and abnormal sensations. I say so far as our observations enable us to speak, for I can hardly conceive of an abnormal sensation except as coincident with some structural change of tissue, although this be so fine as to elude our present means of research.

On the other hand, we meet cases presenting at first view only objective symptoms, as for example, chronic, cutaneous affections and heterologous formations. And yet I believe that in every such case, if we take a broad enough view of it, including the history of the case, we shall find a tradition of subjective symptoms. However this may be, and whatever may be their relative number, and what comparative importance we may be disposed to attach them, these are the two varieties of symptoms which patients present to us.

Now we may study symptoms under two views, with two different objects: First, we may study the science of symptoms as a branch of medical science, as a department of the science of biology, - much as we study physiology, which is the other department of biology, - without any view to a practical application of the results of our study, without any reference to a proposed application of the therapeutic art, without considering how we shall remove the symptoms by interposing the action of a drug; and Second, we may study symptoms with reference to the practical application of our knowledge in bringing drug action to bear upon the patient’s symptoms.

Let us first consider the study of symptoms as an independent department of science. It is one; let me say, which has not received the attention to which its great importance entitles it.

The patient is before us, the object of our observation and inquiry, just as the healthy human being is before us when we study his constituent tissues and organs and their respective functions in pursuing the sciences of anatomy and physiology. We observe his objective symptoms and learn from him his subjective symptoms.

A fact of prime importance for us to remember at the outset of our inquiry is this; that as in nature there are no accidents, so there can be no symptom which is not directly the result of some immediate cause operating in the organism of the patient; no abnormal appearance or condition of any tissue or organ which does not proceed from a modification of its cell structure, its nutrition, or of the normal proportion of the tissues which compose it; no abnormal sensation experienced by the patient which is not the result of some change, either appreciable in some tissue of the body, or assumed to exist therein, or referred to the indefinite realm of dynamics, the convenient habitat of functional derangement for which we have not as yet discovered any structural substratum.

    

No symptom, then, is to be passed over as unimportant. We know not how important that which now seems trivial may tomorrow be proved to be. This we know, that everything in the human organism, as in the universe, moves and occurs in obedience of nature, we fail of the reverent spirit of the true and faithful student, if we pass over any phenomenon assuming it to be of no account, just because our faculties are so little developed that we cannot see that it has any significance. If it be true, as the Lord of Glory tells us, that of two sparrows which are sold for a farthing not one falls to the ground without our Heavenly Father, that the very hairs of our head are numbered, how can it be that changes of tissue or of excretion or secretion should occur, that abnormal sensations should be experienced save in accordance with some law of organism? The noble sentiment of the Latin poet, “I am a man: Nothing that is human can be alien to me,” is true in a physical no less than in a moral sense.

It is our object to observe everything that is a deviation from the healthy condition. We must then keep up, during our observation, a constant recollection of the condition of organs and tissues, and the performance of function in the healthy subject; and our observation will be a sort of running comparison.

Our object is to note every deviation. We must necessarily follow some method in our investigation; otherwise among such a multitude of objects some would surely escape us. If it be necessary for a dog in hunting to scour a field according to a certain method of line and angles, surely method must be needful when we are beating up this complicated field of the human organism, and that too in search of game which does not start up at our approach.

We may adopt the regional method and survey the whole body, passing from region to region in anatomical order. This is a valuable method and indispensable to a certain extent. It fails, however, to give us sufficient information respecting organs and tissues which, from their situation, are entirely removed from our physical examination or exploration, as, for example, the kidneys and the ovaries. The anatomical method of investigation must be supplemented by what I may call for a moment, somewhat incorrectly, the physiological method. By this we seek to arrive at the condition of that organ. If we find albumen and certain microscopic objects in it, we may be certain that a portion of the kidney has become changed in a very definite way, which, however, we could not otherwise recognize during the life of the patient. The same is true of many other organs.

This knowledge has been obtained by accumulated observations of the symptoms of diseases, and of the results of diseases as noticed after death. But so difficult is the art of observation, and so had is it to obtain from patients all of their subjective symptoms, for the reason that patients have not been trained to the observation of natural phenomena, and are not good observers even of themselves, that we should hardly succeed in getting all the symptoms of a case if we did not add to the regional and physiological another mode of observation. The history of disease has taught us that when certain symptoms are present in some one organ or apparatus of the body, there are almost sure to be present certain other symptoms, objective or subjective, in other organs often anatomically quite remote, and of which the patient probably is hardly aware until his attention is called to them by the physician.

I my cite as examples the fact that certain pains in the head, persistently experienced by the patient, are found, by observation of a great many patients, to co–exist with certain uterine affections, of the existence of which the patient was hardly aware; and the immediate symptoms of which would probably have been overlooked in the recital. Another noteworthy instance, a recent discovery, is the coincidence of a certain morbid condition of the retina with a form of Bright’s disease of the kidney, to which attention may thus be called at an earlier stage than at which kidney symptoms would have discovered it.

To recapitulate, the: we observe the changes in form and structure which are open to our senses, we use whatever methods we posses to discover others; we illuminate the interior of the eye, the rima of the glottis, the canal of the urethra, the meatus of the external ear. We sound the thorax and auscultation; we analyze the secretions and excretions, and reason from the results – through our knowledge of the history of disease – to a conclusion respecting the condition of organs and tissues hidden from our observation. Thus we obtain our complete series of objective phenomena.

We then address ourselves to the task of taking the subjective symptoms of the case. Availing ourselves of the regional method which investigates in topographical order one region of the body after another; the physiological method which traces sensations from one organ to another, and leads us to look for sensations or even objective symptoms in some part of the body because we know them to exist when certain others are present; and, finally, employing our knowledge of the history of disease to trace symptoms, both subjective and objective, from one organ and apparatus to another, we make up our series of subjective phenomena.

Now it may occur to some of you that when I speak of the modifications of tissues and organs found in the patient, and of the necessity of exactly observing and studying them, I am advocating the study of pathological anatomy; and that in showing how a study of the connection of symptoms in the patients may greatly facilitate the discovery of symptoms by showing their mutual connection, dependence and succession, just as the study of physiology enables us to grasp the phenomena of the healthy organism, I am defending the study of pathology. And so I am. For just here we have the province of pathology and pathological anatomy, which are indispensable instruments in the study of symptoms. Let us not be frightened from their legitimate use for the reason that they have been put to a false use.

 

If we disregard these auxiliary sciences, our collections of symptoms must be for us incomplete lists of unmethodized and unarranged observations. How can we imagine that any department of medical science can exist and be pursued which would not be a useful auxiliary to the physician?

Let us turn now from this glance at the independent study of symptoms as a science, to their study as the means to a practical end. As practitioners of medicine, what is our object in collecting and studying symptoms?

If we regard our duties to our patient in the order in which they were stated in my last lecture, that we are to ascertain for him where and what he ails, whether and how soon he can recover, and finally what will cure or help him, we study symptoms, first of all, to form our diagnosis. Viewed with this object, the symptoms we have obtained from the patient at once classify themselves in our minds. Certain symptoms take front rank as indicating the organ which is chiefly affected, and the kind of deviation from a healthy state which exists in it. Such a symptom is called pathognomonic; and is entitled to that epithet if it be found only when a certain diseased condition exists, and always when that condition exists. We cannot pronounce a symptom to be pathognomonic, nor recognize it as such, unless we are acquainted with the history of disease. Then we require to form our prognosis. Here again we must have a knowledge of the history and course of disease, that we may recognize any symptoms which indicate a lesion so extensive that recovery is unusual or impossible. We must know, likewise, the history of disease, as its course is capable of being modified by medical treatment, and by different varieties of medical treatment.

Third: our object in the study of symptoms is to get into position to ascertain what drug shall be applied to cancel the symptoms and effect a cure. This is the practical end.

The homoeopathist obtains his series of symptoms, and then, in accordance with the law, similia similibus, he administers to the patient the drug which has produced in the healthy the most similar series of symptoms.

Now, in speaking of the independent study of symptoms as a science by itself, I have urged the necessity of eliciting all of the symptoms, both objective and subjective, bringing every auxiliary science to aid in the search for symptoms. But when we come to the practical application of the law, similia similibus curantur, when we come to place side by side the two series of symptoms, those of the patient and those of the drug respectively, it is manifest that those of the patient to which we find nothing corresponding in the symptomatology of the drug, are of no use to us in the way of comparison. Practically, then, unless the observation of symptoms as produced by drugs in our proving is developed pari passu with that of symptoms as observed in sickness, there will be much of which practically we can make no use. And you will find this view to explain much that is said in disparagement of the study of pathology and pathological anatomy, and of any aid which they may afford to the practitioner.

The difficulty resides in the present imperfection, respectively, of the sciences of pathology, symptomatology and pathogenesy.

Of the symptoms which we have obtained from our patients, the question of their relative value must occur to you. I have mentioned pathognomonic symptoms and their supreme value as determining the diagnosis. Are they as valuable when we are in search of the right remedy? To answer, let us see what we are doing. We are seeking that drug of which the symptoms are most similar to those of the patient. We may have seen in our lives a hundred cases of pneumonia. Every one of these presented the symptom which is pathognomonic of pneumonia. And yet the totality of the symptoms of each patient was different, in some respects, from that of every other pneumonia patient. And this must necessarily be so, because the diseased condition of each patient is resultant of two factors, the morbific cause, assumed to be the same for all, and the susceptibility or irritability to that cause, which susceptibility may be assumed to be different for each; the resultant must be different for each. We must look, then, for the symptom which shall determine our prescription in some other symptom than the pathognomonic, in some symptom which from the diagnostic point of view is far less important, in some subjective symptoms, or in a condition which individualizes.

Is it essential that the pathognomonic symptom of the case should be present among symptoms of the drug? Theoretically, it certainly is. Practically, in the present rudimentary condition of our provings, it is not. We attain a brilliant success if not a certain one, where it has never been observed; although I think we are bound to assume, and are justified in assuming, that were our provings pushed far enough it would be produced. This subject will come up again hereafter.

Recalling now the practical division made of symptoms into objective and subjective, the question presents itself: Do we, in the practical use of our symptom series, make use of objective symptoms as in the independent study of symptoms? Unquestionably, wherever the character of our provings has made this possible, and indeed wherever clinical observation has supplemented the provings.

In skin diseases, wherever we meet the well-defined, smooth erysipelas of Belladona, or the vesicular erysipelas of Rhus, or the bullae of Euphorbium, or the cracks of Graphites, or the lichen of Clematis, or the intertrigo of Lycopodium, or the hard scabbed ulcers of Mezereum, from the edges of which thick pus exudes on pressure, - do not these symptoms almost determine our selection of these remedies? Or the white tongue of Pulsatilla, the red-tipped, dry tongue of Rhus, the moist trembling tongue of Phosphoric acid, the broad, pale, puffed and tooth-indented tongue of Mercurius solubilis, the yellow coat at the base of the tongue of Mercurius proto iodatus, or the patchy tongue of Taraxcum, - do we not recognize these symptoms as most important indications for these remedies respectively? Shall I further mention the objective symptoms, - sandy grains deposited in the urine, or a red deposit which adheres to vessel, or the various peculiarities of feculent excretion and of sputa, which are well –known and universally admitted indications of certain remedies, or the radial pulse, or the heart rhythm?

It appears, then, that objective symptoms are valuable indications for the remedy, just in proportion as they have been observed in proving drugs, so as to afford a ground of comparison; and just in proportion as the observation has been precise and definite, enabling us to distinguish one case from another, or, as we term it, to individualize the case.

Such is the value of objective symptoms. But our object being to individualize the case, it frequently, indeed generally, happens that the distinctive symptoms are subjective.

How now shall we examine the patient to get his symptoms? Do you say that this is an easy matter? Gentlemen, it is the most difficult part of our duty. To select the remedy after a masterly examination and record of the case is comparatively easy. But to take the case requires great knowledge of human nature, of the history of disease, and, as we shall see, of the materia medica.

We see the patient for the first time. If the case be an acute one, it may be that at a glance and a touch we shall observe certain objective symptoms which, at least, help us to form our diagnosis, and constitute the basis of the picture which leads is to the choice of our remedy.

Further examination reveals other objective symptoms. For others, as well as for subjective symptoms, we must depend on the testimony of the patient and his attendants. We have then to listen to testimony, to elicit more testimony by questioning and cross-questioning the patient and his friends, and to form conclusions from their evidence. We have to weigh evidence, and here we encounter a task which is similar to that of the lawyer in examining a witness, and success in which requires of us obedience to the rules for the collection and estimate of evidence. We must study our witness, the patient; is he of sound understanding? May we depend on his answers being true and rational? He may be naturally stupid or idiotic, he may be insane, he may be delirious under the effect of the present illness. Or, putting out of view these extreme suppositions, is the patient disposed to aid us by communicating freely his observations of himself, or is he inclined to be reticent? You will be surprised at the differences in patients in this regard. Some meet you frankly, conscious that by replying fully, and by stating their case carefully, they are aiding you to help them. Others act as if they have come to an encounter of wits, in which they are determined that their cunning shall baffle his shrewdness. Others again are morbidly desirous of making themselves out very sick, and will unconsciously wrap their statement of their symptoms so as to justify their preconceived notion of their case; and if you question them, however you may frame your question, they will reply as they think will make out the case you seem to apprehend. Others, on the contrary, so dread to give testimony which, they fear, may make it certain that they have some apprehend disease, that they cannot bring themselves to state facts as they are, but twist and misstate them as they fain would have them.

I might pass without mention the case of those who deliberately conceal or deny the existence of symptoms which would betray the presence of diseases of which, with abundant reason, they are ashamed, because, I take it; you will be minded to have no dealings with those who refuse to their physician their unlimited confidence.

There is another class whose statements are plus or minus what exactness would require. Almost all of our descriptive language is figurative. We describe sensations certainly according to our idea of what effect would be produced by certain operations upon our sensory nerves, e.g., burning, boring, piercing. This involves an act of the imagination. We are differently endowed with the imaginative faculty. Some persons cannot clothe a sensation in figurative language, and are therefore almost unable to describe their subjective symptoms, and are very difficult patients. Others, again, naturally express themselves in this wise, and, where imagination is controlled by good judgment, are excellent patients, because they describe their symptoms well. This is a matter dependent upon natural endowment, and not upon education or culture. Some persons who cannot construct a sentence grammatically will give us most graphic statements of symptoms; while others who have borne off the honours of a university are utterly at a loss for the means to express what they feel.

Finally, some persons have a natural fervor and tropical luxuriance of expression, which leads them to intensify their statements and exaggerate their sensations. And some, like the Pharisee who believed he should be heard for his much speaking, think to attract our attention, and excite us to greater effort in their behalf, if they magnify their sufferings and tell us a pitiful tale. Others, on the contrary, of a more frigid temperament, give us a statement unduly meager in its Artic barrenness; or else, fearing to seem unmanly if they complain with emphasis of suffering which is perhaps the lot of all men, understate their case and belittle their symptoms.

In estimating your patients in these regards, judging while the tale is being told what manner of man you have to deal with, what allowances you must make, what additions, what corrections, you will have full scope for your utmost sagacity and savoir faire; and of the value of this estimate of your patient I cannot speak too highly. I have often seen the thoroughly scientific man led astray and bamboozled, where one far inferior to him in scientific knowledge detected the peculiarities of the patient, made the necessary corrections, got an accurate view of the case, and then the prescription was easy. Why, sometimes the patient will, in good faith, state a symptom so incompatible with others that we know and must declare it impossible, and so it is finally admitted to be by the patient.

If it be necessary to make this estimate of the patient, so must we likewise of his friends, who, besides having the peculiarities already spoken of, may be unfriendly to us or to our mode of treatment, and may thus be reticent or reluctant witnesses, or may even mislead us willfully.

We make this estimate of our patient and his friends while he and they are stating the case to us; and this statement we should as far as possible allow them to make in their own way, and in their own order and language, carefully avoiding interruption, unless they wander too far from the point.

We must avoid interrupting them by questions, by doubts, or even by signs of too ready comprehension of what they are telling us. It will of course happen that they skip over important details, that they incompletely describe points that we need to understand fully. But we should note these as subjects for the future questions, and forbear breaking in upon the train of our patient’s thoughts, lest once broken he may not be able to reconstruct it. When he has finished, we may, by careful questioning, lead him to supply the deficiencies. We must avoid leading questions, and at the same time must not be so abstract and bald that for lack of an inkling of our meaning, the patient becomes discouraged, and despairs of satisfying us. It is never our object, as it may be that of the lawyer, to show our own cleverness at the patient’s expenses, and to bamboozle him. We must, on the other hand, make him feel, as soon and as completely as possible, that we are his best friend, standing there to aid him in so reviewing his case that we may apply the cure. And so we must encourage his diffidence, turn the flank of his reticence, lend imagination to his matter – of – fact mind, or curb the flights of his fancy, as may be required.

We want a statement of the case in graphic, figurative language, not in the abstract terms of science. It does not help us to hear that the patient has a congestive or an inflammatory pain (however correct these conception may be); but a burning or a bursting pain in available. Nor does it specially enlighten us to know that the patient feels now just as he did in last year’s attack, unless indeed we attended him then.

Having received the patient’s statement and made our own observations, we have a picture of the case, more or less complete. What are we to do with it? What is the next step? We have now one series of phenomena. The law tells us that the drug which will cure that patient must be capable of producing in the healthy a similar series of phenomena.

Seeking the means to cure the patient then, we look among drug provings for a similar series of phenomena. Let us suppose that we find one which corresponds pretty well. Not exactly, however, for here are certain symptoms characteristic of that drug, of which the patient has not complained. We examine the patient as regards those symptoms. No! his symptom in that line are quite different. We try another similar drug, comparing and trying proceed until we find a fit. This is a mental process, so expeditious sometimes that we are hardly aware how extensively we engaged in it. But it shows how difficult it is to take a case unless we have some knowledge of the materia medica, and how much an extensive knowledge of materia medica aids us in taking the case; and this explains why the masters in our art have given us such model cases. ( In consultations, a doctor will send his taking of the case. We cannot prescribe from it. We must take the case ourselves.)  In thus fitting the case and the remedy be honest with yourselves, just as in getting shoes for your children. Do no wrap or squeeze to make of it a fit.

And now, before we go further, let us ask what the symptoms are generally which give the case its individual character, and determine our choice of the remedy. Are they the pathognomonic once? They cannot be unless we are to treat every case of disease named by a common name with one and the same remedy. Are they those which are nosologically characteristic? No, for the same reason. They are the trifling symptoms, arising probably from the peculiarity of the individual patient, which make the case different from that of the patient’s neighbor. They may be a sensation or a condition. If it be metrorrhagia, the mere fact that the flow is worse at night may determine the choice between two such remedies as Calcarea and Magnesia.        

The Repetition Of The Remedy – R. Gibson Miller

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The Repetition of the Remedy

By R. Gibson Miller, M.D., Glasgow, Scotland

“As homoeopath we properly give our chief consideration to the selection of the correct remedy for the cure of any individual case of disease. But however accurately we may select the remedy; it will prove of little value unless properly administered. It is a safe statement to make, that more cases are spoiled by improper repetition of the remedy than through any other cause and the purpose of this short paper is to restate the rules that must guide us and to elicit the views of the members of this congress on this important subject.”
Much as all those who accept the master law of Similia Similibus Curantur differ with regard to sub laws, yet there is almost complete unanimity with regard to the following, viz:- that whenever the remedy has produced a positive effect, no repetition is permissible until that action has spent itself.
Two theories have been put forward to explain the action of remedies in a Homoeopathic cure, viz:- (a) Hahnemann’s: that the remedy excites a contrary but stronger disease than natural one, so extinguishing the latter, and (b) the more modern theory: that the remedy causes a reaction on the part of Nature, which reaction is the true cause of cure. But let the theoretical explanation be what it may, the fact remains, that in some way or other the remedy restores the equilibrium of the bodily forces.
In our endeavors to restore the equilibrium, great care must be exercised that we do not overdo things and add unnecessarily to the sufferings of the patient.
It is true that this overreaction in many cases does small harm, beyond retarding somewhat the recovery of the patient; but in more critical cases improper repetition may make all the difference between life and death. That this is true will be borne out by all who have had any lengthened experience in homoeopathic prescribing, when they recall cases where, through errors in judgment and above all through excessive zeal, in their anxiety to hasten the cure they have by too hasty repetition turned back the flowing tide, and converted what seemed certain victory into disaster.
To turn to the practical application of this law we find, as is the case with most natural laws, that here also, while the theory is simple, the application is at times exceedingly difficult. In the first place we shall, I think, find it convenient to look at the question of repetition from two aspects, viz:- the primary and the secondary, each of which requires different consideration.
After a remedy has been exhibited in any case, be it an acute or a chronic one, we have always, when considering its effects, to ask ourselves three questions.
(1) Have we selected the proper remedy?
(2) Have we chosen the proper potency?
(3) How long a period must be allowed for the manifestation of a positive action?
This paper has nothing to do with the first and will only allude later to the second, and at this stage we shall consider only the last.
Elements To Be Considered
It is obvious that the duration of this period will vary within very wide limits, according to whether we are dealing with acute, subacute or chronic diseases, and also that many other factors must be taken into consideration in determining the time that we may reasonably allow for the manifestation of this action.
In many ordinary acute diseases, the period that is required for a positive action to show itself will, as a rule, be of short duration; sometimes the action is almost instantaneous, and the improvement, as experienced by the patient and observable by the physician, is so sharply defined that in this class of cases there will be little difficulty in deciding when to stop the remedy.
But even in acute disease we cannot always expect the positive action to show itself in this prompt manner. For such diseases differ largely, in regard to intensity of suffering, in plane of action and also in what may be called their normal duration.
Patients also vary greatly in their responsiveness to remedies- some being over- sensitive, and promptly and involuntarily proving every remedy they receive, whilst in others the reaction is very slow. We must accordingly vary our tactics in each class, though it must be confessed that in dealing with a case for the first time it is not easy to determine how to classify the patient. A very similar condition of affairs is observable with regard to the causation of acute disease. Of two persons exposed- say to a cold wind- at the same time and under exactly similar conditions, one will invariably sicken within a few hours while his companion may feel nothing wrong for forty- eight hours.
The rapidity of response to the remedy will not infrequently be found to be very much diminished in cases that have been long drugged allopathically, and in many such cases it is necessary to repeat the remedy frequently before a positive action can be obtained.
Even in such cases we must not assume that, because the case has been extensively drugged, the ability to respond to the remedy promptly has necessarily been diminished, for experience demonstrates that in many such cases the positive action shows itself after the normal interval. A probable explanation of this difference in rapidity of response in such drugged cases is that when the abused drug has borne little resemblance to the patient in disorder and consequently had no power deeply to influence the same, the medicinal load being removed, the elasticity of the individual enabled the disorder to resume its ordinary course and the patient to react normally to the similimum.
When the abused drug has borne a more or less close resemblance to the true similimum, and has, as a consequence, been able considerably to distort the true image of the disease, then the response to the proper remedy will naturally be slower. A glaring example of this is found in old syphilitic cases where Mercury and Iodide of Potash had been used for long periods. Such cases are often very slow in responding to the similimum, so much so, that many claim that it is not possible, by homoeopathic remedies, to cure them. This view, I am convinced, is erroneous, and all that is required is the patient use of the correct remedy, until a response is obtained, though at times it is necessary, first of all, to antidote the drugging before the true symptoms can show themselves and so lead to the selection of the similimum.
Closely akin to these cases are those which have been treated by inappropriate, somewhat similar, potentized remedies until the entire case is so confused, and the sensitiveness of the patient to remedies so blunted, that it is not possible at first to obtain any prompt response.
Another factor of importance in this connection is the Sphere of action of the disease and the selected remedy. When we are able to select the similimum or a near simile, then the rapidity of response will, as a rule, be normal. But if it is possible only to select a remedy whose sphere of action very partially coincides with that of the disease, the positive action will not be induced so easily.
The pace of the disease also profoundly influences the rapidity with which the primary response manifests itself. In very violent diseases with severe suffering – such as neuralgia – the positive action will, as a rule, manifest itself very quickly for from the very nature and pace of such a disease we expect suddenness of onset and comparative briefness of duration. In such cases a single dose may be all that is needed, though of course it is at times necessary to repeat the remedy frequently.
Acute Cases
In the ordinary run of acute cases, where the pace is slower and the suffering much less acute, it will as a rule be found necessary to repeat the dose several times before reaction occurs. Still more manifest is this in cases of continued fever. Here the entire course of the disease is slower. There is usually a prodrome, during which marked changes indiscernible by the patient or physician are taking place; and even when the onset is abrupt, the disturbance of the economy that has preceded it has in reality been very profound. In such cases it is not reasonable to expect that one dose or a few doses will be sufficient to produce a reaction, and it is necessary, in the vast majority of such cases, to repeat the remedy every few hours for at least two or three days, before a positive reaction is manifest. While this holds true in most of the cases of continuous fever, yet if the vitality of the patient is very low, it is often dangerous to repeat frequently, for the reaction induced by a series of doses, rapidly following one another, may be too violent for the strength of the patient to withstand.
Improper habits of life, or unsuitable hygienic surroundings, always interfere more or less with the production of the positive reaction, and may at times absolutely prevent it. We do not always know or fully appreciate the circumstances and habits of our patients. Doubtless at times, upon observing no effect, after giving the number of doses that as a rule would be sufficient to induce a reaction, we have all decided that the remedy selected for the individual case under consideration was not truly indicated, whereas our mistake lay in not realizing what a load of resistance was required to be overcome. In such circumstances, even when reaction is induced it is apt to be so imperfect and short lasting that very frequent repetition is absolutely necessary.
Patients nowadays habitually make use of so many cosmetics, perfumes etc. – to say nothing of tobacco and alcohol – that at times it is almost impossible to induce reaction. It is true that frequently the potencies, especially the higher ones, will act in spite of these substances even when they are distinctly antidotal to the drugs in the crude form. For example, who has not seen one or two doses of high Phosphorus or Sepia act promptly and after the normal interval when given to excessive smokers? There are many cases where no action can be obtained, unless by frequent repetition, and it is to be feared that often, in our ignorance of such counteracting forces, we muddle along with most unsatisfactory results, and after a time conclude either that the law has failed or, if humble-minded enough, that the failure has been ours in selecting the improper remedy. Then, turning to some other and unsuitable remedy we make confusion worse confounded.
Much of the foregoing has had relation to the amount of repetition that is necessary to induce a primary positive reaction in acute or subacute cases. In such, mistakes are as a rule discerned and corrected with comparative ease. But when we turn to the truly chronic diseases (and this term I use in the Hahnemannian sense of the chronic miasmatic diseases); the problem is much more difficult. In such chronic diseases a considerable time must naturally elapse between the exhibition of the remedy and appearance of reaction. Here again we have to decide in each case how many doses must be given, and how long we must reasonably wait for reaction. So far as I know, no law governing this phase has yet been formulated – though law there must be.
In these circumstances we can only turn to the accumulated experience of the masters in Homoeopathics and learn what they have to teach us until the law is discovered. The consensus of their opinions is that in chronic cases of people of ordinary constitution, the best procedure is to give a single dose and then wait at least ten or fifteen days, before concluding that one dose is insufficient to produce a positive effect.
In many long standing, chronic cases, where the suffering is not very acute, it may be necessary to wait three weeks or more. It is in such cases we are apt to go wrong in our over eagerness to cure. We do not realize that, once reaction has begun, any interference will likely bring it to a stop – for action and reaction are contrary and opposite.
While the foregoing is the best routine procedure, it must ever be borne in mind that there are patients of less sensitive nature, and that with such it is necessary to give repeated doses before a primary reaction can be induced.
I am well aware that some teachers claim that even in ordinary chronic cases it is necessary to give very frequent doses in order to obtain an action, but the experience of the masters absolutely traverses this view. It is well to keep in mind the fact that it is possible, by repeated doses, of even the highest potency, to suppress symptoms for a time without truly curing the disease.
While in acute cases it is true that almost any potency at all removed from the crude substance will, in the majority of cases, prove curative if properly indicated, yet I have no hesitation in stating that the medium and high potencies act much better in such cases, and induce a positive action much more quickly than do the lower potencies. Accordingly, while in acute cases the exact potency is not, as a rule, a matter of vital importance; it is very different when we come to do deal with chronic disorders.
In chronic cases, the almost unanimous experience of those who use the medium and higher potencies is that such potencies induce, as a rule, not only a much quicker positive reaction, but also as infinitely deeper and more lasting one, with the result that it is not necessary to wait so long for the reaction as when using the lower ones. As I have already stated, we know only in a very imperfect manner the laws that govern such phases, and most of us have learned from bitter experience that the foregoing does not always hold true, and that, at times, little or no positive action can be obtained, at least at first, from the higher or medium potencies, and only the lower or lowest bring response.
Chronic Cases
In chronic cases, how can we know that the desired positive reaction is taking place? As a rule, the earliest indication is the appearance of the homoeopathic aggravation. This is at times of such severity that the patient believes himself to be poisoned; is at other times slight; not infrequently, entirely absent. This last is doubtless the ideal, if only we could always attain thereunto. But to attain it habitually implies a profound knowledge which experience alone can confer, both of remedial and of disease forces, so as to render it possible to adjust things so nicely that equilibrium is established.
Apart from the homoeopathic aggravation, I take it that the most important indication that reaction is taking place is the general feeling of the patient. If he declares he is again experiencing the return of that indefinable feeling of well- being and comfort that is the very antithesis of disease, we may safely conclude that the medicine is acting. So unmistakable is this indication that even if the patient paradoxically declares that though his headache or backache is unchanged, or even worse than formerly, yet he feels better in himself, then we know with absolute assurance that reaction is taking place and no more medicine is required in the meantime.
Secondary Repetition
Let us now consider what I called the secondary repetition. We will take for granted that, as the result of either a single dose or repeated doses, an improvement has been brought about. It is agreed by all that such reaction must be allowed to exhaust itself – for no remedy can be homoeopathic to reaction. Consequently, so long as the patient continues to improve, even though slowly, we can only wait until it is evident that reaction has come to an end. If after the remedy the patient steadily improves and the symptoms change in an orderly manner – even new symptoms appear, but finally the symptoms go back to their original state, yet are not marked enough to cause any special suffering – then we must wait, even for months. If no other symptoms appear we can only give another dose of the same remedy. If the symptoms first prescribed for now return unchanged, and there is otherwise no alteration in the case, then all that is necessary is to repeat the medicine, and as a rule, in the same potency. In acute or subacute cases this procedure is all that is necessary. In chronic cases, after several doses at long intervals have acted well, it will usually be found that the action becomes much more feeble, and, if the same remedy is called for, it must be given in a different potency.
Experience demonstrates that generally in chronic cases when a change of potency is necessary, it is better to give a higher one – though at times a lower one will work, and work well.
When several doses, given at long intervals, have acted well and the range of available potencies is small, we may, instead of changing the potency, give a series of rapidly repeated doses of the same potency, which will often induce deeper and stronger action than a single dose has done.
In many chronic cases, where it would at first be decidedly dangerous to give more than a single dose of one of the higher potencies, it will be found that after a number of such single doses at long intervals, it becomes quite safe, and often advantageous, to give a series of rapidly repeated doses.
Very frequently the problem of secondary repetition is not so simple. It is by no means uncommon to have the improvement in chronic cases interrupted by short secondary aggravations, and before repeating it is necessary to make sure that the recrudescence is truly permanent and not simply temporary.
Apart from such minor difficulties it is not always easy, in chronic cases, to determine whether real improvement continues to take place or not.
Owing to the complex nature of miasms, and at times to the presence of more than one, to say nothing of the distortion they have usually undergone through previous inappropriate treatment, the progress of cure is often apparently very erratic, so that the patient deems himself worse when improvement has truly set in and is continuing. In such a state of affairs, however disturbing it may be to the patient, so long as the symptoms progress from within outwards, in the reverse order of their original appearance and from above downwards, we may rest absolutely assured that there is as yet no call for any repetition.
In incurable cases the same law holds true, viz:- that so long as reaction is occurring no medicine may be given. It is to be noted that is such cases, however accurately the remedy may correspond to the symptoms, its force is soon exhausted and frequent repetition is necessary. In this class of cases the symptoms tend to change with much rapidity, and consequently no one remedy accurately corresponds for any length of time.
In diseases that are characterized by periodic attacks of sufferings, it is often difficult to know when to repeat. In many such cases the patient feels absolutely well during the intervening period, and it is only when the paroxysm appears that it is possible to judge what progress is being made.
So long as such attacks come at longer intervals or the attacks are less severe, it is best to assume that the deeply – acting remedy is working curatively and that there is, so far, no need for repetition.
If it is evident that the action of the last given dose is exhausted, the proper time to repeat is after the periodic attack is past. To give another dose of the deep acting remedy immediately before or during the acute phase would in all probability cause an unnecessary aggravation. If, however, the suffering is so severe as to necessitate interference, there can be no objection to exhibition of the appropriate short – acting remedy.
I have purposely spoken at greater length with reference to the primary than to the secondary repetition. The latter has had much attention paid to it, and there is a more general agreement with regard to the proper procedure, between the different sections of our school, than there is in connection with the former.

Different Ways of Finding The Remedy - M.L.Tyler, M.D.

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Finding the remedy in Homeopathy is a troublesome job. Following is an article by Dr M. L. Tyler on the very same topic. 

Different Ways Of Finding The Remedy

 

                                  By- M.L. Tyler, M.D.

In Homeopathy, the REMEDY is the thing. Potencies, administration – the questions that divide us- are matters of personal experience.

Brilliant work has been done by people of widely different range of potencies and administration, provided that they had found the remedy. Without that the magic refuses to work.

We are here to consider DIFFERENT WAYS OF FINDING THE REMEDY, because the essential thing, for a homoeopathic prescription ( and on this we all are agreed), is A LIKE REMEDY FOR A LIKE ABNORMAL CONDITION. But in order to get the “like” remedy, one must get accurately the disease picture that has to be matched. And perhaps the most difficult thing of all is taking the case.

Somebody said the other day, “If the case is well taken, any fool can find the remedy.”

Certainly, if the case is not well taken, it is impossible to find it.

Pathological case taking will not help. Symptoms that go to make up the diagnosis, we must have, but they will seldom lead to the curative drug.

This may point to a group of remedies, useful in such a disease. They will not pick out the ONE REMEDY demanded by the symptoms of THIS patient.

Dr. Drysdale laid it down that, “Te greater the value of a symptom for diagnosis, the less its value in the selection of the remedy.”

That does not mean that we must not or need not diagnose! We must! – if only to discount symptoms common to the disease, and not peculiar to this patient with the disease; or symptoms dependent on disease ultimates, mechanical perhaps and not expressive of the patient. Also for prognosis; and for information as to what range of potencies it is wise to employ.

Again, in sheer self-defense. Failure to diagnose may wreck the physician, while “Diagnosis, without the remedy, is poor consolation for the patient.”…. “These ought ye to have done and not to have left the other undone.”

As a matter of fact, homoeopathic case taking, is merely a big addition to ordinary case taking, it never supersedes it. Just as homoeopathic material medica is a huge addition to the material medica of the schools.

The homeopathic doctor is all that the others are- and the MORE.

First, then, briefly to consider taking the case.

It is all Hahnemann. But, instead of quoting. I will try to cut it down.

Begin by writing down the patient’s statement in the patient’s own words.

Why? To avoid errors and misconceptions, but especially for purposes of comparisons.

The material medica consists of the statements of simple people, in simple language. They match.

This has been a reproach to homeopathy. Its facts are not recorded in the scientific terms of our day.

And yet it is just this simplicity of truth that has saved homoeopathy and made it available for all times and for all peoples. Had it been done into the scientific jargon of a hundred years ago, it would be long obsolete.

The science of one generation is often the nonsense of the next. And conversely in this instance. For what , in homoeopathy, has been decried as nonsense for a century, is now being recognized as the latest word in science.

TRUTH IS GREAT AND HAS A WAY OF PREVAILING – IN THE LONG RUN

You have recorded the patient’s story. Now you start on the quest of the “strange, rare and peculiar.” That is to say, you take him through it again and make him amplify and qualify his statements.

By this means you may stumble upon one or two invaluable symptoms, peculiar to himself and not merely diagnostic of the disease.

The fact that he is breathless-in asthma – will not go far. It is part of the programme and common to all asthmatics.

But the fact that he can only breathe when lying on flats or in the knee- elbow position, may be peculiar to THIS case and highly diagnostic of one or of two or three remedies. You will underline that.

If you are so skillful or lucky, as to get two or three invaluable symptoms, your work may end here. For turning up the drugs that have caused these symptoms, you may find in one of them, a complete picture of the patient’s case, disease and all.

This seems to have been a common method of finding the remedy with Dr. Erastus Case and it led him to brilliant results with many rare remedies that would not “work out” by more tedious repertory methods. His little book is well worth study – stuffed full, as it is, with instructive cases.

Next, you try to extract anything definite and well marked in the general symptoms of the patient: his ( especially) altered reactions to environment, mental and physical. The effect on him of temperature, humidity, thunder, foods, light, noise, smells; his cravings and aversions, with delicate probing for mental symptoms, especially where these denote change from his normal.

You may get help from nurse, from friends or relations ( who will often lie, by the way, if the patient is present). And all the time you are using your own observation to check, to confirm and the things that you are not told.

Dr. Burnett used to say, “With children, lunatics and liars, you have to use your own observation.” He seemed to imply that this was pretty well always.

For there are the persons who “pile it on” – hypochondriacs – or in hysteria. And the person who conceal; from shyness, from shame; and invariably what is most important.

Remember “leading questions evoke misleading answers”

Make the patient consider. Never ask a question that can be answered by yes or no. Only record what is considered and definite.

In our earlier days we ask a good many questions and we write down a great deal. Later on we ask many more questions and record much less.

In complicated and chronic cases get the patient’s PAST HISTORY. He may not remember it the first time; for example that eruption when a small boy. He will tell you more after thinking things over and asking people who know.

FAMILY HISTORY is often of the greatest importance.

And what about VACCINATIONS? – frequent – perhaps unsuccessful. We will go into that later, with Dr. Burnett’s work.

SMALL- POX is one of the things that may hit you in the eye. It has branded its victim.

And with variolinum you can amazingly improve the health, physical and even mental, of persons who have had small pox. One has seen case, after case where the facial deformity has yielded to what would seem as impossible extent: and that after 40 years! The skin smoothing out and resuming normal coloring after a few doses at long intervals of Variolinum 200.

But, may this not be the case with other acute diseases and their viruses?

Then old malaria or quinine. Here, again, Burnett comes in with his brilliant little monograph, which made the case for Natrum Muriaticum.

Look out for T.B. manifestations, scars in neck, T.B. family history. Here you have a legitimate short cut to such drugs as Tuberculinum or Drosera, which raise resistance to tubercle, besides a group of the polychrests, Phosphorus, Psorinum, Calcarea etc., according to symptoms.

Then Hanhnemann’s Chronic miasms – psora, syphilis, gonorrhoea.

If these are not prescribed for, especially in chronic disease, you will not permanently benefit your patient – so Hahnemann says and such is our experience.

You may cover the superficial drug-picture, but you will have to go, ultimately, for the deep disturbing cause before you can get maximum results. This, as I will show you, is Hahnemann.

Prolonged dosing with any drug will give you that drug’s disease-picture muddled up with the patient’s own symptoms; or it may be the whole case.

The same drug in high potency can antidote itself in crude preparation. But any drug, of course, having the same symptoms, will antidote.

It is always a question of matching symptoms.

Among drug-symptoms, many arise from toothpastes, douches, gargles etc.

A septic tooth may be poisoning the patient. But what about a septic pessary? – Foul, very often and indescribably offensive.

And now THE CASE HAS BEEN TAKEN.

The patient’s story has been recorded and the common symptoms with which it abounds, qualified and out of these (Unless otherwise, for prescribing) some things “strange, rare and peculiar” have been culled – and underlined.

Mental symptoms, most precious of all, if marked and true, have been angled for, and, where definite and reliable, recorded.

Where these deviate from the patient’s normal, they are of the highest importance. They may be used as eliminating symptoms, to throw out drugs by the dozen, in whose pathogenesis they do not appear.

And now we have the patient’s disease-picture complete; i.e., his deviation from his normal. How are we to find the remedy?

How did Hahnemann solve the problem?

Hahnemann and his immediate followers had great advantages over us.

They had fewer remedies to choose from.

They knew them better and could recognize them more easily in their patients.

For years, for half a lifetime, they had been “proving” drug after drug and suffering its effects in their own minds and bodies. Naturally, they had less difficulty in recognizing a personally-experiencing drug-picture in a patient. It had been branded on their memories by suffering.

Every personal suffering makes the doctor better able to recognize, sympathize with and help suffering in another. The greatest ability to help is achieved ever at the greatest cost.

No great work has ever been done without great effort and great self-sacrifice. Homeopathy is no art for the lazy and the dullard.

But our immensely wider range of medicines is compensated by fuller repertories. And the problem is how to use them to best effect.

And here the amount of time and labor involved in finding the remedy by means of the repertory may be immensely lightened if we realize the GRADING OF SYMPTOMS; that is, their relative value. This is the key.

Even in laboriously “working out” a case by aid of the repertory, the three hours dreary plodding- with often doubtful results – of the uninitiated, resolves itself into ten or fifteen minutes work for the practiced physician.

Or, where he knows his remedies, and has gained experience and confidence, it is often no matter of working out at all. He may spot the remedy at a glance and a few questions prove that he has got it. Typical Sulphur, Calcarea, Sepia patients can hardly be missed. This makes heavy out-patient work possible.

Hahnemann speaks- and we are apt to talk glibly of the TOTALITY OF THE SYMPTOMS. What do we mean by this?

Does it mean that every little symptom and every symptom dependent on some gross pathological lesion has to be covered? Endless work, with poor results.

You do not recognize your friends by counting up their fingers and toes, but by things personal to themselves only of all mankind.

Their totality, as it appeals to you, lies in sex, statue, coloring, voice, expression and mind; not in what is common to men, but in what differentiates.

In the same way a drug picture, to be complete, does not consist of strings of little symptoms but of broad outlines of mental and peculiar symptoms; peculiar, that is, to one drug and distinguishing it from all others.

As Hahnemann puts it, “The symptoms which determine he choice of the remedy are mostly peculiar to that remedy, and of marked similitude to those of the disease.”

Hosts of symptoms are common to a thousand drugs and therefore diagnostic of none. If you give undue prominence to these, you might as well toss for the remedy.

“Each medicine differs in effect from all others”. It is the differences, not the correspondences that concern us.

Hahnemann says of indefinite symptoms, loss of appetite, of sleep, weakness etc., that they are useless, as “common to every drug and to almost every disease.”

Hahnemann says, “In comparing the disease-symptoms with lists of symptoms of proved drugs, the more prominent and peculiar (characteristic) features of the case are specially an almost exclusively to be taken. These should bear the closest similitude to the symptoms of the desired medicine, if patient is to cure.”

And again, “The state of the patient’s mind and temperament is often of the most decisive importance in the selection of the remedy.”

And again, Hahnemann speaks of “the totality of the characteristic symptom”

Let us realize then, that the TOTALITY means the CHARCTERISTIC TOTALITY and cease counting fingers and toes.

KENT was one of those who went back to Hahnemann and great work. Here is what Kent wrote to me in 1912: “The methods you use are hard and arduous and differ decidedly from mine. You do an enormously greater amount of work than I do in my cases.”

“When looking over a list of symptoms, first discover 3,4,5 or 6 as many symptoms as exist that are ‘strange, rare and peculiar’.”

“These are the highest generals, because ‘strange, rare and peculiar’ must apply to the patient himself.”

“When you have settled on 3 or 4 or 6 remedies that have those first generals, then find out which of them is most like the rest of the patient’s symptoms, common and particular.”

“When you have taken a case on paper you must settle the symptoms that CANNOT be omitted, in each individual.”

“Do not expect a remedy that has 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.”

“Get the strong, strange, peculiar symptoms and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT.”

“If you see the keynotes of Arsenicum see that the patient is chilly, fearful, restless, weak and pale must have the pictures on the wall hung straight – and ARSENICUM  will cure.”

“Or the keynotes look like Pulsatilla. See to it that she is NOT chilly, likes windows open , wants cool air, to walk in open air, is better from motion, thirstless, tearful and gentle.”

“The trouble with keynotes is that they are abused. They are often characteristic symptoms. But if keynotes are taken as final and the generals do not conform, and then will come the failures.”

Among ways of finding the remedy is the elaborate repertory way, which yields excellent results in the majority of cases.

By working through the case on mental and general symptoms, with due regard to their relative importance one gets the remedy, provided it shall have been: (a) well proved; (b) well represented in the repertory, which is the case with a very large but, of course, limited number of drugs.

It means labor, but less and less as one gains experience. It means grit.

But, unless you are careful not to take such symptoms too easily, it will lead you every time to well proved drugs, well represented in the repertory – “polychrests.”

But what about the valuable remedies, one half-proved, and even so, inadequately represented in the repertory?

You may need one or other of these only once in half dozen years, but when you do need it, nothing will take its place.

Accidental poisoning has supplied the data regarding some of these drugs. Or again, serpent bites or insect stings.

They may appear in only one rubric in the whole repertory – but there in black type.

Take heed to any rare, black type remedy that has the salient symptoms of a patient. Go straight to material medica and see whether it dose not perhaps fit the case through and through. A remedy so learnt is never forgotten. You have one more arrow in your quiver to speed at suffering and disease.

Here is an instance. A case of melancholia, with an insane fear of insanity. Pulsatilla  more or less came through, as did Ignatia, but she got steadily worse. She was smile less, sat apart, neglected everything, could neither eat nor sleep, lost color and flesh, thought of nothing but her TERROR.

Mancinella covered the case and quickly cured. Mancinella does not appear more than a couple of times in the repertory, but it stands in black type for her one overwhelming mental symptom- fear of insanity.

She got two or three doses only, at long intervals for slight threatening of relapse that melted away, since when she has been well for a dozen years.

Latrodectus mactans for angina pectoris is another such ill-proved, ill-represented remedy Black type in the one rubric, “Pain, heart, extending down left arm,” should send you straight to material medica to find the most perfect picture of that terrible condition. And it works.

Many drugs can be got only by reading and studying their genus.

One of the veterans used to lay down his own law. “Read a drug a day, and two on Sundays.”

But mark or underline, as you read, the strong, rare and characteristic symptoms of each drug. You can afterwards easily run through your markings and get a drug-picture that will stick to you.

In reading any drug note also:

Its LOCAL actions.

The TISSUES and ORGANS it especially affects. ( Burnett, following Rademacher, made great use of organ remedies, as well as the polychrests).

Also, its peculiar sensations, mental and physical. In Clarke’s Dictionary special stress is laid on these, in the remark’s that preface every drug.

Nash’s LEADERS, Allen’s KEYNOTES, Boger’s SYNPOSIS, are all based on drug characteristics, and these books are immensely helpful.

If you have Allen’s Cyclopedia you can do happy and useful reading even here, provided that you can through his black type symptoms, and his symptoms in italics. You get an extraordinary insight into remedies this way. And even in the ordinary type you may find strange symptoms; underline them.

Where in a case there is a strongly marked mental symptom which you feel must be matched. You may lighten your work by using that as an eliminating symptom. And , in going through the rubrics of the other symptoms, record only those that have this mental symptom.

In the many cases where you have to work solidly through the marked symptoms of the patient, from mentals to generals, in their order of importance, you may, in my experience, lighten your labor thus:-

Remembering that general symptoms, reactions to temperature and weather, to foods, to environment generally, must be very definitely marked in the patient to be used at all, and that, if so marked and definite, they should correspond in importance of type with the drugs in their rubrics.

Therefore, in strong, general symptoms, it is generally enough to write down only the drugs in black type and italics. And this is really, even in long rubrics, not such a terrible task.

There is a limit to the amount of work one can put into a case.

And, as a matter of fact, the more you put in, in a heavy mechanical, painstaking way, the more you are likely to be landed with a big choice of remedies, and the less likely you are to find the one. Homeopathy has to be mixed with brains.

But Hahnemann discovered, as well all discover sooner or later, that there are cases where the most careful symptom covering does not carry us through. Patient improves again and again, but health is not re-established.

In a simple pneumonia you cover the symptoms and abort the case; or, if it is more advanced, you carry it through with a minimum of distress, to early resolution.

Whereas other cases, even of such an acute disease as pneumonia, hang fire. Why is this? Does not our experience teach us that there are patients that cannot throw off even a pneumonia without one of Hahnemann’s “Antipsorics” – Sulphur, Lycopodium, Calcarea – or where there is a T.B. history Tuberculinum.

Much more is the case with chronic disease; that is to say, with those who, year in year out, are ailing; who improve only to slip back.

Hahnemann got to work on this problem, and evolved from it his CHRONIC DISEASES.

I doubt if any of us pay enough attention to this part of hahnemann’s work and teaching. We are apt to be more than content when the miracle works in simple cases, and to classify the rest as old chronics, as if thereby all has been said.

Not so with the wise old healer. He had not been content with old school medicine. He was not content with homoeopathy if in some cases, it failed to completely restore patient.

“For years he had been employed, day and night to discover why such homeopathic remedies as were then known did not effect a true cure of certain chronic miasmatic diseases.”

 He says, “All chronic miasmatic diseases are so inveterate, after they have become developed in the system, that unless thoroughly cured by art, they continue to increase in intensity till death. They never disappear of themselves, are never diminished, much less conquered by vigorous constitution, regular mode of life, strictest diet.”

“All chronic diseases” he says, “are based upon fixed chronic miasms, which enable their parasitical ramifications to spread through the human organism and to grow without end”.

“The chronic miasm are semi-vital, morbid miasms of a parasitical nature.”

And he says that, in his opinion, “miasmatic infection, in acute as well as in chronic disease, takes place in a moment, provided the moment is favourable to the contagious influences.”

For “Miasms” read “Micro-organisms” and see how Hahnemann was on the spot 100 years ago, (“The Chronic Diseases” was published in 1828).

Hahnemann realized, then, that there are life-long conditions following some acute disease of long ago, even of centuries ago, that may have to be taken account in prescribing.

He worked on three of these: Syphilis, Sycosis or Gonorrhoea and Psora. (The last much derided by those ;who have never taken the trouble to understand it, but coming into its own now as “Scientific,” so I am told, in Germany.)

These diseases he met with remedies, homoeopathic to their manifestations and symptoms, the greatest number to the most widespread, hydra-headed, PSORA.

His Sycotic remedies were Thuja alternately with Nitric acid.

Alternately? What? Did Hahnemann himself alternate?

Yes. When symtoms changed. And observe! Alternately, with Hahneman never meant alternate sips from two tumblers at a few hours interval all day, because the physician cannot make up  his mind which is best indicated.

These are Hahnemann’s directions in alternating:-

“Gonorrhoea may be cured in the most thorough and durable way the internal administration of a few globules of Thuja 30, which must be allowed to act from 15 to 40 days. After that time, give an equally small dose of Nitric Acid, letting it act during an equally long period.”

And here we have, since Hahnemann’s day, another magnificent weapon – Medorrhinum or Gonorrhinum. And in Kent’s repertory there is a little rubric, “Gonorrhoea,” with some other remedies that have been found useful in that disease where symptoms agree.

Such remedies as Medorrhinum, Syphilinum, Tuberculinium are on Hahnemann’s own lines, who used Psorinum for Psora, and who recognized variola, or inoculations by Variola, as curative conditions – ophthalmia, deafness, dysentery – such as are often the squelae, he says, of small –pox.(Hahnemann says, by the way, that small-pox will extinguish the less virulent cow-pox, while cow-pox will lessen the virulence and danger of small-pox).

Hahnemann’s great remedy for Syphilis is Mercury. He found the 30^th potency to act better than the lower ones, but if several doses were needed the lower potencies might be employed.

Syphilis, uncomplicated and untreated  and in the primary stage, “in 50 years” practice he had never failed to cure with the smallest dose of the best mercurial preparation. Of course the Mercurius for syphilis are pure Homeopathy. Their symptoms are often indistinguishable. The one has been mistaken for the other.

Don’t scoff at the idea of curing syphilis with unit doses of Mercury in potencies till you have tried.

Here also we have Syphilinum and Merc. Cy seems to be by far the most powerful of the mercuries for syphilis in all its manifestations and stages. And Kent has a quite a longer list, with eight drugs in black type, for Syphilis. Only the symptoms can decide between them.

In cases of chronic disease, complicated by the three miasms, Hahnemann gives the order in which their remedies should be used.

“First we annihilate the psoric miasm by the indicated antipsoric. Then we use the remedies indicated for sycosis. Lastly, the best mercurial preparation against syphilis. These different orders of remedies are alternately employed if necessary until the cure is completed. Leave to each medicine, he says, “The necessary time to complete its action.”

When we sneak in, as it were, a dose of Syphilinium or Medorrhinum or Tuberculinum or whatever it may be, we have a sort of guilty feeling that this is, perhaps, no part of homoeopathy – as taught by Hahnemann.

But it is! Hahnemann was very much there before us. Our only doubt was, because we did not know the fullness of our heritage.

As a matter of fact, we are only following Hahnemann’s steps when we interpose a dose of  Tuberculinum where the case hangs fire and where there is a hereditary chain of Tuberculides in persons of T.B. parentage.

Or when we realize that such a diseases as malaria leave chronic conditions, especially when complicated with quinine poisoning and that these can only be successfully met by their appropriate remedies, Natrum mur, Sepia, Arsenicum etc. That old malaria will give the casting vote, often among competing remedies.

And here in, in conclusion, I will briefly epitomize for you Burnett’s brilliant work in another chronic condition that has arisen and has to be recognized and which he calls VACCINOSIS.

Compton Burnett’s little monograph on VACCINOSIS AND THUJA was written “to establish vaccinosis as form of chronic disease and Thuja as one of its chief remedies.”

He contends that in vaccinating you do not make a healthy man healthier. On the contrary, you establish a diseased state to protect, perhaps for years, from a like disease (small-pox).

Vaccination therefore, is a form of HOMOEOPROPHYLAXIS.

He defines vaccinosis as “that profound and often long lasting morbid constitutional state engendered by the vaccine virus, euphemistically termed ‘LYMPH’, but which is, of course, pus.”

“The vaccinate is one who suffers from vaccinosis. He may not be ill, but he must be in a subdued morbid state. He has been blighted, or he is no vaccinate”.

“Some of the worst cases of my vaccinosis were just those in whom vaccination did not ‘take’.”

“Not a few persons date their ill health from a so-called unsuccessful vaccination.”

“‘Taking’ is the constitutional reaction whereby the organism frees itself; more or less, from the inserted virus.”

“If the person, did not take, and the virus has been absorbed, the taking becomes a chronic process- paresis, neuralgia, cephalagia, pimples, acne etc.!”

“The less a person ‘takes’ the more he is likely to suffer from the genuine vaccination disease in its chronic form.”

But what about other and more modern forms of homoeo-prophylaxis? Vaccines, immunizing etc. Are they additions to the health of the healthy? Or are they new forms of chronic disease that will have to be reckoned with later on?

Burnett’s little book is stuffed with brilliant cases to prove his case for VACCINOSIS as a chronic disease and for Thuja its great remedy.

And it works!

Burnett says, “In chronic disease, when the right remedies seemed barred in their action, Hahnemann……recommended his disciples to interpose. Sulphur as the great, most-likely antipsoric. Most of us have found this a very valuable clinical suggestion.”

“Similarly, I have found that vaccinosis frequently, bars the way and then Thuja comes in with simply the beautiful effect of a genuine simillimum.”

I think you will agree that one has got not fully TAKEN THE CASE till one has recorded for every patient vaccination, especially any bad or unsuccessful ones, as well as any personal or family history of tuberculosis, syphilis or gonorrhoea.