Erastus E. Case
Presidential address before the Connecticut Homoeopathic Medical Society, May, 1889.
This was written at a time when answers to the questions considered were earnestly sought, and the 2c was thought to be a high potency. Since then a lower one has been very rarely used. The selection of potency and number of doses given show the inexperience and prodigality of youth. Later experience has taught that usually a repetition of dose is not only unnecessary, but also may be injurious by causing an aggravation that increases the suffering of the patient. A single dose of a high potency proves to be the most effective in healing the sick. Sometimes, however, when the vital force is sluggish, several doses of the remedy, preferably dissolved in water, are required to establish the reaction.
This subject was chosen for two reasons, namely:
1. Because it is a theme rarely considered at our meetings
2. Because it is to me of first importance and greatest interest.
It is not my purpose to present a solution to this problem, but to state some rules which I have adopted as guides in prescribing, and to cite cases from records illustrating their application. I assume :
1. That we accept the truth of that Natural Law, Similia Similibus Curantur.
2. That the symptoms of the case have been carefully taken, giving us, as expressed in the appropriate language of Hahnemann : “The outwardly reflected image of the inner nature of the disease; that is, of the suffering vital force”.
We find those symptoms confusing, often conflicting, and a host in number. Some are peculiar to the constitution of the patient; some are resultant from former disease; some are functional; others are pathological, really diseased conditions of the organs; still others are sympathetic, the result of those diseased conditions; many may be due to the action of drugs already administered; some may be purely imaginary.
We have been taught to give that remedy which has produced all the symptoms of the patient. It frequently happens that we cannot find a remedy whose pathogenesis contains them all. Some of you doubtless have worked out a case, as I have often done, with a repertory, and found that the symptoms led not to a single, but to several remedies, one seeming to be just as applicable as another-a disheartening result after hours of faithful study. Shall we employ the remedy which covers the greatest number of symptom-a purely numerical comparison-or can we select some special symptoms which have more weight than others in making the choice?
Dr. Drysdale divides symptoms into two classes, absolute and contingent. “Absolute symptoms are those which belong to all patients suffering from the same pathological process; contingent symptoms are those which vary with the individual and are not essentially pathognomonic”. He declares that “the greater the value of a symptom for the purposes of diagnosis, the less its value for the selection of the remedy”.
Prof. T. F. Allen aptly divides symptoms into determining and resulting. “Determining symptoms are those which precede and determine the development of a lesion, which, when established, becomes the fountain of new and resulting symptoms. Resulting are those which are not of prime importance to the therapeutist who seeks to arrest the progress of the real malady”. He concludes : “1. Some symptoms are of more value than others. “2. The most valuable to the therapeutist are the determining symptoms, both in acute and chronic diseases”.
Hahnemann’s Organon, Paragraph 153, reads thus : “In the search for
the homoeopathic specific remedy-that is, in the comparison of the total signs of the natural sickness with the lists of symptoms of available drugs in order to find among them one bearing a pathogenetic power corresponding to and resembling the disease to be cured-the striking, remarkable, and peculiar (or characteristic) signs and symptoms of the case of sickness are to be especially and almost exclusively brought before the eye; for these, especially, must be very like the drug that is being searched for in the symptom lists, if this is to be most suitable for the cure. The general and indefinite symptoms, such as loss of appetite, headache, weakness, restless sleep, discomfort, et cetera, if they are not more closely defined, deserve little attention, for we find something about as indefinite in almost every sickness and caused by almost every drug”. Upon comparing the teachings of Drs. Drysdale and Allen with that of Hahnemann, we find no inconsistency between them. Dr. Drysdale places of highest value the contingent symptoms-those peculiar to the sick individual under consideration; Dr. Allen-the determining symptoms-those individual peculiarities which precede the development of the lesion. They simply interpret and explain the words of the master without adding to the truth contained in them. Our guide in finding the remedy, then, is as follows : “The striking, remarkable, and peculiar (or characteristic) symptoms are to be especially and almost exclusively brought before the eye, for these must be very like the drug most suitable for the cure”.
Now we see why our earlier attempts with the repertory failed of the best results. We were placing the absolute and general symptoms alongside the characteristic as of equal value, instead of giving them a secondary place, using them to confirm the choice of remedy made from the characteristic symptoms. A careful study of the Organon should have taught us better. It may be urged that a characteristic symptom cannot be found in every case, but surely no two persons are just alike in form and feature, and the differences in the constitution, and in the disturbance of the physical economy in disease, are so great that individual peculiarities are always present. Our success will be determined in great measure by our acuteness of observation in recognizing the peculiarities of the patient, and our skill in adapting to them the appropriate medicine.
Choice of remedy
Rule I. Other things being equal, give the preference to a mental symptom rather than to a bodily one.
Illustration: A printer, aged thirty-eight years, chronic dyspeptic, presented these symptoms :
1. Stomach full to satiety after only a little food.
2. Stomach distressed by cold food or drink; bears only warm things. 3. Abdomen tympanitic; worse in the afternoon.
4. Soreness throughout the abdomen in the morning.
5. Sleep disturbed by startings, talking.
6. Difficult to remember what he has read, to recall names and words when talking.
All these symptoms are characteristics of one of our anti-psoric remedies. Any one of them, taken as a starting point, would lead to the right remedy; but if either of the first five had been selected, it would be a work of elimination until the sixth was reached, which would be decisive. The peculiar weakness of mind, unusual to the patient, was given the highest value. Allen’s Symptom Register gives only one remedy under that symptom. This covered the whole case.
1888, Aug. 4. Lycopodium 30 four times a day for a week.
1889, March 6. He was relieved so that further treatment was not needed until recently. The trouble returned, less severe. Lycopodium 2c four times a day for three days. Cured.
Rule II. If there is no peculiar mental symptom, use the most peculiar bodily one.
Illustration. A bank cashier, another chronic dyspeptic, has :
1. Tasteless eructations of gas; no conditions obtainable.
2. Painless pressure in stomach at any and all times.
3. Constipation; stool every morning, but hard and dry.
4. Bleeding haemorrhoids, not painful.
5. Sharp, sticking pains in the pectoral muscles, left side, with soreness; worse from touch, motion, after eating, and in damp weather; better from eructations.
No. 5 was considered characteristic. The stitches and soreness in left pectoral muscles; worse from touch, motion, and after eating, are markedly characteristic of one remedy only. It was a remedy not associated in my mind with dyspeptic conditions. Nevertheless, it was prescribed and made a complete cure. Ranunculus bulbosus 2c four times a day for one week. Was the whole trouble rheumatic to which Ranunculus bulbosus was specific? Would those who were looking for a causal or determining symptom be satisfied with that theory as a guide in prescribing or the patient? By following Hahnemann’s instructions the cure was effected “cito, tuto, et jucunde”.
Rule III. A common symptom, by concomittance, may become characteristic.
Illustration. A carpenter aged sixty-one years has had a cough two weeks, dry, spasmodic, at night, from tickling in the throat. Worse while lying down; relieved if he sits up. The cough is so severe that the muscles of the throat, chest and abdomen are sore. Dry, spasmodic cough at night, relieved by sitting up pointed to the remedy.
Hyoscyamus 30 cured immediately. He lay down and slept well the first night after the prescription.
Rule IV. In subsequent prescriptions, when the same remedy is not indicated, follow the latest symptoms which have appeared. Illustration. A married woman aged thirty-six years had enteritis four months ago under allopathic treatment. Three to eight liquid stools daily ever since then. Stools dark, offensive, containing little lumps of feces. Always goes to stool after eating; tenesmus during and after stool. Dragging sensation through the abdomen, from chest downward; yellow leucorrhoea pouring forth from every exertion. During the past week pain in the bones; worse when beginning to move; better during continued motion. Pain and soreness in the vertex. Sleepy, exhausted condition. Flatulence; eructations of gas after eating. Noisy gurgling in bowels after eating until she goes to stool.
Three remedies come to mind : Arsenicum, Lycopodium and Nux vomica, the last one to antidote the drugging. Nux vomica 30 a dose after every stool. Six days later she reported no improvement excepting that the stools were less in number. A new symptom has appeared. Hacking cough from irritation in the trachea; worse from talking, while lying down, also markedly at 4 p.m. This indicates Lycopodium. Lycopodium 2c four times a day for three days.
Three weeks later patient reported that the troubles were cured. Since the last prescription she has expectorated a large quantity of thick, gray, granular mucus, giving relief from a pressure upon the sternum, which had been present nine years. She then told some more of her history. Nine years ago she was afflicted with asthma, unable to lie down for three months. Finally her physician gave her something to inhale which relieve. Since then dust in the air, over-exertion, walking up hill or stairs will cause an attack of asthma. The onset is always at 1 a.m. ; she awakens suffocated. Tormented by thirst for cold water, small amount at a time. She now has an attack of asthma. Arsenicum album 30 four times a day four days.
She improved at once, but on two of the nights which were rainy, when she always expects trouble, she had dyspnoea for a short period after one o’clock. Since then she has swept her house, ran up stairs, and taken long walks without a return of asthma.
Query : Would Arsenicum have cured this patient if given at the first prescription?
Potency: Now, regarding the potency to be used, there is no known philosophy that is authoritative. I have no doubt that cures have been made by all dynamizations, from the mother tincture to the very highest that have been prepared. Each must follow the course to which study and experience shall lead him. I have been led to adopt the following rules :
Rule V. Give the higher potencies to those accustomed to the low or to allopathic treatment.
Rule VI. To those accustomed to high potencies, give still higher, or much lower; that is, change the potency for the patient.
Rule VII. After improvement stops change the potency if the same remedy is indicated. These rules are sufficiently illustrated in the cases quoted elsewhere.
Repetition of the dose
Rule VIII. In cases with a well marked exacerbation give a dose at the time of, or immediately after an attack.
Illustration. A girl aged three years has had dysentery one week under allopathic treatment and is desperately ill. Stools almost every hour of bloody water, a little mucus; great tenesmus before, during, and after stool. Anus is raw and bleeding from the discharges.
Mercurius corrosivus 2c a dose after every stool. The next day the stools were less frequent and without blood. Saccharum lactis. During the next two days the stools improved in character, but the patient did not rally as she should. Sulphur 2c one dose brought about a rapid convalescence. A disregard for this rule has often caused an aggravation. One example is given. A painter aged twenty-eight years had diarrhoea. Stools small in quantity, yellow, fluid, fetid; worse at night after 1 a.m. Thirst for little and often. Great exhaustion. Arsenicum album 30 a dose every three hours. Four days later he sent for me saying that he had been steadily growing worse since the first day, when he seemed better. Saccharum lactis. The diarrhoea stopped in three hours, and he was soon well.
Rule IX. Repeat the dose until an effect is produced, then stop. Illustration : A married woman aged thirty-seven years wished three large seed warts removed from the hairy scalp where they were troublesome. Her health seemed good, and no leading symptoms were obtained.
Causticum 2x four times a day until a change in the warts was shown, then to report to the doctor. Ten days later the warts were larger and sore. Saccharum lactis, and she was directed to report when the warts stopped growing smaller. Seven weeks later the patent reported that the warts continued to grow smaller until a week ago. No change since then. Causticum 30 four times a day for three days. Six weeks later the warts were entirely gone. Rule X. Never repeat a remedy so long as improvement continues, even if it is slow. It is hard to wait patiently for the action of a remedy to cease, but it always proves satisfactory to the patient and physician when we do so. Impatience has many times spoiled a case for me. This is one. Illustration : A married woman aged sixty-one years, has a moist eczema with much swelling on the left leg. It began two months ago upon the ankle and now encircles the leg from the foot up to near the knee. Stinging, darting pains through the sore, with itching. Worse in the afternoon, especially after 4 o’clock. The urine is scanty. Abdomen swollen, sensitive to pressure. Under eyelids much swollen. These indications for a remedy are plain. May 3. Apis 2c three times a day for three days.
May 10. Swelling and pain much less; improved every way. Saccharum lactis.
May 17. Improvement continues. Countenance looks better; urine is copious; abdomen normal size and not sore; eczema covers the same surface but is not painful. Apis 30 three times a day for three days. This was followed by a severe aggravation and a return of the former distress. She would not come back, but I heard about her condition directly. An experience with several similar cases, in which “patience had her perfect work”, convinces me that this failure was unnecessary. No originality is claimed for these rules, and the cases described are not remarkable. If any are induced to study their patients more closely, and to follow the instructions in the Organon more faithfully, my purpose has been accomplished.