Other peoples paper cases

A few days ago, I was asked by a colleague to look at a paper case that he was given during his training several years ago, and go through it using the Therapeutic Pocket Book as opposed to Kents Repertory.

He duly sent me the case.

I examined it for perhaps 10 minutes, and then phoned him up and said that in real terms, (the patient had chronic back pain) there were no SYMPTOMS recorded that could be extracted for prescribing.  That is not to say that there were no symptoms recorded, there were hundreds of symptoms, all related to her mental state, her food desires, her thirst, how weather affected her… but NONE recorded regarding the actual injury and nature of the pain or modalities etc.

The case was prescribed for over several months perhaps closer to a year with a strange choice of remedies, and the final remedy was the one that I had considered as the FIRST choice based on what physical symptoms I could see in the case related to her problem.

I was told that the cases this practitioner took, often would cover a time span of Eight hours or more!

The I.H.M. bases its paper cases on the model of case taking as outlined by Samuel Hahnemann and practitioners of his time. It is a full and rounded presentation of the malady, the location, the sensation, the modalities and any accessory symptoms that are present or alternate with the main complaint. From the presenting complaint, the essential prescribing symptoms are elicited and compared to the Materia Medica to see if the remedy under consideration has the combination of symptoms, or the nature of the individuals expressed pathology that is both peculiar to the patient AND the remedy.

Here is an example. Please read carefully for this is the essence of case taking in both acute and chronic.

Samuel Hahnemann.

  • All who feel a true desire to assist in elucidating the peculiar effects of medicines – our sole instruments, the knowledge of which has for so many centuries remained uninvestigated, and which is yet so indispensable for enabling us to cure the sick – will find the directions how these pure experiments with medicines should be conducted, in the Organon of Medicine, 118-142.
  • In addition to what has been there stated, I shall only add, that as the experimenter cannot, any more than any other human being, be absolutely and perfectly healthy, he must, should slight ailments to which he was liable, appear during these provings of the powers of medicines, place these between brackets, thereby indicating that they are not confirmed, or dubious.
  • But this will not often happen, seeing that during the action upon a previously healthy person of a sufficiently strong dose of the medicine, he is under the influence of the medicine alone, and it is seldom that any other symptom can show itself during the first days but what must be the effect of the medicine.
  • Further, that in order to investigate the symptoms of medicines for chronic diseases, for example, in order to develop the cutaneous diseases, abnormal growths and so forth, to be expected from the medicine, we must not be contented with taking one or two doses of it only, but we must continue its use for several days to the amount of two adequate doses daily, that is to say, of sufficient size to cause us to perceive its action, whilst at the same time we continue to observe the diet and regimen indicated in the work alluded to.
  • The mode of preparing the medicinal substances for use in Homeopathic treatment will be found in the Organon of Medicine, 267-271, and also in the Chronic diseases. I would only observe here, that for the proving of medicines on healthy individuals, dilutions and dynamizations are to be employed as high as are used for the treatment of disease, namely, globules moistened with the decillionth development of power.
  • The request of some friends, halting half-way on the road to this method of treatment, to detail some examples of this treatment, is difficult to comply with, and no great advantage can attend a compliance with it. Every cured case of disease shows only how that case has been treated.
  • The internal process of the treatment depends always on those principles which are already known, and they cannot be rendered concrete and definitely fixed for each individual case, nor can they become at all more distinct from the history of a single cure that they previously were when these principles were enunciated.
  • Every case of non-miasmatic disease is peculiar and special, and it is the special in it that distinguishes it from every other case, that pertains to it alone, but that cannot serve as a guide to the treatment of other cases. Now, if it is wished to describe a complicated case of disease consisting of many symptoms in such a pragmatic manner that the reasons that influence us in the choice of the remedy shall be clearly revealed, this demands details laborious at once for the recorder and for the reader. In order, however, to comply with the desires of my friends in this also, I may here detail ONE of the slightest cases of Homeopathic treatment.

Case 86 – W – e
A weakly, pale man of 42 years, who was constantly kept by his business at his desk, came to me on the 27th December, 1815, having been already ill five days.

  1. The first evening he became, without manifest cause, sick and giddy, with much eructation.
  2. The following night (about 2 AM) sour vomiting.
  3. The subsequent nights severe eructation.
  4. Today also sick; eructation of fetid and sourish taste.
  5. He felt as if the food lay crude and undigested in his stomach.
  6. In his head he felt vacant, hollow and confused, and as if sensitive therein.
  7. The least noise was painful to him.
  8. He is of a mild, soft, patient disposition.

Here I may observe:

To 1.
That several medicines cause vertigo with nausea, as well as Pulsatilla (3), which produces its vertigo in the evening also (7), a circumstance that has been observed from very few others.

To 2.
Stramonium and Nux vomica cause vomiting of sour and sour-smelling mucus, but, as far as is known, not at night. Valerian and Cocculus cause vomiting at night, (61, 62) and can also cause sour vomiting, (66) but not the other symptoms observed here. Pulsatilla, however, causes not only sour vomiting in the evening (349, 356) and nocturnal vomiting in general, but also the other symptoms of this case not found among those of Iron.

To 3.
Nocturnal eructations is peculiar to Pulsatilla (296, 297).

To 4.
Fetid, putrid (249) and sour eructations (301, 302) are peculiar to Pulsatilla.

To 5.
The sensation of indigestion of the food in the stomach is produced by few medicines, and by none in such a perfect and striking manner as by Pulsatilla (321, 322, 327).

To 6.
With the exception of Ignatia (2) which, however, cannot produce the other ailments, the same state is only produced by Pulsatilla (39 compared with 40, 81).

To 7.
Pulsatilla produces the same state (995), and it also causes over-sensitiveness of other organs of the senses, for example, of the sight (107). And although intolerance of noise is also met with in Nux vomica, Ignatia, and Aconite, yet these medicines are not Homeopathic to the other symptoms, and still less do they possess symptom 8, the mild character of the disposition, which, as stated in the preface to Pulsatilla, is particularly indicative of this plant.

This patient, therefore, could not be cured by any thing in a more easy, certain and permanent manner than by Pulsatilla, which was accordingly given to him immediately, but on account of his weakly and delicate state only in a very minute dose, i. e., half-a-drop of the quadrillionth of a strong drop of Pulsatilla.

This was done in the evening. The next day he was free from all ailments, his digestion was restored, and a week thereafter, as I was told by him, he remained free from complaint and quite well.

The investigation in such a slight case of disease, and the choice of the Homeopathic remedy for it, is very speedily effected by the practitioner who has had only a little experience in it, and who either has the symptoms of the medicine in his memory, or who knows where to find them readily; but to give in writing all the reasons pro and con (which would be perceived by the mind in a few seconds) gives rise, as we see, to tedious prolixity.

For the convenience of treatment, we require merely to indicate for each symptom all the medicines which can produce the same symptoms by a few letters, (e. g., Ferr., Chin., Rheum, Puls., ) and also to bear in mind the circumstances under which they occur, that have a determining influence on our choice, and in the same way with all the other symptoms, by what medicine each is excited, and from the list so prepared we shall be able to perceive which of the medicines Homeopathically covers the most of the symptoms present, especially the most peculiar and characteristic ones – and this is the remedy sought for.

* According to our present knowledge and experience the same object would have been attained by taking one of the smallest globules of Pulsatilla x (decillionth potency) and with equal certainty a single olfaction of a globule the size of a mustard seed of the same potency of Pulsatilla.

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One response to “Other peoples paper cases

  1. So clear. So beautifully simple. Not easy, but simple! Especially with all the damned unlearning needed!

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