Pathologic Simillimum-I
NATIONAL JOURNAL OF HOMOEOPATHY 1996 May / Jun Vol V No 3.
Gunavante S M.
Cases.
` Crot-h.
The following has been added as an additional chapter to my book "Perceiving Crucial Symptoms", when it came up recently for bringing out a second edition. This much neglected approach if sufficiently understood and applied, promise to give us excellent results. As such it needs wide discussion. Readers are requested to send their observation and experiences.
PATHOLOGIC SIMILLIMUM:
In the last section 17 of "Perceiving Crucial Symptoms", mention was made of Dr J. H. Clarkes (the celebrated author of the three volumes of the Dictionary of the Homoeopathic Materia Medica") prescribing Tuberculinum in the case of a patient who had been crippled after an attack of influenza. The patient who had been crippled after an attack of influenza. The patient recovered fully in a few months. Dr. Clarke has set out in this case how he came to prescribe Tuberculinum as the Pathologic Similimum which, he said is of the "very first order" in some cases. This approach to finding the remedy is hardly mentioned in our literature, and therefore, I began to search for the opinions and experiences of able prescribers. I am glad that I was able to find considerable support to this method, which I will set out in brief below. What awakened my sharp attention to this aspect is a case submitted to me for inclusion in Homoeopathic Heritage of August 1996 ("When all Hopes were given up") in which Dr. Meena Mankani gave Crotalus-horr 30 to her father who was admitted to a hospital under the care of several top physicians, with remarkably quick recovery. The patient had chronic renal failure and was a B-Thalassaemic. In the hospital he was put on dialysis, his gangrenous toes were amputated, there was retinal haemorrhage which obstructed vision. He was prostrated so much that he could not talk, could not turn in bed, could not even swallow. Under Crotalus horr the dialysis was stopped, the wound arising from amputation healed rapidly, retinal haemorrhage steadily abated and vision improved; he regained his strength-to the surprise of the top physicians who had advised the family to be prepared for the worse. The remedy was selected not on mental or physical generals or peculiar symptoms, but chiefly on the pathogenetic action of Crot-horr (decomposition of blood, tendency to haemorrhage and periodicity of complaints only in summer-the only characteristic symptom). The patient continues to be in reasonably good health even after five months.
Dr James Crompton Burnett had used this approach in a number of cases with remarkable success. Writing about "Acne Remedies" he writes (Best of Burnett p 153):.
"The study of varieties of acne is highly interesting and instructive, as almost all the great constitutional ancestral diseases show themselves in young persons in the form of acne. Not frequently, cases of acne are of mixed pathological qualities, and these need all their pathologic simillimum. Remedies only morphologically and radically cure they must be PATHOLOGICALLY SIMILAR.".
Further, dealing with the "mode of treatment" of the Tumours of the Breast, he says (B B p 140):.
First: I begin by remembering Hahnemanns method of case taking...Second: I go over in my mind the various medical doctrines, such as the Chronic Miasms, Vaccinosis, Grauvoglian constitutions, etc, and.
Thirdly: I then take a purely organopathic survey of the organ or part, and then weigh and balance the various facts which physiology, pharmacology and PATHOLOGY tell us about it.
Most commonly I find that tumours are pathologically hybrid in their nature and they will not yield to treatment of a simple nature,m eg, in persons with various complaints, diathesis, grief, etc, resulting in a tumour, such a person in her very history tells the thoroughly competent therapeutist how to proceed without symptomatology at all" ( B. B. p 140-1).
Another quotation from the great Burnett ( B B p 179) : " The ultimate court of appeal is the Materia Medica Pura, and the Repertory shows the way to discover the right remedies. As a very needful check on aimless wanderings in this field, however, we find an accurate knowledge of the pathology-the morbid pathology-of the case in point, and if to this we add the fundamental principle that in scientific therapeutics the RANGE of a given remedy is fixed by its PATHOGENETIC POWERS and possibilities, we are pretty sure to reach the goal. You cannot, however, hit the target a mile off with a gun that carries only fifty yards-no remedy is therapeutically greater than is the drug PATHOGENETICALLY.".
Burnett again (B B p XVII): "The future of medicine belongs to Homoeopathic pathologists, and to really cure the great diseases (with a pathological-anatomical basis), we MUST HAVE remedies Homoeopathic to such morbid anatomy, at any rate in its earlier stages.".
Now, let us turn to Dr. H. A Roberts who has so ably analyzed the principles of Homoeopathy and their application in practice. In his Principles and Art of Cure by Homoeopathy (pp 96-101), he has discussed the importance of the "Chief Complaint" which brings the patient to the physician. He defines the Chief Complaint (p 97) or the leading complaints as those symptoms for which there is a clear PATHOLOGICAL FOUNDATION (emphasis mine); or the symptoms which first attract the attention of the patient or physician; or which cause the most suffering; or which indicate definitely the seat and NATURE OF THE MORBID PROCESS which form the "wrap of the fabric", as it is expressed. Further,.
"We must not fail to recognize the value of the totality of the symptoms; and this must take into consideration the Chief Complaints, those of which the patient most often complains, plus the PECULIAR, characteristic of the patient. If the both these elements are present, we may be sure we are on the right track.".
Roberts concludes: (101): "It is to be remembered that Hahnemann never slighted any symptoms of a case in making a prescription. He had the genius of giving each symptom its true place in the picture without distorting the totality. While it is inconceivable that Hahnemann ever did keynote prescribing, it is also beyond our knowledge of Hahnemanns thorough mind that he eliminated the Chief Complaint in building up the symptom-image". golden mean between these two points, the one too general and the other too individual to assures us of a true totality. If we can find a remedy that has "the more striking, particular, unusual and peculiar characteristic signs and symptoms of the case" (Aph 153) and in addition covers the CHIEF COMPLAINT as well (for which there is clear "Pathological foundation" or which indicates the seat and nature of the morbid process-addition, mine) we may consider ourselves as having a sound basis for the prescription of the simillimum.".
Now, is it possible that Dr. Hahnemann, that deep thinker, experimenter and critical observer of his experiences, who revised the "Organon" six times, overlooked the importance of the pathologic simillimum (based on the pathogenetic effects which are nothing but the Proving record)? Let us read Aphorism 192 of the Organon:.
"The restoration of health of the entire body is best effected when, in the investigation of the case of disease, along with the exact character of the local affection, all the changes, sufferings and symptoms observable in the patients health, and which may have been previously noticed when no medicine had been used, are taken IN CONJUNCTION to form a COMPLETE picture of the disease, before searching among the medicines whose PATHOGENETIC EFFECTS are known, for a remedy corresponding to the totality of the symptoms, so that the selection may be truly Homoeopathic.".
Let us now turn to Dr. Richard Hughes, who dominated Homoeopathy in England for half a century before Kents philosophy and practice threw his teachings in the shade, mainly because Hughes approach was pathological and did not allow for potencies higher than 12th. Nevertheless, Hughes accepted all the principal tenets of Hahnemann, the law of similars and the importance of peculiar symptoms, He says in his "Manual of Pharmacodynamics" (p 91):.
"The similarities which I shall seek to establish between the drug-action and disease would be in the main Pathologically. The lecturer on Materia Medica will survey the field of pathogenetic phenomena he has to characterise. My main object will be to set forth the sphere of action of each drug. Every medicine, even thought it be one of those great polychrests, which seem to embrace nearly the whole organism within the circle of influence, has one or more centres are we learn, sometimes from the pathogenetic, sometimes from the clinical side. When we have learnt them, they become all -important stand points for the understanding and the remembrance of the medicine. Besides these I shall endeavour to set forth the kind of action of each drug action upon a certain organ or tissue, a certain physiological function, a certain pathological process, may belong to it in common with several other medicines; and yet there is nearly always something special in the manner of its action which differentiates it from others and gives it an individual character. ... the facts about drug-action known as "characteristics" and "Key-notes"....
"The pathogenetic effect of drugs having been ascertained and recorded, we have but to refer to such record, after we have examined our patient, to discover the simillimum to his case.".
A few words of practical wisdom from Dr. C. M. Boger :"In taking the case. . .we must divest ourselves of all speculative opinions as to the origin of such odd manifestations. These things belong to the obscurities of diagnosis, nor does this mean that a diagnostic symptom can never be a major indication. . . .
It is the striking nature of the SYSTEMATIC EFFECT upon the whole organism (ie, Pathogenetic effect) that determines the value of a given symptom, a manifestation that is prone to occur without any obvious connection with the disease itself. In chronic cases it is very apt to be a concomitant, while in acute cases it often stands out like a freshly painted guide-post. The physician must know how to give it the right value. A case from Boger:.
CASE: Sore aching from the region of the gall bladder to the left scapula, better lying on the stomach, as of a lump under the sternum, then the mouth becomes white with foam. Very foul back stools. Prolapsing, bleeding piles. Nails very thin, split and turn black, Dry skin. Anaemic, emaciated and very weak. Constantly caves in Aggravation from pressure of clothes and from fat foods.
Four doses of Leptandra in different potencies have in three months, returned her to nearly normal flesh and strength. The nails are absolutely normal again; her colour is quite good and an old very foul leucorrhoea has returned in spite of which she keeps right on gaining. (My observations: Mark the "foul black stools" which denote the nature of the MORBID PROCESS, to use H A Robertss words, which must have weighed with Boger in selecting Leptandra. Note also how Leptandra also covers the other symptoms which "cause the most suffering").
