A case of cerebral paresis, of six years’ duration, cured.
BY E. W. BERRIDGE, M.D.
1874, July 17th. Mr. Samuel L., aged 44. Had been ill for six years, could not sleep or carry on his business as a lawyer. Was treated allopathically. After a sea voyage got much better, but since the end of April has been getting worse, and has had to leave his business again.
Present state.—Bodily and mental depression. Stiffness of legs on walking. Constantly inclined to stoop forward. Desires to be alone. Forgets names, and what he is about to do. Absence of mind when reading. After diarrhea hits headache on vertex. Deafness, especially of right ear. Appetite irregular; eats no meat, only eggs and farinaceous food; no coffee or tea. The mental depression is relieved by passing much urine. Tongue pale brown. Pulse feeble. For last three weeks, and previously, twitching of arms and legs. At times has had shivering over body after urination. After urination things appear brighter, and lighter, and clearer, bath mentally and physically. Is subject to diarrhea of ingesta, sometimes frothy.
Diagnosis of remedy.—The rule which Hahnemann lays down for our guidance is to select the remedy which corresponds best to the totality of the symptoms (Organon 7, 18, &c.), and whatever may be the medicine, or whatever our theory as to the nature of the « disease », to give that medicine and that alone; always individualizing each case, and treating it just as if no other case had ever existed, remembering that as Homoeopathicians we treat patients, not diseases. Yet there are many cases where we cannot find a remedy corresponding to the totality of the symptoms. Hahnemann has not left us in the dark here; he says we are to be guided chiefly by those symptoms which are characteristic (Organon 153); that is, those which individualize the case from others of a similar nature, and- those which
individualize one medicine from another. From this it follows that though a diagnosis of the nature of the disease should always be carefully made, as both the prognosis, and the hygienic and dietetic treatment depend upon it, yet the selection of the homoeopathic remedy is totally independent of such diagnosis, for the simple reason that those symptoms which we call diagnostic of the disease (i.e., which enable us for the sake of convenience to classify cases) are just those which are common to nearly every case, and from their general character common to a large number of remedies.
Again, Hahnemann teaches us that the mental symptoms are of more diagnostic value in the selection of the remedy than those of the body. (Organon 210, 211, 213.) Again, the symptoms which are the most recent are, caeteris paribus, of more value than the earlier. (See Chronic Diseases, vol. i., pp. 171-2.) Again, it is obvious that, caeteris paribus, the most severe symptom of the case is of more importance than those which are comparatively trivial. Lastly, I would venture to suggest, from my own observations, that in periodical diseases, the initial symptom of the attack will be found of more diagnostic value for the selection of the remedy than the subsequent ones. Dr. C. Lippe confirms this view with regard to ague. (U.S. Medical Investigator, v. 4, p. 353.) Applying these rules in the above case, we first examine the mental symptoms, and commence with that one which seems the most peculiar, viz., relief of the depression after urination. This symptom, according to my MS. Head Repertory, is found under Eugenia Jambos. The same repertory also gives it under Desire for Solitude, with sixty-four others. Eugenia does not possess the symptoms of loss of memory or absence of mind, but, on the other hand, it has the brightness of objects after urination (see p. 238 of my Eye Repertory), and also shivering after urination. (For all these symptoms see 2, 3, 24, and 120 of Allen’s Mat. Med.) Eugenia, therefore, corresponded best to the most peculiar symptoms, and the patient was ordered a dose of 30th potency night and morning.
August 11th. Sleeps better. Appetite much better, and regular. Diarrhea returned at times, sometimes watery, some times soft, with darker lumps in it; only once of ingesta. Spirits better. Still easily fatigued, inclined to stoop, and legs stiff. Heartburn. Less aversion to company, or absence of mind when reading. Memory still bad. Not much headache. Deafness unchanged. Very little twitching of arms and legs. All the urinary symptoms gone. Tongue clean. When writing, forms the letters better than he could. Eugenia Jambo9 200 (Leipzig) night and morning.
October 3rd. Has had no medicine for three weeks. Has been much better, steadily improving,; has had two relapses of diarrhea, one while taking the medicine and the other afterwards, but since the last relapse has felt better than ever. Now he sleeps better; appetite natural; diarrhea gone; feels stronger and in better spirits; not easily fatigued; legs less stiff; does not stoop nearly so much; less heartburn; less aversion .to company; memory still bad, especially for names; less deaf; writes very much better; pulse stronger; tongue slightly coated; no twitching or urinary symptoms; not much headache. Stop medicine.
November 17th. Only two or three very slight attacks of diarrhoea. Sleep more natural. Appetite fair. Shortly after last visit, till two weeks ago, had low spirits, irritability, dislike for com‑ pany, and stiffness of limbs; this has now all passed off. Not nearly so much stooping, not even during the above-mentioned relapse. Heartburn bad at times. Memory better. Headache bad at times; better now. Deafness was worse during last relapse, better now. Writing is firmer. Can read. better; ideas clearer when writing a letter. Feels decidedly better than when I first saw him.
December 29th. Has been engaged in legal studies, and can attend to them fairly. Only one slight attack of diarrhoea. Sleep good. Appetite variable, usually fair. No lowness of spirits till the last few days, and then very slight. Legs stiff on exercise. No stooping. Heartburn, memory, headache, and depression better. Writing firmer. Power of thinking and understanding better; he understands a book which he reads, formerly he could not recollect what he had read. Feels stronger.
1875, February 4th. Can exercise his brain very much better.
No more diarrhoea; bowels better than they have been for ten months. Digestion better, can eat meat with impunity every two or three days. Sleep and spirits good. Pain in joints and fingernails. Pain in finger-nails as if the nail had been forced up from the quick. Stoops rather more. More easily fatigued on walking. Frequent urination. Less heartburn. Memory much better. Very little headache. Less deaf. Writing firmer. Understanding better.
Note. — Here a new problem had to be solved; some of the symptoms had increased, and a new one had arisen. Should the medicine be repeated, or still allowed to act, or a new one be selected? This problem must be decided in each individual case by the general condition of the patient. New symptoms may arise from two causes;
1- symptoms directly caused by the medicine, and
2- symptoms belonging to the patient, excited or aggravated by the working of the medicine in the system.
In the first case, obviously no new medicine should be given, unless the symptoms imperatively demand immediate relief, which is often then obtained by giving the same medicine in a much higher potency. In the second case, aggravation of the existing symptoms, occurring at intervals of days or weeks, is what is almost always met with in the cure of chronic patients, and should not be interfered with by any change of treatment; the stirring up of old symptoms, which had not been noticed lately, is a favorable sign, and shows that the medicine is attacking the disease in its inmost recesses, and gives hope of its thorough eradication. (Chronic Disease, vol. i., p. 150.) The rule, then, is simply this: if the general state of the patient is improving, give no more medicine of any kind; but if the general state is worse, or if these new symptoms persist, the patient not improving after waiting a sufficient time, then select a new remedy, being guided chiefly by the new symptoms. It rarely happens that the same remedy is of use again, and if it is repeated, it is best to give a higher potency, otherwise aggravation of the symptoms may occur.
As the patient was generally better, no medicine was given. March 17th. Memory and power of thinking better. Sleep not so good. Pain in nails gone; had very little more after last visit. Heartburn returned. Stoops still from feeling of weakness in the stomach. Not much headache; working does not cause it. Less deafness. Sight better. Still easily fatigued on walking. Writing firmer. Diarrhea worse. Diarrhea alternates with constipation; the costive stools are dark green, gradually becoming paler, and then the diarrhea comes on, sometimes pale, or black-green or frothy. He felt cold from a journey after his last visit, and has had the diarrhea ever since.
Note. — The new symptom of the nails had disappeared, and the change for the worse was a recurrence of old symptoms, while in other respects the patient was better. The former problem now recurred. The persistence of this state of relapse indicated that the medicine had ceased to act; while the non-occurrence of any absolutely new symptoms pointed to a repetition of the same remedy. Not being able to procure a higher potency than that previously used, I gave ‘him Eugenia Jambos 200 (Leipzig) night and morning for three weeks.
April 19th. Reports by letter that the bowels remained natural after the first dose; still has the sinking at stomach; digestion better, can eat meat; appetite and sleep good. Eugenia Jambos night and morning for three weeks.
Note. — The same problem is here repeated, but the solution is different. Although the patient said he felt generally better, yet he had a new mental symptom, indifference to what formerly interested him. Added to this, the loss of memory for names still persisted, though in other respects it was better. The diarrhoea, also, was of a different character. The indifference was of too general a character to be in itself diagnostic, though a symptom which must be covered by the medicine given. Under Loss of memory for names, my MS. Repertory gives anac. (bell.), chlor., croc., fluor-ac., glon., guiac., limulus., mere., oleand., puls., quiniae-sulph., rhus., strum., sulph.
Under Stools lumpy and liquid, it gives ant-cr., con., lycop., sulph-ac. This reduces the number to lycop., which is found also under Stool hard, then soft, and Heat in rectum during and after stool; also under Indifference.
I accordingly gave him Lycopodium Cm. (Fincke) night and morning for about a month.
October fith. Reports by letter as follows : — For about a week after last visit felt better and stronger, both mentally and physically, than he had ever been since he first consulted me; then he relapsed, feeling depressed, weak, heavy, and easily fatigued, mentally and physically, with more or less indigestion and general disturbance; but still was not so bad in any respect as he frequently had been during such attacks on previous occasions. A fortnight ago began to improve, and since then he has been much better in every way, and has done more actual continuous and general business in a way more satisfactory to himself than he had been able to do during the same time since he was taken ill. Has passed, and continues to pass, great quantities of urine, which was the first sign of improvement. Appetite and sleep better, and can take exercise without great fatigue. The most noticeable thing is that he is more troubled to remember names than ever, though this has been better during last three or four days.
Note. — The patient’s state was clearly improving, in spite of the aggravation of the loss of memory. No medicine was therefore given.
November 29th. Reports by letter : —Has had no return of his usual low, wretched attacks, except once to a very slight degree.
Is now in the regular swing of business, and attends to anything at any time, and does not feel any bad results from contentious matters which used to excite and irritate him greatly. At the end of a week’s work he requires rest, but a day or two of change of scene and fresh air is sufficient to restore him and bring back his impaired faculty of sleeping; loss of sleep and a certain degree of restlessness, which comes on after a more than usually hard spell for a few days, being the strongest sign that he needs change and rest. Appetite good; as a rule sleeps’ well; is cheerful; memory better; and is altogether as capable of business as most men; but still without care feels he would relapse.
1876, January 20th. Depression quite gone. Memory very much better, but still, some deficiency for names. Has attended to the entire business for two months, and done it well; even continual mental exertion does not bring on the old pain. Feels mentally and bodily tired after two or three hours’ mental work, but this is much less than formerly. Mind stronger; can comprehend as well as ever, but cannot continue so long. Sleep and appetite good. Occasionally frequent desire for urination, with weight in bladder if he does not relieve himself. Takes an interest in business. Very seldom has stiffness of legs on walking; can walk quickly and well. Much less stooping. No desire for solitude, nor absence of mind when reading. Diarrhea very much slighter; the heat in rectum very seldom. Deafness of right ear much less, scarcely any difference between the two. As a rule can think well after food. Feels generally better since last report.
March 3rd. Still better and stronger in every way; more fitted for business; less easily tired. Mental depression at times, but slight. Memory nearly perfect. Used to have sinking at stomach, as if he wanted food after an hour or two’s mental work; this has gone. Requires less sleep. Urinary symptoms very much better, and less often. Very seldom has stiffness of legs on walking. Stooping nearly gone. No diarrhoea. Deafness quite gone.
May 14th. Has not been so well, with disinclination to work, and undigested food passing away, but much better for two or three weeks. Has been subject. to headaches, relieved by food, on right or left side, or both. Heartburn with the undigested stools. Urine cloudy (brick-dust sediment) after standing. Memory much better, at times deficient with regard to names. At _times depressed, dislike for work and company. When out of health, wakes irritable and inclined to find fault.
Note. — The patient was evidently relapsing, and important new symptoms had arisen. Under Ill-humor on waking, my MS. Repertory gives agar., ant-t., arsen., bell., berb., carb-an., caust., cham., cupr-ac., janiph., kali., lycop., mere-bin., magnet-austr., natr-s., petr., puls., sulph-ac. Of these lycop., natr-s., and puls., have brick-dust sediment in urine; lycop. and puls. have loss of memory for names; and of these two, only lycop. has faultfinding. By this process of eliminating medicine after medicine, lycop. was found to be the simillimum, and was given in the Mm. potency (Boericke), night and morning for four weeks.
About a year afterwards reported that he had been at work as usual for many months; can do a hard day’s work with impunity, and the only symptom he suffers from is occasional slight heartburn.
1- It was about two years before this patient fully recovered, though an improvement was speedily manifested. Hahnemann says (Chronic Diseases, vol. i., p. 173) : « A great chronic disease may be cured in the space of one or two years, provided it has not been mismanaged by Allopathic treatment to the extent of having become incurable. One or two years ought to be considered a short treatment. In young robust persons, half this time is sufficient; in older people, on the contrary, this period has to be considerably prolonged, in spite of the greatest care on the part of the doctor, and the strictest obedience on the part of the patient. » Many patients are dissatisfied at not being cured of chronic ailments in a few weeks; others, again, leave off the treatment as soon as they are relieved of what they consider the most troublesome symptoms. Both are in error; relief is soon obtained when the simillimum is given, but time is required to thoroughly eradicate the constitutional taint, and unless that is done, the patient is sure to relapse, perhaps in after years, when a cure is more difficult.
It should be noticed that in this case Allopathic treatment, combined with rest and voyaging, only relieved temporarily, the patient relapsing so soon as he resumed his work; Homoeopathic treatment cured him permanently, and enabled him to attend to his business with impunity.
2- It has been stated that in brain diseases large doses (i.e., the mother tinctures and lowest dilutions) are necessary. The above case, which is only one out of many similar ones which I have treated, shows the fallacy of this statement.
3- The repetition of the dose is one of the most perplexing problems to the beginner. Hahnemann’s latest practice (evidenced by the statements of Bönninghausen and Croserio) was as a rule either to give one dose, or to repeat the dose daily till an effect was produced, and then let it act undisturbed. It has been stated that in acute cases the dose should be repeated more frequently than in chronic cases. Hahnemann says (Chronic Diseases, vol. i., p.155) that, generally, the more chronic the disease, the longer the duration of the action of the medicine, and vice versa; but while there are cases of chronic disease which seem to require frequent repetition of the dose, there are also numerous cases on record where a single dose of a high potency has cured the most acute attack. I believe that if a simillimum to the entire state of the patient is found, one dose of a high potency is sufficient, either in chronic or acute cases; but when the medicine does not fully correspond, as may often happen through the deficiencies of even our large Materia Medica, the dose may have to be repeated, the want of a complete similarity hindering the curative action of the drug; and in these cases the more acute the disease, the more frequent must be the repetition, because the action of the drug then becomes more speedily exhausted, unless it is sufficiently homoeopathic to subdue the disease at once. This view is in accordance with the teaching of Hahnemann, who says (Organon 246, note): « In pure syphilitic diseases I have generally found a single dose of metallic mercury 30 sufficient; and yet not unfrequently two or three such doses were requisite, given at intervals of six or eight’ days, when the very least complication with psora was perceptible. » The coexistence of psora, to which mercury was not homoeopathic, hindered its action, and therefore the dose had to be repeated. In a chronic case in which I commenced with Arnica Cm. (Swan), I had to repeat the dose for a time, the improvement ceasing as soon as it was discontinued; and in an acute case of neuralgia, I had to give Kali. in a high potency, every five minutes, during the paroxysms, before I could subdue it; but in each case other medicines were afterwards indicated, showing that neither the Arnica nor the Kali were completely adapted to the patient’s state. On the other hand, I have frequently cured both chronic and acute cases with a single dose. I am of opinion that in the case which forms the subject of this paper, the dose was unnecessarily repeated, and that the aggravation which occurred after Lycopodium might have been avoided. One thing is certain, that when once the curative effect has well set in, we should let the medicine act undisturbed till its effect has entirely ceased, and even then wait and see whether the patient, after remaining stationary, or even relapsing for a short time, does not again improve, an event which very frequently happens in chronic cases. Even if the improvement continues a year or more, let the medicine act undisturbed without change or repetition, and a perfect and permanent cure awaits the patient. But the repetition of the dose, with a historical and chronological account of Hahnemann’s teaching thereon, is a wide subject, which must be deferred for a separate paper.