The Selection Of The Remedy Illustrated.
No. .1.—Three Cases Of Whitlow.
BY E. W. BERRIDGE, M.D.
THERE are two ways of illustrating the Materia Medica. The first is to collect all clinical cases in which a given remedy has, proved curative. There cannot be a better plan in the case of a comparatively new remedy, since thereby we see at a glance what symptoms have been clinically confirmed, how often, in what combinations, and under what conditions; from which study we can determine more accurately its characteristics, and supply the deficiencies in its provings. In the case of well-known medicines, however, such a plan would be tedious; and it is better to classify these cases, carefully and minutely worked out, under nosological headings.
But it will be said, « Have not homoeopathicians always taught that so far as the selection of the remedy is concerned they treat patients and not diseases; that to give a generic name to a series of cases more or less agreeing in their essential character is simply for convenience in terminology, for statistical purposes, for general hygienic purposes, and for ‘science’; and that these very symptoms which are our guides to such classification are the very ones which do not indicate the remedy, and for this very reason that they are so general; while those which characterize each individual case, and so distinguish it from others of the same genus, are diagnostic of the remedy, but are not diagnostic of the disease, because they are individual and not general? »
This is perfectly true, and it is for this very reason that articles on different « diseases » are useful, to show that the pathologically-selected name of the disease has nothing whatever to do with the selection .of the remedy, but that any disease may require any remedy if the symptoms at the time happen to correspond.
CASE I.–Feb. 16th. A girl, aged nineteen, had had for five days a whitlow in the last phalanx of left thumb, increasing up to to-day. The suppuration is in the palmar surface, not reaching to the tip. In the affected part there is throbbing pain, sometimes with burning. The throbbing is aggravated by warmth, warm water, letting the hand hang down, and in the evening after
sunset; better when in bed. Nux vom. 94m (Fincke), one dose.
The pain was better next morning, and ceased in two or three days. Then the whitlow became brown and dried up without discharging, and the skin peeled off.
CASE II.—Dec. 8th. A girl had a whitlow on the right thumb; it began to pain her on Nov. 28th; on Dec. 5th pus began to form; on the night of 7th the pain kept her awake. This evening (8th) I found a whitlow in the palmar surface of the ungual phalanx of the right thumb; the skin was yellow, and the pus could be seen and felt beneath it; there was throbbing and burning in the whitlow, and she could not bear the weight of a poultice. Hepar 3 m (Jenichen) every four hours.
Dec. 9th. Had relief after second dose; slept better; this evening very much better, less heat, no throbbing; has had pricking like a needle in whitlow.
Dec. 10th, evening. Pain much less; the whitlow has not discharged, but the skin over it has become brown, and the touch shows fluid beneath; the swelling has extended lower down the phalanx. Stop medicine.
Dec. 16th. Hardly any pain; the skin at end of thumb is of a chocolate-colour and feels baggy, showing an absorption of the fluid beneath. Afterwards an accidental blow broke the skin, and a little discharge escaped.
CASE III.—April 12th. A child had a whitlow for six or seven days. Now the last joint of the right thumb is inflamed, swollen, and itches, with throbbing, shooting, and burning in it.
The redness is mostly in the dorsal surface of the phalanx, the throbbing worse in the palmar surface; the part is dark-red, and pus is visible. Has taken hepar (on the authority of one of the wretchedly-deceptive works on « Domestic Homoeopathy », written by pretenders who need to be taught themselves), but has become worse. Sepia Cm (Fincke) every two hours, and a bread‑poultice to thumb.
April 15th. On evening of 13th the pain suddenly ceased; the whitlow discharged yesterday at 2 p.m. Thumb now feels very sore and itches a little, but there is no throbbing, shooting, or burning. Stop medicine.
April 21st. Thumb nearly healed; no pain; itching still. May 2nd. Quite healed; skim peeled off; thumb aches a little on using it.
May 8th. New nail forming; otherwise quite well.
One of the first apparent difficulties which the student of homoeopathy encounters is how to treat organic changes, the simile of which he cannot find in the known pathogenetic action of drugs. Hence he argues that homoeopathy is imperfect, and needs to be supplemented by surgical or allopathic means; or, if he is told that he must in such a case treat the patient according to the totality of the symptoms irrespective of the organic lesion, he thinks that this is unscientific in theory, and must prove inefficacious in practice, because it seems to involve the treatment of the effect rather than the cause. We, however, maintain that in carrying out this latter method we are not treating the effect only, but, are using these effects as the only sure guide to that remedy which will eradicate the cause, and thus cure the organic lesion as well as its resultant subjective symptoms; We further maintain these two points : —
(1) That our Materia Medica, though as yet imperfect with regard to the production of organic lesions, is not necessary or inherently so; and
(2) That were it absolutely complete in this respect, the symptoms so obtained would be so general in character, that they would prove but the faintest guide to the selection of the homoeopathic remedy.
First, therefore, we maintain the inherent perfectibility of our imperfect Materia Medica. We find that aurum, has caused exostosis; secale, dry gangrene; fuligo, a peculiar form of cancer, &c. if, therefore, an opponent urges that there are many organic lesions to which we can find no simillimum in our provings, we reply that we have sufficient evidence of the power of drugs to produce such, and that when a prover, very sensitive to the action of a medicine, is found willing to test on himself the effects of that medicine thoroughly, so as to establish a chronic poisoning, we shall then obtain the desired organic changes. In the meanwhile, we must be content with accidental cases of chronic poisoning and experiments on animals; and if these are not considered sufficient, we can only recommend that the skeptic
should put into practice on himself the motto, « Fiat experimentum in corpore— —. »
We may here also refute another similar objection which is sometimes urged. It is stated that the law of similars fails, because we cannot produce by means of drugs artificial diseases like measles, scarlatina, typhus, &c. But to this we make a similar reply. The law is, « Let likes be treated by likes; » but how much « likeness » is required? Certainly as much as we can discover; but fortunately for the sake of the sick, it is not necessary to cure a case of scarlatina that a medicine should be found which has produced all the symptoms thereof in the same sequence, combination, and duration; it is sufficient that it has produced the symptoms of the individual patient (or at least the most characteristic of them), even though in different combinations, or on different provers. Nevertheless, we find here also that our remedies have more pathopoietic power than they sometimes get credit for. They do, under certain conditions, produce groups which resemble complex « diseases », the only difference being that these artificial « diseases » run a shorter course than the natural ones. Sometimes, even this difference is wanting; fatal cases of arsenical poisoning have been diagnosed as « diphtheria » till the cause was known, and the fungus of mouldy wheat straw has produced symptoms which, in their character, combination, sequence, and duration, exactly resembled an attack of measles. When such correspondence exists, the absolute simillimum is found—a simillimum because all the effects correspond in every particular, not an idem because the existing cause is different.
But, in the second place, let us suppose that our provings were thus completed; should we be better able to cure? No, because just as twenty cases of enlarged ovary, or psoas abscess, or caries of the spine, or scarlatina, or measles, can only be distinguished from each other by the symptoms belonging, not to the generic disease, but to the individual patient, so it would be with these artificial diseases; and after all this suffering, though « science » might be benefited, we should be able to cure no better than we do now.
But it may be urged, « If you admit that no medicine can cure an, organic lesion unless it is capable of producing it, would not
the result of these heroic provings be to show what medicines could and what could not produce them, so that we should at least be able to exclude from our first choice a large number? »
To this we reply; that we can never prove that any particular organic lesion cannot be caused by any particular remedy; we can ,only rely on positive, not negative, evidence; however far our provings might be carried, something could always be done further, and the 10,001st prover might exhibit symptoms not evolved in the provings of the first 10,000. The very fact that tumors have been cured by medicines which have not yet been known to produce them, but which were selected from the similarity of the other (often subjective) symptoms of the individual patient, is a proof that to rely upon the similarity of organic changes would exclude us from a wide range of remedies.
Let us now apply these rules to the above cases of whitlow. If we take the organic change which we call « whitlow » as our key-note, we find no less than sixty-eight remedies which have produced or cured it. If we restrict our selection to those which are known to have caused it, we manifestly are excluded from the use of many which clinical experience has shown to be of value when indicated by the other symptoms; while, if we add our clinical experience, our sixty-eight remedies are too many for « whitlow » to be regarded as the basis of selection, not to mention the possibility that even this list may be incomplete. Shall we prescribe pathologically, and argue (as is covertly suggested in the Monthly Homoeopathic Review for 1877, p. 136), that because there is suppuration, hepar must be the « specific » ? if so, how shall we explain the fact that it cured in one case and failed in another? or shall we apply a poultice covered with chloride of lime, as is now done by a professed homoeopathician who holds a high position in the « London School of Homoeopathy? » This latter treatment would be more devoid of science than the former, for, whatever effect it might have in relieving the pain (which the above cases show can be done without it), it would not remove the constitutional state which caused the whitlow.
Treating each case in the homoeopathic method, we arrive at, the following differentiation. In all three cases the thumb was the
part affected; in Case I. it was the left thumb, and in Cases II. and III. it was the right. For the reasons stated above, we must not exclusively regard those medicines which have « whitlow of thumb », for the subjective symptoms might point more strongly to medicines which had simply « whitlow of fingers. » Nevertheless the precise locality of a symptom (especially the side of the body on which it occurs) is of so great importance, though not to be relied on exclusively at any time to the neglect of the other indications, that as there are only thirteen medicines under this rubric, we will take it as our starting-point.
Suppuration of thumb is found under allium.-cepa., amm.-mur.,borax.,bufo., eugen., fluor.- ac., granat., hepar., kali.-iod., nux.-v., sepia, and sulph. The side has only been noticed in the case of bufo, which has « hot bluish-red swelling, followed by suppuration at the lower border of the left thumb-nail. » In this respect it agrees with Case I., but the colour of the swelling and the part of the thumb affected do not correspond; and as the side is not mentioned in the case of ten other medicines, we must in this case ignore it, the deficiency of our provings having a negative value only.
In analyzing the subjective symptoms of Case I., we find as follows : —
Throbbing in thumb.–Borax., carb.-v., hepar., magnes.-arct., magnes.-aust., magn.-c., sarsap., stront., zinc.
Burning in thumb.— Granat., graph., hepar., laches., lauroc., magnes.-aret., magnes.-aust., merc., nux., oleand., ol.-an., sarsap., staph., zinc.
Worse from warmth (symptoms of upper extremity).—Ant.-t., bry., calc., caust., cham., dulc., led., nux., puls., rhus., sabad., stront., zinc.
Worse by letting limb hang down.—Angust., cina., ignat., magnes.-aust., natr.-m., nux., paris., phos., phos-ac., plat., puls., ruta., sabin., stront., sulph., sulph.-ac., valer.
Better in bed.—Amm.-mur., bry., canth., nux., oleand., sepia.
Worse in evening is found under sixty-six remedies, including nux. Nux, therefore, corresponded best to the totality of the symptoms of Case I.
In Case II. the only indication (besides the locality) was the
character of the pain, no conditions having been noticed. Of the thirteen remedies found under « Whitlow of thumb », hepar is the only one which has burning and throbbing of thumb, and it also has extreme sensitiveness to touch. It was therefore selected.
In Case III. there are two fresh symptoms — »shooting in thumb », which is found under ambr., anac., asaf., cast., colch., graph., grat., guiac, ignat., kali.-iod., kali.-nitr., lauroc., magnes.-arct., magn.-s., meny., merc., mez., natr.-s., nux., ol.-an., petr., phos.-ac., rheum., sabad., sabin., sarsap., silic., spong., staph, verb., viper.-t., zinc.; and « itching of thumb », which is found under ant-c., carb-v., cocc., grat., oleand., ol.-an., plumb., spong., staph.
Of these, ol.-an., and staph. correspond best to the subjective symptoms; but they are not amongst the thirteen remedies having « whitlow of thumb. » The question arises, which indication is the key-note of the case 2 On re-examining the case, the inflamed part is found to be « dark-red », a symptom belonging to lycop., rhus., and sepia; of these, only sepia has « whitlow of thumb », and it has the analogous symptoms, « panaritium in left index-finger, with violent beating and shooting in the same. » Rhus has « shooting in whitlow », but not « burning; » lycop. has neither; sepia, therefore, was selected as the simillimum.
Comments.—(1) In Case I. there was no evacuation of pus; in Case II. only a little towards the end, when the skin was accidentally broken, previous to which some had evidently been absorbed. Homoeopathic treatment, can therefore cause the absorption of pus, not probably as pus, but after being disintegrated, changed, or resolved into an absorbable fluid, not inimical to the life of the organism or of the blood.
(2) These cases show that in whitlow (and, by analogy, in other cases of suppuration) it is not necessary to evacuate the pus artificially. When in cases of internal suppuration the truly homoeopathic remedy is given, the first effect is to relieve or remove the pain; the second either to cause absorption of the pus or to cause its evacuation externally, the action of the homoeopathic remedy being to throw the disease from internals to externals, that is, in a direction the reverse of that in which a progressively
increasing disease travels. It has been argued that as nature relieves the system by the evacuation of the pus, we should imitate her operations; but this is illogical. In the first place, when an abscess opens naturally, the discharge is generally intermittent, the cavity contracting after each flow, so as to exclude air as much as possible, till more pus is formed and again discharged; when the abscess is artificially opened, the edges of the wound become inflamed, which prevents their closing sufficiently to exclude air : in the second, it should be remembered that the curative efforts of nature are the efforts of a diseased organism, and therefore necessarily imperfect, and not to be followed.
(3) In Case I. the pain was removed without a discharge occurring; in Cases II and III before the discharge. If pain disappears under homoeopathic treatment before a critical discharge takes place, it is a cure; if after the discharge, it may be only natural recovery.
(4) In Case I. one dose sufficed to cure; possibly in the other cases it would have also sufficed. In Case II an error was made in not stopping the medicine on Dec. 9th, as soon as there was a decided relief; possibly the continuance of it caused the extension of the swelling on Dec. 10th.
(5) The above cases illustrate some of the various starting points in the selection of the remedy. The locality was an indication in all three cases, but it left us with a choice of thirteen remedies. The selection of the simillimum out of these similia was determined in Case I. by the conditions of the pain, the character of the pain proving of secondary importance; in Case
II. the character of the pain was the key-note; and in Case III. the appearance of the part was the indicative symptom, the character of the pain not being sufficiently diagnostic.
Such is the homoeopathic method of selecting the remedy, but the Pathological School consider this method to be « unscientific », « mere symptom-covering », and, while still retaining the name of Homoeopathicians, openly avow their belief that pathological indications are the most reliable, symptomatology being resorted to by them only when the former fails. We will take them at their word, and ask them what was the varying pathology of these three cases which made Nux curative in one case, Hepar in another, and Sepia in a third. If they cannot answer, they must confess that the homoeopathic method is superior to their own.
But, say the Pathological School, the homoeopathic method gives too much trouble and occupies too much time! In the Monthly Homoeopathic Review, June, 1867, one of the editors states that « A physician of eminence (!?) who had long practised homoeopathy » told him that « if he were to practise medicine strictly according to HAHNEMANN’S rules, he could not properly attend to more than twelve patients a-day. » This statement may have been perfectly true as far as he was concerned—we do not wish to question it in the least— but the mere fact of HAHNEMANN’S immense practice at Paris proves that there is no inherent impossibility in the thing. The writer continues, « It is therefore of the first importance that some other method of practising homoeopathy should be adopted. A physician cannot sit down before every patient at each visit, pen and paper in hand, and write down his state under each of the heads as they occur in the symptomatology. [Here follows a list of twenty-six headings from « General Symptoms » to « Legs. »] To subject every patient to such a cross-examination would in many cases be as impossible as it would be useless. Then when this is all done, and the Hahnemannian has copied down all the required symptoms, he has not accomplished half his work. He must now consult every medicine which covers any one of these symptoms, and carefully compare them wish the list of aches and pains and sensations he has taken down. The search through, say twelve or fourteen medicines,
cannot occupy less than one or two hours, even if the man has a great facility for comparative research. The general practice of the profession could not possibly be carried on in this manner. The patients would be worn out by the severe cross-examinations, and the doctor’s brains be confused by this ardent symptom-hunting. » Then, to save all this (imaginary) trouble, he gives his idea of the best treatment : « To be a good homoeopathist a man must be a good pathologist, and able to diagnose the disease definitely. In doing this he must appreciate its distinguishing features—those which make it a distinct disease; seizing upon these as the central ailment, he has at once an ideal as his indication for treatment. He then turns to his knowledge of the physiological effects of medicines, and selects that medicine whose central and most prominent effects correspond with the diseased ideal he has found. » This improved (?) mode of treatment sounds very plausible and learned, but it has these fatal defects : —(1) It is based, not on facts (symptoms), but on the theory which each physician may form as to the nature of each case; hence arises the strange sight of a number of professed homoeopathicians disagreeing upon the medicinal treatment of a case, though they all profess to be guided by a definite law; (2) it ignores the symptoms which characterize each case of a « disease », and relies upon those which are common to all’ cases thereof; in a word, it generalizes instead of individualizes. This is not homeopathy.
But to refute the objections of « too much labor and too little time. » The whole description is a caricature, based on two delusions; (1) that there is no such work as a Repertory to lead the physician at once to one or at most a few of the most similar remedies, but that in every case every remedy which corresponds to any of the symptoms must be read through to see if it has the remainder or not; (2) that every patient must be afflicted in every organ of his body, and that at every visit the same sad tale has to be repeated, necessitating the same laborious work. If the writer speaks from his own experience in the latter matter, it does not say much for his success; the homoeopathician, on the contrary, finds that after giving the truly homoeopathic remedy in the manner which HAHNEMANN enjoins, improvement sets in, so that at the
next visit he has merely to write « better » in his case-book, and dismiss the patient with suitable instructions till the next visit. It is true that the first consultation is often long, for it is necessary to get a complete picture of the case in all its past as well as its present details; but when that is done once for all, the future work is comparatively easy. But even at the first visit the work is not so laborious as the writer imagines; for if the patient says he has no symptoms of his head, eyes, ears, or other of the twenty-six headings, surely no more need be asked on those points. We never have yet met with a patient who complained of every organ being affected, and therefore requiring to be questioned under these twenty-six headings; if we ever do, we will send him to the writer of the above article for his advice as to treatment; we think in such a case our learned friend will be considerably more puzzled as to the treatment than we should be; for while he is perplexing his brains in order to find a pathological theory of the nature of such an extraordinary case on which to base his prescription, we should simply find the remedy which produced symptoms the most like those of the patient; and the latter would probably be on the road to health before our pathological friend had extricated himself from his difficulty.
In the above cases of Whitlow, though much time and space were occupied in writing out the mode of selecting the remedies, the selection itself only occupied a few minutes.
 We do not find all these conditions stated as belonging to burning and shooting in the thumb, but only as belonging to certain symptoms of the upper extremity generally. Conditions may have a far wider range than appears from our yet imperfect provings; clinical experience shows that the conditions of a symptom may also belong to other symptoms of the same organ, or to the same symptoms in other organs; it may be even of universal application. Hence no Repertory or Materia Medica is perfect which does not only give the conditions under their respective individual symptoms, but also arranges them in collectives, that the simillimum may be selected by analogy when other means fail. C. Hering’s Materia Medica is the only one in which a comparative view of localities, conditions, sensations, etc., is thoroughly carried out. All that he has published of his Materia Medica, as well as the two published parts of his Analytical Therapeutics, are indispensable to the homoeopathician.