How to take the case and find the similimum By Eugene Beauharnais NASH, M.D.

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How to take the case
and find the similimum
By Eugene
Beauharnais NASH, M.D.
Presented by Deepak M. R. &
Sylvain Cazalet

Dr Eugène
Beauharnais NASH
(1838-1917)

Many
failures to select the right remedy for the sick are due to a failure to
select the line of properly taking the case. We might as well under take
to recognise a person by looking at his hand, or hand and foot, as to
cover the case with the appropriate remedy from a few symptoms when
there are many to come into the complete picture.

Oftentimes
in a case half reported the very symptoms that are most important, so
far as the selection of the remedy is concerned, are left out. This is
especially true with the homeopathic system of prescribing. It is so
natural for a patient to think that if he tells us that he has a cold,
or indigestion, or rheumatism, that we ought to be able to prescribe for
him forthwith, and strange to say, I have met more than one physician
who seemed to have no better conception of homeopathy than this; and
evidenced it by asking such questions as , “Doctor, what is your
best remedy for diphtheria”, or rheumatism, etc.

There
is of course, only one proper answer to such a question, from a
homeopathic standpoint, viz, the indicated one.

The
name of a disease may be helpful so far as calling to mind a class of
remedies that have been found curative, but the symptomatology of the
case in its entirety, and especially in those symptoms which are
peculiar and characteristic, in correspondence with the remedy which in
its pathogenesis has the same, must decide which ONE of the class
is the true similimum.

But
some one will object, I cannot wait to hunt down a case like that. Life
is too short. I answer “Then you will wait for your cure, and life
may be too short for that”. Of course recovery may come (no thanks
to us), but never cure.

Then
if Similia Similibus Curanter is
true, the taking of case in the entire range of its symptoms is of first
importance.

Where
shall be begin?

LOCATION

In
the majority of cases, the patient
will locate the trouble without your asking questions, as “Doctor,
my head is troubling me.” It may be headache, vertigo or an
eruption. It may be in the chest, as pneumonia,pleurisy, pericarditis or
organic heart trouble; or it may be in the abdomen in the region of the
stomach, liver, kidneys, or pelvic organs. In all such cases the patient
will locate the pain, or other
suffering, and we must if possible interpret in the light of our
knowledge as physicians, and at the same time bear in mind the remedies
known to produce similar pain and suffering, in the same localities. Or,
if not borne in mind, all that remains for us to do is to hunt them up
in our repertories, or Materia Medica. For instance: Is there a pain in
the upper right chest, Arsenicum
acts characteristically there.

Right
middle chest? Belladonna, Sanguinaria, Calcarea ostearum, etc.

Lower
right? Chelidonium, Kali carbonicum, Mercurius

Left
upper? Myrtus, Pix liquida, Theridion, Sulphur, Tuberculinum, etc

Left
lower? Natrum sulphuricum, Phosphorous

Here
I have named a few remedies that have a particular affinity for these
locations in the chest, and in all these cases, this is generally in
connection with lung troubles, and further examination will disclose the
remedy most appropriate.

If
such pains in the chest region should occur outside
the lung itself, it might indicate Bryonia,
Squilla or Sulphur in pleuritic troubles, or Arnica,
Cimicifuga, Ranunculus or Rhus tox in rheumatic pleurodynia,
or intercostal rheumatism.

It
is not the province of this writing to draw the distinction between
remedies, which the case in all its local manifestations, concomitants
and modalities would suggest, but to impress upon our minds the
importance that must attach to locality.

But
one will truly object that sometimes the sickness or suffering does not
localise. The patient in answer to the question as to where the pain or
suffering is located, answers : “All over,
I feel badly all over; weak, aching, sore and trembling.”

This
might be a case of incipient typhoid and Gelsemium
or Baptisia would be in place,
or the prostration might be a result of some drain on the system, as
haemorrhage, leucorrhoea or loss of semen, and call for such remedies as
China, Phos ac, Nat mur, Kali carb or Stannum.

Still
although the trouble does not manifest itself in any particular part or
organ (and some would relegate it to the realm of Sensation),
I think it might come under the head of location, like absence of pain
would come under the head of sensation. It is located all over and in no
particular part. It is under the head of location in a negative sense
and significant. Now, in either case we have made a good beginning in
taking the case, and the next step is as to

SENSATION

Trouble
in what location? What about it? Is it pain, coldness; heat or burning;
sweating; cramping; emptiness; fulness; or any other abnormal sensation?
Describe it as nearly as possible.

Is
it a burning pain or sensation? Apis
mellifica, Belladonna, Arsenicum, Cantharis, Capsicum, Phosphorous and
Sulphur all have that very markedly

Is
it sticking pain? Then Bryonia, Kali
carbonicum and Squilla come to mind.

Sense
of fullness? Aesculus, China,
Lycopodium and Carbo veg; especially if in the abdomen,
pelvis or anus.

Is
it a sense of emptiness or goneness? Cocculus, Ignatia,
Phosphorous, Sepia or Sulphur.

Constriction?
Cactus grandiflora, Natrum muriaticum, etc.

Cramping?
Cuprum, Colocynth, Magnesia Phosphorica.

Faintness?
Ignatia, Hepar sulphuris, Nux moschata, Nux vomica, Sulphur.

Numbness?
Aconite, Lycopodium, Platina, Rhus
tox, Secale, are prominent.

And
we might go on to mention many more sensations that have been observed
in so-called disease and pathogenesis of drugs. These sensations are for
purpose of prescribing, invaluable to the homeopathic
physician, and occur in almost every abnormal state to which flesh is
heir.

Not
of less importance in the taking of the case than Location and Sensation
is that which is termed

MODALITY

What
aggravates or ameliorates?

First,
as to time. Are the symptoms worse in the
morning? Remember Nux vomica, Nat
mur, Podophyllum, etc

Forenoon?
The same.

Afternoon?
Belladonna, Lycopodium, Apis mellifica.

Evening?
Aconite, Pulsatilla, etc

Night?
Arsenicum , Mercury, Rhus tox.

After
Midnight? Arsenicum (1 to 3 A.M.), Kali
carbonicum (3 A.M.), Rhus tox.

As
to circumstances:

Aggravation
on movement calls for such remedies as Bryonia,
Nux vomica and Arsenicum

Amelioration
of movement : Rhus tox, Pulsatilla, Ferrum, Lycopodium

Aggravation
on descending : Arsenicum and Calc ost

Aggravation
in wet weather : Dulcamara, Rhus tox, Natrum sulphuricum, Nux
moschata, Rhododendron

Aggravation
in dry weather : Hepar Sulphuris, Causticum, Nux vomica

Ameliorated
by hot applications : Arsenicum, Magnesium phosphoricum

Ameliorated
by cold applications : Apis mel, Pulsatilla

Aggravation
in cold air : Hepar sulphuris, Arsenicum, Nux vomica, Silicea

Aggravation
in warm air or weather : Antimonium crudum, Bryonia, Pulsatilla

Aggravation
after eating : Nux vomica, Bryonia, Pulsatilla, Arsenicum

Amelioration
after eating : Iodine, Chelidonium, Anacardium, Petroleum

Aggravated
after fat food : Pulsatilla, Carbo vegetabilis

Fat
food agrees and is desired : Nux vomica and Nitric acid

All
these and many more may be classified under the head of what are by some
called Generals. Another class is
termed Particulars, because referring to regions or particular
organs such as:

Diarrhoea
aggravation in the morning : Sulphur, Bryonia, Podophyllum,
Natrum sulphuricum and Rumex

At
night : Arsenicum, China, Mercury, Psorinum.

Chest
affections aggravation worse when lying : Psorinum, Laurocerasus.

Amelioration
sitting : Arsenicum, Kali carb

Anal
trouble, worse after stool : Aesculus, Aloe, Muriatic acid,
Nitric acid, Sulphur.

Many
more are there which are both general and particular just as important
to show the equal importance of Modalities with Location and Sensation.
To try and produce them here would be to incorporate a large part of
Boenninghausen’s Pocket Book, and
all the repertories extant.

We
cannot use space to mention any of the many possible concomitants
(another of Boenninghausen’s divisions), which are no less important
than the preceding in the necessary “make-up” of a case, but
will come to the apparent.

CAUSES

of
diseased conditions. Boenninghausen includes these under the head of modalities,
but they ought in my opinion to be seperated, as they often equal in
importance the other three.
For instance was it fright? Aconite,
Gelsemium, Ignatia, Opium, Lycopodium and Veratrum
album occur to us.

Exposure
to dampness or cold air : Dulcamara, Rhus tox, Natrum
sulphuricum, Nux moschata

or
exposure to dry cold air : Aconite, Bryonia, Hepar Sulph,
Causticum.

Cold
bathing? Antinomium crudum, Rhus tox, Sulphur

Suppression
of an eruption? Sulphur, Psorinum or other anti-psorics.

A
badly treated or suppressed gonorrhoea? Thuja, Medorrhinum

We
might under the head of causes mention many more than we have, but the
skillful homeopathist will not under-rate any of them in his
examination of the sick. And now, though coming late, we must not fail
to call attention to another important thing for consideration, namely

CONSTITUTION
AND TEMPERAMENT

Some
would have noticed this first, and it is certain that the
“personal” of the patient cannot be ignored and their diseases
often present symptoms that find their similar in a certain class of
drugs. Dr. TL Brown, one of the best prescribers I ever knew, used to
say, that is he met a pure Pulsatilla temperament
he would always find the symptoms and conditions to correspond. That is
putting it strong, and it might be found that Nux
vomica would be indicated in a Pulsatilla
subject. These are the exceptions that prove the rule.

Sulphur
will rarely be called for in a Calcarea
ostearum temperament, an vice versa.

Iodine,
Lycopodium and Nitric acid
are three of the remedies that often find their indications in brunettes
of spare habit, and so we find them in the remedies oftenest adopted to
the sanguine, nervous and bilious subjects. Not only is this true in
regard to the choice of remedies, but the rule holds good in the proving
of drugs. The subject most responsive to the curative action of certain
remedies will also be the most susceptible to their pathogenetic
effects. Some undoubtedly place too much stress upon this feature in
taking the case, and thus run into routinism, while others underestimate
it. There is a point where extremes meet and form the completed circle.

Constitution
and temperament must certainly come into the totality
of the case.

This
method of taking the case is the one adopted by Boenninghausen, and the
outcome was his celebrated Therapeutic Pocket
Book. There is another method in use, and employed by some of
our best prescribers, which is also a good one, which I will illustrate
by a case so taken. The symptoms are grouped under two heads Generals
and Particulars:

Sr

Generals
(symptoms as given by the patient)

Generals
(Same as found in the repertory)

1

Worse from physical exertion

Aggravation by physical exertion

2

Tendency to take cold

Tendency to take cold

3

Efforts to think made the mind
seem blank

Aggravation by mental exertion

4

Easily hurt by what people say or
do

Sensitive

5

Mind dwells on breaking up of
home

Dwells on past disagreeable
events

6

Which is a lasting grief

Ailments from grief

7

She could not think or remember
well

Weakness of memory

8

Attacks of low spirits lasting
days

Sadness and mental depression

9

Has lost all ambitions

Loss of ambition

10

Would hardly speak, even when
addressed

Aversion to talking

11

Fear of death, if left alone

Fear of solitude

12

Trembling when tired or excited.

Trembling externally

13

Felt as if going insane

Fear of insanity

14

Worse after eating sweets

Aggravated by sweets

15

Always weak since scarlet fever

After scarlet fever

16

Felt very tired

Weariness

17

Nervous prostration

Nervous weakness

18

Lying down relieves

Amelioration by lying down

19

Feels tired and bad in the
morning

Aggravation in the morning

20

Great menstrual difficulty

Painful menstruation

21

Menses profuse

Menses profuse

22

Menses long lasting

Menses protracted

23

Menses too early

Menses too early

Sr

Particulars
(symptoms as given by the patient)

Particulars
(Same as found in the repertory)

1

A bursting pain the front part of
the head

Bursting pain in the forehead

2

Redness of the nose

Redness of the nose

3

Discharge from nose, bloody mucus

Discharge from the nose, bloody

4

Nose is full of scabs

Nose scabs

5

There are brown spots on the face

Brown spots on the face

6

An unclean taste in the mouth in
the morning

Bad taste in the mouth

7

Intolerance of anything in her
throat

Throat sensitive to slightest
touch

8

Stomach gets sour

Sour eructations

9

Has heart burn

Heartburn

10

Sensation of stone in the stomach

Sensation of stone in stomach

11

Wind in stomach

Flatulence in stomach

12

Stool is partly expelled and then
recedes

Stool slips back

13

Smarting pain in rectum

Smarting pain in rectum

14

When not constipated stool is
expelled like shot

Stool shooting out

15

When desire for micturition is
felt it has to be satisfied immediately, or urine cannot be
retained

Must hasten to urinate or urine
cannot be retained

16

Colds of a croupy form

Croupy

17

Hairs turned gray

Hair becomes gray

18

Sensation of weight on her chest

Heaviness in chest

19

Seems as if would strangle when
coughing

Choking when cough

20

When hurt very excited and heart
palpitates

Emotional excitement and
palpitation

21

Curvature of the spine

Curvature of the spine

22

Spine externally sensitive to
touch

Backs, pains, spine

23

Sudden desire for food which must
be gratified

Ravenous appetite

24

Palpitation caused by lying on
left side

Palpitation when lying on left
side

25

Upper part of spine is stiff

Stiffness of cervical region

26

Rubbing ameliorates

Numbness ameliorated by rubbing

27

Burning in the back

Heat up the back

This
was the case, and was of one years standing. Before “chasing it
down” in the repertories I predicted that Phosphorous
would be the remedy. It was worked out by another physician, and
when she got through the Generals
she came to me with a smile and showed the result: Natrum
muriaticum, 44; Pulsatilla, 39;
Phosphorus, 38; Nux
vomica, 38; Calcarea ostearum,
38; Sulphur, 37; Lachesis
32; Mercurius, 32.

“How
about Phosphorus?” said she. I
answered, work out the rest of it. The particulars stood : Phosphorus,
41; Nux vomica, 39; Sulphur,
37; Lachesis, 33; Pulsatilla,
31; Lycopodium, 27; Arsenicum,
27; Mercurius, 28; Calcarea
ostearum, 25; Natrum muriaticum,
24.

Summary
: Phosphorus, 79; Nux
vomica, 77; Sulphur, 74; Pulsatilla,
70; Natrum muriaticum, 68; Lachesis,
65; Calcarea ost, 63; Mercurius,
60.

(After
this work is done, I find that about the first seven remedies may be
taken for further comparision. Not only the totality of
symptoms, but those that are characteristic and peculiar.
(See Organon paragraph 151), must be recognised. For instance if with
the two remedies, Nux and Phos in the case, Phos
had five characteristics, while Nux had ten, the later
remedy would deserve preference and further examination of the
pathogenesis, verified and unverified, would place it there. This is
where the judgement and skill of the man with long experience and
practice in the art of prescribing becomes invaluable)

Now
I do not claim that I can with certainty always predict the remedy that
will come out ahead. I remember another Phos
case in which I predicted that Calc ost would
be the remedy, and the result of the “hunt” placed it
second.

To
the skillful and experienced physician, the case so taken may sometimes
stand out prominently in its characteristic
and peculiar symptoms as to
carry on its very face the sure indications for the remedy. But other
cases will come to us so complicated that the best of us must make long
and arduous study of it. Especially this is true in chronic
diseases.

None,
but the true homeopathic physician realises the importance of
throroughly taking and working out such cases.

Rarely
will a case come out so clearly that the cure can be performed with one
remedy, but a succession of remedies will be necessary, and here is
where the so-called complementary relations of remedies come in for
recognition and skillful application.

P.
S.: On reviewing the foregoing, I feel constrained to add,
lest we be charged with not being up-to date, especially in pathology,
that for purposes of diagnosis, the tests for evidence of disease,
bacteriological, chemical, etc should not be neglected. The urine,
sputum, blood, excretions, etc, furnish important signs.

But for the
purpose of prescribing, we do well
to remember the teachings of Raue, who stood high both as a pathologist
and prescriber. He said : “The symptoms which go to make up the
choice of the remedy often stand outside those that go to make up the
pathology of the case.” Every prescriber accorsing to Similia
Similibus Curanter understands this.

Copyright © Deepak M.
R. 2000 http://www.onlinehomeo.com
Copyright © Sylvain Cazalet 2000

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