CONTINUING HOMOEOPATHY MEDICAL EDUCATION SERVICES

QUARTERLY HOMOEOPATHIC DIGEST VOL. I, JUNE 1984.

(A compilation of some of the more important articles in the British, American and German Homoeopathic Journals –

No index entries found.condensed. Also articles and news of general medical and scientific interest with particular reference to Homoeopathy)

(Translation, condensation and compilation by Dr.K.S. Srinivasan, Chennai.)

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THE TRIAL OF HOMOEOPATHY :(Condensed from The Lancet, January 15, 1983)The Pharmaceutical Society has lately been

challenged to sponsor an inquiry into the promotion and sale by pharmacists of Homoeopathic remedies not only because of their lack of scientific validity and evidence of effectiveness, but also because of the large profit margins associated with their marketing.

Its claims should be subjected to the same rigorous tests as those required of orthodox medicine. In this issue we publish results of a controlled trial in which the allopathic drug

ContentsNo table of contents entries found. Fenoprofen was compared with the Homoeopathic remedy Rhus tox. and with placebo in patients with Osteo-arthritis. No significant difference was found between Rhus tox and placebo, but Fenoprofen had significant analgestic and anti-inflammatory effects and was strongly preferred by the patients despite a higher incidence of side effects. A welcome aspect of this study is that homoeopathic and allopathic physicians co-operated in its design and execution. Such co-operation is essential if criticisms of patient selection, symptom definition, and treatment assessment are to be avoided. It is hoped that the large number of other marketed homoeopathic and naturopathic remedies will be evaluated in similar rigorous trials.

CONTROLLED TRIAL OF HOMOEOPATHIC TREATMENT OF OSTEOARTHRITIS: Michael Shipley, Hedley Berry, Dept. of Rheumatology, King’s college Hospital, London SE5; Gill Broster, Michael Henkins, Royal London Homoeopathic Hospital, London WC1; Anne Clover, Hospital, Turnbridge Wells, Kent.

In a double-blind, placebo-controlled crossover study to compare the homoeopathic remedy Rhus tox 6x

with Fenoprofen in Osteoarthritis of the hip and knee, Fenoprofen was shown to have beneficial analgesic and anti-inflammatory effects which differed significantly from those of placebo. The effects of Rhus tox 6x and placebo did not differ significantly. Patient preference was for fenoprofen. Similar results were seen in all patients regardless of whether they had been referred to and assessed by a homoeopathic physician or a rheumatologist.

Pain of many patients of osteoarthritis can be satisfactorily controlled by anti-inflammatory and analgesic drugs. However, sometimes pain relief is incomplete and surgery may be indicated or side-effects are sufficiently troublesome to pre lude use of these drugs. Many have thus turned to alternative forms of treatment which has led to considerable increase in interest in homoeopathic medicine.

Rhus tox produces many toxic effects few of which mimic symptoms of patients with osteoarthritic joints. Homoeopathic physicians frequently use a preparation of Rhus tox in such patients. The use of Rhus tox is sufficiently widespread to justify testing it against a standard anti-inflammatory analogesic. (Fenoprofen).

Patients between the ages of 18 and 85 years were entered in the trial. Any patient who had previously received either Rhus tox or fenoprofen was also excluded. The mean age was 65 years. 17 patients had OA of one or both knees, 15had OA of one or both hips and 4 had involvement of three joints. The study was a double-blind, double-dummy, place-controlled cross-over comparison of fenoprofen (600mg 3 times a day), Rhus tox 6x and placebo.

Analysis of the results was statistically evaluated. There was no significant difference between the effect of Rhus tox and placebo. Fenoprofen produced highly significant pain relief compared with Rhus tox and placebo. When fenoprofen was compared with either placebo or Rhus tox., it was clearly preferred to either. When Rhus tox and placebo were compared with each other, each was equally preferred. Over all, patients preferred fenoprofen (21 patients) to Rhus tox (5 patients) and placebo (5 patients).

We have shown that under the conditions of this study treatment with drops of Rhus tox 6x 3 times a day does not differ significantly from placebo in its effects on the pain of osteoarthritic hips and knees. Fenoprofen is a useful anti-inflammatory analgesic but causes a relatively high incidence of side-effects. Compared with both placebo and Rhus tox, its beneficial effects were highly significant and despite its side-effects fenoprofen was still preferred by most patients. Evidence from our study leads us to conclude that Rhus tox alone had no greater effect than placebo on pain of osteoarthritis hips and knees.(Condensed from the Lancet, January 15, 1983).

That Rhus tox was the decided loser in this study is not surprising. In fact, any future studies set up along such lines will invariably result in the homoeopathic remedy taking second place to the allopathic drug. This controlled trial was designed to see which substance had the greater analgesic and anti-inflammatory effect, in a word, which substance had the greater palliative effect. Most homoeopaths try not to palliate their patients. Rhus tox is only one of scores of homoeopathic medicines capable of curing various forms of arthritis. Homoeopathic remedies can never (with the possible exception of Arnica for soft tissue injury) he prescribed as allopathic drugs are. Rhus tox will never act efficaciously in a majority of cases of osteoarthritis of the hip and knee. It’s like asking apples to taste like oranges.

Along as studies such as this one continue in vogue, homoeopathy will always appear to be no more effective than placebo. Homoeopathic medicines work when tailored to the individual patient. But the fact remains: homoeopathic medicines need to be taken out

of the realm of the anecdotal and given greater scientific responsibility.[Extract from the Editorial of the Journal of the American Institute of Homoeopathy, Vol. 76, No. 2, June 1983].

2. CASE TAKING IN CHRONIC CASES IBARRA Raul (JAIH 76, 2/1983)

While interviewing a chronic patient, the homoeopath must remember certain basic ideas:

1. A complete clinical history must be done to obtain information such as family history, past illnesses, the degree of organic pathology, past surgery, vaccinations, and of course, prior (or current) drug therapy.

2. Laboratory studies, i.e. urinalysis, bloodwork, X-rays, etc. may be in order, not for diagnosis but for prognosis.

3. Keep in mind that often acute symptomatology will temporarily cause chronic symptoms to abate or disappear. This latter will reappear after the acute illness has run its course.

4. Symptoms which are more or less constant and not of recent onset are more important than occasional symptoms in a chronic disease.

5. The totality of symptoms which includes all the modalities and peculiarities must be obtained.

6. Miasms must be kept in mind. The predominating miasm will determine the actual symptomatology.

7. The chief complaint is not the most important symptom. Treat the patient, not the disease.

8. Symptoms (sensations) are much more important than signs (objective changes, i.e. observable).

9. After taking the case, symptoms should be analysed and evaluated and arranged in a hierarchy.

10. “Common” symptoms must be separated from the “strange, rare and peculiar”.

11. During follow-up of the case it is important to bear in mind Hering’s Law. Check to see if old symptoms are reappearing and in what order. Especially note new symptoms and separate from old ones.

12. Patient’s age and vital force must be evaluated for potency selection.

13. Never be afraid to “wait and watch”. Depending on what appears, decide whether to

repeat or increase the potency, change the remedy or antidote.

14. Repertorisation is done primarily on the peculiar, individualizing symptoms.

15. A complete physical examination is important.Following quotations are on the differences

between common peculiar (or characteristic) symptoms:“Pathognomonic symptoms are always common”.“Common symptoms have no place in our

repertorisation”.“Symptoms must be judged as to their value as

characteristic in relation to the patient”.“Symptoms most peculiar to the patient must be

taken first, then those less and less peculiar until the ones that are common and not peculiar are reachec”.

“The greater the value of a symptom for diagnosis, the less its value in the remedy selection”.

“We must discount common symptoms to the disease”.

3. The case of the warm-natured Arsenicum ROBINSON Karl, MD. (JAIH 76, 2/1983)

A 60 year old woman, A.K., habitually in excellent health, recently was “falling apart”. Had three surgeries on her right foot in the past two years. Last operation was bunionectomy in Jan. 1983. the wound failed to heal, was reopened and “an infected stitch” removed.

Her central problem was her married daughter, who was mentally very ill and was in the process of being committed. Her daughter carried a loaded gun, had assaulted her husband and was given to wild acts of violence such as slashing tires and beating holes in walls with hammer. She was under thecare of a psychatrist who had adopted a permissive attitude. The daughter had tried suicide several times. The situation had so upset A.K. that she had become sleepless. Awoke most nights at 2 A.M. in a highly anxious state, worrying about her daughter. At that time she would walk about restlessly, occasionally drinking water. She would stay awake till daybreak.

“I feel so powerless,” she said referring to her daughter’s dilemma. “It’s getting out of hand. I’m angry at my daughter’s psychiatrist”.

Recently she had begun to misplace keys and important papers. Earlier very neat, but now only moderately neat. At present time, she was very warm-natured; was overheated in bed and often stuck her feet out. Liked fresh air on her face, “If my face is cool, I don”t feel too miserable anay anywhere else”.. During

the past six ;months feslt somewhat chilly on going o bed, but later would overheat. Her palms were warm and dry.

Likes to drink water with a slice of lemon in, liked hot, spicy foods, fruits, meat, fat on meat, fish, milk, cheese and eggs. She dressed with great care, liked clothes. Disliked being alone; was careful with money abut not obsessive with it.Case Analysis:

An obvious case of Arsenicum except for her warm-nature. I had never seen a warm Arsenicum except for her warm-nature. I had never seen a warm Arsenicum 1M was given. Following day she went “to pieces”’ crying endlessly. Thereafter she improved dramatically and was entirely normal within three days.Cases Analysis:

An obvious case of Arsenicum except for her warm-nature. I had never seen a warm Arsenicum. Psychologically Sulphur did not fit. Arsenicum 1M was given. Following day she went “to pieces”, crying endlessly. Thereafter she improved dramatically and was entirely normal within three days.

Had anyone else seen a warm Arsenicum? If so, how about a letter to the Editor?

4. The homoeopathic treatment of Tardive Dyskinesia

WEINSTEIN Corey, M.D. (JAIH 76, 2/1983)

Introduction Tardive DYSKINESIA is an illness which

affects as many as 250,000 – 500,000 people in the United States today. It is a result of maintenance therapy with various neuroleptics. TD is an iaotrogenic disease which has only recently been identified and studied, despite a significant prevalence since the widespread use of neuroleptics began in the 1950s. Tardive refers to the occurrence of these symptoms after months to years of treatment, and DYSKINESIA describes the defect in voluntary movement.

Drugs which cause psychomotor slowing, emotional quieting and affective indifference are called neuroleptics. The term was coined by some of the first chlorpromazine researchers. Neuroleptics have been used for 30 years to calm the symnptoms of anxiety, confusion, hallucinations and unacceptable behaviour. Half of our hospital beds are used for people with primarily mental and emotional symptoms, and neuroleptics are often taken for years by inpatients and outpatients.

TD is a drug poisoning which is more dependent on the length of use than the dosage. It can

be expected to occur in some from in as many as 40% of the people who are prescribed neuroleptics; in 60% of the users between the ages of 50-70; and in 75% of those over 75 years of age. The symptoms can get worse upon withdrawal of the neuroleptic and, in fact, are often masked in those receiving high doses. One to two years at any daily dose can be enough to cause TD although the symptoms spontaneously and slowly regress in some people upon withdrawal of the drugs.

The classical description of TD includes involuntary movements of the lips, jaws and tongue, including smacking and sucking of the lips, thrusting, rolling and fly-catching movements of the tongue, lateral jaw movements and puffing of the cheeks, choreiform movements of the extremities and/or athetoid, circular motion of the toes occur frequently. Early symptoms may include fine vermicular movements of the tongue, circular movements of the big toe, tics of the face, ill-defined mouth or eye movement, mild chewing movements, rocking or swaying, and restless limbs. Sadly, these symptoms may turn out to be more socially disabling than the symptoms originally treated with neuroleptics.

There are problems in the diagnosis of TD, Mild TD can be confused with mannerisms and other motor disorders caused by disorders such as Parkinsonism and akathisia. Also TD symptoms undergo extensive fluctuation from day to day, change in response to various emotional states, are inhibited by voluntary movement and disappear during sleep.

It was the peculiar motor abnormalities which led me to think that it would be fruitful to investigate homoeopathic remedies for T.D. symptoms are unusual, quite specific and seemed likely to be amenable to repertorisation. Certainly homoeopathy has been used efficaciously in helping people heal illness created by drug poisonings from the mercury and arsenic compounds of the 19th century to today’s prednisone and pain killers.

There is no standard treatment for T.D. except to mask the symptoms with higher doses of neurolepotics, which ultimately makes the illness worse; so homoeopathic treatment would possibly help many T.D. sufferers.

CHLORPROMAZINE: Chlorpromazine (CPZ) has been studied through homoeopathic provings by JULIAN in France (23 members of the Societe Medicale de Biotherapie, 2/68) and PAI in India (16 members of the Association of Homoeopathic Doctors, Mumbai, 12/63). Toxicological information from the standard literature rounds out the description of the symptoms caused by this prototype neuroleptic.

MIND: Thinking slow. Memory poor, concentration poor. Decreased sensitivity to stimuli.

Hallucinations, especially visual. Confused dreams. Apathy, must make a real effort to work. Irritability. Premonition of bad news. Extreme anguish at 10 a.m. Despair, hopelessness. Agitation. MUSCULOSKELETAL SYSTEM: Muscle movement slow, stiff. Catatonia, total immobility. Muscle cramps and spasms, esp. mouth, face, eyes and arms. Trembling. Involuntary writhing squirming and grimacing, esp. legs, face, mouth and tongue. Facial paralysis or paresis. Foot tapping. Cold feet extending to thighs.GENERAL: Inner restlessness. Seizures. Hyperpyrexia with chills. Fainting on rising agg. end of day (postural hypertension). Lactation, increased milk, Gynaecomastia. Weight gain.SKIN: sensitivity to sun with eythema. Violet discolouration of the skin.EYE: Pigmentation of lens or cornea (retina). Brownish discoloration of the conjunctivae.MOUTH: Aphthous stomatitis. Dry. Itching and sensitivity of gums. Bleeding gums. Tongue dry and cracked. Uncontrolled salivation and drooling.THROAT: Dysphagia with feeling of lump in the throat.CHEST: Oppression. Burning in chest.HEART: Irregular heart beat. Fast heart rate.GASTROINTESTINAL: Constipation. Hypogastric colic. Anorexia. Nausea in the morning. Burning pain in the stomacj. Sensation of a stone in the stomach. Icterus, liver enlarged and sensitive (Hepatitis).GENITOURINARY: Decreased sex drive. Leucorrhoea like white of egg. Irregular menses.

As the symptoms list verifies, CPZ affects the human organism profoundly. Not only is the neuro-muscular system changed, but the mental and emotional states, hormone balance, heart, liver, digestion, skin and eye are deeply disordered. Neuroleptics interfere with neurotransmitters in the central nervous system, which act strongly on the cerebral cortex. Action on the pituitary or hypothalamus causes changes in the hormone prolactin which influences the breast and also changes growth hormone levels. HOMŒOPATHIC TREATMENT: I found one published case of the homœopathic use of CPZ in the literature. Garth W.BOERICKE, MD reported the successful use of potentized CPZ in the Journal of the American Institute of Homoeopathy, Vol.58, 1-2, 1965. The patient was an 84 year old man in a nursing home suffering from hallucinations of sight and hearing, and delusions of persecution and poverty. He talked

continuously and at random and was disoriented as to place and time. Dr.BOERICKE tried various remedies, including Lachesis, Sulphur and Hyoscyamus. Due to lack of success, he finally gave standard doses of CPZ to quiet the patient, but the standard regimen aggravated the patient. Dr.BOERICKE reasoned that if the patient was aggravated by CPZ, then it must be his similar remedy. And, in fact, when given the 5x dilution prepared by Dr.BOERICKE the patient became calm and manageable.

Treating an individual for TD homoeopathically may cause a recurrence of the symptoms that required suppression initially. It is interesting to note that many of the remedies which seem well indicated for TD have mind symptoms, that are typical of the illnesses for which neuroleptics are used. Certainly a full case should be taken, which includes present symptoms and past history, including a description of the symptoms requiring neuroleptic suppression. But prescribing should be based only on the present symptoms. In preparing the repertorization, I used the following symptoms:

1. Tongue, protruding spasmodically, darting, oscilating and trembling.

2. Chewing motion3. Distorion of face, especially mouth and

trembling of face.4. Motion, involuntary.5. Chorea.6. Lactation and swelling of mammae7. Sun, exposure to8. Faintness worse rising

Other symptoms like low sex drive, trembling, restlessness, concentration difficult, apathy, poor memory and a low thinking were not used because the rubrics were too large to help with anything but verification of the remedies.Twenty two remedies had four or more of the symptoms. A variety of Materia Medicas were consulted for investigation of the symptom pictures which most closely fit TD. I used Allen, Hering, Clarke, Boericke and Kent. Based on these findings. I would like to elucidate the 11 remedies other than CPZ in potency which seem most likely to help in the treatment of TD. The first group which includes Lycopodium, Cuprum, Belladonna, Bryonia, Mercurius and Chamomilla has the important general hormone symptoms of lactation and/or breast swelling. The second group lacks this general but has excellent symptom pictures of TD. The second group is made up of Opium, Agaricus, Ignatia, Stramonium and Helleborus.

Conclusion: It is among these 11 remedies that I think the homoeopath will find the most efficacious treatment of TD. Certainly the best remedy is the simillimum.

I have undertaken this study as much to alert the homoeopathic community to the serious problem of TD as to prepare the practitioner to treat TD effectively. Remember that neuroleptic poisoning is related more to length of use than the quantity of the dose. Therefore, some one who takes a little Mellaril or Thorazine daily to get to sleep is at risk for TD. To aid the practitioner in diagnosing TD here is a 10 step examination method. I would appreciate it if practitioners send their clinical experience with TD to me so that we can collect and publish our work.

10 STEPS TO EXAMINE FOR TARDIVE DYSKINESIA

1. Ask the patient if there is anything in the mouth and to remove it if there is.

2. Ask about the current condition of teeth and dentures.

3. Ask if the patient notices any movements of the mouth, face, hands or feet (and how they might be a bother).

4. Observe the patient sitting in straight chair with the hands hanging at the sides (1-2 minutes).

5. Ask the patient to open the mouth and observe for 30 seconds.

6. Ask the patient to protrude the tongue and observe for 30 seconds.

7. Ask the patient to tap the thumb with each finger as rapidly as possible for 10-15 seconds separately with right and left hand while observing the face and legs.

8. Flex and extend the patient’s arms one at a time for rigidity.

9. Ask the patient to stand up and extend both arms in front with palms down and mouth open for 30 seconds while observing trunk, legs and mouth.

10. Have the patient walk around.

5. NEW TOXICOLOGY: CARCINOGENESISFISHER Peter (BHJ 71, 3 &4/1982, 1/1983)Proving as a process presents tremendous

logical and practical problems. This has led to the virtual stagnation of homoeopathic practice, accompanied, paradoxically by a proliferation of speculative and anecdotal approaches which have advanced practical homoeopathy but little. This theoretical impasse can be circumvented by studying modern Toxicology and patho-physiology. When

carefully examined, it is astonishing how closely the findings of modern pathyphysiology accord with the homoeopathic perspective. The cancer problem particularly can benefit from this approach. In this context the chemical carcinogens are crucial.

The history of the recognition of chemical carcinogenesis runs from the 16th century description of the “miner’s sickness” by Agricola and Paracelsus, only later recognized as carcinoma of the bronchus, through the cancer of the acrotum observed by Pott in chimney sweeps, to the identification in this century of carcinogenic coal tar fractions.

The recognition of cancer as a process is due to Galen --- he considered tumours to be due to a silting up process of the circulation – a view rendered untenable by Harvey’s discovery of the circulation of the blood; which discovery also destroyed the rationale of bloodletting, but did not discourage Hahnemann’s contemporaries from practicing it on a murderous scale – hence, perhaps, Hahnemann’s mistrust of physiology.

After Hahnemann’s death the discovery of the cellular nature of cancer was due to Schwann and virchow. There are two principal theories concerning the genesis of cancer – the immune surveillance and mutagenesis theories; they are not mutually incompatible and are attributed to Ehrlich and Boveri respectively.

The main groups of carcinogens are: 1. Polycyclic hydrocarbons, deriving largely from

hydrocarbon combustion—particularly coal products.

2. Aromatic amines, which occur mostly in the chemical industry.

3. Nitrosamines and nitrosamides which occur in a variety of foods and can be produced, in vivo, from nitrites.

4. Naturally occurring, of which there are many; the aflatoxins of fungal origin are among the most significant.Despite their diverse structures and origins all

these carcinogens share two properties; all undergo metabolic transformation to release the active carcinogen and in all cases this active ultimate carcinogen has a strong chemical affinity for DNA.

Virtually all of the main groups of cytotoxic drugs used in the orthodox treatment of cancer present some kind of similarity to different aspects of the cancer process. Some of these similarities are classified into four groups:

1. Pathological: Drugs which are inherently carcinogenic or are close chemical relatives of known carcinogens (e.g. alkylating agents).

2. Structural: Drugs whose molecular structures bear close resemblance to those of key molecules involved in the genesis of cancer, (e.g. the bass analogue anti-metabolities). Methotrexate is a folate analogue anti-metabolite and is anomalous.

3. Mechanical: Drugs whose mechanism of action – intercalation into the DNA helix – is the same as that of know strong carcinogens (e.g. some of the cytotoxic antibiotics – such as doxorubicin).

4. Parapathological: Drugs whose side effects closely resemble the para-malignant syndromes which often accompany malignant disease (e.g. vincristine).We also amplified what had been said in the

first article on the common mode of action of carcinogens and cyto toxic drugs – DNA damage. Serious, overwhelming damage to DNA results in cell death (the cytotoxic effect) but more subtic long-term damage introduces insidious changes into the DNA, lending to mutation or cancer. The realization that mutation and malignant changes are equivalent processes had to the development of useful short-term tests for carcinogens based on bacterial mutation—such as the Ames test. The second article concluded with co-carcinogens, substances which, while not inherently carcinogenic will, if preceded by a carcinogen, greatly increase the probability and speech of a malignant tumour appearing. Important substances of this type occur in plants of the genus Euphorbi8aceae, including Euphorbium and Croton tiglium of the homoeopathic Materia Medica.

I quoted WHO’s 1964 estimate that 80% of cancer is due to extrinsic factors. The definition of extrinsic becomemms more difficult, as it has become clear that the metabolism of potential carcinogens by gut bacteria and other factors, are involved. The most startling figure in the table is the 35% of fatal malignancies attributed to diet. It is in this area that the problems of “semi-extrinsic” carcinogens and gut flora metabolism arises. In some parts of the world, the best example being the aflatoixins in parts of Africa and Asia. But this kind of simple extrinsic carcinogenesis is relatively unimportant in the developed countries (except, of course, for smokers). Far more significant are the carcinogens which may be produced in the gut from precursors in the diet or gut secretions.

Another important chemical process which some bacteria can perform is deconjugation. Many toxic compounds, including the highly carcinogenic polycyclic hydro-carbons are excreted in the bile in the form oa a conjugate with a sulphate or glucoronate group. In this form they are harmless, but a number of

bacteria which may be found in the bowel flora of apparently healthy individuals posssess the enzyme B-glucuronidase, which solits glucuronate conjugates, releasing the active carcinogen into the fut lumen. Some of the bacteria capable of doing this are shown in table 2.

Note that the non-lactose fermenting organisms are generally the most active in this respect.TABLE 1: ESTIMATED PERCENTAGE OF CANCER DEATHS ATTRIBUTED TO DIFFERENT FACTORS:-----------------------------------------------------------Factor Best estimate% Range of estimates-----------------------------------------------------------Tobacco 30 25 – 40Alcohol 3 2 - 4Diet 35 10 - 70Food addic- tives 1 -5(a) - 2Repro-ductive andsexual beha-viour 7 1 – 13Occupation 4 2 – 8Pollution 2 1 – 5Industrial Products 1 1 – 2Medicine And medicalProcedure 1 1 – 2Geophy- sical (b) 3 2 – 4Infection ?10 ?1 - Unknown ? ?-----------------------------------------------------------

a) Allowing for possible protective effects of anti-oxidants, etc.

b) Geophysical factors means maily radiation – UV light, cosmic rays and, and from natural sources. This table greatly underestimates the INCIDENCE of cancers due to UV light, which may be which as 30% of the total, because these are mostly the rarely fatal basal celle e- carcinomas and this table is in terms of mortality.

TABLE 2: GUT BACTERIA, THEIR PROPORTIONS AT DIFFERENT SITES AND THEIR CLUCURONIDASE ACTIVITY”-----------------------------------------------------------Organism % of total flora in glucuronidase

Ileum caecum rectum activity-----------------------------------------------------------Strepto- coccus spp 1 1 1 2.0Lacto-bacillus spp 0 1 1 1.6Bacteroides

spp 22 76 76 6.0Clostridum spp* 0 0 1 1.6Bifodobac-terium spp 69 24 24 1.9Enterobac-teria spp 9 1 1 24.7 inc. Esch- erichia,Salmonella*Shigella *,Proteus*-----------------------------------------------------------* non-lactose fermenting organisms.

It was of course, on the non-lactose fermenting bowel flora that Drs. JOHN and ELIZABETH PATERSON did their classical work on the bowel nosodes. These recent finds vindicate the belief held by the PATERSONS that the presence jof supposedly non-pathogenic non-lactose fermenting bacteria in the bowel can have serious effects on health. In this case by predisposing to the development of malignancies in the bowel and, perhaps, at distant sites. It is high time that the PATERSONS’ work was repeated.

We have seen that a variety of chemicals, of diverse origin and structure, can damage DNA. Following this damage there is a latent period, which may last ten years or more before a tumour emerges; what goes on in this long latent period? And what is the nature of the transformation from the normal to a malignant cell? For malignant cells do not display any characteristics not shared by certain normal human cells; many embryonal tissues metastasize; invasiveness is characteristic of white blood cells and rapid mitotic

rates are found in bone marrow and gut mucosa. The inference from this must be that the DNA damage affects mostly the control of the expression of the DNAcode, rather than the content of the code. There is stil much uncertainly in this area, but it has recently become apparent that the elaborate structure of DNA is important in the control of gene expression. It has also been recognized that there are genes present in the normal genotype which are capable of causing malignant transformation – the so called oncogenes.

An oncogene is a gene present in the normal genotype which, if it becomes overactive, causes the cell to undergo malignant transformation.

An alarming picture is emerging; a world full of potent and ubiquitous carcinogenic influences in the form of chemicals, electromagnetic radiation and viruses – all inflicting insidious damage of the delicate DNA. Space forbids full discussion of the mechanisms of carcinogenesis by radiation; suffice it to say that the ionizing effects of radiation directly or indirectly damage DNA and that this leads to malignant change. The role of viruses in human cancer if, as yet, uncertain, but in animals where they cause cancers viruses do so by interfering with the genetic material.

The use of cytotoxic drugs for malignant disease is bedeviled, in orthodox medicine, by two problems; the inherent toxicity of these drugs, and the ease with which cancer cells develop resistance to them. These two factors combine to produce a poor, and deteriorating, therapeutic index and enforce the use of combinations of drugs. What are the mechanisms by which cancer cells come to develop drug resistance?

Resistance may be due to the fact that the drug simply is not reaching the tumour, or that the drug simply is not reaching the tumour, or that the cell is in a phase of its cycle where it is insensitive. But what interest us are the changes which are invoked in the cell in response to the drug. Among the most important mechanisms are resistance to cytotoxic drugs are undoubtedly the very DNA repair systems we have just discussed – many cytotoxic drugs are potent inducers of these mechanisms. Another important mechanism is change in the cell wall, reducing its permeability to the drug. Such cell well changes may result in changed antigenic character of the cell and production of TARAS . Tumour Associated Rejection Antibodies – which moblize the body’s immune rejection responses. Other changes associated with drug resistance – for instance, the modification of target enzymes may also result in heightened antigenicity, leading to recognition as “mon self” and rejection.

These antigenic responses have not been investigated in great detail and the contribution they make to orthodox chemotherapy is probably very small

– for the simple and ironic reason that the very cycotoxic drugs which might evoke the TARAS have a simultaneous and more reliable effect in suppressing the immune system.

Furthermore, current evidence suggests that the role of the immune system in inhibiting the development of primary malignant tumours is much less than has often been supposed hitherto. But it does seem that immune factors, especially those acting at regional lymph nodes are important in filtering out potential metastatic cells from the blood and lymph. It is this recognition which has led to the abandonment of radical mastectomy. It is ironic that the very agents which are capable of increasing the potential of tumour cells to provoke immune reactions are also suppressors of the immune system. There is a theoretical possibility, though that low doses of some cytotoxic agents could provoke the production of TARAS without associated immune suppression. CONCLUSION:

I have shown that carcinogenic influences are both potent and ubiquitous in the real world. These influences act by damaging DNA, damage which is constantly being made good by remarkable systems operating within the cell. The whole process of DNA damage and repair turns over much more rapidly than is usually supposed. The DNA repair mechanisms are subject to very sensitive feed back control. It is already established that carcinogens in high, but still substantial, dilution can increase the activity of DNA repair systems many fold.

To my knowledge, there has been only one experimental attempts to demonstrate that a carcinogen in potency can reduce the effects of the same carcinogen applied subsequently in substantial doses. This work, by Boiron et.al., failed to demonstrate any effect attributable to the dynamised carcinogen. The experiment was well conceived and was certainly on a large scale (1,000 rats over a 19 month period). Careful scrutiny reveals. I believe a small but fatal flaw 66 in the selection of the carcinogen (which was 2 – acetylamainofluorent). There were also some encouraging aspects to this work; the tumour promoter used phenobarbitone did slightly protect those animals which received it in potency.

I have reviewed and extracted what I consider to be the most relevant facts from a huge amount of data accumulated by cancer researchers. I am convinced that the potential exists for a dramatic breakthrough in cancer therapy.

6. CHRONIC MIASMS

ORTEGA Sanchez, P. (BHJ, 72, 1/1983)

CHRONIC MIASMS by Dr. P. Sanchez ORTEGA, Vice-President for Mexico, LMHI (A paper read to the XXXV LMHI Congress, Brighten, 1982).

We shall try to summarize all that we have been able to investigate and understand and all that we have completed, in relation to HAHNEMANN’s action of the chronic diseases, or miasms.

HAHNEMANN’s DOCTRINE: HAHNEMANN, the genius and founder of homoeopathy, concluded that it was only this which could be considered is truly curative, for this method was founded on the knowledge of essential relationship between the disease and the remedy. He then discovered, after innumerable clinical observations, that repeated morbid processes were some how related to each other, appearing in the same individual, and he proved that they were due to a predisposing factor which demonstrated the true constitutional pathology. This factor was the result of the incorrect suppression of specific acute disease. These chronic diseases were:

1. The chancre diseases.2. The second disease dealt with a morbidity

factor which is the deepening, through suppression or incorrect treatment, of the gonorrhoea-like discharge. This suppression was characterized by the tendency to produce pedunculated or figwart excrescenes. This HAHNEMANN called, Sycosis

3. Lastly a much more important pathological entity which apparently was much older than the other two, and which was the result of the suppression of an itch disease similar to what we now know as scabies.HAHNEMANN himself explains that his

approach was basically to investigate the patient’s clinical history, to ascertain if they had suffered from either the itch, the gonorrhoeic or the chanooid diseases. This was to determine if they had been treated by suppressive means. Logically, he only accepted symptoms that were repeated many times after similar suppressions.

Later HAHNEMANN confirmed the possible co-existency in the same patient of two or even three of the miasms which over-lapped each other. He insisted that the physician needs to recognize and handle them adequately (Organon paras 204-207)

HAHNEMANN’s conclusions are of the utmost usefulness and essential to take them into account and put them into practice so as to obtain a truly homoeopathic treatment.(See paras 48 and 49 and 78 – 82)

Why is it that in view of this magnificient legacy homoeopaths all over the world, even when

trying to follow the master faithfully, have not been able to determine a correct technique so as to recognize miasmatic problems, not have they been able to match his miasmatic theory with a clinical practice that would prove its validity.

After HAHNEMANN, some of the main authors are J.H.ALLEN, who made many observations. KENT foresaw in his Materia Medica groups of symptoms that belonged to the different miasms. It is primariily in his Repertory where he defines minute but very significant differences in the fundamental attitudes of the human mind which can be connected to the characteristics evident in psora, sycosis or syhilis. Next H.A.Robert’s as well as by Hanohigino C.PEREZ. We also recall, GHATAK from India

The master left unfinished the description of the miasms. This is the most important thing to bear in mind in order to understand the persistent waste, for over a century of such a wonderful doctrine. No significant conceptual error can be found in the HAHNEMANNian method. This is true also in relation to the miasms.

THE BASIS FOR RECOGNIZING THE DIFFERENT MIASMS: HAHNEMANN states that even in his times syphilis was recognized as a miasmatic disease, which is the result of not curing properly, or of suppressing, its initial manifestations. There is no reason to modify the initial appreciation of the obviously destructive and degenerative tendencies in syphilis found in each one of its characteristic lesions.

The second miasms of sycosis is the constitutional pathological form or condition that is the result of the suppression of gonorrhoeic discharges, similar to syphilis in its transcendency and its relation to suppression. It is characterized in its manifestations not only by the production of fig like warts, but also by hyperplasis, hypertrophy or expansion.

Psora, is together with the other two miasms, the chronic of the constitutional disease brought out by the unnatural suppression of cutaneous conditions.

The birth of cellular pathology confirmed the ever-present correspondence of the whole with every one of its parts. Every dysfunction, every lesion had its beginning, or at least its concomitant, in the cell. That is deduced from the fact that no organ or part can withdraw itself from the condition of the whole or of the totality. Likewise, cellular pathology demonstrated that every transcending disturbance in the cell begins in the functions of assimilation. These disturbances can only be of three types: deficiency, excess or deviation.

In spite of the many discoveries and the never ending future discoveries and interpretations, the fundamental notion of an imbalance in the organism, as seen by a deficiency, an excess or a deviation, still holds

true. This is confirmed by the fact that in the realm of physiology and psychology these same morbid tendencies can be recognized. The most surprising thing is that these disturbances each correspond to HAHNEMANN’s three miasms of chronic diseases.

It was KENT in particular who admirably deduced or intuitively recognized the classification of the fundamental pathological symptoms. We find these symptoms expressed in his repertory, which is an absolutely essential reference work. The psoric lack, the sycotic excess or the syphilitic deviation.

A slow sluggish or depressed mind will be psoric. A hyperactive, hurried psyche with a changing unstable nature will make evident the “hypertrophy of the ego” (Paschero) in the sycotic individual. The tendency towards destruction and death will constitute the syphilitic position.

To summarize we may state that psora will be all that which means inhibition, sense of inferiority, coldness, functional deficiency, lack of productivity, or of holding back, Sycosis will be manifested by expansion, precipitancy, hypersensitivity, hyperactivity, hypertension, hypertrophy, pride, exaggerated fears, irascibility (manifest anger), hyperthermia neoplasms, hurried. Syphilitic will include degradation, indifference, loathing life, a perversion of biological functions, abnormal secretions, rage (Blinding anger), convulsions, spasms, deformities, haemorrhages, putrefaction, and destructive tendencies in the tissues (consumption) as well as in the mind.

The following examples are taken from Kent’s repertory and Allen’s Materia Medica, where a correspondence with our miasmatic classification can be found.

Sadness is of a psoric nature because of its inhibitory quality. Grief is the sycotic manifestation of sadness because of its expansive quality. Prostration of mind exhibits the destructive syphilitic quality of sadness.

A slow pulse can be classified as psoric, a rapid pulse as sycotic and an irregular one as syphilitic.APPLICATIONS OF MIASMATIC DOCTRINE:

If we comprehend the depth and extent of Hahnemann’s classification of diseases we have enormous possibilities in understanding humanity as a whole as seen in each one of our patients. The features, the physical constitution, the attitudes and all the artistic, intellectual and spiritual expression will show the influence of the miasms. Only the concept of a spiritually and physically perfect human being could lead us to imagine the existence of some one free from miasmatic tendencies.

We will consider the clinical possibilities of this doctrine when dealing with our patients. Firstly, we make a list of all the symptoms or abnormalities we find in the patient. Then we separate these symptoms into the corresponding miasms, e.g. those that manifest a lack, deficiency, hypofunction, etc. as Psora. In another list we write down the symptoms that have an opposite quality i.e. the exteriorization, the instability, excape, hyperplasia and hyperfunction as sycosis. The third list would include all that is destructive and degrading, with a tendency towards involution and degeneration. We then select from these lists the predomination, extraordinary, singular or curious symptoms as recommended by the master is paragraph 153 and 209 of his Organon.

The predominating symptoms dominate the whole picture, affect the sensibility and have the greatest influence of the final state of the patient. The extraordinary symptoms are not habitual, but only belong to a final stage. The singular symptoms are in relation to a very peculiar manner of the patient’s reaction. The peculiar symptoms manifest reactions belonging to the individual patient. This group of symptoms is what Hahnemann considers essential to obtain the characteristics of a case. They constitute the minimum syndrome of maximum value. They are the most certain total symptoms which represent the existential moment to be dealt with in the patients. This may include as few as three or four symptoms.

On the basis of this group of symptoms we arrive at the true similimum. This marks the beginning of the correct evolution of Hering’s law. The last layer of the corresponding symptoms, is the first to disappear. The symptoms and manifestation of the miasm underlying in the next layer will become apparent, if we allow time. The miasm, which reaches the surface level and forms symptoms, is eliminated thanks to the gradual liberation of the vital force.

It is easy to deduce that the miasmatic doctrine thus established and understood, has many applications that help to a comprehension and explanation of events that occur in human life, from the simplest to the most complicated. We insist that this is true not only about the changes which occur in the stage of disease, but also throughout all our expressions. (Condensed form the British Homoeopathic Journal, Vol.72, No.1, January 1983)

CAUSTICUM AND THE REMEDIES FOLLOWING IT

G.v. KELLER (AHZ 1/1983)

Two cases of Dr. GOULLON from the year 1865, who practiced in Weimar. He reported

progressively about cures of serious burns and Erysipelas in those days was known as Red Leaf.

“The first case is of a lady of 30 years, frequent, severe, mostly of many hours duration, purely nervous, migraine. The Erysipelas developed from the nose outwardly and progressed with increasing burning pains, forming pustules, over the forehead, over the entire hairy scalp down up to the neck. Fever increased up to the fourth day particularly the pains were almost unbearable and obstructed the entire sleep. Belladonna then Rhus did not bring the least alleviation; the situation was dangerous. The great similarity of the appearance with the burning in the second grade, the type of the pain and the disposition to coma vigil pointed for the first time, Causticum. The result was almost immediate, soon sleep came and quick recovery.

“Another case of eczema of face, every morning and after getting up the entire face began to redden and become hot which remained upto evening when a violent burning, itching remained, was soon cured by Causticum.

In those days acute, life-threatening diseases were treated. The main reason for my citing these two cases is to point out how much more one had to treat severe and life threatening diseases. If a child ailed from measles, the first concern was to keep the child alive. So it is in Goullon’s cases, the maintenance of life the most urgent work of the physician. The fact that the patient suffered from severe migraine has been mentioned only by the way. The migraine is “purely nervous”.

If such a case comes to bus now, the patient will be under treatment for migraine for a fairly long period. The Erysipelas may only be a passing episode whose exit could be hindered everytime by anti-biotic. In any case, after the fading away of the acute manifestation, we will not now-a-days speak of ‘cure’, because for us the chronic state is very problematic. But those days one spoke of cure when the danger to life was overcome. A medicine either worked or did not work. One could unmistakably differentiate whether one had hit upon the right medicine or not.

The treatment of chronic diseases usually requires employment of more medicines successively. Now-a-days these differentiations is not any more simple. We need, to cure a case, a full series of medicines following each other. Hahnemann said in para 171 of Organon: In the chronic diseases, to effect a cure, we require often more successively employable anti-psoric medicines so that every successive one being homoeopathically chosen in consonance with the group of symptoms remaining after completion of the action of the previous medicine. And in para 182 “thus the imperfect selection of the medicament, which was in

this case almost inevitable owing to the too limited number of the symptoms present, serves to complete the display of the symptoms of the disease; in this way it facilitates the discovery of a second, more accurately suitable, homoeopathic medicine.”

This paragraph refers to cases with paucity of symptoms. Our cases are often with symptoms-paucity in this manner, not only because they are chronic cases with relatively little graded, less violent diseases, but also because our patients come to us at the beginning itself with a complete diagnosis and are not familiar with a thorough and exact subjective description. Our cures then become zigzag cures as Lippe pointed out once.

Earlier the difference between the correct and incorrect medicine was clear and essential for the treatment of life-threatening acute diseases. Either the patient died or he was cured. A mistake made in the choice of medicine could work fatally. The fear of wrong choice of medicine has been with us long and now again we can hear opinions about how serious harm can be rendered by wrong choice of medicine. Depending as to how similar it is, if they do not represent the Simillimum they will become into a disordered confusing collection of disease picture.” The aim of cure “will not thereby be achieved but only an unsuitable medicine will be proved unintentionally upon a patient, because that would make the case into a muddle and the choice of correct curative medicines made impossible.”

HAHNEMANN was not of this opinion. An unsuited medicine of course a kind of proving upon the patient, but it did not make the choice of the proper medicine impossible, on the contrary a less suitable medicine rouses in the patient new symptoms and thereby brings the cure of the entire case, closer. In paragraph 181: “Let it not be objected that the accessory phenomena and new symptoms of this disease that now appear should be laid to the account of the medicament just employed. They we their origin to it certainly, when they were not caused by an important error in regimen, a violent emotion, a tumultuous revolution in the organism, such as the occurance or cessation of the menses, conception, childbirth so forth. But they are always only symptoms of such nature as this disease is itself capable of producing in this organisms, and which were summond forth and induced to make the their appearance by the medicine given owing to its power to cause similar symptoms.”

The complementary medicine, the medicines which follow each other well are often similar to each other: KENT spoke of this in 1885, he said, that it will become essential in such symptom-poor cases to draw out though doses of Carbo veg., Sul., Calc.carb., Psor., Lyc., or Sep. develop the disease aright. That is the idea

for the recommondation. “When the indicated remedy fails”, to give Sul., or Psor. Also the idea of the complementary remedy, the remedy which has been observed as following each other well.

Only about the inimical medicines I am of the view of Nash mentioned in his ‘Leaders’. In the 45 Causticum cases I have recorded in the tape-recorder in the past seven years, I have given in two cases Causticum and Phosphorus immediately following each other without any intervening medicine, with an interval of some months. In one case both the medicines worked well, in the other Phosphorus given after Causticum remained inactive and the patient appeared to have actually developed a two week long large number of striking new symptoms quickly passing over. That was all. I have given again and again Calcium carb. or Sulphur once Sepia also, before I had given Causticum and that both have worked well, in each case. That agrees with the theory of complementary remedies is found in Boenninghausen’s concordances, Calc. carb. and Sulphur and also Sep. and Sil.have been cited thus as remedies which often compliment Causticum since they have similarity with Causticum.Causticum: Pressure in Ear; when we study a medicine like Causticum we will study the symptoms with peculiar sensations, noteworthy modalities or unusual connections. One think is some times that such symptoms could come up only once in hundred years, but when has understood it, one would be surprised by these symptoms from patients often. There is this symptom No.261 by HAHNEMANN: “as if contraction in left ear and in the whole side of the head in the evening, after lying down, ameliorated by hard pressure”. Now my case No.45.

No.45: Mrs. S.A. “In a moment the irritating cough troubles me most and I can’t simply retain water. Once it went clear down. The I took a sip of water and it is better. What now disturbs me is: I have there, inside, always, as if cramping pain and when I press it becomes better. A pain below the right ear, below and behind the right ear, as if something constricting and when I press upon it, it passes off again. I have again once gone out without my cap, which I cannot afford to do. It was again cold today and I am glad that I have my woolen cap. It does me good I need warmth at the back of my head. Tonight it was a bad time at 3 a.m. The pain come alone, lying agg.”

I would be lying, if I say, that this ear symptom was known to me earlier. I must find out whether it was already mentioned in similar form. The repertories help us in these localization.

Therapeutic objections against the prescription on single symptom: When we search for spasmodic, constricting ear aches, and ear aches which become

better by pressure and which are worse lying, we find Causticum pointed. When we then look into the pathogenesis of Causticum, we find this symptoms No.261 which could convince us by this symptom which is strikingly, similar with have declared against prescription on single symptom, on theoretical grounds. On two grounds I cannot follow this rejections: First, there are cases in practice in which is strikingly, similar with the patient’s symptom. Several Homoeopaths, KENT amongst them, have declared against prescription on single symptom, on theoretical grounds. On two grounds I cannot follow this rejections: First, there are cases in practice in which such single symptom alone is available, which can be evaluated and with which some constitutional attributes of the patient may not be confused with rare general symptoms. If for example the above cited lady patient answers to suppropriate questions that she sometime has heat sensations or she keeps her feet uncovered in bed, or that at sometime has had a skin eruption, could one, when one did not know that Causticum also has brought out these symptoms, then think of studying Sulphur? With Sulphur we find corresponding ears symptoms also the ameliorated by pressure but you see clearly that the similarity is shown in different grades to much dis-advantages of Sulphur, particularly when we consider how much better Sulphur was proved. Had I given Sulphur in this case nothing further would have taken place except that the patient would have brought out Causticum symptoms clearly in the next consultation and it is not a fatal. We find the escape of urine while coughing, the amelioration from drinking cold water, the cold sensation of the head and the time 3 o’ clock night. More we do not actually require to decide choice between Causticum and Sulphur. We are not prescribing blindly and automatically when we give a medicine from a single symptom.

Causticum: Sensation of emptiness in the forehead, sensation of shortening, stitches in the right abdomen: For the next symptom No.97 of Causticum: “headache as if something was forcing itself between the forehead and frontal part of the brain or as if the part behind the frontal bone was hollow.

No.9: Mrs. U.M on 10-12-1975: The headache becomes worse in the mid-day; it presses down upon the eyes. The brain is pulled down so that there is Hollowness above, as if there is a vacuum between the skull and brain. Actually more in the forehead.”

No.15> Mrs.S.U. on 23-3-1975; “A pressure in the brain as when where is nothing there, like an air balloon, an empty sensation”.

Now follow two proving symptoms which appeared together in a patient of mine: HAHNEMANN’s No.10208. “Tendency of left arm becoming numb at night during sleep, because of which

he woke up” and No.1052 “pain in the left elbow bend by stretching the arm, also as if a tendon was too short.”

No.37: Mrs. B..R. On 4-1-1980: “Sensation as if the muscles in the elbow bend is too short. I cannot stretch the arm well. Nights in bed it pains maddeningly, it becomes then absolutely stiff, I have the feeling that the arm is heavy and numb and dead; pains tremendously.”

Here also it was the right ear, which was ailing while the prover experienced the pain in the left. So was it with the ear symptoms. The sensation of contraction is present in other places both in proving and also in my patient, in the calf, in symptom, which appears common by the two modalities and the exact agreement with the proving symptoms, but rightly indicated is, as follows:

No.3: Miss S.C. on 5-12-1974: “always in the evenings, in lying stitches in the upper right half abdomen.”

HAHNEMANN’s symptoms No.623 says: “stitches in the right sise of the abdomen in the evening’ and No.631 “Dull, lancinating pain in the right side of the abdomen when lying down”. These symptoms are easy to find in the KENT’s Repertory, for the lancinating abdominal pain while lying down, we find only Causticum.

The Causticum cough: It would take too much time to describe the Causticum cough in its ramifications, I therefore turn myself to the noteworthy symptom No.435: “Mucous comes into the throat which she cannot eject by hawking, but has to swallow down”. That has been given in H.C.ALLEN’s Keynotes, as: Cough with inability to expectorate, the sputum must be swallowed”.

No.5: “Mrs. R.K. on 5.5.1975: “If I drink water it loosens. The mucous should possibly be drawn but by hand, otherwise I have to swallow it”.

No.24: Miss L.C. on 2.2.1978: “More often it stays tough, does not come exactly up, when I least attempt to bring it up. When the mucous is further up, it stops. I cannot bring it up so that I could spit it out.”

The dryness: Further as generic to Causticum is the amelioration by dampness. Causticum is, doubtness, a dry medicine, general condition is ameliorated by rainly weather. A sip of cold water relieves not only the dryness of the mouth and throat but also generally. In the proving is found epileptiform convulsions, ameliorated every time by cold water. In the first case of ear ache it was so.

No.38: Mrs.W.A. on 4.3.1980: “Often the throat pains as though I had a dry mouth. I think, that I must drink something then. The dryness is more in the roof of the mouth”.

The sensitivity to cold: In the proving we find only general sensitivity to cold which has been emphasized by HAHNEMANN in the foreword. Mezger writes: very sensitive to cold, this affected him much. I have observed in my cases that this sensitivity to cold is often found particularly in head and in the nape and the patient likes to put on a scarf or cap.

No.2: Mr.H.A. on 28.10.1974: “Headache when I have been exposed to cold air, or after cold rain, behind in the neck, better by something warm around the neck”.

Mrs. L.E. on 11.4.1975: “Headache from neck, my ears also then ache, I must then put on a fur-cap”.

No.26: Miss F.G. on 4.9.1978: “Suddenly hoarseness and dry throat. If I have the collar open and the cold air from outside blows, it is as if inflamed”.

No.45: Mrs. S.A. on 4.3.1981: “I have ventured to go without scarf, whether the ear thereby will not become worse? Today it is cold, I am glad to have my woolen scarf.”

We cure often in a zig-zag way: Here one perceives the similarity between Silicea and Calcium carbonicum. It is clear that the medicines so similar to each other, often follow each other well. I have already stated that repeatedly I have given Causticum before or after Calcarea carbonicum or Sulphur with successful results. That was the second reason as to why I have cited the story of Goullen’s cures; I wanted to point out how often the Causticum cases are similar to the Sulphur cases.

We cannot distinguish always with certainty these concordances or complimentary medicines. In a case in which Causticum has worked well Sulphur, Calcarea carbonica might in its place brought about a quicker success. We cannot be certain that the inverse order of remedies would have worked better. We can give the medicines only one after the other and observer that both the medicines do their work.

Also the medicines are always simillimum only at a specific point of time; we only everytime say that in this patient now, today, the maximum similarity to his ailments appeared to be with Causticum. It is probable that in some months a different medicine may become indicated.

To this theme is suited another passage from the discussion of Kent’s lecture “The second prescription in 1836. Wesselhoeft said “I said recall that I spoke to Hering, for the first time during practice, about a case of mental illness which I had cured with Apis and I told him: “This cure may not have been possible without your Apis.” Lippe was present and contradicted: ‘Of course, it may have been possible, in all likelihood through a zig-zag cure with Pulsatilla, Graphites and Sulphur and obtained same result’.

And it cannot at all be anything else. We bear in mind, that the early homoeopaths had to get on with such a small number of remedies, for the cure of their patients and at the same time today only a very small fraction of the medicines have been well and broadly proved and so well known that we can well recognize the medicine needed by this patient. No, it must be so that we should be able to achieve success with a patient in different and more ways; if only one medicine is efficacious in a patient we could successfully treat only a very neligible fraction of our patients. [Condensed from the ALLGEMEINE HOMÖOPATHISCHE ZEITUNG, 1/1983 – Jan/Feb, 1983; translation and condensation by Dr.K.S. Srinivasan, from the original German; for private communication only]

CASE REPORT: Erysipelas by Dr. Matheson, Hamberg Mr. W.C., 34 years, came on Friday afternoon to the clinic. Has high fever and from yesterday has an Erysipelas of about three times the size of palm, on the right leg. As it was bluish-red, he received, Lachesis 12x, 3x 1 tablets. He is a teacher and I wrote out a sick certificate and asked him to come to the clinic again on Monday. As it was the first time that this patient had acquitance with homoeopathy I was anxious when he did not turn up on Monday. On Tuesday he rang me up that he had oppression of the chest. The leg was already well in a day, so that he was back in school on Monday. He had, however, taken the tablets further also since they had helped him so well. He came to the clinic on Tuesday. The Erysipelas has been healed completely and oppression was conditioned only by the taking of Lachesis for a too long period. After stopping of the Lachesis for remaining complaints vanished.

WHAT IS THE SIGNIFICANCE NOW OF HAHNEMANN’S SYPHILIS CONCEPT?Dr. Will KLUNKER

The theme raises two questions:1. What was HAHNEMANN’s concept Syphilis?2. What is the significance of this concept in

Homoeopathy today?HAHNEMANN’s concept of Syphilis: To

HAHNEMANN and physicians of his days Syphilis encountered in daily practice was different from now. It is not therefore surprising that HAHNEMANN’s scientific interest was directed in thoroughly practical manner, to this ailment. This practical interest is clear from HAHNEMANN’s “Instruction for Surgeons respecting Venereal diseases, together with a new Mercurial preparation”, published in 1789. This

treatise of HAHNEMANN presents his new soluble Mercury preparation (Hydragyrum oxydulatum nigrum), which we employ now as Mercurius solubilis HAHNEMANN, homoeopathically, and which HAHNEMANN, employed with great success in treatment of Syphilis before discovery of Homoeopathy. this essay of 292 pages gives in addition a detailed picture of HAHNEMANN’s clinical knowledge of those times which considered gonorrhoea and Syphilis as nosologically united. In his essay HAHNEMANN gives accurate as also the secondary and tertiary stages with the appropriate therapeutic instructions.

In the year 1816 HAHNEMANN published an essay with the title “On the venereal disease and its ordinary improper treatment”. In it HAHNEMANN controverted the entire dominant medicine, the “venereal disease which from its beginning onwards has been bungled and local expulsion of the chancre is seen as the main business of the cure of the venereal disease, the requirement of Mercury internally being of minor importance”. It is essential to high light the underlying concept of Syphilis of HAHNEMANN. These are:a. HAHNEMANN places Syphillis in analogy with

the acute miasmatic eruptive diseases, from which the chronic is left out.

b. After infection, through contact, the eruption, that is, the chancre “does not come to the fore until the whole organism is infected completely”.

c. The chancre indicated the completion of the infection and development of the miasmatic disease and hence the subsequent eradication of the chancre is futile.

d. In as much as the chancre emergies only “to silence the internal veneral disease and as its substitute, its eradication is not only therapeutically futile but at the same time dangerous also. since with the eradication of the vicarious local symptoms the syphilis does not any more break out fully.

e. in the year 1816, the hemorrhage and its connected symptoms were not any more connected with Syphilis.

f. HAHNEMANN, indicated the contagion in Syphilis as “Poison or miasma”.

g. The miasma is caught and transmitted to the whole organism only by contact and from the moment of inoculation.

h. The syphilis, “as veneral disease, remains always the same with respect both to their origin and nature”. In the words of the Organon it is also a firmly fixed veneral disease.

So much about HAHNEMANN’s conception of syphilis in 1816.

Later HAHNEMANN recalls, that the question of Homoeopathic cure of non-veneark varieties of “chronic diseases” occupied him for 12 long years from 1816. the results of these is his work “the Chronic Disease, their peculiar nature and their homoeopathic cure” which appeared in 1828. the second Edition appeared in 1835. accordingly curable are:1. The acute diseases, contagious and fever.2. The chronic veneral disease.

Incurable remain the non-veneral diseases. How one cured these homoeopathically? According to this syphilis is not part of actually difficult “Chronic Diseases”. Nevertheless HAHNEMANN recapitulates in it besides the figwards, syphilis also. He does this not only to be systematic but also because syphilis was for him, as pandigm, miasmatic chronic disease, in agreement with his experiences with non-veneral chronic diseases. The non-veneral chronic diseases likewise was figured out as miasmatic disease Psora.

In the last sixth Edition of Organon of Art of Healing (1842) syphilis is spoken of in ten paragraphs (para 29 foot-note, 40, 41, 79, 197, 201, 294, 206, 207, foot-note and 282 footnote). From above references emerges the fact that between the periods 1842 (vi Edition), 1835 (Chronic Diseases) and ‘on the veneral disease …..’(1816), basically nothing has been changed.

2. What is the significance of HAHNEMANN’s conception of Syphilis for Homoeopathy now?

The syphilis concept of HAHNEMANN, as shown already, is not different from exact syphilis. As disease concept it is purely medical concept including the aetiology, manifestation, progress and therapy. As a medical concept it fits in this course of medical history. HAHNEMANN’s not-closer-definable ‘Miasma’, was identified as ‘spirochaetae pallia’, by HOFFMAN and SCHUDINN in 1905. thus the interpretation of HAHNEMANN as a physician of transmission of an agent by contact only which spreads from its commencement was corroborated. On the other side HAHNEMANN’s method is total eradication of local symptoms along with the homoeopathic specific remedies Mercurius solubilis or Vivus C30 as the case may be. Today the Pencillin treatment does the same. But are they same?

In any case it is certain that the different current interpretations about a homoeopathic cure of the so-called syphilis miasm cannot be identified with HAHNEMANN’s concept of cure of syphilis, whether and how far these theoretic and practical interpretations basis genuine phenomenons or whether based upon speculation which cannot be proved. Homoeopathy must now make it subject of critical exercise, where the

current miasm theory and such must become questions to be considered.