TOMAS PABLO PASCHERO

The 50th year Jubilee of Homœopathy in Argentina was celebrated in 1964. Homœopathy in Argentina owes itself to Dr.Tomas Pablo PASCHERO (1904–1986). Dr.PASCHERO was a classical Homœopath following KENT and high potency prescriptions and giving predominance to the mental symptoms of the patients. He was thorough in Sigmund FREUD’s psycho-analysis methods and always tried to grasp the ‘innermost’. His ‘totality’ is the ‘bio-pathographic’ totality. He was very close to the Indian philosophy and Swami VIVEKANANDA

Dr.PASCHERO considers the clinical meaning of Psora as an idiosyncratic state or pre-disposition which acts as a receptive ground and fundamental cause of all sicknesses. The miasms are not diseases proper but rather dyscrasias or diathetic states which conditioned illnesses or syndromes. They are the dynamic basis of the illnesses. They are morbid alterations of the whole organism, which could have an effect on the very structure of the individual affecting his genotype - HAHNEMANN called them hereditary - and they can therefore, be considered as constitutional illnesses as the collective morphological, physiological and psychical qualities which characterize a human being.

Correct understanding of Man is fundamental to Homœopathy. By nature the human being as a child is egotistic, isolated and self-satisfied. In the process of maturity he opens himself for integration and communication with the real and omnipresent fullness of life. Psora arises when the proceedings are hindered. It will be expressed as anxieties, internal restlessness and in many other forms of mental symptoms. Through that the individual will get awareness of his true identity. Real cure of the human being has to be achieved at this level.

Every man make his own disease, better said, he formed a pathology both of his psychic personality and of his physical organism in accordance with an unconscious determinism originating from a dynamic miasmatic alteration of his Vital Force. That morbid determinism is contained in his biographical history, in his hereditary and particular antecedents, in his way of feeling, thinking and living and in all subjective symptoms that reveal his personality and make him a unique and personal case.

The knowledge of psychology and mental symptoms is the very marrow of the processes of the patient, not a paramedical semiological activity; and a very good homœopath is fit to utilize a deep knowledge of the human soul.

The characteristic totality of the dynamic symptoms of the psychophysical personality perceived by the comprehension of the patient through his character, his affections, his hatreds and aversions, habits of professional life, emotional accidents, diseases, intoxications and everything which constitutes his personal history, gives the picture of his chronic disease condensed in that characteristic complex.

The mental symptoms are the characteristic symptoms par excellence of psycho-physical personality, not only because they represent the highest expression of the individual’s singularity, but also because the phenomena of somatic pathology are the structural consequence of the psychic dynamism, conditioned to the particular neuro-vegetative hereditary stigmatization.

But, to identify the mental symptoms, it is necessary to penetrate into the intimate nature of the human mind and to understand the psychological defense mechanisms which conceal or adulterate them, making their recognition nearly impossible in most of the cases.

First of all we must keep in mind that mental symptom, evident as it may, cannot by itself determine a prescription. As with every symptom, it must be completed with its particularities and concomitants, in as much as it is valid only as an integrating factor of a characteristic whole.

This characteristic complex represents the totality of the symptoms of the patient, the clinical synthesis of the morbid processes and so the real expression of the primary vital perturbation which dynamically produces the actual pathology. It is this synthesis of the clinical problem that the homœopathic diagnosis points to, with the clear conscience that Homœopathy only seeks to cure the chronic disease in its etiological and constitutional aspects and not in its terminal physiopathological manifestations, which are its consequence.

The essential factor of the constitutional homœopathic prescription and treatment is the identification in the patient of the characteristic nucleus of general and mental symptoms which reflect the temperamental structure and which have determined his morbid tendencies and the present pathological picture. If the clinical visualization of this characteristic nucleus of the personality has not been evaluated clinically, it is hardly possible for the homœopath to rationally reach a cure, since the numerical whole of General symptoms and particular symptoms without a psycho-characterological characterization does not give a clear idea of what is it that should be cured in each patient, as HAHNEMANN postulates in paragraph 3 of the Organon.

A patient’s biopathographical history is much more than a mere record of the diseases, accidents and moral disturbances he has gone through in life. It is mainly and essentially the expression of the process of humanization or personalization.

Life can be no other than a surrogate of the creative activity. That is why in the study of the human being we should not concern ourselves only with his anatomical structures and mechanisms, but rather with man’s whole process of life through which these very structures and mechanisms are put to the knowledge of the terms within which his inner world is, thus conditioning of his own personal life to the rhythm of the universal law.

The long road to become a good homœopath is full of difficulties which can be decisive for the failure of many with a good intention. Consider the doubt, hostility, failures, which are the human results of relativity. Lack of a solid base in the knowledge of homœopathic philosophy, the instinctive trend to make no efforts, etc., cause many homœopaths to let this flame burn out, this inner fire that sparks the enthusiasm of their first steps.

Medicaments are offered to us ready, with a pure pathogenesis free from troubling repetitions and digested by ancestors who throughout a life time have caught the distinctive genius, and the medicine’s image.

PASCHERO insists, after many years of practice, that to know how to see a patient, is the most difficult thing.

Homœopathy is not an empirical therapeutics subject to the whimsical deviations of each doctor who practices it but a science respecting rules and principles without which it is not Homœopathy any longer. Our duty is not only to spread it, but to spread it correctly.

PASCHERO stresses that a patient is not considered ‘cured’ if the complaints for which he approached the physician are removed but does not result in the patient obtaining a positive outlook towards life, and further more he must be “free from the blocking of his negative mental symptoms” and live his life in the world with a positive outlook knowing his true identity.

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INFANTILE PSYCHOLOGY IN HOMŒOPATHY

Infantile Psychology is studied in Homœopathy as a symptomatic manifestation of the constitutional disposition or diathesis. The character and conduct of a child are the faithful reflection of his morbid temperament which responds to the environment in a specific way.

This constitutional disposition expressed in the child’s conduct and reactions may be modified by the great medicines of the Homœopathic Materia Medica. Inquiry into the psychological mechanism helps us to understand the mental symptom in its authentic state. Psycho-analytic schools agree that the child’s behaviour follows a chain of causes the obvious link of which may be a conscious motive (either a product of his imagination or a real one) which in turn is linked to deeper sub-conscious forces which depend on inherited constitutional peculiarity.

HAHNEMANN’s reflections on chronic illnesses led him to establish inductively his theory of Psora as a fundamental disturbance of the vital equilibrium whose primary manifestation is anxiety. The Psora is the original state of susceptibility and imbalance that predisposes to infection and that also establishes the basic existential anxiety that every child brings into the world. Latent in the human species, it expresses the ancestral fear of separation from the mother, whom at first the child identified with itself.

Anxiety is a longing, a waiting with fear for something that will calm a tension of need, and this is originally related to the sensation of hunger, the first manifestation of the instinct of self-preservation.

HAHNEMANN takes the symptoms of the unconscious Will (the psycho analyst’s libido) as characteristic of the total picture of the patient, precisely because the fundamental disturbance of Psora is in the instinct of self-preservation. The natural expression of this is in the gastro-intestinal system.

Disturbances in appetite, likes and dislikes for food, compulsive needs for salt, sugar, fats, calcium, stimulants and indigestible substances make a great chapter in Homœopathic semiology. Psychic keynote symptoms such as anticipation, apprehension, anxiety, epileptic aura, etc., felt in the stomach clearly show that the digestive apparatus mirrors the child’s deep anxiety and fear of annihilation.

Psora, the fundamental illness behind all pathology, is not due to previous infection or toxemia nor to some deficiency, but is a state of hypersensitivity or allergic susceptibility which expresses alarm at threats to the balance of the internal economy, produced by the instinctive conflict of self preservation. And we say instinctive conflict because to this nucleus of primary anxiety that conditions ancestral fear of death, there is opposed the instinct to live, the Vital Force that pushes the child to react with fury, aggressively and destructively to abolish the intolerable sensation of hunger that corrodes him. He feels unable to live through the separation of himself from his mother, and as for him the world does not yet exist but only himself, he turns his fury on his mother, placing on her the intolerable feeling and consequently the aggression to annul it.

The child bites the breast of the mother who feeds him. Later he will hit her, and subsequently he will develop all the forms of aggression against the world he lives in, a mother substitute. And so he will fight all his life between the two opposing tendencies that move all human beings, and that are in constant conflict and interaction. Such forces of attraction and repulsion, anabolism and catabolism, creation and destruction, love and hate are seen in physics, chemistry, biology and psychology.

To achieve the maturing and therefore the cure of the child the umbilical cord must be cut. He must be made independent of the childhood ties that keep him in a state of slavery, on the one hand of the primordial anxiety that binds him to his mother, his father or any other person (his wife and children later on), and on the other to the aggressive reaction that submerges him in a state of guilt leading to the great obsessions that make failures of so many human beings.

Depth psychology does not yet appreciate the subtle and varied ways in which the child reacts, using the precarious defensive mechanism of his incipient self, to this basic conflict between anxiety and destructiveness. Hence comes the vulnerability, uncertainty and instability of the sick child. One may deflect the psychic mechanism up to a point, but speculation and clinical reasoning cannot discern the nature of the deep experience that generated it. We may quote St. Augustin, “It is obvious that I understand the meaning of time, if I am not asked what it means. But I am greatly perplexed if I am asked to give an accurate explanation of the question”. The child defends himself from the conflict and reacts by aberrations in behaviour or by organic illness according to these inborn tendencies. But the potentized medicine homœopathic to his case will reach that psoric nucleus of anxiety and is in fact our only means of getting at the dynamic constitutional state underlying the psychological conflict as shown by neurotic behaviours and illness.

In 1957 a girl was brought to me who ten months previously had sprained her right foot. A fortnight later the right knee swelled with intense pain. Fluid was aspirated twice and a cast applied; and she was given Streptomycin (25 vials), Nicotibine, Cortisone, etc., and finally as a last resort surgical exploration was advised; before this she was brought to me. Her pathological background was almost nil; Measles at 3; but her emotional picture was clear. From earliest childhood she had been afraid of loneliness and shivered with horror at the approach of night. She was in constant fear that her mother or father of whom she was very fond, would go missing. She also had horrible nightmares, waking up screaming. As she grew older a fear of weakness developed and of not being mentally capable “like other girls”; nevertheless she was physically healthy and developed well until a year ago when her father died of cardiac angina. She fainted and then wept uncontrollably. Three weeks after the father’s death she went to the cemetery and near his tomb the sprain occurred. Two weeks later the knee swelled, and in another month an abscess developed at a molar root, then influenza with pulmonary congestion and few weeks later suppurative bilateral conjunctivitis.

All these pathological accidents expressed the radical change in this girl from a state of health and strength to sickness, obviously starting from the time of the emotional shock. This causal relationship with the heightening of her original anxiety because of the loss of her father (father and mother are a single person in the child’s affective experience) was very obvious to her family and doctor.

The latent psora had exploded under the liberating action of the emotional factor revealing the constitutional picture previously hidden behind a seeming equilibrium. The pathologist studying these different events sees them only as separate unconnected episodes. The homœopathic doctor without speculating on the mechanism behind the somatic expressions of anxiety, finds this young patient has the following general psychic and physical picture, leaving aside the problem of her knee.

Already before her misfortune and now in a marked way she is afraid that something may happen to her family (this was fulfilled with the death of her father).

Fear of night and solitude

Fear of weakness and sickness

Fear of not being capable like other girls which implies fear of mental imbalance or incapacity

Feeling of apprehension in stomach or as if something would come up from her stomach to her head

Feeling of levitation

Feeling of coldness in certain parts of her body (head, abdomen, the painful knee)

Frozen feet with cold perspiration, sometimes with a fleeting sensation of internal heat

And the previous knowledge that when she was very small her head perspired copiously, wetting the pillow.

This picture clearly fitted the symptomatology of Calcareacarbonica, and so it was. A single dose of the M potency caused a radical change in a few weeks; the swelling of her knee completely disappeared and normal ease of movement was restored, her general health was improved and especially the mental aspect. The remedy freed her from the need of self-punishment because of her father’s death, she recovered her gaiety with a normal perspective towards her sorrow and entered in a few more months under higher doses of Calcareacarbonica into a psychic situation she had never known, free of fear and with greater mental capacity to develop her possibilities.

This happened 5 years ago and today this girl is completely cured of her knee for which she was to undergo surgery after unsuccessful medical treatment. Her knee was cured by the homœopathic diagnosis of her mental symptoms and not by those of the local condition.

Long before psychosomatic ideas of the patient as an indivisible soul-body unit were current, HAHNEMANN had stated that bodily illnesses are no different from mental; in the former there are always some psychic alterations and in the mind that controls the body and in the latter some physical symptoms. But it is the mind that controls the body and for the homœopath it is the symptoms of the personality and character that express the child’s constitution. Thorough observation of these allows the homœopathic doctor to grasp the Simillimum that will correct both mind and body.

On August 17th 1961 there came to my consulting room a little girl of 4 years, with sub acute rheumatism in knees and ankles. The joints were swollen and painful and caused great difficulty in walking. Thin and pale, she had frequent headaches with vomiting and was very nervous and weepy. The tonsils had been removed 6 months before and she had had other treatment without benefit.

A year previously she had had her first attack of acute articular rheumatism with fever, having been in bed for 2½ months, and had had intensive antibiotic, vitamin and anodyne treatment. There was now afternoon fever, constipation and sensitivity to cold and she had frequent fits of rage from contradiction or slight causes, followed by shivering and deep sleep, almost stupor.

When the fever mounted she became loquacious, anxious and restless. She was always full of whims, nothing satisfied her; she would start to eat something and no sooner had she tasted it than she would put it aside. She complained and wept all the time. There was a symptom one sees in tuberculinic cases: she could not stand anything white or the light reflected from a white surface, so that her mother had all the mirrors covered.

This picture together with pains worse in damp weather, headaches with weeping and emaciation, gave us a clear indication for Koch’s Tuberculin. One dose of the 200 was given.

The mental symptoms correspond to those of the tubercular state in infancy: sudden irritability, rages followed by shivering and weakness. Restless, capricious, they don’t know what they want. Older children don’t know what to study or do, they crave change of scene or of occupation. They are very sensitive to all impressions - light, music, noise, pain, etc.

But there was no definite sign or psychological symptom that would define this patient. Nosodes alone do not cure Psora except when they are given on detailed symptomatic indications. We require the mineral antipsoric that corresponds to the essence of the patient’s dynamism. After the Nosode there sometimes appears this constitutional picture that permits the selection of the similimum.

In our little patient we expected that and we got it. One month after the dose of Tuberculinum.Koch 200 she was much better, had gained weight, ate everything, rested well, did not complain of pain. The swelling of the joints subsided and her character calmed down. She did not need another dose till 10 months later, June 7th 1962, when she returned with pharyngo-tracheal catarrh and fresh pains in knees and ankles without the previous peri-articular œdema.

I had seen her 5 times in those 10 months and had prescribed only placebo to calm her mother who did not believe in a cure with only one dose. Nevertheless 4 or 5 months back she began to show a marked change in her character. She became very frightened once during a storm and thereafter got very excited and afraid before storms broke; when the rain came she fell into a deep exhausted sleep.

Ever since the fright she was restless, started at every noise, showed fear of thieves and darkness, and would not be left alone a moment. Above all her family noted with surprise a change in her psychic attitude. Perhaps because of her marked desire to be indulged, comforted, loved, she now developed an obsessional preoccupation about others. She felt sorry for every person and animal, if someone was sick she wanted to carry his meals. She constantly asked what she could do to help people, and really showed sorrow and fear lest something might happen to one of her relatives especially a grandmother whom she loved very much.

There was no doubt that this symptom “sympathetic” so clearly defined, had emerged as a psychological characteristic after the fright of the storm, also her fear of thieves and darkness and her excitement and restlessness. The ‘sympathetic’ symptom being so marked was taken as the determining characteristic of the patient and showed the image of Phosphorous.

After one dose of Phosphorous 200 she did not complain of pain again and her rheumatism was completely cured, with gain in weight, improved appetite, sleep and well-being. The tendency to be indulged in and petted was persisting and also to look for comfort and affection characteristic of all children who “give” themselves (a symptom of Phosphorous and the opposite of Natrummuriaticum with its denial of all sympathy).

In this case Phosphorous was the similimum that remained latent behind the picture of Tuberculinum which as a good Nosode awakened the typical symptoms of the real constitutional remedy.

Some day medicine may determine the psychosomatic picture resulting from a specific conflict or psycho-emotional complex, but experience shows that when the homœopathic doctor pays thorough attention to the child’s mental problem as well as his general physical reactions, then he certainly modifies the tendency to illness and neurosis, the mind is always the undisputed basis for homœopathic prescription.

A 6-year-old girl was brought by her mother because of a wart the size of a pea in her left upper eyelid, vulvitis with leucorrhœa, enuresis, pains in knees and ankles, anorexia, and a doubtful hypersensitivity to cold. This picture might make us think of Thuja, with its coarse sycotic manifestations, but the mother added that shortly before the appearance of the rapidly growing wart, the child’s character changed. She developed intense fear of darkness and of being alone, could not sleep without a light and obsessively watched for the closing of doors at night. This syndrome characterized Causticum and a single dose of the 200 caused the wart to become loose in 8 days and cured simultaneously the nocturnal fears, the enuresis and the articular pains.

How can one explain the relationship of the anxiety and the wart? Where lies the specific between a psychodynamic factor like fear of darkness and a pathological formation of new tissue, the wart apparently determined by the fear?

Physiology and biochemistry have no explanation and so psychology is estranged from clinical medicine. But if one thinks of the sycotic miasm as a perversion of the physiological function of reproduction, in which the cell proliferates anarchically producing warts, condylomata and neoplasms of all kinds, and if one admits that the vital stimulus to the cell can be physically transformed into the reproductive instinct, it is not so surprising that this child developed anxiety, fear and an obsessive neurosis in the face of the threat of her emerging aggressive erotic instinct from which she defended herself by closing doors and lighting lamps.

The constitutional homœopathic medicine correctly applied and allowed to act may be the solution to the biological problem urgently demanded by FREUD in the course of a difficult psycho-analysis.

Every child’s fundamental problem is to free his Vital Force, his own vis medicatrix naturae, from conflicts derived from his psoric anxiety and destructive aggressiveness, which bar the way to psychological maturity. The law of healing established by HAHNEMANN and stated by HERING not only controls irregular strivings towards freedom but stimulates devolution of the child’s psyche from dependent selfishness with its dual anxiety and aggression towards autonomy, real liberty, psychological maturity, that essentially implies an attitude of giving out authentic love for others from a level of independence.

A patient, 18 years old, at the end of her treatment expressed spontaneously and clearly the psychological transformation experienced by herself. She had been a sad melancholic girl, poor of spirit, anxious and agitated with crises of anguish on waking and also fits of great irritability and destructive fury. She was very sensitive to noise and could not bear being talked to in a loud voice or touched. Highly intelligent and imaginative, yet she could not concentrate on her studies, being incapable of prolonged mental effort. Her frail, thin, pale appearance, her anxious nature and her fits of rage determined the parents to bring her to my office. Since very young she had developed an obsessive character with marked scruples of conscience. She worked in a kindergarten and confessed to fear of hurting the children whom she liked and wanted to help. Very close to her mother, she felt anxious at the shortest separation and panic-stricken at the idea of losing her.

She constantly felt a fear that something would be demanded of her that she could not do, especially when having to see someone or fulfill an engagement.

This psychological picture is summed up in the symptoms: anxiety with consciousness, fear from anticipation, obsessive nature, hypersensitive to noise. The symptom picture was completed by headache ameliorated by pressure, great sensitivity to cold and damp which aggravated, continuous colds, profuse perspiration at dawn, offensive foot sweat, inveterate constipation, and recurrent styes.

Her constitutional medicine Silicea was given in 200 and 1M potency, three doses at 4 months intervals.

Six months later when her tiredness and general symptoms had disappeared, her weight and poor physique improved and even her nails she noted stronger than they had ever been. She stated: “ I now feel able to view myself from the outside and I see how much I have changed in my attitude towards life. I was submerged in a terrible anguish because of the fear of losing mother and was always clamouring to be given everything: affection, aid, moral help, protection of my near ones, as an insatiable need for security that yet could not quiet my anxiety. Today I feel capable of giving, of helping or doing something for somebody, and of myself being the one to take care of my mother, of living outside myself. Life and things have acquired a new value because I feel I have now cured my selfishness and have stopped worrying only about myself. In a word, I think I have now grown up and am a person.

When I came to see you I was under psycho-analytic treatment that I soon gave up when I found that I no longer needed it. The doctor (analyst) had become my aid and my support but I felt growing within me a feeling of freedom I had never known before, and I definitely left him, as I had left my absurd fears about having my near ones missing”

These spontaneous expressions of the patient eloquently describe the vital transformation that occurred within her under the influence of the constitutional remedy, I must state that when she left her analyst she did not transfer her emotional conflict of dependence to me. She visited me only 6 times in the course of almost 2 years.

The patient had grown up as she said; had reached her psychological maturity and overcome the infantile mechanism of dependence that chained her to regressive ties which stopped her evolution and development. This is what homœopathic medicine may achieve when it stimulates the vital impulse of growth and cure from the principle of the animistic Will rooted in the utmost depth of biology whence the child fulfills its difficult progression to maturity.

Properly applied, Homœopathy based on a minute scrutiny of the mental and physical symptoms (which are always intimately related) may solve the psychological problems of the child, by going to the constitutional base which determines the deep difficulty in metabolizing primeval psoric anxiety. It is this psoric anxiety that with the excessive eroticism of the Sycosis and the destructiveness of Syphilis genetically causes the child to create as a means of defense the neurotic mechanisms that offer such difficulties to psychotherapy.

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THE PRACTICE OF HOMŒOPATHY

[ From a paper read at the 26^th International Homœopathic Congress, Bad Godesberg 1962]

Personal experience in the practice of Homœopathy deeply confirms the conviction that, until the doctor reaches a total clinical picture of his patient and perceives the radical unity which establishes the morbid nucleus that he must try to heal, he will not be able to control the cure. Without this clinical cosmo vision of each particular case it is impossible to apply the similimum that will influence the Vital Force to stimulate the healing reaction. The homœopathic physician must not limit himself to treating the actual picture, but must undertake to discover what it is that he must cure, after making a biographic and characterological study that will qualify him to understand the temperamentally morbid disposition that determines the present pathological lesion.

The success that Homœopathy undoubtedly has in the treatment of local illness with similar medication can only be considered by the Homœopathic physician as a necessary means of palliation which on many occasions forces him to determine suppressions seriously harmful to the future of the patient. In this sense Homœopathy is not by any means less aggressive than Allopathy or any other therapeutic, when it is applied to suppress local or organic processes without taking into account the derivative function of these processes, and therefore losing sight of the essentially dynamic nucleus of the chronic disease. It suppresses the illness but the patient escapes. In the present illness, even if one is to prescribe carefully, one will not find all the characteristic symptoms that will enable one to individualize the constitutional similimum. Even so, the medicine that will cover the general needs of the present moment will act as the revealing factor of old latent symptoms that enable us to diagnose the similimum of an earlier phase, and so on and so forth until we reach the childhood constitutional remedy.

Clinical observation has proved that the illnesses that have occurred during the life of a patient are not separate episodes but successive aspects of the same diathetic state that emerges from its latent situation because of the specific stimulus of a microbic, traumatic, alimentary, climatic or emotional noxiousness. Not anybody who wants to get an illness gets it, but only those who can, and only those who have the morbid susceptibility to receive the external emotional or physical impact can get.

The series of acute episodes that the individual shows in his biopathographical history is strictly conditioned by the basic disposition of each one.

The Hahnemannian concept of the latent Psora is clearly identifiable with the theoretical notion of diathesis or constitutional disposition demanded by all great clinicians, including PASTEUR. It does not refer to the remnant of acute infections, nor to certain deficiency or metabolic states, but to a permanent dynamic perturbation that engages the individual in the very center of his vital activity, where he feels anxiety, the essential symptoms of Psora, as his first morbid symptom.

Before any infection sets in there already exists this vital perturbation that predisposes for illness and puts the patient in the condition to make the anguish more severe, as he faces the emotional impacts.

If the pathologist is certain to have broken a biological automatism by the removal of a cancerous stomach he cannot, nevertheless, assert that his patient is cured of the original anxiety which had led him to the gastric anguish of anticipation and subsequently to the ulcer that preceded the final Cancer.

The homœopathic cosmo-vision of chronic illness qualifies the doctor to go deeper into the mechanism of healing and to face the present illness as a direct continuation of all preceding illnesses. Even if he may not fully understand the kind of relationship that may exist between the final Cancer and the preceding gastric anxiety, he may affirm that he knows the face of Cancer in a way he may never be able to know it in the laboratory.

It is not in the virus but in the mind of a man that we must look for the original elements that will determine the cancerous illness. It is in the radical psychic unity of the patient where we find the characteristic elements of that vibrant perturbation of the vital energy that conditions the physiology of the body and the pathologic structure.

But if we want this investigation into the mind of the patient to be of real clinical value the homœopathic physician must previously make: a complete biographical history; a correct evaluation of the hygienic, moral and drug transgressions that the patient may have made; a decision as to whether the case is or is not homœopathic; and finally whether it is curable or incurable.

The main reason for the lack of prestige that affects Homœopathy throughout the whole world is the bad selection of cases and the incorrect application of remedies.

All therapeutics, whether homœopathic or not, if applied without the endorsement of a complete clinical judgement which will allow a thorough understanding of the patient in his historical and personal entirety, is absolutely empirical and lacking in seriousness, even if a momentary success certifies a correct diagnosis. A correct synthesis after a thorough analytical examination gives the doctor a real notion of the value of the symptoms and the understanding of exactly what and how deeply he must cure the patient.

Daily practice gives us examples in all and everyone of the patients who come to the homœopathic physician.

A German lady, 32 years old, mother of four, consults about a chronic Pansinusitis that dates from two years back. She has gone through numerous treatments without any positive results and because of this it is considered that as a last resource she must be operated on. Before submitting to the surgical operation she decides to consult a Homœopathic physician. She has constant burning pain in the frontal and maxillary sinus cavities, with purulent rhinitis.

Her complete clinical history reveals that she also had gastro-intestinal upsets with pain in the right hypochondrium and epigastrium after meals, pronounced eructations and flatulence, sensation of hardness at the mouth of the stomach, apprehension in the stomach from any anxiety, and pasty, foamy and fetid stools.

When asked about her mental state, one encounters a certain resistance on the part of the patient who says she comes to the homœopath to avoid an operation on her paranasal cavities, in the same way as the person who had recommended her had avoided a similar operation with homœopathic treatment. I explain to her that in that case too, I had to study the patient in her entirety, as I was not about to try to cure a sinusitis but a patient, and therefore needed to know her biographical history. She then proceeds to tell me that from the age of her menarche she began to have certain nervous manifestations that grew steadily worse up to her marriage. Subsequently her husband, a man of wealth, and she herself advised by the doctors she had consulted, thought it necessary for her to see a psychiatrist.

Many years before her present sinusitis, right after her first parturition, eleven years ago, her state grew worse, with bouts of irritability and anger, alternating with a profound melancholia, periodically succeeding each other. She also had peculiar sensations, as that of feeling double, that her mind and her body were separate, and a strange feeling of disintegration, as if her body were delicate and fragile and would dissolve or break with the smallest blow, either physical or moral, as she had no mental stability whatsœver.

Because of her fits of anger, which had reached the point of exasperation, her symptoms of depression and her phobic-obsessive ideas, she was treated with various remedies, sedatives of the nervous system, later on she was placed in a psychiatric clinic and finally treated by hypnosis and electro-shock. As she continued to be in the same state, already established in a time-cycle picture, she was taken to Munich in Germany, where she was placed in a clinic and went through a thorough medical check-up, after which she was given sedatives and hypnotic treatment, later followed by psychotherapy of the psychoanalytical type.

The patient improved from her hypomaniac crisis and from her intense melancholic depressions, but she did not relinquish her obsessive ideas for a single moment. She returned to Buenos Aires where she continued her psycho-therapeutic and nervous treatment up to two years before when an acute violent coryza with fever and general breakdown appeared, which got better after five days of antibiotic treatment. Since then she suffers from a purulent rhinitis that affects the paranasal cavities and which resists antibiotic and vaccine therapy, but her mental state, as regards her fits of anger and melancholic depressions,. has improved. At the present time we find a patient who has, on the one side, a mental picture that has been psycho-therapeutically treated, and on the other a sinus affection treated as a local illness. Although it is true that no doctor could escape the clinical reasoning that attributes vicarial functions to the nasal and paranasal processes as regards the mental problem, the truth is that they were treated as two different illnesses.

I am also sure that no conscientious doctor can reject the idea that the mental symptom has a physiological corelationship, clinically discernible, even if scientifically he cannot formulate an experimental equivalence between the psychic phenomenon and the physiopathological alteration.

The homœopath cannot offer pathogenic formulae but, thanks to his medicinal pathogenesis, he has in his hands the way to solve therapeutically the problem of the cure that requires, indispensably, a clinical vision of the entirety of the reactions of the patient as a unique and indivisible entity.

Our patient, leaving aside her local phenomena which had somewhat bettered her mental state, continued to have ideas, sensations and general symptoms that gave us the following picture.

A sensation that she feels things from outside her body as if she were apart or had been divided in two. She says she feels as if she were “distributed”, that she is not normal. She does not know who she is.

She has the feeling that she acts wrongly, that she thinks wrongly, that she has fixed ideas which she is unable to control and that she only feels better when she gœs to see the psychoanalyst and feels protected; in that situation the feeling of being guilty of something she has done, what,she does not know, is mitigated. She prays and she asks God to forgive her for her bad thoughts, but she does not know how to tell what these are, except for thinking insistently of suicide, to run away from this mental confusion.

She has the sensation that her body is fragile and that she may hurt herself, so that she does not want to be touched, and asks her husband and children not to come too near her, as they may harm her with the slightest of impacts.

She has a profound sadness, combined with boredom, disgust and an aversion to life; she desires death, so as to runaway from this tedium. Nothing satisfies her nor attracts her.

She cannot read, as she is unable to concentrate, she feels as if she were stupefied.

Sensation of apprehension at the mouth of the stomach, as if she had a stone in it that stops her from eating. She is very thin and anaemic; she weighs 54 kgs and is 1.63 metres tall.

She feels generally worse in wet and cold weather.

She has rhinitis with copious mucopurulent, non-excoriating discharge.

Menses are copious, long and frequent, sometimes with up to two periods per month

The symptomatology was therefore established as follows:

Anxiety of conscience ( as if guilty of a fault )

Confusion as to her identity;

Delusion of being double;

Aversion to being touched;

Loathing of life;

Disconnected;

Stupefaction of mind;

Apprehension in stomach;

Worse by wet weather;

Coryza with copious discharge;

Menses copious.

In her biographical history we find that she had measles and diphtheria when she was a girl, and that she had her tonsils out when she was nine and an appendectomy at eighteen. She now has four children and had been treated several times by the gynaecologist who has cauterized the neck of the womb and suppressed an abundant, fetid and excoriating flux which she had had up to two years ago.

Her father died of stomach cancer and her mother is diabetic. She is an only child. It can be clearly seen that she is a patient with a psychotic heredity and is dynamically hurt in her mind by the psychosis that marked her with her fundamental morbid characteristics, as regards her confusion as to her identity, her feeling of guilt, and her obsessive character with a tendency towards a manic depressive psychosis.

An easy recall of the Materia Medica ratified by the repertory allows us the immediate recognition of the picture of Thuja, a diagnosis that certainly does not affirm itself in the local process of the patient, but in her mentality, without which it could not have been categorically based.

The patient was given three doses of Thuja in 12c, 30c and 200c to take one dose every 12 hours.

The morning after the last dose she woke up feeling a great irritability, restlessness and mental confusion that made her recall her worst times. She had dreamt about her mother whom she hated and could not endure since she was a young girl, especially since the death of her father, to whom she was very much attached, and because of this uncontrollable feeling she felt full of guilt, lamenting herself and crying bitterly.

After five days she began to suppurate copiously from the nose and from the orifice of an upper molar she had had extracted seven months before. She was like this for a week, scarcely able to sleep, with intense suppuration of the sinus cavities through nose and mouth, in a state of confusion and losing weight. She lost another 3 kgs and this intensified her general weakness and left her in deplorable physical state. But after 8 to 10 days she began to calm herself, felt more sure of herself, more optimistic; she felt less pain and generally better all over, ate with increasing eagerness, recovered weight and strength, and above all stopped feeling the sensation of having body and mind separated, as if they’re two things apart, an idea that had pursued her for so many years.

After two months her psychic life had completely changed. She had neither obsessive ideas nor depressions; neither sadness with an aversion to life nor the sensation that her body was fragile, and she allowed her children to kiss and embrace her with pleasure, something she had been unable to tolerate before.

The suppuration through her nose still continued, though highly diminished, and that through her mouth had stopped . After five months the patient had gained 8 kgs. her rhinitis and periodic bouts of acute coryza which provoked a slight suppuration, and her obsessive mental state had disappeared though she nevertheless still sustained hate for her mother and consequently her feeling of guilt.

Since then she has in the course of two years received two doses of Thuja 10M and one of 50M with which she definitely cured her neurosis and her sinusitis, being spared the shock therapeutics and surgery, both imminent in a patient who surely would not have got out of her chaotic situation had she not approached Homœopathy that could make, with Thuja the therapeutic diagnosis of a patient who was absurdly being considered to be suffering from two different illnesses.

Another patient, 37 years old, came in for a consultation in April 1955 because she had to be operated on for a cyst in her right ovary.

Four years before she had been operated on for another cyst in the left ovary and 8 months later she had had to be operated on again for a new cystic formation in the same spot which turned out to be one and half metres of gauze forgotten there from the first operation.

In view of this experience, and listening to the advice of a friend, she came to the homœopathic physician to try and avoid in any possible way another operation.

Her history was as follows: during her childhood she had been of an unhealthy nature, very thin and slight; she had had measles, whooping cough, repeated bronchitis and suppurating otitis in both ears, and had had to submit to repeated paracentesis. During all her childhood she had a chronic catarrh of the nasopharynx periodically worsened by various acute crises of bronchitis. At the age of 16 she had contracted pleurisy of right lung, with serofibrinous discharge. She recuperated slowly and married at the age of 20 also a sickly man who died from a cardiac syncope after 10 months of marriage.

She was still thin, with continuous colds, pain in pulmonary bases, and unable to gain weight in spite of her good diet.

At the age of 29 she fell ill again with a diagnosis of cortico–pleurisy, recovering slowly with intense antibiotic medication.

After her marriage she had started to have an abundant muco-sanguinous leucorrhœa which was treated locally and successfully stopped.

After the cortico-pleurisy the vaginal flux reappeared and after one and a half years of unsuccessful treatment a diagnosis was made of ovarian cyst for which she was operated on four years ago.

Her father was a chronic asthmatic who died of Cancer in the mediastinum.

The actual picture of the patient was:

Great nervous weakness with hypersensitivity and irritability.

Physically and mentally tired, everything represents a big effort; even eating is; more than she can cope with.

Uncertain, full of doubts, it is a real agony just to make up her mind about the most trivial things.

Nothing satisfies her, she is most changeable; she wants first one thing and then another, does not adhere to anything, has a constant wish to change her occupation or the scenery that surround her, wants to travel, changes doctors constantly, is not sure of anything. She is afraid to die if left alone, so she always seeks to be in company.

Great physical and mental restlessness, with an eagerness to do something, to occupy herself with something new and interesting.

Together with this mental picture she had as physical symptoms extreme sensitivity to cold with repeated coryza and a tendency to catch cold easily, as soon as she enters any cool place or room.

Emaciation, in spite of good appetite and adequate diet.

Need to breathe fresh, clean air, in spite of her sensitivity to cold.

With these symptoms she is given Tuberculinum 1M which covers the case in its entirety.

The patient got better, she gained 4 Kgs. and after eight months the gynaecologist found the cyst much smaller in size and advised her to wait and continue with the homœopathic treatment.

After two years of treatment the cyst disappeared completely, but her nervousness, irritability and restlessness continued, together with abundant perspiration at dawn and pronounced sensitivity to cold.

As Tuberculinum was no longer effective I gave her Silicea 1M, without being too convinced as there was no clear picture. Then after an examination a year and half later she showed a characteristic picture that had defined itself during the last few months.

These symptoms were:

A sharp return to sadness, melancholia; and apprehension about her future, with a marked tendency to cry.

Great anthropophobia and aversion towards members of her family and certain friends, with whom she has broken off her relationship.

Fear of people, whom she avoids in order to be alone.

Intense sensitivity to music; it makes her cry and causes her great anguish.

She is excessively affected by other people’s troubles upto the point of crying if she sees a sick animal.

Abundant nasopharyngeal catarrh.

Menses scanty, with amenorrhœa of 1-2 months . Constant sensation that menstruation is about to occur.

Summing up, the syndrome was composed of:

Aversion to certain persons:
Aversion to members of family:
Fear of people:
Sensitive to music:
Sympathetic:
Catarrh post-nasal:
Menses scanty.

Natrumcarbonicum1M and 10M brought this patient back to absolute normality. She is now completely recovered, weighing 66 kgs., without any colds or tiredness whatsœver, in spite of hard work , but with a happy and calm disposition.

The ovarian cyst for which she was to undergo surgery once more disappeared after a therapy that considered her general state and disposition, with mental symptoms that at the beginning corresponded to the picture of Tuberculinum and later showed the psychic image of Natrum carbonicum. The understanding of a case shows up in the typical picture integrated by subjective symptoms which determine the affective and mental state of the patient. It is they that decide a prescription; provided they are in accordance with the general symptoms as regard temperature, climate, mobile activity etc and though I do not regard it of great importance, the majority of likes and dislikes in food, The keynote must be authenticated by the general symptoms, principally by the reaction to changes in climate, but the determining symptom of good similimum is always the mental feature, even after a meticulous summing up.

The homœopathic physician must also be an artist to discover the real characterological physiognomy through the reactive formations which mask the patients, but always after having been scientist first in the analysis and scrutiny of the symptoms.

The repertory almost always shows up two or three remedies that are similar in their general outlook but opposed to one another in the mental aspect, and which because of their similarity act as antidotes to each other.

A patient whose repertory gave Sepia and Pulsatilla with equal values and who would make us lean towards Pulsatilla because of her affability, docility and bonhomie, made us, diagnose Sepia with certainty when we discovered that she was very contrary at home that she sent her 2 year-old son to nursery school and placed her other son, 6 years old, as an all day boarder in school, remaining alone with her husband whom she disliked. Her education and culture had made her offset with an apparently kind and submissive attitude the characteristic symptoms of indifference towards her sons and aversion towards her husband that distinguish Sepia. On her second visit we discovered through her husband another mental symptom that corroborated the diagnosis: aversion towards Homœpathy and the doctor, also a sign of Sepia. The result was excellent and we “therapeutically” gained the ultimate confidence of the patient.

Another patient, whose repertory gave us Natrummuriaticum and Phosphorus with a picture of emaciation, muco-sanguineous diarrhea, intense thirst, a marked desire for salt, tendency to catch cold, fear of misfortune, fear of insanity, also had the symptoms of restlessness that can be confused with hurry.

As we studied his personality in his occupations we found that he was at bottom asthenic and lacking in will power, excited and nervous: he started to do things enthusiastically, but never finished them, left them very soom after beginning them, and passed on to something else. Phosphorus behaves in this way, whilst Natrummuriaticum, who more than being restless is in a hurry, never starts something without finishing it, but does it with haste. And Phosphorus decided the indication.

A patient, for instance, who had got better from a chronic migraine with Sepia, prescribed because of her affective indifference, dislike for her children, etc., suddenly came in five months after the last of Sepia 10M and said that she no longer had headaches; that she was well and happy, normal in her relationship with others, but that she suffered great apprehension when she drove the car; she feared crashing, felt uncomfortable amidst the traffic in the center of the town, and that she felt like this even when her husband was driving. On my insistence that she should tell me all the sensations that she felt she said that she was ashamed to confess that she also felt a great aversion about going to public places, as she cannot tolerate the smell of people, the smell of dirt or whatever is that people smell of when they are crowded together, and that it was precisely this, together with her dislike of heated rooms, that made her believe that she might not be altogether normal or well psychically.

We see that four symptoms:

Worse on riding,

Worse for unpleasant odor,

Worse in warm room,

Fear of insanity,

clearly give Sulphur, which completely cured a patient with continuous migraine that made her follow a great variety of treatments, and a completely erroneous situation in her matrimonial life because of psychological conflicts derived from her morbid situation.

As last instance in this review of examples common in the clinical experience of every homœopathic physician I should like to tell of an eloquent case as regards the action of the single remedy.

Three weeks ago, there came to my office a man, 64 years old, of very good appearance, only to say hello. He had last been my patient on the first of March, 1937, and since then he had not had any need to consult another doctor.

I looked in my files for his clinical history and found that on 2nd August, 1935, this patient had come to me complaining of a duodenal ulcer, proved by X-ray picture, with indication to operate. His local symptoms were: a great hyperchlorhydria with burning and heartburn. He followed a diet of eating every two hours, and the ingestion of milky foods momentarily alleviated the burning pain in his stomach. He also had rheumatic pains in major joints, headaches, constipation and hemorrhoids. His general symptoms were: warmth with heat sensation on sole of feet, rheumatic pains worse in cold, dry weather, getting better in humid weather, intense thirst and desire for ice-cold drinks, salt and sweets. His mental symptoms were fear of darkness and of death. The prescription had been Medorrhinum 200 one dose and placebo. There followed four other prescriptions which the patient had kept and brought with him this time. These had been but placebo, two months later Medorrhinum 10 M on 24^th September 1935 and Medorrhinum CM on his last visit, 1st March 1937.

He told me that he got better and then completely well fast and definitely. A few months after his last dose of Medorrhinum CM he had had a herpes in the region of the base of the left thorax. He did not consult me, he said, because he remembered my advice that any manifestation of skin or mucous tissue which appeared would have to be respected without taking any measures to suppress it. Since then, he had enjoyed perfect health, trying only to follow a hygienic life in every sense of the word. He had never again had any gastric symptom.

The single remedy, prescribed on the basis of the mental characteristics and general habits of the patient constitutes, together with the decisive attitude of the homœopathic physician with regard to old and new symptoms that may appear during the evolution of the treatment, the best guarantee of sure success in the practice of Homœopathy in its maximum goal of healing.

There is no other possibility of healing than that of dynamically stimulating the patient’s own vis medicatrix from his vital center, wisely respecting the exonerative and derivative manifestations that answer to the extractive process, and also the manifestations of old morbid episodes that may reappear.

The indiscriminate medication of local illnesses with a nosological criterion, without a total clinical vision of each particular patient, with allopathic or homœopathic medicines always runs the risk of making a suppression, many times much more serious than what the doctor imagines, and that will always be contrary to the laws of healing.

Any physiopathological entity, as any acute illness, even if that is only a simple coryza, never constitutes an isolated and simple process, but is tightly bound to the patient in his own and personal biopathographical history.

Experience has taught us that it is less and less necessary to use medication of limited or partial action, except in the cases where the present illness urgently demands this, and more important to have a profound knowledge of the great medicines in their characterological personality, to match them, with the greatest possible accuracy, with the mentality and characteristic habits of the patient.

This is the homœopathic clinical practice which demands that the physician must know what it is that he must cure in each patient, as postulated, with absolute conviction in Hahnemannian thought.

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TUBERCULINUM

The fundamental characteristic of the tubercular type is the changeability of symptoms. The patient has no fixed symptoms, only constantly varying ones. As soon as one thing is cured, another appears. Today the trouble lies in one organ, tomorrow in another. One day good, the next bad. The well-chosen remedy, corresponding nicely to the patient, far from helping him, simply changes the symptom picture and he returns with another set of symptoms corresponding to another remedy. The word ‘change’ fully expresses the essence of the tubercular state.

This particularity, so characteristic of the tubercular miasm, is as much physical as psychological. The patient has a desire to travel, to move about, to change his surroundings. It is as though he were captivated by an uneasy restlessness from which he knows no respite, no peace.

Another characteristic is irritability. An angry, excitable patient, he is weak, nervous and bad-tempered, especially in the morning. Nothing satisfies him. It is impossible to please him. Always ill at ease, he becomes angry at the least little thing.

He makes mountains out of molehills. He has a strong dislike for certain persons which can become obsessive. He does not control his reactions; he cannot suppress his impulse “to do something” or even break something in order to release his aggressiveness and calm his hypertense psyche.

This irascibility is a symptom of great value in uncovering the tuberculous miasm, particularly in the case of a child normally mild-mannered and calm, who overnight becomes transformed into an aggressive little monster, someone who curses, throws things, wants to fight, is antisocial, and cannot tolerate having his anger in any way stifled. Like Colocynthis, Ignatia, Natrummuriaticum, and Lycopodium, any restraint on his aggressive nature brings on trembling, weakness, and general debility.

Tuberculinum is also very fearful, mistrustful, and anxiety-ridden. He has a fear of death, of animals, especially dogs. Fears he will die if left alone - that he might succumb to a suicidal impulse. It is as if the fears, the sadness and depression had been engrafted onto him. He cries easily, often without reason. He can often be unable to stop crying over totally insignificant matters. A non-stop complainer, he is filled with hopeless despair.

His dissatisfaction results in a marked indifference to everything combined with laziness, apathy, and an uneasy restlessness. On the one hand he has an aversion to both physical and mental work. To him everything is an effort, even eating and drinking. He has no enthusiasm for anything. He detests speaking or being spoken to. He doesn’t even want to make the effort of replying to a question.

On the other hand, he is unendingly restless, always wanting to do something; to travel, to change his job, occupation, his course of study. He changes doctors constantly. He is full of doubts and cannot make even small decisions. Ambivalence characterizes him. He wants something and then does not want it.

Deep down, Tuberculinum is overwhelmed by a deep depression affecting his mind and body. To concentrate and do intellectual tasks is painfully difficult. He must read and reread a sentence in order to understand it. He has brain fag plus a certain amount of dullness and confusion which makes things seem bigger than life, out of proportion, or downright weird. Because his reasoning powers are weak, it is difficult for him to have an appropriate intellectual attitude towards his perceptions.

To summarize the mentals of Tuberculinum we can say he is a patient subject to constant changes, who has a variety of symptoms, and whose mental state is contradictory and ambivalent. In addition, he is sad, depressed, angry, apprehensive, fearful, anxious, indifferent, lazy, restless, and confused.

There is a certain Tuberculinum which presents with a schizoid personality: egotistic, autistic, and introverted with a tendency to biting, destructive criticism. This destructive side of his temperament is syphilitic. It binds with Psora to form the tubercular miasm.

An important general symptom of Tuberculinum is that he is always chilly, always feeling the cold. This chilliness makes him susceptible to catching colds though it is not easy to know how or where he catches them. In children, for example, we see frequent bouts of tonsillitis with swollen tonsils and adenoids and copious post-nasal catarrh. All these symptoms come with fever and there are frequent relapses coming one after the other. Tuberculinum can do what no other remedy can do for these little ones with a tendency to eczema and a family history of tuberculosis.

Despite Tuberculinum’s chilliness and lack of vital heat, he exhibits a paradoxical symptom: desire for fresh air. He wants the doors and windows open. He can have chills, but he wants to be in the open air. Although he catches cold and becomes worse, he wants that open air.

His hypersensitivity to cold is extended to changes of weather. So sensitive is he that he can predict a coming storm as can Medorrhinum, Phosphorus, and Psorinum.

Another trait of fundamental importance in Tuberculinum is fatigue. It is an overwhelming tiredness that peaks in the morning on rising when he feels faint as if he might fall down with each step. So weak is he from the knees down that he is often forced to seek support from any companion he happens to be with.

Tuberculinum presents with great fatigue, both mental and physical depletion, and with an impaired ability to recover from acute illnesses, especially respiratory complaints, influenzas, or seasonal colds. In children, for example, one can see wonderful results from a single dose of Tuberculinumaviare after measles or a debilitating flu.

Finally, this remedy exhibits a marked degree of loss of muscle mass, wasting and even cachexia.

Despite a huge appetite, despite eating any time, day or night, he tends to lose weight or to remain at a substandard weight. One can state clearly that a patient with such a voracious appetite combined with an inability to assimilate food must be an extremely tired, exhausted individual.

It is not good practice to prescribe on general impressions, but in the case of Tuberculinum like all the Nosodes, the symptoms we have described, without unduly emphasizing any of them, from what Compton BURNETT characterized as the inherited tuberculinic miasm. The particular symptoms of a given case must correspond to the general basic constitutional framework. Local symptomatology, such as the migraine headache thereby acquire special significance.

The headaches of Tuberculinum are extremely intense and constant. Located in the right forehead or above the right eye, they extend to the neck and spine. The headache produces a sensation of heat and heaviness in the vertex or of an iron band squeezing the head. Frequent flushes of heat often accompany this headache. Characteristically, the headache is periodic and alternates with other complaints. It appears every one, two, or three weeks and in between one can see respiratory, nervous, or other complaints. It is a known clinical fact that symptoms of mental derangement can alternate with the symptomatology of pulmonary tuberculosis.

These very advanced tubercular states, which can go into meningitis or into a complete loss of the mental faculties or into fulminant pulmonary TB are extremely difficult to recover from. One of our cases presented as an outbreak of Schizophrenia with a total refusal to speak. She improved with a single dose of Tuberculinum CM . Her mental condition eased up; she began to interact with her environment and she regained the speech. But at the same time, it activated pulmonary tuberculosis which greatly alarmed her family. They were even more upset, however, when told that if we were to antidote the action of the remedy, we might very well bring back her former mental state. Faced with the dismal memories of her madness, the family opted to wait. The sick woman was placed in a sanatorium in Cordoba where later she died. The deeply embedded tubercular taint could not be overcome, and it acted to stop the Vital Force as it moved, curatively, from the mind to the organs, following HERING’s Law.

Another particular symptom in Tuberculinum is constipation alternating with diarrhœa. The constipation is as obstinate as is the sudden diarrhœa which customarily forces the patient out of bed during the wee hours, just as in Sulphur. Chronic diarrhœa is a frequent symptom in pre-tubercular patient. From BURNETT we learn that intestinal parasites tend to take up residence in patients with the tubercular miam.

Rheumatic pains also trouble Tuberculinum. Like Rhustoxicodendron, the pains are worse with movement. The afflicted person has trouble initiating movement as he has to override the stiffness of the joints, but on walking or moving, he is better. That is to say, he is worse at rest as well as from the cold, humidity, change of weather, and storms.

Finally, the classic particular symptom of all tuberculinics: the cough. It is a hard, dry spasmodic cough producing abundant thick yellow expectoration. The cough by itself, however, does not provide sufficient distinguishing characteristics if it is not accompanied by the general symptom picture - loss of weight, fatigue, nervousness, and by the modalities – difficulty in breathing in a warm room, desire for cool open air in spite of a general chilliness and sometimes even chills.

Other particular symptoms could be mentioned, but we insist none of them are worth much if not accompanied by the basic mental and general symptomatology which must furnish to the homœopath a faithful impression of the entire picture.

We consider it useful to relate several typical clinical cases which were benefited by Tuberculinum.

A child of three was brought in on account of his nervousness and extreme anxiety. Crying and shouting, almost nonstop, nothing satisfies or amuses him. At night he gets up and cries or starts to sing. Every so often he catches cold. Permanent runny nose. Recurrent styes. Constantly hungry yet always thin. Intense thirst all the time. Very unpleasant fetid breath in the mornings. Fear of dogs. Crying and fearful shouting when he sees one.

Boy of six brought in for extreme lack of appetite. He is very thin with multiple ganglionic infarcts mainly of the carotid chain (sic). Suffers from diarrhea and frequent indigestion of unknown etiology. Fetid breath. Suffers from insomnia being too anxious to sleep. Grinds his teeth forcefully during sleep. Is always bad tempered and unsociable. Of a sudden, difficult disposition. He is annoyed when spoken to.

An 8 year-old girl. She has a fever of 37.5°C, more or less, every afternoon. She has lost three kilos in the last four months. During the same time she has turned into an irritable, agitated, sad and weepy child. She cries during her nightmare-filled sleep and screams with horror. She cannot be awakened or her anxiety soothed except after quite a long time. For the last 20 days she has had copious fetid diarrhea with three or four morning bowel movements. The first stool forces her out of bed. She presents with intense pains in the right side of the abdomen when running and sometimes even when walking. Lienteric stool and appendicular pains. Intense thirst. Marked flatulence.

A 16 year-old boy. Comes in because he is unable to put on weight. He is very thin, tired, and exhausted. Unable to study due to poor memory and concentration. Sweats copiously on hands, face, and trunk. Dizzy in the morning on rising. Great nervous debility. Everything annoys and vexes him. Any little thing irritates him greatly. Finicky about food. Nothing pleases him. He lives almost exclusively on café-au-lait. For the first three or four years he has had a dry Eczema on his forearm and thighs. Periodically he has vague headaches.

A 53 year-old male patient. Comes in for the following problems: very painful rectal fistula with periodic suppuration. Severe headaches accompanied by heat and a tightness in the forehead and nape of the neck. He catches cold quite often. Endless nasal discharge accompanies. The colds go into bronchitis with copious sputum. He suffers greatly from the cold, but he cannot live without fresh air. He is a vegetarian more than anything else because of an overwhelming aversion to meat. Constantly thirsty. Very excitable and at the same time sad and dejected. Always talking about the unpleasantness of his job. Though aware of his own intolerant nature, nevertheless he manages to have constant run-ins with everyone. Wants to change his surroundings and live somewhere else. He is waiting for his coming retirement in order to fulfill his long-standing wish of moving to another place and traveling.

The above cases demonstrated different facets of Tuberculinum. Such examples, demonstrating the essential characteristics of Tuberculinum, could be multiplied many times. But the important thing is to grasp the morbid temperament of the tuberculinic miasm and differentiate it from the great polychrests.

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ESSENTIAL FEATURES

Here are some very synthetic directives that point to the essential characteristics of some remedies. Do not prescribe ---

Ambragrisea, without establishing a premature senility, an intellectual and physical decline, with emotional apathy, that must be diagnosed not through symptoms but through the global impression of the patient’s attitude;

Ammoniumcarbonicum, without hysteria and a tendency to faint, hysterical features with sudden changes of the state of mind;

Argentumnitricum, without stage-fright, fear and anticipatory anxiety before any ability test;

Arsenicum, to an untidy individual without a demanding neatness and tidiness;

Aurum, without a destructive aggressiveness having a feeling of guilt that carries the patient to a state of tenebrous suicidal melancholy;

Calcarea to someone who has no apprehension or fear of anything;

Kalicarbonicum, to an individual who is not afraid of loneliness;

Lachesis, to an antisocial non-communicative woman, someone who does not converse very much, is not loquacious or jealous;

Lycopodium, to a patient having absolute self-confidence who is not a coward;

Medorrhinum, to some one who is not in a hurry all the time and has a good memory;

Mercurius, to some one who does not show a certain degree of mental retard, intellectual obtuseness, and ideas of killing or committing suicide (the child is wicked, perverse, malignant, gossipy, entangling, crooked, destructive)

Natrummuriaticum, to someone who does not feel mortified, humiliated, unfairly treated, or who seeks the friendliness, consolation, cuddling of Phosphorus (and unlike Phosphorus who is extroverted, Natrummuriaticum is introverted);

Nitricacidum, to a patient who is not ill-tempered, choleric, violent, irascible to a very great extent;

Phosphorous, to a modest and calm individual;

Platina, without a peculiar and disdaining superiority that turns him haughty and proud;

Psorinum without a feeling of abandonment, incomprehension, isolation, in-communication, hopelessness, without anxiety of conscience, and pessimism, both about his health and salvation;

Pulsatilla to someone in whom we have not observed acquiescense, easy compliance, and fundamental pusillanimity, with easy crying:

Sepia, to a woman satisfied and happy with her home and her family, or to a man satisfied with his work;

Silicea to a patient, having a strong and firm charcter;

Thuja, without obsessive ideas, hallucinations, and without a sense of guilt, due to an extremely well-developed anxiety of conscience;

Tuberculinum, to a child who is not stubborn, obstinate, and besides, extremely sensitive and irritable.

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HOMŒOPATHIC DIAGNOSIS

Homœopathy must comprehend the individual patient as a person, so much so that in establishing the nature of the diagnosis, it is always necessary to examine the subjective symptoms in order to formulate the characteristic complex. The greatest difficulty in the consideration of a case is precisely in identifying those symptoms, generally of a psychological nature, which have particular value in the hierarchization of the picture - ones which cannot be observed merely through a superficial anamnesis, but through an intuitive grasp by the physician of the situation as a whole.

The progress of Homœopathy depends on the training of each homœopath to discern the authentic dynamic symptoms of the patient, permitting him to be sure of his prescription, and rationally to follow the evolution of the case; having as his point of reference the progression of those dynamic symptoms. This implies the observation of the tuberculinic or sycotic constitution, not of the changing and metastasic mobilization of the pathological symptoms. The former is the dynamic back-ground which the homœopath physician must diagnose, undertaking decisively and without any psychological prejudices the examination of the personality, where the dynamic symptomatology is shown with more defined characteristics.

Upto the present, there are no surer or more efficient means of diagnosis than a direct scrutiny of the symptoms by a physician clinically trained to recognize and interpret the subjectivity of the patient. No electronic instrumental technique of any nature can obviate the immeasurable value of the physician - patient’s human contact in the presence of the problem of the disease. For this purpose, the homœopathic semiology must be adapted to the present knowledge of the personality, fundamentally bearing in mind that ideas and concepts of the patient regarding himself and his symptoms are related to unconscious ideas and feelings discoverable through the biographical history. The isolated symptoms have no value unrelated to the deep motivations of the personality, whose dynamics must be understood by the physician, to produce a correct clinical synthesis. It may seem over-simplified to state that the characteristic of a true homœopathic consultation is one where the physician channels the patient’s attention to himself, not as a clinical case, a disease, but as a person. The medicine that will heal a patient with neuralgic pain in the arm, for example, corresponds to the general characteristics of the patient relating to the chronic process in which the pain originated, rather than to the nature of the pain itself. Every local process must be approached to observe the clinical elements of continuity which make up the unity of the living being suffering a local disease. There are those who differ in this respect, believing that “all” the symptoms must be covered by medicine, not understanding that the prescription based merely on the total number of symptoms has no consistency; for the prescription must be based on a relative evaluation that makes clear the characteristic complex which in turn rules the rest of the picture.

Any medicine or therapy which does not view the present disease in the total biographical context of the patient, and which does not establish a treatment based on that constitutional syndrome running through the whole life of the patient, lacks the synthesized vision of the clinical problem, and therefore of what must be cured in each case.

Homœopathy, being the only therapeutic based on direct experimentation on the human being, will continue empirical in its application until it decides to face the constitutional, biographical, and clinical problems of the patient. It will continue to fail in the comparison of the actual symptoms - which is the level to which the current homœopathic diagnosis is reduced.

It is not feasible to visualise the medicine as merely symptoms but one must cultivate a good memory for the handling of keynotes, characteristics, and local modalities, while at the same time not ignoring this basic (and inevitable) endeavor to understand the morbid genius of the remedy in terms of the whole personality of the patient. The symptoms must be understood in their geneology and meaning, related to the biopathography of the patient and to his vital attitude.

It is interesting to note, for example, how a patient with a syndrome of functional gastric disorder further deteriorated by sweets (to which she has an aversion), has a confessed hate-situation with her mother, from whom she has separated due to bitter disputes over her father’s estate, finding her remedy in Ignatia which simultaneously covers the hate somatized into intolerance to sweets, which symbolically represents the maternal nourishment; Ignatia has a marked deterioration due to sweets, and anger with silent grief; constituting by their association the characteristic complex of this case.

The homœopath who, as a physician, can integrate the synthesized image of the patient, cannot only discriminate between the organic and the psychical ailment, but can also identify the hierarchies of the symptoms that determine his personal diagnosis.

The law of simultaneity or concomitance of the psychical and somatic phenomena made plain by modern psychology is evident in the homœopathic diagnosis of a medicine that sums up the total reaction of human being. Nowadays it is not possible to practice medicine without incorporating the mental symptoms as clinical values, biologically conditioned to the whole body of the diseased patient. The present physico-chemical trend of thought, that considers the balance and relative proportion of the oligodynamic elements in the organism as fundamental values, fails to grasp that the neurotic process cannot be perceived through chemical formulae. It is unquestionable that the scrutiny of the electrolytic, hormonal, metabolic, vascular, respiratory, and cellular activity performs a very important role in the progress of science, but for the purpose of curative therapeutics, the clinical focus must necessarily exceed the limits of the physio-pathologic mechanism in order to obtain signs of the dynamic aspect of the morbid process put into motion by the whole person of the patient.

In this dynamic aspect only those subjective symptoms, synesthesis, sensations and – manifestations of conduct can appear that reveal the structure of the personality and character; all of them of fundamental clinical values for the homeopath and essential for his diagnosis. The difficulty lies in the fact that these clinical values of dynamic order are hard to perceive; especially by the physician oriented with the organs who also feels a resistance, due to personal affective inhibitions, to an invasion of the privacy of the patient and, consequently, to the incorporation of psychical factors into the clinical history. But for those who have evidenced that medicine must consider the disease “as from” the total person of the patient (and that this must not only include the psychogenic factors of the organic disorder but, on the same biological level, the psychical repercussions of the somatic lesion, trying to effect in each case the interpretation of the meaning, based on the personality, of each symptom), it should be easy to prepare good biographical histories and to discriminate the characteristic picture of the symptoms.

An attentive, careful and patient Anamnesis is the most valued propadeutic means rational medicine has (and particularly Homœopathy), and it is directed towards exploring the pure symptoms of the picture through the hysterical, obsessive, phobic mechanisms and secondary processes with which a patient elaborates or metabolizes the anguish of his friction with his surroundings and reality. Only in this manner will the homœopath be sure of his prescription: on re-evaluating. With regard to the organopathic Homœopathy, the mental symptoms generally hide behind a secondary (and therefore absent from the immediate picture) elaboration.

One patient had attacks of paroxysmic tachycardia with abundant and copious sweat during attacks which lasted from ten to twelve hours, with a sensation of great physical restlessness and violent vertigo in decubitus. Nothing somatical permitted a physical diagnosis, except oscillating hypertension, of a sure emotional origin. An examination did not reveal anything definite, but the anamnesis and vital history showed the clear elements of an Anxiety Neurosis converted into a paroxismic attack of tachycardia.

For the purpose of the homœopathic diagnosis, the patient did not present precise mental symptoms but the biographical history revealed that before her disorders started, she feared death intensely when she was alone, in the form of sudden impulses that made her consider committing suicide. Knowing the psychical mechanisms of somatizations or organic conversion of anxiety, the physician did not need to see her fear of death at that time in order to know that this symptom, determinative of the case, was implicit and in operation in the vital history. It was therefore easy to diagnose Arsenic to a patient, apparently calm, who nevertheless has such anxiety with fear of death that unable to bear it any longer, she considered committing suicide -- whose sudden attacks became worse when she was alone -- a mental complex that is characteristic of Arsenicumalbum.

Another young patient, the mother of two children, aged 3 and 5, presented a picture of anxiety, depression, intense headaches, a sensation that she would become insane, fear of death and of solitude, giddiness, brief fainting fits, very painful and scarce menstruation with amenorrhœa of 1-2 months, aversion to people, hot flushes on the face, chills, and uncontrollable jealousy. She stated that her husband was in the Navy, and that on one of his trips, a year ago, he wrote telling her he had attended a ball. This news produced the effect of an idol crumbling. Since then she has had the obsessive thought of the possible infidelity of her husband and the sensation of becoming insane, withdrawing from people so they would not notice her confused state. She is markedly stouter in the lower part of her body, with preference for salty and cold food, irregular thirst, inveterate constipation, general langour at 10-11 a.m. and an evident attitude of hurry - agitation in everything she does. Except the dysendocrinous and emaciated aspect of her face and neck, the clinical examination did not show anything objective or organic.

The computation of the picture under the aegis of jealousy as the apparent determinative symptom, together with her timid aspect - sad, ashamed, passive made us consider Pulsatilla. If we had also considered the sensation of madness, fearing that people would notice her confusion, as outstanding symptoms, we should have considered Calcareacarbonica, as well as Natrummuriaticum or Phosphorous or Sepia as the result of repertorization based only on the actual symptoms. In this, as in every other case the difficulty lies in the characterization of the picture and the faithful identification of the determinative symptoms. If this patient presented jealousy as the key to her situation, we could not withdraw from the limited scope of jealousy; but - was it really jealousy she had, or should this be confirmed by a personal understanding of the symptoms?

I believed the latter was what had to be done, and what must always be done in order to give the homœopathic diagnosis an assurance which it will never have if it is based only on what the patient informs through a deficient self-observation and secondary neurotic elaboration of her real experience.

A more thorough biographical anamnesis showed that as a child this patient was thin and irritable, with a divergent strabismus in the right eye since age 5, until at 16 she was operated upon; that she was timid, withdrawn and subject to sudden and desperate weeping fits that at that time and even now consolation improved her, but she did not wish her mother nor her father to go near her because her despair became worse and she felt an impulse to attack them; that she had an obsessive fear that either of her parents might die, not on their account but for what could happen to her; and that she still had not overcome the feeling of rage and shame caused by her friends’ gibes at her strabismus.

It is certain that the primary symptoms had suffered a reactive modification that determined an unauthentic present picture. Now, she was not a passive patient searching for consolation with the Pulsatilla sorrowful image in need of affection, but a resentful patient with a tremendous load of repressed hostility towards her parents evidenced by the violent rejection manifested towards them in the middle of her sudden weeping fits, the fear she felt for what could happen to her if one of her parents died (fear of revenge), and her own strabismus as an exponent, through the “pars pro toto” law, of the aggressive tension supported by her muscular system.

Her jealousy was due to an overwhelming need to liberate the reactive hate for her parents, brought out by a trivial incident that triggered the resentment enfixed in her unconscious mind as a conditioned reflex. In this case jealousy lacked the value which determined a personality, because this really was not jealousy but hostility; the basic personality showed a well-defined outline. On the other hand, in Pulsatilla, jealousy arises from a need of affection and esteem in a person who wishes to salve her feelings of inferiority, inactivity and lack of self-esteem with protection, indulgence, and love from everyone not only from her mate but from anybody; she is jealous of anyone who gives attention and love to another and not exclusively to her and in Lachesis, jealousy conceals infidelity impulses projecting an erotic content, exacerbated by the menopause; she accuses her mate, instead of instinctive pressures that cause her anguish, thus obtaining through jealousy a rationalized relief from her tension.

Unquestionably those former biographical incidents permitted an understanding of the real nature of the patient, and an adjustment of the determinative symptoms which, in the correct homœopathic individualization of the constitutional simillimum always correspond to the characterological personality of the patient (symptoms which, as in this case, are often hidden behind a reactive formation).

Having explained it, the characteristic picture of this patient is integrated by the following symptoms: malicious; anger with silent grief; fear of insanity; fear of evil; fear something will happen; aggravated by consolation; hurry; general languor at 10-11 a.m.; preference for salty food; obesity in the lower members; and strabismus (rectified through the operation.)

Repertorization clearly pointed to the Natrummuriaticum diagnosis; but prior to this and even without it, the real vision of the character of this patient provided by the comprehension and genealogy of her symptoms, brought to the physician’s mind the clear image of Natrummuriaticum, with a certainty that can never be given by the simple transcription of the actual symptoms.

It is not as the patient presents himself that he must be considered, but how he really is, as he generally looks for a diagnosis which he has already made and unconsciously tries to confound the physician.

There is sufficient evidence to see how a patient with a syndrome of fatigue, violent headaches, dyspepsia, spasms in the biliary tract, vomiting, etc., without any organic lesion or alteration, in a reiterated and resentful manner refuses to accept that he is suffering a neurotic tension in the face of a circumstantial problem and who changes physicians, searching for someone who will agree with him and who may even carry him to a surgical operation.

When as in Homœopathy it is necessary to scrutinize a clinical problem which does not end with the pathological diagnosis, but one where the key to understanding can be found in the knowledge of the patient, the involuntary lack of frankness must be considered - as well as the inability to analyze oneself from which all patients suffer - preventing the physician from obtaining a clear, accurate vision of the state of being. And it is precisely in this state that the homœopath is interested, rather, than in the blood pressure, the electrocardiograph tracing, the hepatograms, the electrolytic balance, the study of the internal medium and the analysis of the intestinal flora - doubtless of great clinical importance as unobjectionable analytical elements - but as medical values always conditional to the whole of the patient, as given by his total biography and his attitudes.

Another patient of 44, with 3 children, complained of intense headaches, an intense burning sensation in the stomach after eating, pain in the hypogastrium with a marked bearing-down feeling stronger before the painful menstruation, heaviness of the legs with marked varices, a dizzy sensation when she stood up ( she had fainted several times while kneeling in church). The patient did not present any organic disorder except abundant flux, but she manifested a characterology that consisted according to the patient and the person with her, of a great fear of diseases, intense emotion with constant weeping, deep sadness and, at the same time, a marked obsessive condition that kept her in constant activity with extreme supervision of her home, controlling even the minor details watching that the food, clothes, floors, appliances, etc., were clean and impeccable. She reacted with anger to the slightest transgression of the rules of hygiene and order imposed by her, and had earned the reputation within the family of being arrogant, violent, intolerant, impulsive and unaffectionate. In the course of this narrative the patient started weeping disconsolately, stating that she truly felt maladjusted and strange in her home which she admitted she did not love.

With this manifest picture the diagnosis of Sepia was evident, determined by the following: the fit of weeping in the consulting room, fainting in church, fear of disease, irascibility and intolerance, emotional indifference, bearing down sensation, acid dyspepsia, abundant flux, heaviness of the legs, weak ankles.

However, we could not be convinced that we had the image of Sepia before us. The patient did not present the indifference, physical apathy, and loss of interest which is always observed at the bottom of Sepia cases. There was a deep sadness in the painful weeping evidenced in the consulting room, which showed rather than an attitude of renunciation and lack of interest in her life and possessions, a frank rebellion against her impotence to carry on with the household duties and her family. Yet Sepia indifferently attends household duties.

The biographical antecedents did not reveal pathological disorders except that she was an only child whose father had died three years ago of hepatic Cancer. Until she married at 26, she had lived with her parents (the mother is still living and healthy), and had always carefully looked after her father, a chronic hepatic, to whom she was united by an intense love and devotion. The patient said that her father was the greatest love of her life and as this was emphatically stated in the presence of her husband, we observed a flagrant aggression against him, corroborated by her general attitude of arrogance-haughtiness. She stated she is frank, likes to say things face-to face, does not like to see disorder in the house, and admits she does not tolerate anyone attending to things for her. She fears illness and being unable to do the household duties or having to depend upon a maid for cleaning, which she would not tolerate. She has even renounced her holidays in order not to leave her home at any time.

The scope of her life is now clear to us. She is obsessively flaxed on her home, with a desire for domination, and an aggression that may hide anxiety over a deep feeling of inferiority; she is haughty and arrogant as a reaction to the insecurity caused by the death of her father, who always deferred to her as his only daughter. She has no confidence in her self and has none in other people because she has not been able to resolve her deep desire for affirmation and success.

The real picture of this patient, on understanding the feeling of inferiority which she felt, together with the reactive formation with which she defended herself from this anxiety, was integrated with the following determinative symptoms; haughty, dictatorial, conscientious (compulsion obsessive), want of self-confidence, grief, suspicious, stomach burning sensation, hypogastrium pains before menstruation, and heaviness in the legs. We must omit the following symptoms; fainting in church, and weeping fit in the consulting room, as these are related (the patient’s own expression) to her father’s death, for whom she renewed her mourning to the point of wanting to die when she prayed for him. The fear of disease was based on her dread of being unfit to carry out her work according to the compulsive obligations he had imposed.

The Lycopodium diagnosis was clearly indicated over that of Sepia, more on the basis of the characteristic syndrome of her nature than on the repertorial decision.

We demonstrate another case: A patient 58 years old, said that he suffered rheumatic pains and frequent colds, with coryza, inflammation of the paranasal cavities and bronchitis. He was very sensitive to low temperature and easily caught cold even when only one part of his body was exposed to low temperature, such as the head or feet. Likewise he suffered periodical headaches that affected the left side of his head on the supraorbital region or occiput; slow digestion with eructation, flatulence and borborygmus; cramps in the legs; somnolence during the day and insomnia at night; and a marked state of agitation and nervousness that impelled him to constant movement and activity. He insisted and vehemently stated that he desperately needs to hurry when he begins any work, especially when it is related to his job.

Taking into consideration his manifest aspects the determining symptom that stood in this picture (due to his intensity in describing it), was the hurry-agitation, the desire to do things rapidly, that constituted one of the characteristics of the Sycosis and that appeared as the exclusive symptom in this patient. However, going deeper into his biographical history through a narrative which it is unnecessary to transcribe, we arrive at the conclusion that he was an extremely ambitious man, that all his life he was motivated by the laudable desire to obtain a high position, together with an unsurmountable dependent disposition that made him incapable of starting an independent business. This vital conflict caused him to assume his consequent attitude of revelry with his employer and other persons, having to repress due to his dependent condition the aggressiveness due to his frustrated desire for success. The result was an obsessive neurosis, manifested by the excessive zeal and conscientiousness in carrying out the tasks given him by his employer. He confessed that the hurry and agitation mentioned previously (the principal motive for the consultation) overwhelmed him when he had to render accounts to the cashier for collections made, and deliver amount of 20,000 to 30,000 pesos. It was then he was overcome by an anxious fear of being found at fault, of not rendering an exact account and of losing the confidence of employer. Furthermore, everytime he was directly entrusted with a task, he “felt” the same hurry and agitation, making his responsibility maximum which does not happen when he does tasks at home or tasks not related to his job.

Consequently, this patient’s picture must be governed by the determinative symptom derived from his obssessive neurosis - conscientiousness - and not by the hurry to do things that is manifested only when he has to cover the fear of ruining or attacking his employer. Therefore the characteristic complex is integrated by the following symptoms: conscientious, want of self-confidence, hypersensitivity to cold, susceptible to cold in one part of the body, head or feet, hemicrania on the left side of the head, of the supraorbitary region of the occiput.

Silicea was the simillimum medicine of the case, which as a diagnosis corroboration, reproduced an old and intense bromhydrosis of the feet which he had not mentioned in the first consultation, together with a marked improvement of his neurosis and general condition.

If we had confined the search for the medicine to the determinative symptom that was apparent in the first stage of the anamnesis hurry, agitation, we would have had to exclude Silicea, which does not have agitation, and would have mistaken the diagnosis. It is evident that symptoms must not be transcribed just as they appear without understanding their meaning or origin. but by means of a comprehension of the total personality one can know their latent content and see the symptoms in their true context.

A patient of 42, a radiotechnician, stated that for 26 years he has suffered intense pain in the right hypochondrium in the form of irregular attacks. He was treated as vesicular hepatical, amebiasic, appendicitic, and allergic. In New York he was hospitalized for investigation and was informed that he had something in the colon that could not be determined. He followed many treatments without result. His painful attacks often appeared after nervous excitation, heated discussion, or intense preoccupation; and consisted of colics with cramps calmed by leaning backwards. For this reason an eminent homœopath prescribed Dioscorea. His characteristic symptoms were the following; getting worse by milk, fruit and fasting; intense thirst, perspiration on the neck, apathy, ill-humor, anxiety.

With only the above symptoms, the picture seemed undefined as it did not comprehensibly delineate the type of patient, with the common symptoms of anxiety and ill-humor, together with the phenomena that were also common (i.e. of hysterics of somatic conversion in the form of abdominal colics), there was no definition of the patient. But on going into his characterologic background, we were surprised to find a patient who presented the picture of the truly socially resentful person. He was the youngest of five brothers, and very spoiled by his father who died when he was 15. He then had to leave school and start working. The contact with everyday life for which he was not prepared, caused him to develop a resentful rebellion against what he believed was an injustice of destiny and he became obstinate, disobedient to any direction of his employers, and disposed to reject any suggestion with insults and offensive words, as if he continually felt pursued by enemies who tried to humble and censure him. His paranoid attitude and his irresponsible tendency to offend his employers was the reason he could not keep a stable job or position in any enterprise, notwithstanding the fact that he was a good radio technician with outstanding capabilities.

It was clear that this personality integrated the picture formed as follows; reproaches to others, disobedience, contemptuous, desire to be alone, worse by milk, fruit and fasting, thirst, perspiration of neck. From this repertorization, China, which has a paranoiac personality with a marked tendency to insult and offend persons, was clearly indicated.

It was surprising to observe how this patient changed his disposition after seven months of treatment; with three doses of China, two of 1,000 and one of 10,000 his abdominal syndrome disappeared and the patient became a normally docile and agreeable person, at present occupying a stable position in a private company.

A lawyer aged 49, consulted regarding repeated bronchitis attacks, with asthmatic manifestations and an ear suppuration of 30 years duration which resisted every treatment. He also had repeated boils in the inguinal region and relapsing styes on the eyelids of both eyes. He was very nervous, irritable, excitable, sad, desired to be alone, was averse to consolation and had become a misanthrope. He often started in his sleep, was very sensitive to cold, especially in the head, and had odorous perspiration of the feet. His wife, who accompanied him, stated that she had to overcome his obstinate apathy and indifference to seeing the doctor again, that she has to support and encourage him all the time to carry on his professional work, as in the presence of any difficulty he is frightened and discouraged and gives up the fight. On the other hand, in his profession, he is extremely meticulous and given to detail, even going to abnormal extremes over those details which create an anxious sense of guilt.

This description from the wife, revealed an obsessive patient and one totally diminished in his personality. His symptoms are the following: conscientious about trifles, obstinate, aggravated by consolation, worse by cold, sensitive to cold in head, starting from sleep, bromhydrosis of feet. This is the syndrome characteristic of Silicea, which forms the constitutional “simillimum”.

As in the case of this patient, Natrummuriaticum has the outstanding characteristic of aversion to consolation, but Natrummuriaticum rejects consolation due to grudge and rage as he is resentful, while Silicea rejects it because it is not enough.

A syndrome must be understood based on a personality that implies a whole characteristic, and not as an isolated phenomenon, which has no meaning by itself.

An unmarried patient of 30 consulted regarding repeated boils and pustules acne on the face, for which she submitted to several treatments without result. Her picture presented heat waves, intolerance to heat, desire for ice-cold drinks, easily bruised, and great itching on the head. She did not present explicit mental symptoms. Without repertorization Phosphorus could be considered, but it was necessary to consider also the mental symptoms that always appear when the manner of living, family history, and character are investigated. When she was 10, her mother had died, as a result of a surgical operation for Fibroma; on this occasion the doctors discovered that the mother had syphilis, and determined that the child should follow a specified treatment of Arsenic and Bismuth over a period of 8 years. When her mother died she went to live with an aunt, to whom she was deeply attached as a result of the anguish of her mother’s death. Years passed and four years ago, the aunt married, and at present has two children. The character of the patient then changed: she became sullen, aggressive, and bad; she started having boils and pimples and developed an unsurmounatable aversion to her aunt’s children, whom she will not tolerate in any manner, making the family life completely unbearable at present. It is certain that the jealousy symptom is the determinant syndrome of the picture integrated by jealousy worse by contact with clothes, worse by heat, heat waves, desire for cold drinks, bruises, and syphilis.

Phosphorous was excluded from this diagnosis, whose determination was based on uncontrollable jealousy.

The unquestionable “similimum” amply corresponded to Lachesis, although this medicine has no desire for cold drinks -- a symptom that lacked value against the well-defined personality of the patient. It is always the total characteristic that determines the therapeutical diagnosis of “similimum”, but this total must be defined by the mental personality.

On August 20, 1955, a patient attended the consulting room (spinster, age 50), because she had a fibroma the size of a grapefruit and she desired to avoid the surgical operation recommended by three physicians.

She complained of heavy digestion, with pyrosis and nausea. She suffered from chronic constipation. She cannot tolerate heat and the sun caused her violent headaches, although she had low resistance to cold weather. Her blood pressure was 200 maximum and 130 minimum; she had no other physical symptoms. She lives with a married sister and has a great affection for her nephew, aged 15, to whom she is a second mother. Besides her nephew, she does not maintain a close relationship with anyone; on the contrary, she dislikes her brother-in-law very much, and people in general, and resists any social contact. She is sad, melancholic, depressed, and pessimistic. She avoids people and before relatives and strangers she has unconquerable timidity. She cannot do any intellectual work because it produces violent headaches. When she was 36, a month before the marriage, her fiancee left her, and since that time she had developed this sad disposition, interspersed with sudden attacks of anxiety, palpitations, and trembling, caused by the memory of the person who deceived her. Having been a very good concert pianist, she cannot sit down to play without experiencing a painful anxiety crisis that obliged her to abandon play in altogether.

In view of the few general and particular symptoms, we would not have been able to individualize this patient whose well-defined characteristics are only outstanding in the context of her life situation. The mental symptoms manifested by her conduct, added to the few general symptoms and character form the following picture: timidity, aversion to members of family, aversion to certain persons, anxiety playing piano, worse by work, headache from exposure to sun, indigestion. These seven symptoms clearly point to the characteristic picture of Natrumcarbonicum, which was prescribed in 200; 1,000; 10,000; and 50,000 in several doses of each dynamization over a period of four years; until to this date, July 4, 1961, after one year of placebo alone, the patient attended the consulting room stating that she did not want to become fat. The fibroma has completely disappeared, her digestion is absolutely normal, she has tranquil sleep, and has no other symptoms. She continues living with her sister and feels contented and happy. She has overcome every abnormality in her social life and maintains a cordial and happy relationship with family and friends.

I am certain that her fear of getting fat, the motive for her present consultation, lies precisely in the fact that she is too well - she, at age 56, has a slender body praised by everyone (weight 55 kilos, 1.55 meters tall), and she does not desire to lose this admiration and prestige. She feels young, spirited, strong, healthy, enthusiastic with life, and only fears to loose those gifts, which make her repeat the unnecessary consultation; also done partly to thank the physician for her total recovery.

In this as well as in the previous cases, the decision and surety with which I diagnosed depended on a total biographical understanding of the patient. It is obvious that I have not mentioned the organic examination because it was negative. There was no pathologic symptom that could form a nosologic diagnosis; but in any case, beyond anything the patient may physically have as an expression of his illness, the physio-pathological diagnosis must always refer to the constitutional personality integrated with the dynamic symptoms of the vital perturbation which constitutes the essential aspect of the disease. This aspect, the fundus of pathology, is where the physician must arrive by a scrutiny and understanding of the profound subjectivity of the patient. The characteristic syndrome spontaneously and clearly appears in the mind of the physician, as a result of a synthesized inductive understanding of the whole life of the patient, with his hereditary and pathological antecedents, intoxications and infection, physical and moral traumatisms, living conditions of his development and present affective emotional situation.

Symptoms are physiological mechanisms and reactive expressions of a primary dynamic process, whose roots lie beyond any discoverable clinical reality, in the patient’s hidden personality.

HAHNEMANN identified the primary disturbance of the Vital Force, in the hidden personality as the destructive, deadly spirit of Syphilis, Perversion of Sycosis and the underlying anxiety of Psora – the fundamental disease of humanity and the origin of all morbid and pathological processes. That is why, the physician must trace the physiopathogenic origin of each symptom.

Homœopathy requires the systematic scrutiny of the characterologic back-ground of every manifest expression of disease, even of those that appear with a pain and advances to tissue pathology, where many times it is urgent to apply a local and a palliative therapeutic. Applied with all its fundamental requirements, it not only satisfies a claim for humanization of all medicine, but explains its own clinical work by getting into direct contact with the animus of the patient, in order to understand - logically, with common sense, and without theoretical speculations - the true nature of the concealed symptoms, reactivate a transformation, or defense mechanisms which the patient himself manipulates. Thus the physician can have a security in his integral diagnosis which cannot be given any technical procedure that pretends to replace the physician in his direct perception and understanding of the problem of clinical diagnosis.

[Presented at the 35th International congress, Sussex, Brighton.]

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PSORA, IDIOSYNCRASY FUNDAMENTAL OF PATHOLOGY

The most debated concept of the Hahnemannian doctrine, which has also been used for theoretical speculation, is that of Psora. However, it is convenient to go over it again, to make its clinical meaning clear and go deeply into what we consider to constitute the ineludible basis of Homœopathy as a whole.

HAHNEMANN conceived Psora as an idiosyncratic state or predisposition which acted as a receptive ground and fundamental cause of all sicknesses.

The deductive process through which he reached this conception was the result of deep and close clinical observation which enabled him to realize why a sick man treated with the corresponding analogous medicine had relapses or new symptoms. Evidently the disappearance of the symptoms that patient showed did not mean that he was cured, as other disturbances ensued. It was evident that the present state of the patient was only a partial and episodical aspect of the real illness which in its greater part remained hidden.

In the search for this deeper affection which correlated with the various morbid episodes of a patient’s life, as if these were alternating and substituting metastasis of a deep course, three predisposing dispositions of the organic system were pointed out as being characteristic. They subsisted as dynamic entities conditioning the ground, that is to say, as morbid tendencies governing the pathology towards the conformation of three distinct types of affections.

They could not be properly called illnesses but rather dyscrasic or diathetic states which conditioned the birth of the illnesses or syndromes, each one being wrongly considered as clinically separate and independent entities. He identified these three dyscrasias by the name of Psora, Syphilis and Sycosis. They were morbid alterations of the whole organism, which could have an effect on the very structure of the individual, affecting his genotype -- HAHNEMANN considered them hereditary -- and they can, therefore be considered as constitutional illnesses or as the collective morphological, physiological and psychical qualities which characterize a human being.

Going back to these dyscrasias or miasmata, as HAHNEMANN called them, which are not illnesses but the dynamic basis of illnesses, we come to the conclusion that these three directions or morbid dispositions are no more than the perturbation par excellence of the three vital functions: excitation, inhibition and loss of function, which imply a perversion of the vital activity.

The primary excitation that constitutes the reaction of original alarm of the organic system before the external aggression would correspond in the particular perturbation to the Psora, which is then to be regarded as a defensive reaction, morbidly conditioned by susceptibility to become supernormal excitation. This condition, lined up with the functional manifestations of excitation, should place the organism in conditions of receptivity so that the syphilitic stimulus stirs up the inhibiting activity of the vital energy; the blennorrhœcial seric, vaccinial or proteinic agent being the perversive activity of the organic functions.

The dynamic genesis of the whole pathology would be thus presented as disturbance of function of the normal mechanisms of the immunizing organic defense which tend to maintain life both in a state of health or sickness; a first diathetic state of hyperexcitation being thus created., This would give the impression in the vital dynamic of an inhibitory diminutive tendency leading towards destruction in the case of Syphilis and an opposite tendency, increasingly compensative towards degenerative proliferation on the part of the Sycosis, the corresponding miasmas to the blennorrhœa or to the incorporation of extraneous proteins.

The truth is that we cannot put aside the conception that these three morbid entities are anything other than the dynamic perturbation of the vital functions inherent in the individual. How is it possible to consider sickness, but as an adaptative reaction towards the environment in function of those same vital resources which give reason to life itself?

The principal problem would be reduced to the understanding of this fundamental diathesis, Psora, derived from the abnormal exaltation that the individual undergœs in his vital dynamic and which logically must be accepted with HAHNEMANN, as the fundamental disposition for all illnesses.

Why is this abnormal exaltation of the reactive sensibility produced?

The individual emphasizes his sensibility, perturbs his normal resistance activity when facing external aggressions under which the normal play of his defensive capacity is handicapped or opposed.

This assertion is an essential postulate of normal and pathologic physiology. The reiterated inhibition brings along an increase of tension and vegetative distonia. We observe it as the origin of mental and personality disorders, in stagnation during infantile stages due to repression or frustration.

The essential function of the organism is the liberation of its energy from the center to the periphery, from the mental organ to the emunctories. Every transgression in the normal course of this trajectory, governed by the fundamental rules of healing, implies a pathogenic inhibition which has given rise to the most important chapter of pathologic etiology: suppression.

Psora is in its origin the result of a suppression of exonerative cutaneous manifestation which gives rise to an internal perturbation due to the retrocession of the efferent vital energy. This is the very essence of the whole Hahnemannian doctrine.

Retropulsed vital energy, upset in its eccentric trajectory is directed inwards and converted into tension which makes the individual susceptible,. The rule of healing which governs cell, tissue and organ tendencies towards the restoration of the homeostatic balance of the organism, that same normalizing and exonerating tendency of the vital energy which HIPPOCRATES called Physis, has been inhibited in the performance of its essential function.

HAHNEMANN considered that the suppression of the itch produced internal psora which acquired the characteristics of a many-headed hydra capable of violent eruption when faced with an infectious aggression as when it is faced with “a favorite of the prince was overthrown”, “a mother lost her only child” or “a romantic girl fell into deep melancholy due to a scorned love” with which the dycrasia acquired the characteristic of real moral Psora.

It is necessary to investigate the semantic value that the word itch has. For the rejection that was suffered by the HAHNEMANNian theory of Psora, identified with the itch, was due to a wrong interpretation which still today subsists though in his time the clinical concept of suppression had already been outlined.

The itch is the Psora of the Greeks, the “Itch” of the English and the Rona of Languedoc.

In those times it was described as a pruritous infection of the skin with phlyctena, pustules and scabs, and the treatises which followed the school of SYDENHAM had it that although the itch was uncomfortable because of its prurience it did not mean any danger to the life of the patient so long as it did not get into his blood. It was said that the itch was rather a critical and wholesome illness which put an end to serious illnesses and kept one from the other complications. It was even capable of curing some affections when it was inoculated into certain patients.

At that time they talked about critical itch which ensued upon acute or chronic diseases as an effort of nature to bring those evil humors to the surface and, therefore, instead of combating and so forcing it back into the blood it had to be helped out with a convenient diet and adequate internal medicine.

Besides it is worthwhile to remember that the word exanthema in Greek means “flower”, with the evident reference to the flowering on the skin of the internal sickness.

The itch we nowadays know as the parasitical eruption due to the Sarcoptes scabiei, seemed then to be a dermic affection much more widespread than it is nowadays, as are many other clinical varieties of pruriginous ailments, mistaken all of them in a common entity which included leprosy, scurvy, smallpox, itch itself, generically conceived as the outcome of filth or dirtiness of the patients.

It is evident that they already had the ancient concept (it gœs as far back as HIPPOCRATAES) that there was an eliminatory current which, like the current of a full-flowing river, came from deep down in the individual, leaving skin, cellular tissue, serous and mucous membranes as the slime of its impurities on its banks. And when the excretive channel of the skin is blocked up, an effort is made to open up a new vicariant route, giving rise to the metastasis, fundamental theory of medicine which grants to the emunctorial drainage, exonerative of energy, libido, humours and toxins, the capital function of the vital economy of the individual.

In truth, as a product of the transgression to a natural law, Psora would not be anything more than a state of permanent allergic hypersensibility as a result of old repressions of the efferent current which normally flows through the vital energy, so that this diathesis becomes the consequence of the first and fundamental transgression of the natural rules of healing which govern every biological activity and tend to keep the composition of the internal medium constant.

The symptoms which express this constitutional diathetic state are of the accessional critical type, with a tendency to the paroxysmic increase of the so-called defense phenomena, such as the sudden congestive vascularization, increase of capillary permeability, spasms of the smooth muscles, exudative crises of the skin and mucous membranes and all the physiological signs which betray a violent tendency to recover the spontaneous faculty of the organism, so as to exonerate its morbid energy in function of the laws of healing.

All acute illnesses and paroxysmal manifestations are explosions or critical accesses of this tendency to restore their lost balance due to repression which is of such importance in both vegetative and psychical life where the symptoms of anxiety and anguish are evident. In the psychoanalytical theory, the libido, repressed in its natural development, creates anxiety due to tension and tries to liberate itself with those crises of anguish.

The word allergy first used by von PIRQUET to designate the abnormal reaction of the organism owing to repeated injections of horse serum as well as the word anaphylaxis with which RICHET differentiated the hypersensibility experimentally produced by extraneous proteins, may be applied to the understanding of what HAHNEMANN called Psora, and which he pointed out as a state of hypersensibility of abnormal reactivity, which predisposed the organism to illnesses. This concept gœs beyond the therapy of allergy and anaphylaxis and is related to a neuro-vegetative stigmatization, the psychical derivations of which enable us to understand neurotic phenomenon. Recently, MACKENN, of London, has proposed the concept of atopy which he defines as a congenital tendency to react when incited by certain sensitizing substances.

By extension, all that refers to the acute, accessional paroxysmic organic reactivity that appears as episodical eruption, in which an abrupt exaltation of the organic defences regulated by the law of healing is shown, is a psoric phenomenon identical to that described as allergic.

The concept of allergy has been circumscribed as allergic chemical humoral mechanism of susceptibility experimentally brought about, but its scope involves all that which indicates reactive capacity of the organism, both in the physiological aspect as well as in the psychical, by allergens which range from food, climatic variation, infections, etc., to emotional outbursts. It is an alarm reaction to a stressing agent which may be of external origin through local irritation, infectious (staphylococcus, etc.) or parasitical (scabieii) or internal due to alimentary or hormonal imbalance, with a hereditary conditioning factor which determines the neuroarthritic of psoric ground.

Psora, as a disposition of morbid susceptibility, is a purely funcional dynamic state of defensive activity, without structural pathology such as syphilis and sycosis are. These last two give rise to physical symptoms, suppuration, hypertrophy, neoplasias, ulcers, necrosis, etc., and Psora to functional reactive symptoms: pain, itch, congestions, spasms, paroxysmal phenomena and neuro-vegetative manifestations.

Actually it is always Psora which reacts before whatever allergen, whether it be food, cold, dampness, a moral upset, etc. and what syphilis and sycosis do is to fix the allergic mechanisms in the shock organs which correspond to the morbid nature of each diathesis, carrying the dynamic process generated by the allergic susceptibility on to the organic pathology, that is to say, towards the specific types of tissue lesion. That is why, empirically, from simple observation of the clinical process, HAHNEMANN and his followers established the need to remove the psoric reactivity -- with Sulphur, for instance -- when the patient did not show a clear symptomatic case history or when there was no reaction to the apparently well chosen medicine and they demonstrated the need to begin and end a chronic case by treating the Psora, hence the sequence of medicines such as Sulphur, Lycopodium and Calcarea, which was brought to a conclusion by going back to Sulphur to overcome the Psora, that is to say, the conditional state of susceptibility of the system, which had made the fixation of the organic sickness possible.

The essential characteristic of the psoric state is its capacity to produce shock reactions such as the acute illnesses which may be brought about through an excitant or allergen of the cosmic specific microbial or emotional type. Nothing prevents us from considering the necessity of therapeutically attacking the allergen in those individual cases in which the physician formulates an economic estimation of the vital reaction capacity that the patient may have to face the external aggression alone.

But it is obvious that the fundamental thing is not to take care of the offensive agent, but rather of the offense capacity of the individual by eliminating the sensitivity of the patient as the very first therapeutic and prophylactic objective.

An understanding of the Psora as a case history of morbid constitutional potentiality, purely dynamic, functional, produced by allergic susceptibility, can only be achieved by studying the outstanding medicines of Materia medica, such as Sulphur, Psorinum, Silicea, Sepia, Natrummuriaticum, Lachesis, Iodium, Heparsulph., etc., all of which are desensitizers of the hypergic psoric state, which at the same time, give the impression of a connection between the different nosographic entities described as isolated unities and which allow of our grasping the mysterious play of the morbid alternatives and the contradictory substitutions which the chemical -- humoral analytical concept of medicine cannot cover.

The appearance of the Hahnemannian doctrine of disease as a dynamic entity which includes the whole of the individual in the unity of a psychophysical reaction involving the symptoms of the physical personality, makes Psora a fundamental illness of the human being, not really a sickness in the nosological sense but an idiosyncrasy or susceptibility disposition which is beyond the concept of allergy, while the latter does not rise above the humoral plane. Between allergy and Psora there can be no qualitative difference except of quantitative clinical penetration which enables us to recognize the allergic idiosyncrasy in its dynamic aspects.

In the same way as the atomistic medicine systematically rejected the clinical estimation of the psychical and mental symptoms because it could not reduce them to physical-chemical quantitative terms, likewise it could not transcend the humoral plane of the allergy problem without grasping that the allergic hypersensitivity not only constitutes the essential substratum of pathology as a whole but also this substratum is of a dynamic nature and, therefore, it finds its most authentic expressions in the dynamic system par excellence: the nervous cortical diencephalic vegetative system, which abridges the organic, psychical and spiritual activity of the individual as a person.

The conception of the Psora as a hypergetic exaltation of the normal organic defensive excitation enables us to grasp the essential aspects of the chronic illness.

Every paroxysmic shock manifestation is psoric; it is an expression of the abnormal reactivity of the anaphylactic type conditioned by the state of latent idiosyncrasy.

The crises of anxiety, fear, anguish, mania, the aggressive impulses, everything that is accessional and paroxysmical, is an abrupt interruption of the morbid energetic tensional contents which seek a way out for liberation.

It may very often happen that after treating a patient with the medicine corresponding to his particular case history there appears, rather late in the process an outbreak of urticaria, exanthemas, eruptions, or congestive manifestations, feverish atypical crises, unexpected colitis or crises of anxiety, anguish, asthma, that is to say, symptoms not of aggravation produced by the immediate shock of the medicine, but because of the psoric, vicariant critical exaltation which tries to eliminate toxins and repressed tensions.

These are crises that demonstrate the recovery of the normal reactive capacity of healing which is exacerbated by the Psora, because of its hypersensibility.

We must respect the emunctorial movement of the vital activity and only assist it with the corresponding anti-psoric in so far as it deviates from its exonerative function or does not exhaust its susceptibility.

We should also understand the patient’s reactions as a whole, throughout his case history, as a total unity, and realize what he has repressed, emotionally or pathologically, what have been the psoric cutaneous episodes, excretory, painful or psychical episodes that have taken place in his life as expressions of that morbid hypersensitivity created by the repression of the libido, of the vital energy, in its natural expansive necessity and which gives birth to the pathology as a whole, from the primordial anxiety with which the man commenced the illness, the principal sign of the moral Psora, up to the simplest tissue lesions produced by Syphilis and Sycosis which end up in Tuberculosis and Cancer or Psychosis.

Clinical Demonstration of the Psora

We shall try to show by means of the case history of a patient we have attended the real existence of the Psora as a latent dyscrasia which conditions the dynamic background of all illnesses and as a pragmatic clinical concept which enables us to understand the essential desideratum of the diagnosis and therapeutics: that is, to know what is to be cured in each patient and to know what is to be expected from the medicinal action.

We treated a 39 year-old patient, married, with a 17 year -old daughter.

When she was 22 she had a dystocial delivery with vulval rent (forceps). She then began to suffer from pains in the lower abdomen, gravitous, weighing pains as of a fallen abdomen, with cramps in the legs and pains which radiated from the pelvic belt.

Simultaneously abundant excoriating fetid flux appeared. She underwent local treatment with antiseptic washings, cauterization of the neck and general treatment with barbituric sedative.

Three other pregnancies followed which she interrupted because the general and local state of her genital vias were unbearable.

As her pains did not cease, she was operated on for appendicitis, in spite of which her pains became even more intense. Therefore she was again operated on after a diagnosis of a probable intestinal obstruction. The result was negative.

An inspection of fecal matter showed amœbae. She underwent an intense treatment with Yatren and Emetine.

Pains, cramps, general exhaustion, nervousness, migraine, depression and irritability went on.

X-rays were applied -- deep radiotherapy -- which suppressed her menstruation for seven months, with no effective result.

In the meanwhile antibiotics appeared. Penicillin, Streptomycin, Aureomycin and finally aurum preparations were administered.

Her state remained hopeless. She could only achieve some relief by remaining submerged for hours in hot water.

A hysterometry was then carried out by a doctor when an acute pain was felt deep in the matrix, caused, according to her, by the hysterometer (the physician denied having hurt her). From that incident on (about nine years) she continued to have an acute piercing pain, as if she had been pierced by a sail maker’s needle at the bottom of her pelvis.

They convinced her that she had adhesions which gave the pulling sensation and produced the pains and as a ventral hernia from the first appendix operation had remained, she was once more operated on without any favorable result being obtained.

She then went back to radiotherapy which again suppressed her menstruation up to the present, there having now been 14 months’ amenorrhœa.

In a new attempt to soothe her pains she was treated with injections, truncular anaesthetics of Novocaine-alcohol, but her sufferings were not alleviated.

The patient came to consult us in a state of despair, with an anxious expression upon her face and showing hostility, distrusting the medical treatment and demanding urgent relief of her pains. She felt as though they were pricking her, piercing her with a dagger through her pelvis, from the front to the back, with a fiery burning sensation, as that of a lesion, or open wound, as if a flame was burning her; all this together with great anxiety, restlessness, excitation, and desperation. Her relations were at a loss; her husband, whom I am treating, says that he cannot stand any more, her daughter has become neurotic and stays away from home. She is in an unbearable humour, extremely irritable, accusing and reproaching everyone.

She has a pale and emaciated face, with large bluish rings round her eyes. She was proportionally fatter in the lower part of her body, with varicose legs, her blood pressure being 12.9. Tachycardiac pulse. There were no lesions either in her cardio-circulatory or respiratory apparatus.

She has an aching, tympanitic, distended abdomen with much pain and indicated pain centers at the center and deep in the pelvic excavation.

The gynaecological examination showed a slight ulceration of the neck, slight flux and a somewhat outsize matrix in retroversion.

Her hereditary and familiar antecedents are of no importance. Personal antecedents: she was healthy till her delivery, she declared. Had measles. Eczema when a child, at 2 years old. It was treated with ointments.

Seventeen years ago, the year after her delivery, she had eczema in her right hemiface and auditory right duct which was treated with a nitrate of silver: the eczema disappeared at once. She had always serious migraines in the upper ciliar region and right frontal lobe.

She was given to furious crying because of her pains. She vehemently demanded relief of her pains. She talked of accepting the removal of the matrix which had been proposed. Her husband was against this for she had already been through many operations without result.

She had intense flushes of heat with profuse perspiration. She presented large ecchymoses with real subfusions and procident varices in the section of the saphenous, principally on the right.

This patient presented a conversion hysteria engendered psychically by anxiety, caused by the restriction of her sexual instinct in conflict with the prohibition which she imposed

upon herself after such a traumatic delivery as she had at 22.

The pelvic neuritis was a phobic displacement of her fear or anxiety because of her delivery or pregnancy which she rejected refusing sexual contact. In fact we learned that she refused to have any sexual contact with her husband except on a very few occasions during those 18 years after her delivery. Her husband had a lover and she knew it. She declared she did not mind at all and put all the blame on herself because “she is no good”. She made a definite gesture of wounded dignity before which all comment de trop.

The few occasions on which she had contact with her husband in those 18 years caused her as many pregnancies which she at once rejected with the consent of her doctors who admitted she could not go through with them because of her intense sufferings.

Therefore in this patient there was a deep repression of her sexual instinct with hysteria of somatic conversion which took the form of pelvic neuritis. But this neurotic repression of her instinct was not a pure psychical mechanism originated by the delivery traumatism. This patient was sycotic because immediately after her delivery she had abundant fetid excoriating flux with exulceration of the neck which she suppresssed with washings and cauterization as well as pelvic algias and cramps which announced neurotic lesions of the sycosis; when she suppressed her exonerative sycotic manifestations her character changed and she became irritable, violent, anxious, hysterical with repression of her sexual instinct rationalized by fear of delivery for which there was no reason if there were no sycotic basis of affective perversion.

This patient had suffered from repeated suppressions. Her leucorrhœa had been suppressed. Her menstruation as well (radiotherapy).

Three pregnancies which represented the erotic liberation of the pregnancy, delivery and lactation had been suppressed.

They suppressed her eczema which had appeared a year after her delivery and which implied a vicariant elimination of the sycosis.

She suppressed her affective instinctive manifestations (sexual frigidity).

She was physically and animically blocked up. A liberation of the patient’s repressions and the re-establishment of the exonerative law of healing was urgently required. The only positive diagnosis was that of morbid dynamic tension created by the introjection and the only hope was the curative restoration of the morbid discharge, through the skin and the mucous membranes.

Due to the etiopathogenic antecedents, sexual and affective frigidity, the flushes of heat together with the portal ecstasy graph and weeping during the consultation, she was given Sepia 200.

On October 24th we made this prescription which produced no change. On November 17th we prescribed Sepia 1000 which did not modify the case either.

We reconsidered the position and noticed that the patient adopted an overbearing, haughty and proud attitude. Her husband and daughter had already informed us of her overbearing attitude and her marked tendency to dominate. Besides we discovered the symptom that she wished to be left alone, not meet anybody, was very unsociable, but was terrorized when left alone in the house. She would not meet people, she did not know or be introduced or have contact with anyone at all. But she was constantly talking out her things or her family. She ran away from people not through dislike, but because she had no self-confidence, she feared contact with the others because she said she was unable to think ((it was fear of intellectual not affective contact). In consequence her symptoms were: a haughty, proud domineering air, wish to be let alone, but with people around her, dislike of people because of feeling of inferiority, of impotence, sadness, depression, weeping.

These symptoms led us to prescribe Lycopodium M, with the expected result.

Eight days later an eczema appeared at the back of the ears which spread over the right cheek and neck. In the course of 20 days the eruption spread to her breast, shoulders, back, the whole face and part of the scalp. It reached monstrous proportions, with considerable œdema, honeylike secretion and meliceric scabs, and when these fell there were sections of fiery red with exposed dermis.

This extraordinary eczema lasted three months and some days. Only placebo was prescribed together with the constant moral comfort that her eczema meant towards her healing. In spite of her extraordinary aspect, the patient tolerated this situation much better than the previous one. A few days after the eruption appeared, pelvic pains which she had for so long completely disappeared. She felt more calm and at ease.

On January 30th, 1952 we prescribed Lycopodium 10M, when her eczematous outbreak was in full evolution, it having remained stationary. Twenty days after this last dose the eruption completely disappeared and the patient could consider herself cured.

In March, 1953, she had abundant sour smelling perspiration as well as tiredness without motive, headaches and flushes of heat. We prescribed Sulphur 10M, which ends the case history. At present she is going on well with no symptoms, without eczema and without the least pelvic trouble. She has even reconditioned her family life in the happiest way, with the consequent moral recuperation of her husband and daughter.

This patient was psoro-sycotic, victim of reiterated suppressions, who was totally cured when the process could be transmitted to the skin, thus liberating the morbid energy reissuing an eczema she had as a child and 17 years earlier and which was suppressed by means of nitrate of silver.

Upon first observation it is evident that the eczema acted as a healing manifestation of an internal illness, ratifying the function of the skin as an emunctorial organ closely connected with the rest of the whole organism as a biological unity. No organ can be treated independent of the rest so that skin diseases cannot be considered solely as diseases of the skin.

In the second place it is evident that the eczema was pathologically related to the pelvic neuritis, the genital inflammatory syndrome and the alterations of her character. The physiopathology could not explain the pathogenic case history and the eczema, but such connection clinically exists and the evolutionary course of the patient clearly shows it.

Immediately after her delivery there was abundant leucorrhœa which was suppressed bringing about an inflammatory pelvic state. One year later eczema which was also suppressed appeared, a serious general and psychical state both for her private life and that of the family becoming established. A medicine was selected according to her psychical case history and the eczema which had been suppressed 17 years before reappeared, curing the patient.

What is that common root which unites such unlike affections as an inflammatory process, mental alteration and cutaneous eruption? Isn’t it evident that these intercalating phenomena of her biographical history are metastases of only one affection, the eczema which initiated and closed the case history?

This common root cannot be conceived, but in terms of a constitutive dynamic disposition of the individual which tends to project a flow of energy towards the exterior and which becomes morbid when it is opposed by repression or suppression. The fact that such energy is of a purely psychical instinctive libidinal type is chemically transformed into segregated toxins by the mucous membranes and skin, only confirms the concept of functional totality of the organism as a biological psychophysical unity. What happens in the conceptual elaboration of this concept of functional totality is that in the scientific analysis of the physical, chemical, humoral and nervous mechanisms which the organism develops, the chain is interrupted when we reach the psychical point and the examination must take a leap to bridge the unknown link which unites the mental to the organic, the animic to the corporal, the psychic to the physiological. It will never be possible to establish a scientific correlation between the psychical and the organic except in the plane of pure clinical observation which allows the synthetic grasp of each case through the patient’s biographical history. The real illness of this patient was a dynamic alteration of her organism produced by the suppression of her genital flux of a sycotic nature due to its physical characteristics and the suppression of the drainage of the affective energy which consequently produced a deep alteration in the personality of the patient. The sycosis exonerates through the mucous membranes and this route was closed due to the intensive local treatment. But as an underlying state to all psychosomatic pathology, there exists the constitutional diathesis called Psora by HAHNEMANN which consists of a latent idiosyncrasy or dynamic state of allergic hypersensitivity that provokes the exonerative activity of the vital current in a paroxysmic or accessional form, invariably from the center to the periphery, from the most to the least vital organs, from the mind to the emunctories.

This efferent vital activity made itself evident in our patient in the form of an outbreak of eczema which she had as a child. This was suppressed and re-appeared a year after her first genital episode and it was again suppressed. The patient remained with her morbid internalized energy in a permanent state of susceptibility or psoric hyper-ergy exacerbated by the suppression of her cutaneous manifestations with neurotic alterations of the psychical personality, determined by the suppression itself. The conclusion suggested by this case is that only a strict clinical historiographic observation through the therapeutically originated phenomenon of the reissue of old symptoms enable an understanding of the causal relation between the different morbid episodes and conceptual identification of the diathesis which underlies as a dynamic disposition, the chemical as well as organic pathological manifestations.

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THE MENTAL SYMPTOMS

The mental symptoms are the characteristic symptoms par excellence of the psycho-physical personality, not only because they represent the highest expression of the individual’s singularity, but also because the phenomena of somatic pathology are the structural consequence of the psychic dynamism conditioned to the particular neuro-vegetative hereditary stigmatization. But, to identify the mental symptoms, it is necessary to penetrate into the intimate nature of human mind and to understand the psychological defense mechanisms which conceal or adulterate them, making their recognition nearly impossible in most of the cases.

First of all we must keep in mind that a mental symptom, evident as it may be cannot by itself determine a prescription. As with every symptom, it must be completed with its particularities and concomitants, in as much as it is valid only as an integrating factor of a characteristic whole.

As a rule, the general symptoms, when very manifest, may constitute a characteristic whole and may decide the diagnosis of the constitutional similimum; but since these general symptoms refer to the reaction of the patient as a whole to conditions of climate, food, activity and neuro-vegetative manifestations, they are sensations and cenesthesis registered and interpreted through the mind, so that the physician is led to investigate the vital attitude of the individual in the midst of his circumstances.

If the homœopath succeeds in understanding the mental syndrome through the patient’s biographical history, his professional activity, his conduct and his relations with the surroundings, he will have a much greater certainty in the characterisation of the total picture and in the adequate appraisal of these same general symptoms.

Further more, the physician must be convinced of the dynamic, structural unity of the human being and must possess the scientific vision of the organism as a dynamic structure subject to the process of a constant preservation of its equilibrium under the action of the two antagonistic forces, known in the physical field as attraction and repulsion and in the psycho-biological field as instinct of life and instinct of death, or love and hate.

It is necessary to assimilate this concept of the inseparability of structure and dynamism, or of body and soul, established by HAHNEMANN, and to assert that “the material organism without the vital force is incapable of feeling, acting and of conserving itself”. Clinical experience has proven that there exists in every human being a constant interaction between emotional and physiological processes, in such a way that a determinate emotional conflict forms a psychosomatic unit with the determinate physiological function or organ; in this unit an amount of potential energy remains latent, which is being exposed when either the mind or the affected organ is subjected to a stimulus.

However, although chronic illness starts always in the mind, in its primogenetic manifestation -- psoric anxiety, the organ or the physiological function electively conditioned by the miasmatic stigma suffers a physiopathological change which appears as the principal disturbance in the manifestations of the morbid picture, so that the mental symptoms are often left in the background. It is for this reason that, in the course of a homœopathic treatment, the mental symptoms are wont to change or to appear after the initial consultation and medication.

The handling of the mental symptoms -- absolutely, necessary in Homœopthy -- demands furthermore a well-integrated concept of the miasms.

Hahnemannian Psora is a structural disturbance of the vital dynamics which consists in an allergic exaltation of its susceptibility in such a way that it disturbs the reactive function of the organism to metabolize and release the instinctive energy. Anguish, vertigo and general congestion are the essential symptomatic terms of the psychosomatic unit established by Psora between the mental anxiety -- caused by instinctive repression -- and the neuro-circulatory erethism, which appear jointly in acute illnesses or paroxysmal reactions to emotional, traumatic or infectious stimulated instinctive energy. Apart from these paroxysmal manifestations of instinctive release, the typical example of which is the Aconite picture, the psoric diathesis is being transformed into a latent disposition hidden behind diverse neurotic superstructures created by the human being as a defense mechanism in the face of the intolerable anxiety caused by the repression of his vital energy.

In many patients, especially children, it is easy to find these symptoms on the “surface”, without concealment by reactive characterological formations, as for example, in the simple case of a girl of six years of age who was brought to the consultation by her mother on account of a condylomatous wart, the size of a pea, on the left upper lid, together with vulvitis with a mucous leucorrheic secretion, presenting the symptomatic picture of enuresis; articular pains in knees and ankles; anorexia and a certain sensitiveness to cold. This picture which made us think of Thuja on account of the plain sycotic manifestations, was however, spontaneously amplified by the mother who stated that sometime before the appearance of the wart, the size of which increased within a few days, the child changed its character and developed an intense fear of darkness, was terrified when left alone, could not sleep without light and watched obsessively the locking of the doors at night. This mental syndrome typified the sycotic picture in a way which permitted the diagnosis of Causticum, and a single dose, 200C, caused the wart to fall off within a week curing simultaneously the nocturnal terror, the enuresis and the articular pains.

How can one explain the relation between anxiety and the wart? Where resides the specific union of a psychodynamic factor like fear of darkness and a pathological phenomenon of neo-formation of tissue, both tied together as if the latter one were determined by the former one?

With the limited concept of physiological physicochemistry this cannot be explained, and it is for this reason that psychology is being somewhat relegated by the current clinical practice; but if one thinks dynamically that the sycotic miasma is a perverted exaltation of the physiological function of reproduction, for which reason the cell proliferates anarchistically, causing the formation of warts, condylomata, tumors and any kind of neo-formation of tissue and if -- on the other hand -- and admits the incontrovertible fact that such physiological activation depends upon the same vital stimulus as exalts the instinctive life, it is not surprising that this girl should have developed anxiety, fear and an obsessive neurosis in the face of the sycotic exaltation of her aggressive erotic instinct which she experienced like an internal danger and which she projected as a threat from the external world, defending herself by locking the doors and asking for light.

We wish to mention another case, a boy of sixteen, who came to the consultation complaining of vertigo with fleeting obnubilation and photophobia. He had consulted an oculist who diagnosed astigmatism and prescribed glasses, inspite of which his vertigo persisted.

He presented furthermore: intense headaches, irregular in their appearance and without any special characteristic; he catches cold easily, with nearly permanent nasal obstruction, followed by abundant yellow, thick and odorless secretion; his paranasal cavities frequently become inflamed and he has had bronchitis several times; since approximately two years’ time he has every three or four days sub-febrile temperature of 37.5 to 37.8° at nightfall.

As general symptoms he presents: increased sensitiveness to cold; intense thirst for beverages; good appetite with light preference for salted food; copious and profuse odorless perspiration after the slightest exercise or emotional excitement; and a marked abdominal flatulency with normal evacuation. He does not perspire at night, nor has he had nasal hemorrhages or asthma.

His aspect is that of a patient of robust constitution, overweight -- he is 1.58m tall and weighs 66 kg.; he looks pale and shows a timid character. He is not abulic, but he had frequent fits of violent rage which he controls immediately with repentance. He is very emotional, with permanent sadness which leads him through periods of melancholy and crying fits.

He is very sensitive to music, especially to that of Chopin, whose works he has studied on the piano and to whose concerts he listens with awe, practically always with tears and weeping. He is attending high school, but his one and only vocation is the melodious and classical music to which he intends to dedicate his whole life, in spite of the repercussion it has on his sadness and his mental depression.

He is an only child of healthy parents. His personal antecedents are: measles at the age of two and diphtheria at the age of nine, with strong medication of whey. At the age of three he eliminated rings of tapeworm which was expelled with taenia fuges. His frequent colds and constipation date from that time.

His mother, who accompanied him, stated that since early childhood he has shown a marked inclination for music; at the age of six he learned to play the piano and she has often seen him crying when listening to some score played by himself on the piano.

From the picture of the general symptoms of this patient, tuberculinic on account of his characterological idiosyncrasy, there appear the following determinative mental characteristics: sensitiveness to music, weeping on account of music and weeping on account of piano music. The other symptoms: shyness, sadness, depression; melancholy; fits of fury; sensitiveness to cold; thirst for cold beverages; copious perspiration; chronic coryza; thick yellowish catarrh and the flatulency, corresponded according to the repertory to Natrummuriaticum, Natrumsulphuricum, Natriumcarbonicum, Lycopodium, Phosphorus and Sepia; but of all these the one which presented the mental characteristics of the patient with equal intensity and predominance was Natrumcarbonicum. Two doses of Natrumcarbonicum (200 and 1000) cured this patient.

When the mental symptoms and the characteristic general symptoms come forth through the knowledge of the individual nature of the psyche, certainty of the similimum is complete.

Symptoms like avarice, criticism, resentment, egotism, pride, hate, hysteria, indifference, envy, jealousy, lasciviousness, suspiciousness, maliciousness, obstinacy, pugnacity, shamelessness, roughness, etc., cannot be interpreted by a descriptive history but only by the comprehension of the patient’s personality and of his reactive position in front of life. On the other hand, symptoms like irritability, irascibility, sadness, sensitiveness, fear, desire for company or for loneliness, aversion to consolation etc., which the patient states to have, may not be taken into account unless they agree with the characterological picture. And we know very well that the character is not an isolated quality but a contradictory “relation” between instinctive impulses and the demands of the external reality, which establish a fixed formation (armor) to protect themselves from anxiety.

A demonstration of this assertion is the case of a woman of 43 years of age who came to the consultation on account of a nervous affection determined by the death of her husband, four years ago. They had a business in partnership with the woman’s brother; her husband went to collect some bills and was run over by a car. The patient appeared very excited and depressed, started crying bitterly, accusing herself for her husband’s death, without knowing why, but willing to accept the divine punishment. Since the accident she had developed an obsessive fear that any of her sons -- she has four -- might not come back from the street; furthermore her menstruation since that time had become irregular, with two or three months of amenorrhea; she had acquired a rebellious constipation with strong spasmodic constriction of the anus and frequent abortive urge; intense migraines with sensation of contraction; strong restlessness in the legs with necessity of movement and slight fibrillary contraction in the muscles of the arm, with numbness, and finally, she noted that she is having difficulties when reading because she sees the letters very small.

Our attention was aroused by the fact that, in spite of her anguish and weeping, she told us that upon the death of her husband she immediately separated from her partner-brother, after a violent quarrel, and set up a new business with her sons, who -- especially the two oldest ones of 18 and 20 years -- refused to stay with their mother and tried to become independent. When asked to explain this, she says that she had managed the business for her husband and her brother in view of their incapability to do so successfully and that upon her separation from her brother her eldest sons now wanted to direct the firm, but that she is better prepared for this, since she has always managed her home and her husband with greater ability and intelligence.

From this panoramic vision of her life we recognize that we are in front of a proud, narcissistic woman who greatly over-estimates herself, regards with disdain the value of others and is making herself disliked by everybody.

We associate this personality, structured with arrogance and excessive pride, with the mental symptom of fear that her sons might not come back from the street and the sensation of seeing the letters very small -- translation of her diminutive moral vision, since psychologically the people around her are smaller than she herself -- and we find the image of Platina which, after five months and with single progressive doses completely modified the picture with regard to the nervous aspect, causing the disappearance of her obsessive fear, the restlessness, the contractions, the spasms and the constipation; her menstruation became regular but, evidently, her ambition of hegemony did not change.

From the manifest symptoms with which the patient presented herself: sad, weeping, worrying, with anguish of conscience and apparently submissive, we would not have found the medication which modified her present time condition, evident consequence of an emotional commotion, although this medication was not able to act curatively upon the mental characterological background structured with pride and haughtiness, products of a defensive formation, which was created by the fear of passivity. This patient continued feeling well, did not show any more symptoms and was apparently tranquil; she therefore considered herself cured and the treatment finished, in spite of the continuance of her dominating attitude and the obsessive omnipotent control of reality, the roots of which are to be found in a want of protection during childhood, impossible to solve in a woman of 43 years of age and with four children, and also in the present situation conditioned to constitutional biological factors. These cases, where the miasmatic stigma -- the sycosis of this patient, with fear of feminine passivity -- has created a neurotic defense mechanism which came to form part of the structure of her character, are what HAHNEMANN calls in paragraph 224 “a completely developed illness.” Therefore, in spite of the fact that the physician knows that what he has to cure in this patient on a deep lying level, although not the first one is -- as HAHNEMANN states in paragraph 3 -- the fear of being woman, hidden behind the eagerness to develop a male activity, nothing can be done if the patient does not show any symptoms. The only possibility is to wait until new emotions may break this neurotic pseudo-equilibrium and the manifest picture of the latent Psora comes to the surface, making it possible to identify the constitutional anti-psoric remedy, with the risk that the disintegration of her character will confront the patient with her basic anxiety, against which she defends herself by adopting a masculine attitude.

This basic anxiety constitutes the original mental symptom and the essential symptom of the Psora considered as a diathesis of the nervous system which never produces structural alteration of the tissues like Syphilis and Sycosis, but does produce all the neurotic manifestations. with anxiety being the primogenetic mental symptom of human physio-pathology, as has been confirmed by psychosomatic and anthropological medicine, which thus has ratified HAHNEMANN’s clinical verification that in the background of all chronic illness there exists Psora with its essential manifestation, anxiety. Consequently it is convenient that we make an etio-pathogenic examination of this mental symptom which we find in every patient, either at the present time or in his biographical anamnesis.

Furthermore, the understanding of the problem of anxiety is necessary for the homœopath in order to have a psychological notion of the personality, which will enable him intimately to understand the patient.

Anxiety is eagerness, the expectancy with fear of something which will soothe a tension of need and this refers originally to the sensation of hunger as the first manifestation of the instinct of self-preservation.

HAHNEMANN refers rightly to the symptoms of the unconscious Will as the most important ones in the characterization of a total picture, precisely because the fundamental disturbance of the miasmatic stigma pertains to the instinct of self-preservation, the natural executor of which is the gastro-intestinal apparatus; consequently disturbance of the appetite, desires or aversions regarding food, the compulsive necessity for determined foods like salt, sweets, fat, soil, calcium, stimulants and the most diverse substances of nutrition constitute specific variations of the instinctive Will and expressions which belong to the root of the fear of hunger.

The instinct is an excitation which originates in the body and seeks its satisfaction through an object of the external world. This gratifying objective of the external world is the mother, whom at the beginning the child considers as an integral part of its self, since it does not establish a differentiation between the subjective and the objective world. The inexorable separation from the mother and the consequent delay in the satisfaction of its instinctive requirements cause the child to feel that it is disintegrating (the mother, part of its self, gœs away) and that the possibility of satisfying its instinct is withdrawing with the mother. Thus hunger becomes anxiety i.e., nutritive anxiety, eagerness to calm a tension of need which converts itself in fear of death.

In the background of every human being there exists anxiety - fear of annihilation - as a primary mental symptom, and HAHNEMANN could not have meant anything else with Psora conceived as a dynamic state of hypersensibility, or allergic susceptibility, an expression of the alarm of the age in the face of the imminent rupture of its internal economic equilibrium through non-satisfaction of its primary instinct of self-preservation. But there exists, further more, another factor which strengthens the structure of this primary nucleus of anxiety. The child does not find itself defenseless in front of the vital frustration which makes it feel hunger like an annihilation, but it possesses a vital force which drives it to react with fury, aggressively and destructive eagerness, in order to annul the bad and unbearable sensation of hunger and, as it does not distinguish between the ego and the mother, it projects its fury upon her, placing in her the unbearable sensation. It is thus that the mother is considered by the child a bad object, not only because she frustrates it, but also because the child invests her with its own reactive aggressiveness; therapy, when incorporating or devouring her with fury, as she is part of its self, it identifies her with something bad which devours and annihilates it inside itself.

The structuration in the ego of this primary process, generator of anxiety, causes the individual to find himself, during all his life in constant danger of breaking up the economic normalcy of his homeostatic equilibrium and of succumbing through the pressure of instinctive needs aggressively structured in his interior. In the last instance, the aggressiveness which has established itself in the instinct of death, serves the purpose of self-preservation of the organism, effecting - with the incorporation and destruction of food - the chemical disintegration necessary for the nutritive metabolism

The sexual instinct of reproduction--hunger and love are the two forces which move man is nothing but a derivation of the instinct of preservation, with the purpose of preserving the species, with the same sense of vital synthesis in a new living entity, with the difference that it is being exercised .without destruction of the object (food - mother). This leads us to imply that the aggressive and destructive character of the vital manifestations of the human being only accompanies the sexual instinct, in its natural purpose of preservations of the species, as a pathological expression of the hunger for affection in childhood, transferred from the gastro-intestinal tract to the genital apparatus.

The immature sexuality, subordinated to the nutritive instinct corrupted by anxiety, presents to genitality all the perverse elements derived from being, devouring and destroying which pertain to the instinct of nutrition, exalted or perverted in its source of origin, the digestive apparatus. It is the animal being we carry inside, anxious because of hunger, which threatens to devour it, which defends itself against this anxiety by biting and devouring in its turn the object upon which it projects its excitation. The sexual act thus becomes an act of destructive aggression which satisfies old tendencies of the nutritive activity, perverted by a psoric disturbance of the instinct of preservation. Aggressiveness, fury and hate are emotional correlatives of the original hunger, which perpetuate in the man-child, the original non-satisfaction of his digestive demands, with impulses to incorporate destructively the object which awakens the latent mechanism of anxiety.

It is for this reason that man reaches his psychosomatic maturity when the maturing of his sexual glands moves the relation with the world from the bucco-gastro-intestinal apparatus, where destruction is being exercised, to the genital organs, where his relation to the world is constructive; in other words, when he cures his psoric anxiety which fixes him regressively to an infantile stage of his instinctive emotional development, and develops the law of healing which directs the process of psycho-biological growing towards maturity.

The nucleus of anxiety, which lies beneath every biopathographic picture and which is structured with the tension of expectancy and frustration of nourishment together with its destructive impulses projected towards external objects which the ego considers as a threatening danger (against which it defends by attacking in turn) is always covered and dissimulated by the picture of the present illness, the functional and organic pathology of which is the specific result of the defense mechanism developed by the individual in order to overcome the psoric anxiety which thus changes to a state of latent Psora. But there exists no doubt that the human being is not alone psoric. Psora is a neuro-vegetative dystonia, created by the separation from the material protective world, with the logical results of anxiety, fear and the regressive egotistic attitude of attachment to the mother which exists during the whole life as an essential factor impending psychological growth and maturation. But when getting in touch with that objective world from which he was separated i.e., when acting against that external world to human nature which infect him dynamically - on account of the susceptibility caused by his anxious dystonia-with two infections: Syphilis and Sycosis. Both these dynamic infections exalt the reactive nervous irritability, creating a psycho-biological disposition directly to destroy the external or introjected frustrating object, as occurs in the case of Syphilis, or to incorporate it into the self, destroying the object in its individuality, as happens in the case of Sycosis. It is in this manner that we can distinguish the temperamental and characterological disposition of the tuberculinic (psoro-syphilitic) patient from that of the sycotic one. We can observe this especially in children with a strong miasmatic hereditary burden.

The tuberculinic patient is anxious, shy, fearful because of the Psora; but impulsive, irritable, aggressive and eminently destructive because of the Syphilis. When this stigma is accentuated congenitally, it produces a regressive child who is a problem in school, deficient in its mental development, slow in learning and understanding, dull, stupid, stubborn, unsociable, melancholic, sad, with feelings of guilt and self-condemnation, with desire for solitude and impulse of fury, wrath and destruction which may lead it to suicide or crime.

The psoro-sycotic individual has also his background of psoric anxiety, but the Sycosis provides a characterological structure which differs from that of the tuberculinic individual and which in the daily consultation can be observed with unusual frequency in comparison with the times of HAHNEMANN. He is the type of child. . . . practices its aggressiveness for the purpose of destruction or auto-destruction not directly, but in an insidious, perverse and malignant way. He turns deceitful, perfidious, hypocritical, diffident, jealous, suspicious, wicked and cruel in his destructive tendencies, with tenacious concealment of his intentions, projecting its bad tendencies on to others and turning paranoid with great egotism and hypertrophy of the ego.

As a general impression of the child and also of the adult, it can be said that the tuberculinic individual is destructive but frank and loyal, while the sycotic one is also destructive, but insidious, deceitful and malignant. The changes of character, of conduct and of the mental symptoms will give us the pattern of the changes in the miasmatic activity during the patient’s life.

When in the study of the characterological personality, through the pattern of behaviour, reactions, and vocations, we have come to know the fundamental destructive tendency of Syphilis or the perverse one of Sycosis, we have gained an enormous advantage in the characterization of the total picture, associating the mental symptoms in accordance with a correct appraisement. A strong emotion, a moral breakdown, a sudden change of life, an acute infection or the similar medication of the present picture can reveal the latent Psora, revealing the anxiety in its personal form and permitting the identification of the constitutional similimum. Let us observe in this connection the following demonstrative case:

A single woman patient, 30 years of age, came to consultation with piercing abdominal pains at the beginning of menstruation and a depressive state of mind. She wept during consultation, showed herself sad, abandoned, without any joy or satisfaction. She lives with her mother, upon whom she depends in a neurotic way, inasmuch as she carries to an extreme, her protective care, not permitting herself the smallest expansion or pleasant satisfaction. She is extremely sensitive to heat and cannot tolerate closed rooms because of her need for fresh air; she performs an obsessive activity with necessity of movement, which alleviates her, and complains of slow digestion with gastric plethora after meals, acid eructation, feeling of heaviness, abdominal pains and flatulency.

One dose of Pulsatilla 10M in the course of three months, developed a progressive mental aggravation with physical improvement. Her menstrual and abdominal pains were disappearing, her digestion and general state were improving, but there appeared an abundant fetid flux which she did not recall having had before, and she showed an ever-increasing tendency to access of violent fury and a painful anxiety with fear of losing her mind, or falling ill or of contracting an infection. Furthermore she told – while crying bitterly – of her aversion or rejection of people, because she is afraid that they might notice her fears and anxiety.

Her agitation, fear, anxiety and the obsessive desire to avoid all social contact were in complete contradiction to the type of passive patient we saw during the first consultation, and although the somatic picture had improved, we could not assume that the mental deterioration was due to an erroneous prescription, since the psychic symptoms were not the same as those she had shown during the first examination, nor did they partain to the medication and, on the other hand, the appearance or reappearance of the fetid flux showed us that the law of healing had started.

We noted, furthermore, that during those three months she had gained four kilos, thanks to a considerable increase of her appetite favored by the improvement of her digestive functions, and that she did not complain any more of heat or lack or air. Evidently the new mental picture, anxiety with fear of losing her mind, of falling ill or contracting an infection, of people noticing her psychic confusion and the impulsive fury, corresponded to Calcareacarbonica which, in doses of 10M at intervals of 5 months, determined the cure of the patient.

Pulsatilla, similimum of her presenting state, had provoked the appearance of the childhood syndrome of psoric anxiety with its oral desire, which made her gain weight, as well as the compulsive aggressiveness which exposed her to sudden fits of fury. Both sentiments, anxiety and fury, corresponded to the regressive stage of her claim for the mother, covered by the reactive formation of a resigned passivity laid bare by Pulsatilla.

We mention this case as a paradigm of repeated observations, where the situation of a reappearance of the basic anxiety with its various psychic connotations of fear, phobias, obsessions and aggressive exaltation repeats itself after the first prescription which corresponds to the presenting picture, structured generally by mechanism of defense which do not permit one to visualize the personal nature of anxiety and therewith the authentic profound personality.

I have tried to make an etio-pathogenic study of anxiety, because this mental symptom is the principal psychic phenomenon of Psora which exists in the background of every physio-pathological picture.

Psora, being of a purely functional nature is the fundamental misam of pathology, since it is a dynamic disposition of morbid susceptibility of the Vital Force which establishes in the nervous system conditions of weakness, so that Syphilis or Sycosis may impress on the cellular metabolism a dystrophic dynamism with tissue changes. Whenever he can, the homœopathic physician must try to reach this psoric diathesis with the anti-psoric which presents a similar pathogenetic primary group.

The essential factor of the constitutional homœopathic prescription and treatment is the identification in the patient of the characteristic nucleus of general and mental symptoms which reflect the temperamental structure and which have determined his morbid tendencies and the present pathological picture. If the clinical visualisation of this characteristic nucleus or the personality has not been obtained, it is hardly possible for the homœopath rationally to reach a cure, since the numerical whole of general symptoms and particularities without a psycho-characterological characterization does not give a clear idea of what is that that should be cured in each patient, as HAHNEMANN postulates in paragraph 3 of the Organon, the 150^th anniversary of which all are celebrating who, gathered here today, express their gratitude to the Master.

Reference:

HAHNEMANN S.C.F.” Organon of Medicine, 6^th edition.

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THE PATIENT’S PERSONALITY

Contemporary medicine must make a total revision of its approach, both in theory and in practice, to chronic disease in man. The patient should no longer not be regarded as a mechanical apparatus, nor should the therapeutic measures be applied to the physio-pathological mechanism of an organ or a system. Modern clinical medicine compels the physician to acquire a thorough knowledge of his patient, in that he may understand him as a human being.

The analytical investigation of the pathogenetic process, in the tradition of Claude BERNARD (excellent master of experimental medicine, though he never pursued any clinical analyses), led to the formulation of the traditional nosological clinical science. This has made the most extraordinary and remarkable scientific discoveries about the human organism. But the fundamental obligation of medicine is to face a clinical reality that leaves behind the discoveries made in the laboratory and the investigation of the physico-chemical mechanism, in order to concern itself mainly with a thorough knowledge of the innermost recesses of the patient himself.

It is impossible for analytical medicine to make a clear and concise definition of sickness and health. All the results arrived at on homœostasis, the neuro-endocrinal equilibrium, the electrolytic balance and the physico-chemical mechanism fail to establish a close connection with the patient’s subjective, emotional and instinctive world, fail to solve by themselves the particular, special and personal problems of each patient. The practicing physician comes to the conclusion that is evidently absurd to insist upon the enunciation of a general principle that would enable the investigator to acquire a scientific knowledge of a patient based on his physio-pathological mechanism alone. He discovers “how” the biological phenomena take place, but he cannot determine “why” they occur, since they are intertwined with the patient’s subjective world. In order to have a thorough understanding of the problem, he must view it in its total psycho-physical dimension. He must inevitably relate his patient’s disease and present state to the total number of elements which form his bio-pathography, to the psychodynamic disposition that has made such a disease possible, both from the physical and the moral points of view. Furthermore he must find out what the true meaning of the symptom is and he must endeavor to study and analyse his patient as a human being rather than concern himself with the right or wrong functioning of a given organ. A new clinical approach must be developed, so that the physician may step from the pathological manifestations of the disease to the dynamic underlying strata of the cellular pathology, and plunge himself right into the midst of the vital disturbances that form his patient’s personality and the physiological evolution of his whole being as a biological unit.

It cannot be accepted, as the ancient Semitic-Greek medicine maintained and the present-day organicistic medicine appears to insist, that man’s true being is his physical nature. Nor can we accept that his moral and ethical existence, his emotional fluctuations and moral conscience are the result or the epiphenomena of his bodily physiology.

Life can be no other than a surrogate of the creative activity. That is why in the study of the human being we shouldn’t concern ourselves only with this anatomical structures and mechanisms, but rather with man’s whole process of life through which those very structures and mechanisms are put to the test by him. We must gain a knowledge of the terms within which his inner world connects itself with the outer world, thus conditioning his own personal life to the rhythm of the Universal Law.

This deep meaning of human life is acknowledged not only by religion and philosophy, but also by science itself, due to the psychosomatic and anthropological orientations which, thanks to the advent of depth psychology and the exploration of the unconscious soul world, have set in motion a true humanistic revolution in Medicine.

Neither mind nor body fall sick as separate units, nor is the patient ill because his liver or heart, his lungs or stomach are unwell, or because he suffers from some form of neurosis, but because his whole being is sick in the dynamic center of his personality, in his emotional reactions, his inner will, and that hidden innermost recess of his being where his true self throbs and where we shall ultimately find the reason or meaning of his existence.

Once this scientific-philosophic outlook is accepted, the disease will be regarded as a way of living, as a biological behavior or a vibratory dysrhythm of the vital spiritual principle that animates the body and determines the subjective symptoms of sensations, behaviour and temperament.

The experimental investigation of the dynamic effects of potentized drugs on human beings, as is done in Homœopathy, has made evident this new functional pathology of man as a complex unit. Hence, by analogy, it has been possible for us to understand that the physicochemical alterations of tissues and physiopathologic mechanisms are not the disease in itself, but the result of that constitutional dynamic disposition which Medicine has at all times failed to define in scientific terms. The ancients reached no definite conclusions. They only mentioned the necessity of getting to the very core of that unknown field that GALEN himself called preternatural disposition, dyscrasias, or diathesis.

The vitalistic Hippocratic school tried to define clinical medicine by pointing out that there are as many diseases as there are patients, but did not reach the practical results it should have done. It was based upon a physiologic naturalism that simply led to the purely scientific tendency of present day occidental medicine. It ignored the existence of the unconscious and the deep psychological determinations of tissue pathology, though it longed to explore that “unknown field” of the human personality, in order to be able to understand the real meaning of life and sickness in man.

The Greek physiologic medicine of HIPPOCRATES and the ASCLEPIAds, as well as the GALENic school which five centuries later laid the foundations for the physiopathologic and nosological clinical medicine prevalent in our day, lacked the knowledge and understanding of the psychological mechanisms.

Psychosomatic Medicine and Psychiatry came into being in answer to the urgent demands of the human reality. They were forced, however, to maintain the Cartesian doctrine of body and soul, or “psyche and soma”, when confronted with the impossibility of exploring the psyche with the same instrumental methods which were used to examine the somatic phenomena.

The quantitative method cannot be applied to measure and understand a purely qualitative reality, such as the human mind. Lacking the appropriate method, Medicine was forced to leave aside the investigation of psychological mechanisms and pretend to ignore the importance of Psychology (which is like ignoring the patient himself). This led to the development of several spurious practical trends of doctrinal or paleoreligious character (such as Christian Science), finally ending in the well-known quackery of all times. These came to fill the tremendous gap left by Academic Medicine, but nevertheless failed to succeed, since they suffered from a similar ailment -- they did not take pathology into account.

Both currents of medical thought, sustained by every deep and serious physician, meet and merge in the belief that man is a psychophysical unit, based on the truth that the soul is the shape of the body through which that body becomes human. The atoms and molecules come together and form the body as a human body because of the psyche, soul, or vital force conforming it. Greco-Semitic medicine regarded the soul as the “hypostasis” through which the “physis “ of the body became human. Hence we must accept and recognize the vitalistic belief that the organic functions and the physicochemical alterations of a patient’s internal organism depend upon the neuro-vegetative changes that are closely interlinked with the anomalies of his vital energy. This obeys the laws of the cosmic energy from which it springs. The transgression of these same laws i.e., the vibratory interference of the vital or instinctive energy of the human being with the cosmic energy, determines the basic conflict of the individual, due to the transgression of the law of the harmonious adaptation of his instincts to the dictates of his moral conscience -- which is vitally alert within him as the representative agent of the cosmic harmony.

In order to understand disease, we must understand man as a being of soul, in his true self, with his inclinations and temperament i.e., his feelings, sensations, emotions and humour, in short everything that makes up his personality, through which he must fulfill his destiny. The destiny of every human being is to follow a pattern that leads him from a childish autism in which he is only a helpless, insecure, dependent and passive being, to the adult stage or a state of conscience in which the barrier that separates the subjective from the objective world has vanished, so that the individual “ego” and the transcendental “ego” meet. Thus he becomes a human being, free of every infantile automatism, capable of creating his own destiny.

It is obvious that this philosophic conception has a tremendous importance for the correct analysis of the patient’s clinical history. The physician must try to understand the emotional background and the development of the individual as a person, the vicissitudes he has undergone during his process of maturation as a human being, more than actual functioning of the organs and the chemical composition of humours.

The advent of Homœopathy at the beginning of the last century established the pragmatic rule for this, emphasizing the necessity of healing the patient and not the organic or local disease, at the same time regarding his moral aspect and psychobiological behavior as a person as more important than all the pathogenetic or mechanic speculations on his physiology. Thanks to the pathogeneses (an Experimental Medicine applied directly on the human being for the first time) medical science was able to penetrate the underworld of clinical pathology, where the comprehensive dynamic symptoms are to be found. This clarified the characteristic features of that constitutional disposition, diathesis, dyscrasia, or field stigma that HAHNEMANN referred to as miasma, which Medicine had divined and demanded from its very beginning.

It was then possible to establish by analogy that the human being receives from his ancestors a biological heritage stigmatized by a pathogenetic dynamism of vital energy with particular temperamental tendencies of psychobiologic behaviour that enable him to evolve a personality of his own, in which he himself and the world merge under the influence of the miasmatic dynamics rules that conform him.

That is how at the bottom of every disease and beyond the symptoms that reveal the mechanical alteration of the organism we discover in every patient, whatever his pathology may be, and merely by getting ourselves to look for them, the animic symptoms of that morbid core of the deep Will. This intimate and latent affective complex, source of love and hatred is ruled by the principle of pleasure which ‘DESCARTES’ genius located in the pineal gland (in his endeavor to give it a physical basis). It is placed in a commanding position behind the sella turcica, in the diencephalous subthalamic region as the neural concomitant centers of unity between the emotional and biological aspects of life.

The physician who does not penetrate into the innermost recesses of his own affective conflicts and is not closely connected with the characteristic features of his own basic existential insecurity or the affective roots of his own perversions and impulses that determine the psychobiological dynamic sources of hatred and destruction in Syphilis for instance, or the unquenched and obsessive erotism of a cancerogenic psychosis, cannot understand his patient nor the disease he must heal, as HAHNEMANN points out in paragraph 3 of his Organon.

The psychological problem of this conative nucleus, where the homœopathic doctor finds the characteristic mental symptoms, is always closely linked to his own interhuman reactions and objective relations with the world at large, the characterologic terms of which have been established and shaped from his early childhood by the life he has shared with his parents and brothers. Starting with his first childhood experiences, his biographical data reveal the course of his emotional development. He gœs from a childish autism in which life for him is purely an instinctive and vegetative continuity, ruled by the principle of pleasure and rendered secure by the protection of his family i.e., a totally irresponsible existence, to a psychobiological maturity or adult stage that implies responsibility, conception of community life, objectivity and the moral conscience which represents the spiritual element in the human being.

The principle of reality replaces the principle of pleasure and the child given to anguish and infantile reaction becomes the free creative man he was meant to be, just like the girl, restrained by her frustrated anxiety of maternal protection grows into a woman capable of surrounding her children with her woman’s love, ready to consider them as the individuals in whom she herself will find expression of her own freedom.

There can be no other alternative in the vital drama lived by each and every one of our patients. Self-love, egotistic, possessive and destructive, must give way to the love of agape or altruistic love, so that the human destiny for which we were created, of giving life to the Universal spirit, is fulfilled.

I shall only make a short reference to two cases, taken at random from my daily practice, to exemplify this style of biographical clinical history that unmistakably leads to the very core of the patient’s personality and consequently permits us to unravel the determinative characteristic symptoms of his disease.

A patient, 36 years of age, came to my consulting room seriously affected by bronchial asthma. She complained of pains in the leg joints, angina and laryngitis, and of being easily susceptible to dry cold weather. Her mental characteristic symptoms was her fear of dogs and of catching hydrophobia.

Whenever she saw a dog in the street she felt an irrational fear at the possibility of being bitten by it and catching hydrophobia. From the examination of her biography I was able to find out that she harbored a deep rancour towards her mother and a no less intensive envy towards her only sister who received the whole of their mother’s affection, whereas the woman in question was rejected by her and made the object of corporal punishments. She accumulated a tremendous rage and hatred towards her mother, which logically she was forced to hide and keep in check, while she pretended to develop a submissive and dutiful personality. Her anxiety and her guilty conscience made her project her own feeling towards dogs, fearing them because of the possibility of catching hydrophobia (a typical disease of dogs), and together with it the harm she could not inflict upon her own mother in revenge for her affective frustration.

Her symptoms were:

Fear of dogs (KENT, page 44);

Anxiety of conscience (page 6);

Fear something will happen (page 45);

Cold dry weather agg. (page 1369).

Causticum M, 10M and 50M succeeded in curing her asthma completely after aggravating it at the beginning, but more interesting still was her entire change of attitude towards her family problem.

She had persistently insisted upon working outside, to the surprise of her husband who was a man of means, because she said she wanted to be independent. Evidently she tried to assuage her feeling of guilt at her rage against her mother that had been transferred to her husband. At present she is wholly recovered and her manner of being has changed completely. Previously of a sullen and violent nature, she has turned into a loving wife and mother; she loves her home, has no more asthmatic attacks and has lost her fear of dogs.

Another patient, 39 years old, married with a daughter, a dentist by profession claimed that he was exhausted that he suffered from both physical and mental fatigue and that he had taken a number of stimulants and drugs with no positive results.

He felt like an old man with an almost total loss of sexual libido, progressive Amblyopia, vertigo and flatulent dyspepsia. He had no pathologic alterations whatsœver, except a little Varicocele and Pyorrhœa with gingival retraction and small haemorrhages.

From the study of his biography we derived a most eloquent analysis of his affective emotional development,. He had been an overprotected child, spoilt by his mother and three older sisters. As the last and only son, he was always treated like a baby, and even to the present day his unmarried sisters regard him as a small child.

His father, sullen and rude of disposition, reacted in a most violent way against his wife and daughters, because of the overprotection they showed the boy, and to counteract their influence he was extremely severe, submitting his son to a stern discipline, enforcing upon him a strict order in every aspect of his life. He still remembers how his father made him suffer when he woke him up early and almost violently every morning, to make him do his school homework. This daily traumatic treatment, which indeed was almost sadistic, caused him such emotional damage that even today, when he awakes, he feels the same old childish anguish.

Our patient leads an isolated life. As an excellent professional, he carries out his work with an obsessive accuracy. He has a consulting room at home and never gœs out. He leads the life of a recluse and has no friends or relationships whatsœver, since he does not want any connection with the outer world, and has not even read the news-papers for the last two years. He has an insurmountable aversion for people and avoids meeting any human being except in connection with his professional practice, in which he is not very communicative.

It is evident that this man, physically healthy, suffers from a perturbation of his effectivity which seriously endangers his life in relation with the outer world and diminishes his personality.

His extreme physical and mental fatigue, the so-called surmenage that is always due to the tensions of affective conflicts, together with the diminution of his sexual libido, visual strain and vertigo, conform to the clinical picture. It has resulted from the conflict between his childish dependence upon a tyrannical father, made worse still since it was projected over a passive feminine personality like his, developed under his “four mothers” protection, and his own longing for autonomy and liberty. The defensive reaction to the anguish resulting from that conflict was that he developed an obsessive nature by identifying with his own father, that led him to follow a particular pattern of life and resulted in a disease in accordance with the deep anomaly in his process of maturation. His general symptoms were that he was extremely sensitive to cold and heat, and a marked intolerance to the rays of the sun that made him extremely weak and tired.

His symptoms therefore were the following:

Company, avoids the sight of people (page 12);

Conscientious (page 16);

Timid (page 89);

Weak in heat of sun (page 1420) .

This is the minimum characteristic syndrome that clearly corresponds to Natrumcarbonicum, a remedy which the patient took in 10M, 50M and CM doses. This brought about a total modification of his behavior within the following seven months, at the end of which he was strong enough to conquer his misanthropy and become a true adult.

These two cases which I have briefly dealt with are simple examples of the difficult though imperative task that must be performed by clinical medicine: to study the patient as a total unit in order to understand the characteristic symptoms of his personality i.e., of his affective will, the essential nucleus from which the morbid process springs.

Far beyond the experimental investigation of the physiopathological mechanisms and after analyzing (if it is so desired) the pathogenesis of the organic, glandular or systemic changes, it is absolutely necessary for the doctor to understand his patient’s reactions as a human being, through a biographical anamnesis that throws light upon his affective disposition or temperament.

If medicine cannot reach the vital center of the effective disturbance, so as to apply therapeutic measures to it, it will never succeed in healing any of man’s chronic diseases at their roots or fundamental dynamic starting point, in what conforms his predisposition to pathology and determines his own personal destiny. All it will ever do is to suppress the ultimate or superficial manifestations of the morbid process, leaving the patient untouched in his inner being whence his existential anguish springs, quivers and grows.

This same anguish rises from the psoric Anxiety that HAHNEMANN considers to be the fundamental, archaic disease which prevents man from developing his own inner freedom. This is the fundamental aim that modern medicine must pursue.

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SIMILITUDE AND EPILEPSY

TREATMENT AND RESULTS:

Within the field of neural psychiatric pathology the epileptic suffers a disease in which the treatment permits a clinical and electrœncephalographic (EEG) control which is objective and exact: the convulsions are produced or not. The EEG record becomes normal and permanent with its changes.

For this reason this disease was selected in order to see whether homœopathic therapeutics had any demonstrable action. At the outset we began this work not without certain doubts, since our experience with epileptics was not very wide and we had happened to attend patients who rebelled against all treatment.

On the invitation of Professor ESCARDO to carry on this experiment we began, Dr. PASCHERO and I, to treat children who already were sent to us.

The last Congress of Medical Ethics went on record as paying official respect to Homœopathy, making it clear that:

“Homœopathy is a system of cure with a coherent doctrinal basis and with important centers of practice in many parts of the world”, and concluded that “hospital resources should initiate with the maximum scientific precision and free of all prejudice critical studies of the value of the homœopathic remedies and permit the collaboration of homœopaths of recognized integrity”.

We have treated 39 epileptic children who, when sent to us had already been studied from the clinical, EEG, humoral, and psychosocial points of view.

To the clinical history of the patient we added that of the homœopathic symptomatology, seeking to integrate the picture not only bearing in mind the type of convulsion, their timing, and related factors, but also looking for the perfect similimum which is the only medication that will cure the patient and transform the diseased state.

We commenced the treatment by seeking with strict homœopathic technic the similimum by repertorization or consultation among ourselves for the selection and classification of the symptoms. We have administered a single remedy at a time in differing medicated forms: powders, doses in globules or liquid to be taken in a single day.

We administered a placebo in the intervals between doses. To avoid any factor of suggestion in the patient and especially in his family, we administered the remedy without labeling it and without their knowing that we were using homœopathic remedies. For this we depended upon a traveling medicine case in the same room where the consultation was held.

The results obtained in the treatment of 39 epileptic children, we can group as follows:

1. 10 children with convulsive syndrome and equivalents with abnormal EEG who with homœpathic treatment were cured clinically and electrœncephalographically;

2. 9 cases in which there was clinical improvement, practically without convulsions, but in which the irregularities of the electrœnchephalogram persisted;

3. 8 patients with clinical improvement also without convulsions, but with whom we have not been able to repeat the electrœncephalogram;

4. 11 patients of mixed convulsive syndromes, uremia, traumatism, mongolism, that we have been unable to follow up for various reasons;

5. 1 patient whom we consider our only failure, in whom the convulsions continued in spite of treatment and of the different remedies administered, but in whom we hope to be able to control the convulsions. The mother is continuing the treatment with enthusiasm, since, although the convulsions have not disappeared, the conduct has improved.

We have observed that homœopathic medication does not bring about the side effects which the anti convulsives produce. The barbiturates, make the patient more aggressive, of more ungovernable conduct, and increase the problems of conduct, while the homœopathic medication favors the solution of these problems, spontaneously and without specific psychotherapy. The patient becomes more docile and less aggressive.

We call attention to the necessity, once a homœopathic treatment begins, of not suppressing suddenly all the anti convulsion medication, but of giving the homœopathic medication gradually in low and more frequent doses while reducing the sedatives until they are eliminated. Not proceeding as we indicate is the reason that many epileptics give up the homœopathic treatment which could give them such beneficial results.

Of the children we have treated several were refractory to the classical convulsions medicines. With our treatment not only did the convulsions disappear, but their changes of the EEG became normal.

Allopathic therapeutics tells us that there is no treatment for epilepsy, but of each epileptic, that the treatment should be individualized. The individualization which they claim consists only in administering a drug to each patient, or most frequently, a combination of them, with final result of suppression of the convulsions, which is not always attained, or with the consequences of their toxic effects.

Does the prescription of the proper remedy in solving the treatment of the epileptic child suffice for us homeopaths? We think not. Here more than ever arises the necessity of psychosomatic hygiene for the young patient and family. One must inculcate the idea that Epilepsy is a perfectly controllable disease, that the crises take place one at a time and the best thing is to do nothing at that moment; only protect him from biting his tongue. One must avoid excessive protectiveness which becomes an obsession and makes the epileptic an invalid.

One must treat him as far as possible like a normal child, watch over him in sports or in dangerous places without his realizing that he is being watched. One must give him the feeling of responsibility like other children. Terror at the crises is the cause of an atmosphere charged with anxiety and the over-protectiveness so prejudicial to the small epileptic. One must not forget the psychogenic causes which arise from many crises. One must always make a constructive psychotherapy dependent upon the atmosphere in which the child evolves and develops.

Somatic hygiene implies the correction of dietary errors, norms of life, study (not to overload him as is done at present) - school, English, dancing, music, - without sufficient time for the minimum physical requirements of exercise, sleep, sociability and recreation. Only in this way shall we have favored cure and not failure when the homœopathic remedy is the proper similimum.

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HOMOŒPATHY IS ONLY ONE

The long pathway to become a good homœopath is full of difficulties which can be decisive for the failure of many a good intention. Consider the doubt, hostility of the medical milieu, deception owing to failures, which are the human results of relativity, lack of a solid base in the knowledge of homœopathic philosophy, the instinctive trend to make no efforts, etc., cause many homœopaths to let this early flame burn out, this inner fire that sparks the enthusiasm of their first steps.

Any doctor who begins homœopathy makes an effort at the first moment which has the brevity of a flame which is afterwards dominated by routine.

The effort is exhausted before accomplishing the first goal, and habit concludes the work corrosion that time performs upon enthusiasm, fever and disinterest of beginners. But this would be nothing if the first efforts were not so brief. If at least his efforts had allowed him to catch HAHNEMANN’s ideas, to know deeply the basic principles of Homœopathy, to build on firm foundations the homœopathic preparation, even, scarce, it would always have the worthwhile quality of being indestructible.

But what he lost, will only be a discredit to himself and for Homœopathy is that he has built upon the base of an incomplete knowledge of HAHNEMANN’s principles and the philosophy of disease. After this faulty first effort follows a poorly-inspired study of medicine, which is evilly applied. Whœver does not know the laws of healing and is not impregnated with the principle which govern the definite homœopathic therapeutics, will be as empirical as an allopath in the use of elements that Homœopathy places at his disposal, He will merely have a notion of the homœopathic “form” in the use of medicaments but he will not know the homœopathic way of facing a patient.

We have always thought that it is much harder in Homœopathy to learn to see a patient and construct a history, than to know the Materia Medica.

Medicaments are offered to us ready, with a pure pathogenesis free from troubling repetitions and digested by authors who throughout a life time, have caught the distinctive genius, and the medicine’s image. It is not hard to assimilate said image with so many a keen condensations available. Who is the homœopath who does not have in his mind the image of Arsenicum, Phosphorous, Natrum muriaticum, Sulphur, Calcarea carbonica, Pulsatilla, Lycopodium, Sepia, Lachesis, Nux vomica. etc? Thanks to KENT, CLARKE, HERING, DUNHAM, FARRINGTON, NASH, ALLEN, etc., it is not at all difficult to acquire the conception of medicament, it is only necessary to read their writings.

But to have an interpreted, classified and purified pathogenesis is not the same thing as to place oneself vis-a-vis a patient. It is here that difficulties arise and conceptions collide. It is here where Homœopathy is spoiled if the doctor has not learned in that first effort we talked about, HAHNEMANN’s directions expounded in his Organon about which the great masters so deeply insist. It is here where the one who believes that Homœopathy is just to give drugs in endless doses, prepares his own failure. To know how to see a patient, is the most difficult thing, we insist after many years of practice.

The symptomatic wholeness of the patient’s image, it is true. But let us begin by clearing up that it is not a numerical wholeness, but a classified one, that is to say the wholeness of symptoms classified according to their importance in the patient and especially those who consider the patient in his most general aspect. When we consider mental and general symptoms we are actually in a condition to know the most valuable symptoms which express the essential condition of the patient.

The main goal is to know what features individualizes the patient. The symptomatic wholeness must have a personal trait, something that features it.

GUERNSEY spoke about the “key-note”, that is to say, the unusual symptom which is often unexplainable in the pathogenetical level. This keynote differentiates the patient from the others who are affected by the same disease. But the conception of keynote has been generally shuffled.

Many homœopaths let themselves be guided by it exclusively; they apply directly the medicament having the keynote. Not every patient with rheumatic pains worse with movement is Bryonia, quick satiety with flatulent dyspepsia is not always Lycopodium, fat, pale children are not always Calcarea carbonica, nor every languor in the stomach before noon, Sulphur or Phosphorous.

To let oneself be led by a particular symptom of this kind often means to dispense with the general symptoms and wrongly limits thenumber of medicaments which needs to be analyzed.

The homœopath who works this way, will soon become a routinist in using Homœopathy, and he will never be sure of his prescriptions. Since his diagnosis will be inaccurate, without the solid foundation of a careful analysis, his treatment will lack firmness and he will endlessly change the medicament whenever the patient insists his pains are worse.

It is very easy to fall, this way, into what is the usual error; prescription of many medicaments at a time, frequent change of remedy, lack of orientations as to the evolution of a patient who takes many different medicaments, suppression of symptoms and destruction of a case with absolute modification of his original symptoms. Success may be seen in the first moment, but it cannot go on, nor can it lead to a true healing.

It is not our intention to criticize those theories which justify said way to modify the exercise of Homœopathy. We only want to lead beginners along the ways of a good and genuine Homœopathy. HAHNEMANN may be perfected in the form but not in the background, because when we destroy his principles we destroy likewise the foundation of his therapeutics.

So it is not possible to put aside requirements that we consider indispensable and inevitable. They are: enough time for each patient; detailed and correct construction of his history; accurate analysis of the medicament to be given, with or without repertorisation; prescription of only one remedy - pathogeneses have been made with only one drug at a time - general indications as to diet, antidote conditions; psychical and hygienic advises which many rule the patient’s life and allow the medicament to act; observation of the patient’s evolution.

There also exists another important factor: the second prescription. It constitutes a problem that puts to the test the Homœopathic physician’s competence. Nevertheless, nothing seems so easy at the first moment. Its definition is easy: the second prescription must be done when the first medicament has stopped acting. But in the practice it is not very easy to have an accurate notion of when the medicament has stopped acting.

First, we must take into account the medicinal aggravation, encourage the patient by instructing him on the mechanism of the healing process and forget the so many aggravated symptoms which do not always come, as texts usually say, with euphoria or general well-being. Very frequently, that patient cannot tell his sensation, whether they are general or animic, or he focuses his attention in the local pain or discomfort.

Secondly, old symptoms may or may not return, depending on whether the patient has or not the necessary vital force to bring them back again. There may appear symptoms that the patient says he never felt, but whether he does not remember them, or they appear in a different place of his organism, or they may even be apparently different though pertaining to the same nature – a secretion, for instance.

In one or the other case, it is frequent that an inopportune and harmful prescription shall be given. In the first instance because the patient complains, and the doctor is not sure of the medicament. In the second one because the apparently new symptoms offer a new keynote and the doctor takes this as proof to apply another medicament that he deems better.

Doubtless, if there appear actually new symptoms, it is necessary to antidote the first medicament or give the one covering the symptomatic wholeness. But generally the key note is caught in order to save time. Thus, insecurity becomes a habit.

Finally, we stumble against the great obstacle about which we shall never fail to insist sufficiently: wait.

Generally, doctors never wait long enough before giving the second prescription. To know to wait means to know how to observe. It is sometimes hard to believe that how long a medicament may keep on acting. Though this expression is a mistake, since what acts is the complex mechanism of functional recovering and organic reparation set into movement by the medical excitation of the Vital Force. The trajectory of this recovering is not always progressive and uniform. Sometimes it stops and afterwards gœs on in periods of different intensity. In the practice we meet patients who after an open and progressive improvement, stop for a long period, and then start progressing again without our having given them new doses. They claim for the medicament that so much benefited them in the first moment. But the homœopath must know that until the old symptoms appear again, he must not repeat the medicament. Neither must he give another medicament when symptoms change, whenever the patient is better. This all means that the doctor must keep on observing in order to detect the healing trajectory, from the center to the periphery, and respect a process that recovers the individual in his animic center, and impairs his peripheric organs. These are some of the fundamental directions to which a good homœopathic prescription must be subject. Homœopathy is not an empirical therapeutics subject to the whimsical deviations of each doctor that practices it, but a science respecting rules and principles without which it is not Homœopathy any longer. Our duty is not only to spread it, but to spread it correctly.

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KNOWLEDGE OF REAL HUMAN NATURE - THE FOUNDATION OF HOMŒOPATHY

Based on a thorough understanding of human nature Homœopathy is a clinical science essentially different from the purely physiological, organ related or mechanically welded medicine.

Many homœopaths who have not accepted the dynamic concept of disease processes have not been able to appreciate this. The physician must understand that he must treat the patient in his complete unity of his body, soul and mind and not the organic or local disease; that his real duty and basic obligation is to cure those which are as ‘subject’ in every sick patient and not those which are as ‘object’ - taking into consideration his diathesis, his miasms or those which, strictly speaking, signify these ideas, namely the inner dynamic disposition which brings about the pathology and psychopathologic destiny of the patient. Only then has he truly understood what Homœopathy is and what his duty with regard to the science and art in medicine is.

The duty of the physician is to cure. To know HAHNEMANN properly, what is curable in every patient, it is necessary to have a clear idea of the nature and meaning of disease.

The clinical experience reveals; a patient is not cured who has no will to be cured, the desire to be cured, to find out his self, to be in harmony with himself; who does not require further development of his capabilities, his energy potentials; intelligence and sentimentality or capacity to love - in conformity with the requirements for the unfolding of his state of consciousness. This Will- to- be impresses the body and soul in a unique sense, in a unique direction; towards self realization in accord with the All, with the Universal Spirit.

Health is the unconfined expression of the vital energy through the body in a harmonious interaction with the natural and human environment which process represents the psychobiological adaptation, ultimately the inspired opening of own nature which is experienced wrongly as isolated and autonomous oneness, in the true richness of life.

Disease is every kind of alteration, blockage or hindrance of the free and harmonious flow of life energy which strikes the body and mind. This damages its unconfined relationship with the external world, with the external life which arises from the very same impulse as the inner life.

This infantile autism which the human soul holds captive from development of the inner capability, hinder the development of full and true freedom from the directions from the concealed subconscious urges, and aggressions and guilty conscience. These lie as negative powers in the individual and as a result allows the disease as expressions of these suppressions and blockings hindering free-play and field of action of the vital energy.

If we have anxiety of life, if we live in a state of alarm, in a state of perpetual tension, embitterment over the past, envy, hatred, frustration, defensive or competitive states with sense of guilt, phobias, fixed ideas, fears, anxiety, restlessness and in a state of perpetual internal protective wall - then arises from itself a blocking in the vital energy through the body and thence disease. The individual does not then live harmoniously with the external world conforming to the law of cure and growth (from within outwards), but is locked up in self. The diagnosis of the sick person as a totality in his innermost person - the intrinsic duty of the homœopath - demands of him to give the highest order of precedence of decisive clinical value to a mental symptom: the mental symptoms in the sense of internal resistance, concealed in the unconscious, like suppressed feelings and moral commandments which hinder the free deployment of the vital energy for realizing the true fulfillment of life.

The answers to the questions with regard to the physical and mental disease must result in the restoration of free flow of life in our mental, emotional and physical levels, opening out to the Universal or Absolute Spirit.

Man must be conscious of this “unity of the Vital Energy” which pervades him as well as the universe. Thereby he dwells in his own reality, the identity of his true self as man and therefore as expression of the Supreme Being, the Absolute of the universe. It leads to a creative and fulfilled life in this genuine “human condition ”. This understanding of the nature of self which man achieves indicates the comprehension of the true fulfillment of the life or the Absolute which lives in his centre and makes up the innermost Self of his existence. This comprehension is realised, however, only in his profound solidarity with other men and the whole world and only there is found the expression appropriate to him.

The mental symptoms of purely emotional kind - and not the intellectual - are the unique ones which disclose the core of the internal disturbance. The Man unfolds his personal maturing process, that is, his conduct or the mental attitude, the emotional factors of his total life, the historic mould of his child-like conflicts, his life within his family and the social surroundings, his disappointments in love-life and consequently in his self-estimation - in one word, all the emotions which are indispensable clinical symptoms for the fundamental comprehension of the disease which the physician must treat.

The Psora or the main miasm with the internal restlessness, the constriction, the anxieties and phobias are the essential negative factors, those which hinder the free flow of the vital energy - and thereby exposes the potential of energy, intelligence and sentimentality. It constricts the growth of the level of consciousness and therewith the identity of his true self. As defense of the psoric anxiety are the syphilitic and sycotic life or way of life which the homœopath with much skill must uncover, by the biopathographic anamnesis. For that he must always keep in view these aspects of level of consciousness with which the patient executes the processes of growth and maturity and self-realization.

If the patient under treatment does not change his life situation, if he does not develop or does not bloom and develop as a fully responsible person, then he is not on the path to cure. This is only when he lays aside his child-like behavior patterns which make him egoistic, dependent, passive and needing protection. Also if he shows an aggressive craving for power, for dominance over all others and that in a militant attitude of defense and aggression, or if he does not overcome his anxieties, phobias, hatred and guilty feelings, he is not on the road to cure. He who does not conquer his conditioned approaches which hold him captive in his autism and who does not open up in some grade the richness of his life, such a man is not on the road to cure even if the symptoms for which he sought the help of the physician were to disappear. That is only a suppression of the symptoms and not cure of the patient. On the other hand the fact is that if his life attitude opens and his level of consciousness is raised and his intelligence and sentimentality potentials in the sense of expansion to the center and charity for fellow-beings is realized and in the sense of creative attitude and services to the fellow-beings and the joy of others is experienced as if his own; when he indicates in larger or smaller measure that he has been freed from blocking of his negative mental symptoms so as to live his true life with a positive attitude and outlet to the external world: then, only then, is he on the road to cure even if the physical symptoms were not removed, yes even if the preceding symptoms were to recur. Because in this opening out to the fellow-men is fulfilled the “law of cure”, whereby he again experiences the only possible health, in that it unites his Vital Energy with the true richness of life and he identifies himself in it and with it.

The homœopath leads the patient to the realisation of this richness of life. With the use of the Similimum he heightens the Will to cure which activates the spirit-like energy in the deep interior, energy which is inherent in all humans, be he unrefined or intellectual, to their capabilities. Only so can he trigger the cure which as stated above endures in stable equilibrium. It is sufficient to pursue from now without break the maturing of the process of developing, a conscious and responsible life.

The homœopathic medicament performs its work in those Vital Planes which depict the real and exact relationship between the different strata of the total being and makes up the core or the focal point of the WILL for cure. Psora that fundamental disease becomes the godfather of the evolution of man. Its nature of working is bringing out the anxiety of the life from mind to the organs, from centre to periphery from above downward or let the suppressed symptoms to come out. The homœopathic medicament effects that the Psora fulfills the highest purpose of true and the singularly genuine cure: the development from out of the autism and egoism of man for integration with fellow creatures from out of the encapsulated individualism to the blossoming into fulfillment of life with a true fellow feeling where man will find his just and true identity as human, namely in his mental deployment.

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HOMŒOPATHY IS A CONSTITUTIONAL MEDICINE

The position of Homœopathy in modern medicine must be understood on the basis of a conception of chronic disease and it is the chronic disease which the doctor must try to cure.

Modern medicine knows perfectly well that in the therapeutical clinical field the disease must not be confounded with the local lesion, the cure of the anatomicopathological process with the cure of the patient, the suppression of the actual symptoms with the overcoming of the potential diathesis which determined the present pathological case and which inevitably, with the suppression, will produce future metastasis of morbid alterations.

Notwithstanding the great progress in the biochemical, humoral and cellular investigations, it recognises that to solve the problem of curing it needs to involve the patient in his totality in a synthetic clinical vision that will allow it to understand what must be cured in each patient in particular.

Each human being makes his own disease, better said, he forms a pathology both of his psychic personality and of his physical organism in accordance with an unconscious determinism originating from a dynamic miasmatic alteration of his Vital Force.

That morbid determinism is contained in his biographical history, in his hereditary and particular antecedents, in his way of feeling, thinking and living and in all subjective symptoms that reveal his personality and make him a unique and personal case.

There are no two patients alike, there are no two people who produce exactly the same biopathographical history, there are not two human beings who have the same feelings, ideas, emotional reactions; there are no two patients who have the same morbid process in its historical sequence and concomitance. As HIPPOCRATES said, there are as many diseases as there are clinical histories, and HAHNEMANN put into practice this idea of the necessity of strict individualization of each case, establishing that the doctor must reach to know what he must cure in each patient in particular.

The essential aim of Homœopathy is to grasp the clinical vision of the patient in his intimate idiosyncrasy and put the doctor in contact with the crasis or deep dynamic perturbation that has caused and conditioned the actual pathological episode.

This search by the doctor, and his contact with the morbid condition or tendency which underlies the actual state of the disease, is the exclusive sphere of Homœopathy, thanks to the immense fund of knowledge obtained from pathogenic experiments with drugs. The study and conception of constitutional dyscrasia or disposition of the environment were not the result of the anatomicopathological investigations or the biochemical reactions made in the laboratory, but of the direct perception of the dynamic stimulus of a potentized drug. That is the reason why the homœopathic diagnosis of the similimum should never be reached through conjectures nor by pathogenetic deductions respective of physiopathological mechanism, nor by laboratory investigations, nor by biotypological or endocrinological considerations, nor by any other clinical speculation, but only by the strict observation and comprehension of the functional symptoms of the patient.

The specific factor of individualization is undoubtedly the mental symptom which in its profound significance is the psychological connotation of the subjective general modalities. Homœopathy clearly understands that the mental symptom is not a subject of speculative philosophical psychology but a clinical problem, strictly biological.

The neuro-vegetative nervous system, wrongly called autonomic until quite lately, forms the basic structure of the unconscious mind from which arise the instinctive impulses, and is at the same time the sounding system of the chemical changes that take place in the living cell, so that in it the stimulations arising from the body and from the mind are joined and harmonized into a unit expressing one single dynamic reaction. That is why Homœopathy, in advance of all the deductions of functional pathology, asserts by induction that disease is, in its initial phase, a neuro-dystrophic disturbance, which can only be expressed by the particular physiological properties of the nervous system.

The whole of the Organon of HAHNEMANN centers in the idea that the agent hostile to life acts dynamically only on the Vital Force, provoking a dynamic reaction which is nothing else than the stimulation of the “Vis medicatrix” of HIPPOCRATES, a physiological property natural to every biological process.

The doctor who applies HAHNEMANN’s Homœopathy will have accepted the vitalistic concept of the process of disease and will no longer consider it as an incubus from which the organism has to be freed, nor will he regard the organism as a test-tube in which he can reproduce the chemical reactions of the laboratory, nor try to suppress local symptoms without understanding their semiological values in the general context of the patient.

Every experienced homœopath knows positively that unless he reaches the dynamic, constitutional background of the patient, unless he has penetrated and understood the psychological personality and the vicissitudes of adaptation to life which give the earliest symptoms of neuro-vegetative dystonia determining the nature of his character and its particular pathology, he will never know what he has to cure in the patient, whom he does not know because he has not understood him.

The knowledge of the psychology and mental symptoms is the very marrow of the process of the patient, not a paramedical semiological activity, and every good homœopath is fit to utilize the rich subjective semiology which implies a deep knowledge of the human soul.

There is no better way to make this assertion clearer than to refer to several cases in practice, which will give us an exact notion of the clinical reality which I have experienced.

Case 1: On August 20th, 1955, a lady consulted me about a large grapefruit-sized fibroid in her uterus, for which several physicians had recommended surgery which she was anxious to avoid.

She complained of slow and heavy digestion, with heartburn and nausea. She had chronic constipation.

The heat and sun rays affected her very much, producing severe headaches not- withstanding her weak resistance to cold. Her blood pressure was a maximum of 200 and a minimum of 130. She had no other physical symptoms.

She was living with a married sister who had a 15-year-old son to whom our patient was greatly attached. Outside of her nephew she did not have any affection for anybody else. On the other hand she developed a great dislike, particularly for her brother-in-law, and people in general, resisting all social contacts. She refused all contact with people, giving the impression that she was extremely timid.

She could not think, nor do any kind of intellectual efforts as these produced severe headaches.

When she was 36 years old, and just a month before her wedding, her fiancee abandoned her and since then she has been developing a sad mood which is now and then interrupted by quick attacks of anxiety, palpitations and trembling, caused by the memory of the person who frustrated her.

She was once an outstanding pianist and today she is unable to play even a short piece as it produces in her great attacks of anxiety.

With the few symptoms the patient showed, we would not have been able to individualize her if it had not been by the consideration of her situation of life.

The mental symptoms manifested in her conduct, added to the few general symptoms, make up the following picture:

Timidity
Aversion to members of the family
Aversion to certain persons
Anxiety playing the piano
Worse from heat
Headache from exposure to sun
Indigestion

Seven symptoms that clearly show the characteristic picture of Natrum carbonicum which was administered at 200,M, 10M, 50M, in several doses of each potency, through a period of four years.

On July 4th 1961, she returned for another consultation, this time expressing the fear of getting stout, for which she requested our advice. I must stress that during the last year she had received only placebo.

Her fibroid had disappeared completely, her digestion was normalized, her sleep is very tranquil and she has no symptom whatsœver. She continues living with her sister with whom she feels quite happy and content. She has overcome all abnormality in her relations with people, maintaining cordial friendship with her relatives and friends.

I discovered that the reason for her last consultation is precisely the fear of losing her elegant figure so much admired by everybody notwithstanding her 56 years of age (she weighs 55 kilograms and her height is 1.55 meters). She feels young, greatly animated, healthy and very much interested in life and only the fear of losing these qualities made her return for another unnecessary consultation, as well as wanting to thank her doctor for her total recovery.

Based principally on the mental symptoms of her picture we were able to diagnose the medicine which cured her tumor completely. How can we scientifically explain the connection between the mental symptoms and the physical pathology?

Homœopathy offers a pragmatic solution to the problem of specificity of emotional factors in different vegetative neuroses.

Case 2: A patient 42 years old, a radio-technician, informs us that during the last 26 years he has been suffering from intense pains in the right side of the abdomen in the way of irregular crises.

He was treated as hepatic-vesicular, amœbiatic, appendicular and allergetic in Buenos Aires and in New York. In the latter city he was hospitalized for the purpose of obtaining the correct diagnosis. He was told that he had something in his colon that at that moment it was impossible to diagnose precisely. He underwent many treatments without any result. His painful crisis overcame him after nervous excitement, discussion or excitable worries and consisted in abdominal cramps which were somewhat calmed by his leaning backwards. For this reason an eminent colleague had prescribed Dioscorea.His characteristic symptoms were:

worse from milk
worse from fruit
worse fasting
great thirst
perspiration of back of the neck
apathy
bad-tempered
anxiety

With these symptoms the picture appeared very vague, because they did not define the type of patient, as apathy, bad humor and anxiety, together with abdominal pains which showed a case of somatic hysterical conversion, are all common symptoms.

We had to know the patient more intimately in order to particularize him.

Penetrating his character we discovered, to our great surprise, that we had before us a sociably resentful person. He was the youngest of five brothers, extremely patted by his father who died when he was only fifteen. He then had to leave school and start work. The contact with the world for which he was not prepared produced in him a rebellious attitude towards what he considered was an injust destiny. He became obstinate, disobedient to any indication from his superiors. Always ready to repel any observation with insults and cutting words, just as if he felt that he was being persecuted by enemies who tried to humiliate and diminish him.

His paranoic attitude and his irreducible inclination to offend his superiors were the reasons for which he could never keep a permanent job, notwithstanding which he became an outstanding radio-technician.

It is unquestionable that this personality, together with the remainder of the picture, clearly showed us the image of China which in three doses of 30, 200, 1M cured his chronic abdominal spasmodic affection.

China has precisely a paranoic personality with the tendency to insult and offend people and it was very astonishing to see how this patient changed his character completely and became so docile, and is now working in a permanent job.

His picture was:

Reproaches others
Disobedience
Contemptuous
Desires to be alone
Worse from milk
Worse from fruit
Worse fasting
Thirst
Perspiration of neck

Case 3: An employee, 26 year-old, single, presented himself with symptoms of a five months old pyelonephritis with pains in his kidneys and bladder, polyuria and pyuria, feverish state, bleeding and painful piles, very tired, sleepy, dryness of the mucosa, irritability, ill-humored, with fear of being left alone in spite of feeling molested when in the company of his family.

Together with the modalities and local symptoms, nocturnal polyuria, frequent desire to pass urine with the necessity of making great efforts, great abdominal distension, ineffective efforts to move his bowels and a local keynote, sensation of coldness in pelvis. He had the mental symptoms; fear of being alone with paradoxical rebuff of company, not wanting that anybody should approach him; bad humor and irritability. Lycopodium 30 and 200 cured the case in 22 days. But, curiously to say, the patient returned after a year and four months, presenting intensive burning in the urethra during micturition, abdomen very distended, constipation alternating with diarrhœa, sensation of burning in lumbar region and shoulders, return of fetid perspiration in the feet which he had had in his infancy and a great desire to eat highly seasoned foods, with plenty of salt, pepper and hot condiments.

I thought of Lycopodium which was so efficacious the first time, but his mental state was different this time, for now he did not fear so much to be alone, or that he had an incurable disease, or that a great danger would overcome him, so that, with a state of anxiety which he had not had the first time, he sought a security for his future which he considered was threatened by a great danger or imaginary disaster.

The characteristic picture was then:

Anxiety about the future
Fear that something grave would happen to him
Desire for highly seasoned food, which otherwise he could not eat
Heat on back and lumbar region

The clear picture of Phosphorous had arisen from his constitutional background after the alleviation with Lycopodium of his actual disease in the first consultation. Phosphorous cured completely this patient who, for three years now, is in perfect health.

It is obvious that in each patient the actual picture must be treated with the last appearing symptoms, and afterwards, also in accordance with the symptoms, we will treat the constitutional background that will appear.

Case 4: A lawyer 49 year-old presents a chronic bronchitis together with asthmatic symptoms and a 30 year suppuration of the right ear resistant to all kinds of treatment. Complaining also of repeated boils in the right hip and repeated styes in both eyes. He was very nervous, irritable, excitable and depressed and with a pronounced longing to be alone, having an aversion to being consoled and so converting himself into a misanthrope.

He had frequent starts during his sleep, he was very sensitive to cold weather, particularly in the head, and he also had strong perspiration of the feet with bad odour.

His wife, who accompanied him informs us that just as she had to convince him to come for medical assistance, so she has to help and stimulate him in his professional career, because any difficulty upsets and discourages him, leaving him without any wish or desire to fight on. On the other hand he is very conscious of the exactness of his work, to an abnormal extent, even for small details that create in him sense of culpability.

The picture is now very well understood, thanks to the wife’s description which reveals to us an obsessive patient, totally diminished in his personality.

His characteristic picture is:

Conscientiousness about trifles
Obstinate
Aversion to consolation
Worse through cold
Sensitive to cold in head
Starting in his sleep
Offensive perspiration of the feet

This characteristic syndrome pertains to Silicea which is the constitutional similimum of the patient.

Natrum muriaticum has, as in the case of this patient, the aversion to consolation as an outstanding characteristic, because he has hate and anger as a resentful person, while Silicea repels it because, being insufficient, he does not want to be pitied.

A symptom must be understood in its functional relation within a personality and never as an isolated phenomenon.

The principal difficulty in making a homœopathic diagnosis is precisely the tendency to give a preponderant clinical value to an isolated symptom without, many times, referring it to the whole case.

Case 5: A patient 45 years old came to see me complaining of Psoriasis, which started in both shoulders eight years ago and in two months had spread all over the body in the form of big patches. He had consulted many physicians as well as homœopaths without any favourable result.

His symptoms were very few and he explained that otherwise he was feeling very well. He could not affirm if cold or heat affected him and he practiced open air sports which made him feel better as he found it necessary to neutralize his sedentary work in a bank as an employee.

Investigating in his inner feeling I found that he feels very much for even the smallest offense and could not tolerate any little observation from his superiors or companions. For this reason he pays the greatest attention to his work and he is known by his companions as a person very careful about little details connected with his work. Besides, he confessed that the sight of blood upsets him and also that he is easily affected by emotional scenes which provoke in him weeping.

His appearance is that of a tall, strong man, ready to smile and very friendly.

With this picture I came to the conclusion that this patient’s personality was integrated with the following symptoms:

Timidity
Inclined to weep
Easily offended
Conscientious about trifles
Better in the open air
Worse from wet weather

It was very easy to repertorize with those symptoms and to find that Pulsatilla was his similimum.

At first glance it was impossible to see in this patient, a tall, strong and manly looking man, a case of Pulsatilla, but the investigation of his personality produced repertorizeable symptoms which proved the exactness of the diagnosis. The result of the treatment confirms this because after five months of treatment with two doses of Pulsatilla 200 and 1M the Psoriasis disappeared completely and that was 14 months ago.

The first doses produced in him a diarrhea which lasted four days, after which he moved regularly considering that previously he had been very constipated. A remarkable happening which I came to know during the course of the third consultation was that the patient had also greatly improved sexually, so much so that he now felt much more potent than he had been for many years.

Repertorisation is one of the best ways to discover the similimum and is indispensable in the majority of cases, but under the strict condition that previously the physician has comprehended that patient’s personality, and has traced very faithfully the authentic mental and general symptoms, to the language of the repertory and the materia medica.

Case 6: A woman 30 years old consults for repeated boils and intensive pustulous acne in the face, having been submitted to several treatments without any positive result. Her picture presents flushes of heat, very sensitive to heat in general, clothes, weather, sun, very disturbed by clothes on chest or back, wish for iced drinks, sensitive to knocks and great itching on the scalp.

She did not show any mental symptoms. At first glance one would think of a Phosphorus case, but as in all cases when there are no explicit mental symptoms we must investigate the patient’s way of living, the conduct and the family history. Her mother had died when she was only ten years old as the result of a fibroid operation and on that occasion a syphilis was discovered in the mother’s blood which induced the physicians to give the girl specific treatment with Arsenic and Bismuth during eight years.

After the mother’s death she went to live with an aunt for whom she developed a great love. After four years the aunt married and now has two children of her own. Our patient changed her character, becoming aggressive, sullen and bad tempered, and immediately boils began to appear all over her body and simultaneously she developed an aversion, very pronounced, towards her cousins, whom she cannot tolerate, making family life quite impossible.

No doubt jealously is the determinate symptom in the picture of this patient integrated by:

Jealousy
Worsened by clothes
Worse from heat
Flushes of heat
Desires iced drinks
Ecchymosis

Phosphorus was excluded from the diagnosis in this case determined by uncontrolled jealousy. Lachesis was her remedy although she has an intense desire for cold drinks, this being a less important symptom as her personality was very well defined.

It always is the characteristic picture which determines the homœopathic diagnosis, but this picture must be defined by the mental personality.

Case 7: A woman 73 years old with intense rheumatic pains, who improved to such an extraordinary extent that she made a complete recovery from a state of serious illness.

She had long suffered from Rheumatoid Arthritis which kept her prostrated with acute, burning, piercing, irregular pains in nearly all her joints; violent cramps in the legs and feet; intense pruritus of the skin with erythema intertrigo in all the folds; profuse sweating of face and neck, specially at night, so that it was necessary to sleep with the head wrapped in a towel. Excessive heat with marked intolerance of room temperature, confinement, lack of air and warm clothing; voracious craving for jam and sweets; vaginal heat and pruritus, and great general weariness, with sudden lameness during morning hours, for which she took alcohol or sweetmeats.

This picture definitely indicated Sulphur at the first glance, and this prescribed by a competent homœopath, as were also Kalmia and Lachesis, after the failure of the first remedy. But it was evident, as happens very frequently, that this case was not very well examined, mostly in her mental state.

Effectively she has serious lapses of memory; occurrences of the same day were remembered as of many days past; she had hallucinations of hearing, thinking that someone was calling her, used to see large rats running, and all her life she had an extreme terror of darkness which, four years previously, had caused her to rush out from a darkroom, breaking the left thighbone. This extreme fear of darkness had been her essential characteristic since childhood, remarked by the whole family.

So we now have the determinative symptom of this case, fear of darkness, which is the head of the characteristic totality of the symptoms of this patient. This picture was:

Fear of darkness;
Sees faces that peer at her from behind bed;
Sees large rats running;
Thinks someone is behind her;
Weakness of memory for proper names;
Weakness of memory for what she is about to say;
Worse from heat;
Worse from warmth;
Worse from sun;
Desires sweets;
Incontinence of urine, from getting cold.

Repertorization showed very evidently that Medorrhinum was her remedy. Calcarea carbonica was very similar to her mental state, but Medorrhimum covered the whole case not just as a nosode, considering the patient psychosomatically strongly sycotic, but as the exact similimum. Neither Calcarea carbonicum nor Medorrhinum have incontinence of urine, from getting cold.*

For several months now, this woman is walking normally without any pain and her hallucinations have completely disappeared. I am waiting for the clearing up of her constitutional background which probably will give the syndrome of Calcarea carbonica as shown by the repertory.

The mere historical record of the psycho-physical symptoms of a patient does not determine a good homœopathic prescription, but the synthetic grasping of the characterological personality, resulting from clear characteristic symptoms, that is to say, clearly understood as function of the person. The similarity is not in the symptom but in the special co-ordination of the symptoms of the particular case.

The theory of chronic diseases was developed by HAHNEMANN after Homœopathy had failed to cure radically the patient who had been treated only for his actual disease in its acute manifestations. He realized that he had to study the symptoms in their totality corresponding to the entire life record, in order to identify the constitutional basis underlying the tendency to relapse into acute states or to determine the actual pathological disease.

Homœopathy does not cover symptoms or syndromes but tries to understand the patient in his intimate idiosyncrasy, in order to find out what really has to be cured in him.

Homœopathy must be included in the broad framework of analytical, experimental medicine as the Medicine of Synthesis, founded on the fact that the organism reacts to disease in a coordinated manner as a biological entity, and that the reaction can only find its like in a single medicine having similar complex of symptomatic coordination. Pathology can never provide the elements for individualization as these solely derive from the dynamic function of the personality.

But in order to grasp the real symptoms, it is necessary to discover the patient’s authentic psychic reactions including his general symptoms through the camouflage of a defensive elaboration that many times he tries to hide.

We have seen a female Sepia, for example, carefully hiding her disaffection, apathy and indifference, projecting onto her husband her own feelings of aversion, saying that it is really he who does not love her, that he has withdrawn his affection, that he is cold, unloving, and intends leaving her. Inclusively, to preserve her self-esteem, she hides her sexual frigidity, the genital bearing down and the whole complex of signs that show her physical weakness which can produce in her intentions of suicide which also she hides.

* In Synthesis Ed 5 (1993) p. 813 Calc has been given by VITHOULKAS: KSS

But the experienced homœopath will know how to discover the authentic psychological picture, in the presence of this patient who abruptly begins to weep during the consultation, expressing more by her attitude than by her words, the struggle she is having in order to control her aggressive impulses which she does not accept, and which are directed against her husband and her children, from whom she would like to escape, in order to take refuge in a hostile solitude without possibility of consolation.

We have heard many times an Arsenicum patient declare that he does not fear death. But afterwards he shows timidity, that he believes that he will not get cured, that he has a presage of his death, or that he will surely not survive any acute sickness which he might contract.

I have seen many Lycopodium cases hide the characteristic symptoms of their hepatic dysfunction precisely because the anxiety which they felt in their stomachs was produced by the impossibility of contradicting their wives, to whom they were strongly attached in a neurotic dependence conditioned by an old inferiority complex.

I have seen several clergymen, Pulsatilla cases, refuse company and prefer solitude as they want all the time to be under the protection of God because they have an abnormal feeling of abandonment, forsaken, which constitutes their true mental symptom in accordance with their general symptoms. If I had strictly considered their wish for solitude and their refusal of company, without discovering their hidden sentiments of abandonment, I would have mistaken the diagnosis, based on the repertorization of false symptoms, and that very likely would have led us to Natrum muriaticum, a remedy totally opposite to Pulsatilla as regards their mental state, but similar in general modalities such as worse from heat, wish for open air, desire for sour things, etc.

The characteristic totality of the dynamic symptoms of the psycho-physical personality given by the comprehension of the patient through his character, his affections, his hatreds and aversions, habits of life, profession, emotional accidents, diseases, intoxications and everything which constitutes his personal history, give the picture of his chronic disease condensed in that characteristic complex......

This characteristic complex represents the totality of the symptoms of the patient, the clinical synthesis of the morbid processes and so the real expression of the primary vital perturbation which dynamically produces the actual pathology. It is this synthesis of the clinical problem that the Homœopathic diagnosis points to, with the clear conscience that Homœopathy only seeks to cure the chronic disease in its etiological and constitutional aspects and not in its terminal physiopathological manifestations, which are its consequence.

In that way, Homœopathy understands medicine in all its dimensions, incorporating a dynamic clinical view of disease, embracing the entire man from the mental and general symptoms, which arise from the dysfunction of the mesencephalic and cortical centers, where the identification of a personal picture is given .

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VITALISM AND THE LAW OF CURE

Before undertaking clinical practice, it is of the utmost importance to acquire firm philosophical foundation as well as a faith in homœopathic doctrine. Many homœopaths have failed because they thought clinical practice to be more important than an understanding of the basic principles.

In the United States, birthplace of many great masters of Homœopathy, HAHNEMANNian medicine declined when these masters began placing too much emphasis on the successes and failures of treated cases in their teachings, while neglecting to instill an understanding of the law of cure at work in each patient.

Constantine HERING was perhaps the best prescriber in the United States, but of the hundreds of physicians that attended his lectures, very few could follow in his footsteps. Most of them lacked his clinical perspective and thus were not as successful in their prescribing. Calvin KNERR - HERING’s foremost student, who later became son-in-law and the author of the well-known Guiding symptoms told me personally that he had never known anyone with so remarkable an intuition for prescribing a remedy as HERING. But at the same time, KNERR said, no one was as meager in explaining how he had made his diagnosis. HERING’s intuition, based on his knowledge of homœopathic philosophy, enabled him to quickly perceive the essential symptom picture of each patient.

In the art of clinical diagnosis, as in any other applied art, there is an untransferable personal and psychological process. Science is analytical and discriminating in so far as the facts of nature are concerned, but the synthesis that links those facts depends on the researcher’s ability to perceive the unity that particularizes all organized beings.

This awareness allows the homœopath to comprehend the patient’s whole personality.

It is the result of subconscious workings where reason and emotions come into play, yielding what has been called the clinical eye, which every practitioner with an authentic calling can and must develop. There is a general agreement on following the Hippocratic vitalist tradition. The intelligent force that coordinates vital activity and repairs damaged structures was called enormon by HIPPOCRATES and elan vital by BERGSON (1859-1941). HAHNEMANN fathered the law that describes its workings and the MONTPELLIER school developed this concept philosophically, coining the term “Vital Force”.

The Galenic school (GALEN AD? 131-201) has received the seal of approval of Pasteurian dogma. Seeing the germ as the essential cause of disease, the Galenic school produced several generations of materialistically minded physicians, trained to be exclusively concerned with finding and eliminating the germ, virus, or toxin as the visible and specific cause of disease. What they ignored was the importance of the dynamic response of the organism in its attempt to resolve the morbid process.

Unfortunately, the backward thinking that led to the rejection of the vitalist concept of disease is not the product of some external influence or agent, but the activation of the organism’s adaptive response.

Life consists of unceasing dynamic activity; that is why human beings maintain their organic and personal integrity. When faced with environmental factors such as heat, cold or humidity, or with emotional factors that threaten its integrity, the organism strives to maintain its mental and physical homeostatis, that is to say, its wholeness as a living unit. This dynamic equilibrium is unstable, giving rise to anabolic and metabolic currents that cause the constant destruction and regeneration of cellular tissues in an endless and irreversible process. Thus, molecular changes occur in the whole organism in such a way that an individual is not the same as he was a few days ago. An ocean wave that we see coming towards us twenty meters away is not the same wave that drenches us moments later on the beach. The water molecules have transmitted motion from one to another in succession, thus forming that particular shape which we call a wave. However, millimeter by millimeter, every molecule changes on the journey. The wave has been transformed, leaving behind only a form that identifies it as such and which makes up its individuality.

It is the same with human beings. Human individuality has less to do with atoms, molecules, cells and tissues than with the activity of a structure created with a sense of life identical to the law that rules motion in the universe. Human individuality has a purpose, a vital sense that moves towards metaphysical unity. This is what makes an individual a person not the peculiar synergy of organic functions. Nature is the perpetual transformation of never-lost electrons in cycles of contraction and dispersion that form an indistinct part of a mineral, a plant, an animal or a human being. Energy is never lost, only transformed.

Paradoxically, death is the most positive aspect of life, and metaphysically necessary, because dispersion is essential for the continuity of vital motion. What dies is the illusion of autonomy of the being that lives as an individual, without having gained awareness of his place in the totality of existence. Surely, any atom in the body has lived in another being, animal, plant, mineral or star and will continue to live in another individual after the dispersion of the body. Our death as individuals will be inevitable if we fail to fulfill the highest purpose of existence, which is to come to the realization of cosmic unity, from which new syntheses of ever-changing forms and structures come forthwith. As PARACELSUS (1493-1541) said, there is a complete correspondence between the microcosm and the macrocosm.

These speculations lead one to conclude that life has a meaning that can be understood by those who can perceive the law that rules the motion of cosmic energy. The law of cure that gives meaning to biological phenomena is the same law of contraction and dispersion that rules the movement of earth and the stars and gives meaning to cosmic order. Without this absolute law in the whole of creation, there would be chaos no less in the life of a flower than in the life of a star.

The human being is creation’s most perfect synthesis. A few months after birth, a human being materializes a congenital dynamic disposition which, according to HAHNEMANN, is of miasmatic origin. This miasm is a morbid constitutional tendency predisposing the human being to a particular pathological destiny, as yet without emotional imprints, but inevitably tending towards final dispersion or death. As humans, we grow from childish self-centeredness to the psychological maturity that permits our connection with the whole and with the death of our egotistic individuality.

This progression from center to periphery, that is, from embodiment in a living unit towards dispersion or death, is what we call the law of cure. We are born to die. Day by day, hour by hour, we use up the potential for vital energy that we bring with us at birth, as if an electrical battery were being discharged. Catabolism wins over anabolism. Tissues regenerate but nevertheless harden and dry up; atheroma and conjunctive tissues replace healthy cells; skin - a kidney spread out on the body’s surface - ages while eliminating waste. Like a current of energy that discharges itself from the center, our life cycle ends with the dispersion of the elements that make up our physical body.

Even though the organism tries to counteract this integration, it never succeeds completely in neutralizing our final deterioration or in restoring tissues to their state. There is never a restoration towards wholeness. There is always the organic deterioration that ends in a descent into old age and death. The purpose of the law of cure is not to prevent death, but to allow death to come smoothly and normally, thus allowing the individual to fulfill the highest purpose of existence - to become aware of his metaphysical relationship with the whole of existence.

And here we enter a philosophical terrain which is closed to science, but which must concern the physician. Does human life have a meaning, a purpose, or a knowable goal?

Yes it does, and moreover it cannot help but have one. The moral implications of the problem of chronic disease cannot be overlooked by Medicine, now forced to revise the mechanistic thinking that led it to pathological dogma. The human being is not separate and autonomous, but an entity that depends on a transcendental spiritual self with a role to play in the universe. The human being develops a moral consciousness, connecting him with other human beings and with the essence of all things.

This process of personal growth takes place under the same law that regulates adaptation to the environment, organic equilibrium, inflammatory reactions and disease. The whole human being, body and mind, acts as a unit in every case of disease, coordinating the effort to restore the defenses so that the individual may freely fulfill his cycle.

For example, when we have an inflammation, the congestion, local hyperthermia, immobilizing pain, diapedesis, phagocytosis and abscesses, together with the fever, fear of death, accelerated heartbeat, perspiration and digestive and urinary changes, all entail a total participation of the organism under the direction of the spontaneous law of cure - leading to the outward elimination of morbid energy by expelling waste products through the skin, mucous membranes and other excretory organs. Fever is a stimulation of the processes brought into play by the organism to solve, with the appropriate temperature, any physical or emotional crisis.

Thus, in normal life as in illness, the organism employs the same resources to maintain its homeostasis or determine its cure. These resources differ only quantitatively - in their physiological rhythm - but not in their nature. They are part of the same process, the Hippocratic vis medicatrix naturae, or healing power of nature. Everything happens as if an ordering intelligence acted unconsciously in the organism, to preserve it from premature dissolution as a biological unit.

Medicine must develop this concept of life in order to find that therapeutic law which also rules the motion of vital energy. When medicine considers disease to have a mere physicochemical substratum, this inevitably leads to the degeneration of the human being, by the careless suppression of the different ways in which disease seeks outward release. What materialist medicine calls disease is no more than the pathological residue of a morbid dynamism whose first expressions were suppressed with local treatments, failing to understand that what had to be cured was that very dynamic disposition.

It is in this deranged, hereditary, dynamic disposition that it is necessary to solve the problem of the miasm, that is, a vis medicatrix naturae that relates to a structure damaged by past transgressions of the law of cure, and therefore insufficient in its tendency to heal. As HAHNEMANN pointed out, suppressing the outward releases which reflect the workings of the law of cure will have blocked the vital flow in the internal organs, thus predisposing the whole individual to premature decay. When the organism expels metabolic toxins in the form of eruptions, suppurations, diarrhea and colds, which the liver, kidneys and glandular system have been unable to metabolize due to a diminished functional resistance, such outward releases must be respected because they indicate an attempt to protect the vital organs.

The basic problem in medicine is that of suppression - that is, blocking the fulfillment of the law of cure. All that art and science can do is rectify the Vital Force, so that it can cure the dynamic origin of the morbid process. Only homœopathic remedies can do this, provided they are prescribed according to the similarity between a curative reaction experimentally produced in a healthy individual, and the natural reaction of a diseased individual, both being vital processes and expressions of the same law of cure. The fact that suppression inhibits the Vital Force is clear in neurotic cases, where emotional factors play an essential role.

The word “emotion” means a moving outwards, a liberation of feelings. When emotion is repressed or sidetracked from normal consciousness, that is, from the discharge of its psychic energy, it is transformed into physical disturbances. Pathological symptoms are surrogate expressions of repressed emotions. Any physician who has reflected on the problem of human disease will agree that all pathological phenomena have a meaning - referring, in the last analysis, to impulse to action that have been repressed in either a remote or a recent past due to moral conscience.

It has been said that our civilization’s culture in regard to sex has created a punitive moral conscience provoking exaggerated depressions which can lead the human being to serious neurosis, from which he may be liberated by social movements such as existentialism, new wave, and others. I do not personally believe that such a disturbance exists in moral conscience, which I consider to be the healthiest psychological resource that the human being has. It is to moral conscience that humanity owes its spiritual evolution and the possibility of transcendence, as well as the development of religion, art, ethics and law.

What happens is that human instincts and impulses have been deranged in their dynamic origin - they have been disturbed by a miasmatic affection which compromises their functional tendency towards transforming the individual into a mature person. The cell destroying tendencies of Syphilis and Sycosis make demands on the psyche which moral conscience cannot accept, thus causing it to fail. FREUD maintained that this is due to an individual disposition, probably organically conditioned. Clearly, the formidable resistance of many neurotics undergoing psychoanalysis, as well as the prolonged cures necessary in most of these cases, is due to this imponderable factor which FREUD called individual disposition, whose previous correction is essential. The conscious and mature repression of sexual and aggressive instincts produces sublimation - that is, the transformation of selfish energy into impulses towards knowledge and personal development.

On the other hand, instinctive suppression due to punitive coercion, not allowing emotional frustrations to be processed, determines the neurosis that FREUD described as the result of the failure of repression. The correctly chosen homœopathic similimum will provoke a deep curative reasction, unblocking suppressed unconscious contents and restoring the law of cure, allowing a healthy emotional concentration of psychic energy onto a single goal. A mere external treatment of symptom pictures and the elimination of crises will lead only to suppression - that is, as we have said before, to a severe transgression of the law of cure.

The physician, no matter what therapeutics he employs, must be aware that every symptom is a part of the patient’s life context.

Each symptom has a meaning to be unlocked, once a complete understanding has been gained of the pathological expressions and behavior of a unique and untold human life.

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HOMŒOPATHY – THE ANTHROPOLOGICAL MEDICINE*

Dr. T.P. PASCHERO

Journal of The HMAI, Oct-Nov, 1977

It is absolutely necessary that responsible homœopaths should immediately, clearly and decidedly expose the reasons why Homœopathy has changed the practice of its original principles. Since HAHNEMANN and even during his lifetime the fundamental rules have been tergiversated, from a strictly dynamic and total point of view of the morbid process to plurism, complexity, physiologism, etc. which, with the use and indiscriminate repetition of similar remedies, still exist as expressions of a practice totally estranged from the idea of sickness as a process ruled by the law of healing. Too much absorbed by a mechanistic medical formation, today’s homœopath has forgotten that the law must be strictly applied to the sick, the mis-function of the individual as a human person and not to the physio-pathologic mechanism or the physiology of the organ or system. Only by considering the patient’s total characteristic and following without interference development of the healing process activated by the stimulus of similimum, is how Homœopathy fulfills its mission. Anything done in the name of pathologic or nosologic diagnostic, of the so called difficulty in finding general characteristics, of the impossibility to discover mental symptoms, of the necessity to improve the patient’s health without a strict reference of present conditions to the constitutional background everything done in the examination of symptoms without reaching the clinical synthesis of the case, thus breaking the principle of Totality, is a transgression of the Law of Similimum which means a violation of the Law of Curing. It is the patient who has to be cured not the sickness; always bearing in mind that man is not sick because he has a sickness but that he has a sickness because he is sick. This fundamental aphorism of Homœopathy although so well known is not always completely understood by doctors who demand a scientific Homœopathy adhered to the physiopathologic mechanism and dedicated only to local characters.

No consideration is given to the fact that the analytic study of physiochemical mechanism, magnificently achieved by experimental medicine, and Homoeopathy based on physiological pathogenesis, is not enough information therefore to correct the vital law of those mechanisms which give sense to human life.

Every atom, every molecule, every cell, every organ are vital unities reciprocally subordinated to an organization which conditions the individual as a complete being and he at the same time is subordinated to coordination and law that rules the entire cosmos.

Homoeopathy which is not directed by this principle of unity and the law of healing which is solely governed from the vital centre of the individual can never claim to cure the patient but only to repair vital unities considered autonomous structures, thus frequently causing a real suppression.

The homoeopath must have a clear and definite idea of the Law of Healing which is only a corollary of the Law of Similimum.

To transgress this law is to disown Homœopathy.

In normal life as in sickness the organism uses the same resources to maintain the homœopathic equilibrium or to cure, resources that only differ in the quantitative exaltation of its physiological rhythm but never in its nature. They are unquestionably the same and identical vital processes, the same and identical vis medicatrix.

Everything happens as if a regulating intelligence acted unconsciously in the organism, to prevent the premature dissociation which would impede the fulfillment of the life cycle of a biological unit which in its turn takes part in the harmonious development of a universal and vital plan, whose purposes are inscrutable to mankind.

Medicine must mature this profound idea of life to find its therapeutic law, which can be no other than the same curative, and spontaneous law, which governs the activity of vital energy. Everything done otherwise following the ingenious ideas of physico-chemicals of anatomo-pathologic mechanism considered as the inalienable substratum of sickness, will unfailingly lead to disaster and the degeneration of the human being by an indiscriminate and sometimes a grave suppression of the exonerating manifestations of sickness. What materialist medicine calls sickness is only the pathologic discord of a morbid dynamism whose first exonerative manifestations were suppressed by local treatment, without understanding of the fact that what had to be cured was that dynamic disposition causing the pathology.

It is that anomalous dynamic disposition inheritance, constitutional or diathesis, which has to be treated therapeutically to solve the problem of a vis medicatrix, which has risen from a structure stigmatized by archaic transgressions of the law, which is insufficient in its dynamic curative impulse and which HAHNEMANN called miasma. HAHNEMANN said, with irrefutable reasons, that suppressions of the curative law in its exonerative and superficializing activity, had detained and stagnated the vital current of the internal organs causing such misfunction in the whole economy of the individual as to predispose his premature pathological destruction. When the organism violently expulses in eruption suppurations, diarrhoea or catarrh, metabolic toxins which the liver, kidneys and the glandular system have been unable to metabolize by functional meiophragia, such exonerations that imply a preservation of vital organs, must be respected.

The main fundamental problem in medicine is that of suppression which consists in therapeutically detaining the curative law of vis medicatrix in its spontaneous function of a superficialization of the morbid process.

All that art and medical science can do is to correct the vital force for it to fulfill its own law that is to say the cure of the morbid process in its dynamic origin. This can only be done by homœopathic medicament, diagnosed precisely by the similarity shown by the curative reaction experimentally originated in a healthy man with the natural reaction, which is shown in case of sickness. Both vital processes are expressions of the same law of healing.

The idea that suppression consists of an inopportune detention or inhibition of the activity or centrifugal movement of the vital forces, is clear in neurosis when emotional factors play an exclusive role which is being more and more (even thought to be by recalcitrant organicists) the origin and cause of an ample sector of pathology.

The word emotion means an outward motion, liberation or exoneration of feeling which, when checked or deviated from normal conscious elaboration, that is to say, from the discharge of its psychic energy in its corresponding action, transforms itself into vegetative somatic perturbations which become pathologic conversion of the repressive transgression of the law of curing. It has been proved that the pathologic symptoms are substitutive satisfactions for repressed feeling and we have further proved with any other doctors who have thought about the problem of man’s sickness, that the pathologic phenomena have a meaning and that this meaning is ultimately related to impulses for actions which have been repressed by archaic or recent interdirections of various kinds dictated by the moral conscience. About this we must make a brief commentary, which is very appropriate for us as doctors and homœopaths.

It has been said that the educational culture of our civilization on sexual matters has created a rigid and punitive conscience which by provoking exaggerated repressions have originated a more serious neurosis, form which it tries to emerge by a revindicating movement of modern youth which in the name of existentialism, new order, etc. tries to free its instincts from the suffocating restraints of the so-called bad conscience. We don’t believe in the existence of such anomaly of the moral conscience, which we consider the soundest psychic instance of which man is constituted for it is to this that he owes his spiritual development, also to the birth and expansion of religion, art and ethics. What happens is that the affective instincts and impulses are vitiated in their dynamic origin, as we have formerly said, perturbed by a miasmatic and vibratory affection, which endanger its function of tending towards the transformation of an individual into a person.

Syphilis with its destruction of cells and sycosis with its tendency towards the anarchic cellular carcinocinosis, determine psychic requisitions that moral conscience cannot admit, thus causing the scrupulizing and humanizing repression to fail.

The repressive process, not suppressive of the sexual and aggressive instincts causes sublimation, that is to say the transformation of energy in the service of egoistical interests into impulses towards understanding and personal betterment, meaning psychological maturity.

The homœopathic Medicament-Similimum correctly prescribed and well awaited for in the profound development of the curative action that it provokes, can unlock the unconscious and suppressed contentions and restore the Law of Healing which will allow a healthy emotional catexi or the adequate metabolization of emotional experience always by exoneration or superficilization of the process.

To understand the patient’s mental life, his behaviour, his psychic reactions, his childhood, his sensations and feeling is to understand him to the core of his morbid process, the disarhythm of his vital energy, the regulating centers of the biology of the body and organic mechanism, which means to say his animic perturbations.

We must affirm that this clinical position is not psychological but the result of a complete clinical view of the human being which comprise mental symptoms the physical reactions of the organism and the general symptoms which with psychic symptoms express all the reactivity of the patient as a biological unit.

The Platonic-Cartesian concept, which separates soul from body, has been overcome. Within the scope of culture the psycho-physic unity of the human being is now accepted based on the idea that the soul is the form of the body by which this body becomes human, in other words the substance of the body realizes itself as a human because it has a soul which confirms it. The psyche as a formative principle is in the whole body and constitutes the act of that body.

By this concept, created in the profound feeling of the great clinical doctors of all times, medicine has been able to evolve since the anatomist era which come forth in the Renaissance with Padua de Vesalio’s school, passing through the positivist bacterian stage with the natural scientific culmination of the century which boasted of never having found a soul under the surgical knife, until the present era, in which the need of the integral and humanist view of the patient has caused anthropological medicine to crop out. One passes from the idea of the person, of which actual psychosomatism is one derivation, implies the incursion into the purest subjectivism and remains totally prohibited to mechanistic medicine. The only medicine that looks upon the sick person integrating all his physical and psychical values is Homœopathy which, due to experiments with drugs in the human being, has been able analogically to present dynamic, reactional descriptions of perturbations in the individual as a person. The homœopathic physician must be able to understand very well the psychologic personality of the patient.

In all patients there takes place, as a background of their organic perturbations, the evolutionary process which goes from infantile autism towards altruism, from a conscience governed by a principle of pleasure towards a vivenciation of the principle of reality. Man is a spiritual being with biochemical organism. He has the biological and physiological need of his organism but also a sense of eternity and a necessity for transcendency, which ties him to the transcendent ego. He feels that he is part of a whole and that his individuality is not real, that he is part of a cosmos or of a superior intelligence, which guides his destiny under the same laws, which rule creation. He feels all this but cannot understand it because he lacks supreme omniscience. He is a limited being but must search his own truth which implies the existence of his profound unity with the cosmos. He can achieve this truth by intuition or by experience.

Every human being, of any mental class, must undergo this formative process of psychological maturation whose neurovegetative hormonal, organic and pathological connotation are absolutely evident to those with clinical experience. This process in which an autist and dependent boy becomes a free man and the selfish girl a mature woman, is directed in time by the same Law of Centrifugal trajectory, from the centre of the periphery, which in space directs the emunctory exoneration of morbid energy and toxins. It is a state of conscience that is acquired and conquered as soon as the individual restores his internal harmony with the universal order, overcoming ambivalent conflicts between instinctive constitutional pulsations and the interdiction of his moral conscience.

This is the real function of medicine as HAHNEMANN postulates when he asserts that the doctor must liberate the patient from what hinders the fulfillment of the high motive of his existence and help him to change from an egocentric individual into a human person as a spiritual being opened to the world and centred out of his natural limitation, with a sense of community which connects him with the whole world.

The intimate vocation or wish for transcendence is not individualization but personalization that is to say, realization who has overcome captative and destructive autism, to become a dative and altruistic being.

According to HAHNEMANN’s conception of sickness in man, the “Psora” is the morbid fundamental disposition of the human being as a consequence of the rupture of the harmonious relationship between microcosmic man and the macrocosmic universe and the dynamic condition of permanent susceptibility. It is thus that KENT has also been able to assert that the principle determinative symptom in a clinical description is the one with the disturbance of the instinctive will or affective impulse where there exists a conflict between regressive tendencies and those which drive the individual towards the spiritual liberty which transforms him to a person.

If we investigate about every patient we shall always find in an ostensible or latent form, actual or biographic an anxiety problem (psoric anxiety), which tells us of this profound wish for personal realization, always in conflict with the instinct of autoconservation. They will tell us of tremendous affective frustrations, misunderstanding and despair, which is nothing but an insuperable nostalgia of the protection and security and the other end of the conflict; the need of realization, of fulfilling vague and confused desires to be somebody, of being useful, to mean something to others, of being able to give and give oneself in an attitude of surrender, often dramatized by an uncontrollable feeling of guilt.

This conflict, basis of all psychological medicine, whose ultimate end is, on one hand, Schizophrenia, or the absolute loss of affective capacity and communication and on the other hand the extreme mystical renouncement, emphasizes mental symptoms by means of an emotional biography, intelligently understood.

The homœopathic doctor profoundly imbued in the homœopathic doctrine of chronic sickness, knows this cannot be cured unless it is treated in its essential aspect, primary anxiety.

He can only diagnose characteristic mental symptoms if he bears in mind the basic conflict of the process of maturation or personalization, which the patient suffers in a different and totally particular form.

He will not then elaborate a simple homœopathic individualization of the case studying the general symptoms but a real personalization of the patient, that is to say, a comprehensive knowledge of the singular way in which he registers, through his emotional life the process of humanization or transformation into a person.

In this way he will be able, not only to correctly identify determinative mental symptoms on the basis of a characterological comprehension of his patient, but to establish his hierarchy if he is in a very regressive state of evolution, as, for example, egoism, fear, derealization symptomatically expressed by anxiety of conscience, despair, obsessive conscience and lack of trust in himself, etc.

This is how, giving primacy to psychic symptoms in the total characteristic aspect of the patient, homœopathic medicine, is in contact with the essential aspect of the process of adaptation to reality, or personal realization, that he must fulfill, becoming then a true anthropological medicine, that is to say, medicine of the person.

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Journal of The HMAI

Source of the articles

1. IJHM, Vol. 26. No. 3 September 1991
2. IJHM, Vol. 26. No. 3 September 1991
3. JAIH, Vol. 79. No. 4 December 1986
4. THE HAHNEMANNIAN GLEANINGS, June 1980
5. IJHM, Vol. 8. No. 4 July 1984
6. THE HAHNEMANNIAN GLEANINGS, February 1960
7. THE HAHNEMANNIAN GLEANINGS, May 1968
8. THE HAHNEMANNIAN GLEANINGS, April 1970
9. THE HAHNEMANNIAN GLEANINGS, December 1966
10. THE HAHNEMANNIAN GLEANINGS, January 1977
11. ZKH 30, Mar/Apr 1986
12. THE HAHNEMANNIAN GLEANINGS, November 1967
13. SIMILIMUM, Vol. No. 1 Spring 2001
14. Journal of The HMAI.

* Paper presented at the International Homœopathic Medical Congress, Athens, 1976.

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