Best Way to Teach the Student How to Approach and Study the Materia Medica
Read at the I.H.A., Bureau of Materia Medica, June 1929.
By Alfred PULFORD, MD ( homeopath, 1863-1948)
It is the impossible for any mind to remember every symptom of every drug or even every symptom of any single drug in our materia medica, but it is absolutely necessary that the successful physician should have an acquaintance with as many drugs as is humanly possible, and, above all, a knowledge of how to approach and study each and every proven remedy. No teacher can teach one materia medica, the very best that they can do for us is to teach us how best to approach and study it, and it is to this end that we shall attempt to take up this task.
First of all it is necessary, if possible, to find the essential symptom or symptoms which must be present in EVERY case requiring the remedy under consideration. This, or these, when found, will be easily remembered. If this cannot be done our next step will be to find that group of symptoms which is characteristic of the drug under consideration, which symptoms form the skeleton of the drug upon which the rest of the symptoms are built. Then we must find as many symptoms as possible of undoubted reliability which appear under no other known remedy than the one under consideration, and lastly, all those symptoms for which the remedy under consideration is the undisputed leader. In this way one studies from the center or heart of the remedy to its circumstance or from its most important to its least important symptoms. For the rest of the less important symptoms the repertory will be of the greatest importance.
In prescribing intelligently and accurately the first and most important consideration is a knowledge of how to approach and study the patient to accurately elicit such symptoms as are absolutely necessary for the proper selection of THE indicated remedy. This is erroneously styled “how to take the case”.
We are going to take up our task today by introducing Aconitum napellus, the common Aconite, monkshood or wolf’s bane. Aconite, which is a deadly poison to the human, has been eaten by elephants with impunity, showing that animal experiments with drugs for the purpose of prescribing for the human is useless and of no avail whatever.
The leading symptom which is a constant companion and requisite to an Aconite case is AGONIZED TOSSING ABOUT. According to the late DR. T. F. Allen this is essential to a case requiring Aconite and therefore should always be present when Aconite is indicated and prescribed. It is the characteristics, the red strand that runs all through the cases requiring, Aconite. These characteristics or red strands should ever be prescribed upon alone, unless they occur under no other known remedy or in a case with a paucity of symptoms, but they will serve in an emergency to point to the rubric in the repertory to confirm you finding. If it is not the ONLY remedy mentioned the rubric will give you the most logical list of selected remedies with which to compare.
Our next step is to get a list of those prominent symptoms which are the most constant from which to form a skeleton, just as one would take the common constant symptoms in a disease to form a diagnosis.
Under Aconite the skeleton symptoms would be: Agonized tossing about intense anxiety and restlessness, feat, especially of a crowd or of death, expression of fear and anxiety, dry mouth bitter taste, great thirst for cold water, full, bounding, hard, rapid pulse, and a dry hot skin, even during the chill the head and face are hot. Thus we get a skeleton of Aconite easy to remember.
In relation to other remedies having anguish, anxiety and restlessness, Aconite is one of degree of intensity just as Mercurius cor. is one of degree of intensity in tenesmus. The expression of fear is only equaled by that of Stramonium. The fear of a crowd is equaled by no other remedy. So we note from this, then, that if Aconite removes only the restlessness, the other symptoms remaining, it is time to stop the Aconite at once and look for some other remedy for that particular case. Also, when Aconite has caused the dry hot skin to perspire, it should be stopped at once. A peculiar thing about Aconite is, that while its taste is bitter to all things, water becomes an exception. Aconite and Stannum metallicum are the only two known remedies having bitter taste to everything except water.
Now that we have gotten the red strand and skeleton of the remedy let us take a glance at those symptoms that are covered by Aconite alone, found under no other known remedy, so that in cases with a paucity of symptoms we may get a strong clue to the remedy needed.
We have fear of death in pregnancy; pain in the forehead above the eyes from cold, dry wind; inflammation of the eyes from the same source; sensitiveness of eyelids to cold air; tearing pain in teeth aggravated after going to bed; inflammation of the stomach after cold things; pain in the abdomen extending to the chest during stool; burning pain in region of umbilicus; involuntary urination with thirst and fear; cutting pain in the chest after the chill; sense of boiling water poured into the chest; tingling of the foot extending upward; fever with one check red and hot, the other pale and cold.
The above group of symptoms, as far as known, belong to Aconite alone and are of the highest grade and therefore characteristic of the drug. We do not remember of their eve having been stressed or especially mentioned by any one, but whenever and whenever they occur they are final so far as the remedy goes, as well as important, but they are only final or prescribing purposes when there is a paucity of symptoms. In such cases a knowledge of them is very important, also they are important deciding factors when they occur in cases where two remedies run close together.
Our next group in enlarging the sphere of Aconite will be the symptoms for which Aconite is THE leading remedy. they are: Delusion that one is about to die; nervous excitement; fear of death, predicts the day; vertigo, sways to the right; boiling sensation in the head; stitching pain in eyes from motion; redness of eyes from injuries; sensitiveness of the eyes to cold air; face fees enlarged; pain in sound teeth; in teeth in raw, or cold dry wind; blood oozing in the throat; stools looking like chopped spinach; tension in the bladder; ineffectual urging to urinate in children; inflammation of the ovaries from suddenly checked menstrual flow; sharp pain in the uterus; palpitation after fright; sensation of hot water in chest; coldness of the toes; numbness of the left forearm, of the legs on sitting; fever alternating with chill at night. A knowledge of this group is quite important, especially in the absence of an available repertory, and very important, when a repertory is available, as a guide to the proper rubric where other remedies may be found for comparison.
It is, also, a deciding factor when in doubt about two apparently similar remedies, as a group of symptoms in which one of the remedies has the most leaders would undoubtedly fix the choice on that remedy.
The outline of this remedy is by no means final but it is a means of enabling one to find the proper lead into the heart of the remedy, and it gives the student a proper clue to the gateway of the path that will lead him intelligently to the goal he seeks.
In the absence of the above knowledge the repertory will be an important factor in the forget for one moment that the repertory is intensely mechanical and that you get out of it exactly what you put into it. It cannot sort out and classify your symptoms for you. Many collect a mass of symptoms, put them through the repertory for their failure. It is just as necessary to have accurate symptoms to put through the repertory as it is to be able to prescribe without it.
After the student has learned how to approach and study the materia medica, his next and most important step is how to approach and study the patient in order to be enabled to elicit those symptoms peculiar to the patient and his ailment. This is erroneously refered to as “taking the case”. You have already taken the case when you have accepted the patient, therefore “taking the case” does not mean anything and is a misnomer.
The greatest factors, then, in the science and art of to prescribing are, first and greatest, how to approach the patient to study him and elicit only that which bears on his individual case, in the absence of which knowledge the rest is useless; second, a knowledge of how to approach and study the materia medica, which is equally as important as the preceding; and lastly, how to use the repertory. It is our opinion that this latter has been a little overly stressed, especially to the student early in his career. The majority of the rubrics are too lean to give any degree of accuracy, therefore more stress should be laid on the materia medica in order to get a better foundation of the drugs.
A word as to the term similimum. The term similimum to us, does not really mean anything. It is simply the Latin for MOST SIMILAR. Any remedy may mean to many minds the most similar whether it be THE indicated remedy or hot, or, in the language of Pope, “Tis with our judgment as with our watches, none go just alike yet each believes his own”. So it is with those who prescribe, each is positives he has found the similimum (the most similar remedy) yet Nature fails too often to verify their judgment. We would like to suggest to this body that they cast aside blind precedent and coin the word SIMILIMUM as a changed form of the English word SIMILAR and defined as THE INDICATED remedy, which admits of no comparison, and which includes the correct potency.
We have yet to learn the relationship of the various potencies to the various forms and grades of disease, as well as to the various temperaments and sensitivities. We must consider whether the ailment is purely acute, or an acute outburst of a deep chronic ailment, or subacute or purely chronic in character, and how to apply our remedies to each. All those phases must be accurately known before we can become, or even consider our selves, thoroughly masters in the science and in the art of prescribing.
Gall stone colic
Here is a practical application of the skeleton of the drug to a case requiring Aconite. Mrs. N., age 45, robust and plethoric, a former resident of Cleveland, was the victim of what her allopathic doctors diagnosed “gall stones”. She had frequent attack of colic. The best they could do was “hypodermics”. It took her from three days to a week to recover from this treatment. Just before 8 p.m. , March 22nd., the telephone bell range and a male voice asked if we would make a call on a lady who was suffering severely from an attack of gall-stone colic. We put a half dozen remedies in our vest pocket and at promptly 8 oclock the gentleman called for us. As 8:05 we were at the bedside of our patient. As we entered the sick room we heard a pitiful plea for a “hypodermic”. Here is what we found and saw: A plethoric, robust woman of 45 years, writhing and tossing about the bed in the greatest agony; extreme fear and anxiety depicted on her face; calling continually for water; dry, hot skin; full, bounding, hard, rapid pulse; high fever, etc.
There could be no doubt of the remedy. We put a few drops of the 30x in one-quarter glass of water and gave two teaspoonfuls without asking any questions. In just five minutes by the watch she lay back on the pillow and heaved a sigh of relief. Before the end of 10 minutes she entered into out conversation and her agony and tears gave way to smiles. We stayed until 8:25 when we left with the injunction that no more medicine be given until absolutely demanded. At 8:30 we were back home. No more medicine given than that single dose. We have seen the lady several times since and there she been no return of the colic.
DR. MACFARLAN: About three years ago I made a re-proving of Aconite but it was only in the third potency. It is a very quick acting drug. I found two symptoms, referring to modalities which are very characteristic of Aconite in the third potency. I am only speaking about the third potency. One of these symptoms, and it has never been stressed in materia medica, is aggravation after sleep. I have found this much more indicative of Aconite than of the ophidia. The other modality is aggravation on motion which is very characteristic. I think it is much more characteristic of Aconite in the low potency than perhaps of Bryonia. Another indication which I find in the third potency of Aconite is the fact that drinking increases the thirst. I have never seen this in any repertory; I got it from practical experience. Drinking water actually seems to increase the thirst. Aconite seems to have more effect on the rapidity of the pulse than it does on the fever in the third potency. Also I discovered that when you fail to cover them they stop sweating. Covering seems to increase their sweat very, very markedly.
DR.C. L. OLDS: I think that Dr. Pulford did not mention one very characteristic thing to Aconite, as least I have found it such. When newborn babies do not urinate in twelve or eighteen hours, Aconite will invariably bring about natural flow of urine.
DR. G. ROYAL: I have enjoyed this excellent paper, but there is one thing that he left out, individualization, which is a corollary of our law. It is just as necessary for the student in studying materia medica as it is in prescribing. How you are going to teach the student to approach the subject depends altogether on the individual. Let us take for illustration, someone comes from an allopathic school. She has had her anatomy her definition, her pathology, her diagnosis, etc. This is the basis of her viewpoint. This other individual hasn’t had any information at all. He comes as a novice to study materia medica. What books will he study? You certainly can’t give them both the same took.
Let me tell you what my experience is. I would put into the hands of one Dr. Hughes Pharmacodynamics, and into the hands of the other Dewey’s Essentials of Materia Medica. I would say to the one, “Read, study, think. Read Hughes through”. I would say to the other, “Study Aconite. Don’t you read the book”.
One of the most important things I learned in college was how to read. The professor said, “Read a sentence, then a paragraph, then down a column, then down a page”. He would say, “Royal, I will give you two minutes to read ten pages, and then I will give you five minutes to tell me what you saw in it”.
Individualize your students and give them the information just as you would your patient. Give them the indicated remedy.
DR.C. M. BOGER: I am going to say some things that are not exactly orthodox. The first thing is, don’t study too much materia medica, and don’t study too hard. The thing to do is to watch, not your approach to the patient, but the patients approach to you. That is the thing. See how he approaches you.
What is a symptoms complex? A symptom complex is another term for what the women nowadays call ensemble. It is a co- ordination of certain things. The first thing you want to do is to get all your symptoms co-ordinated and put in order. This isn’t a very rapid process. Then hunt them out. If your predilections in the line of study are much toward this remedy or that remedy or some other remedy, you have already prejudiced the case. You want to look at it from an unbiased standpoint and you can’t select a similimum with your mind already prejudiced as to what the patient should have or shouldnt have.
DR. A.H. GRIMMER: This is a wonderful paper. It is a matter of viewpoint a good deal. Some of our doctors didn’t quite hear what Dr. Pulford was trying to put over, which is the fact that whether you use the repertory, prescribe inspirationally, or from your knowledge or materia medica, there are a few points that are essential. The first is the ability to reject the symptoms that are common to all provings, the symptoms that are common to diseases, as therapeutic guides. Of course your remedy must have the symptoms that are related to this disease, but they are not going to be the guiding symptoms for your individual case. When he spoke of the great characteristics that he spoke of those mental states, those, rate unusual sensitive characteristics that labelled this case an Aconite case, or a Belladonna case. I like that point very much, it is the essential thing. We overload our students, as Dr. Boger says. Give them the essentials; start them out with the study of sickness; let them known the things that are common to every sickness so they may known the things that are uncommon. When they learn the common things the uncommon ones stand out much better and so they understand the materia medica and are able to apply it better.
CHAIRMAN STEVENS: I would like to ask in speaking of Aconite, how the symptoms that come under Chamomilla, one check red and the other pale, compare with the one you spoke of under Aconite. Will you close the discussion, please?
DR. A. PULFORD: Certain children will have red cheeks on one side from hyperaemic conditions which will pass away, but the Aconite red cheek will not pass away when the pressure is taken off, and the other cheek will be pale and cold. I have found this to be true time and again, and it has been a leading symptom in a great many Aconite cases.
Furthermore, I intended to bring out that every remedy has its own individuality. When I look at Dr. Royal, I don’t have to see whether he has gray hair or black hair or whether he stands five feet; I know him by his characteristics, and each remedy has its similar characteristics. When our materia medica is fully completed out prescribing will become a very simple thing. You will see the remedy as you see the individual.