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Dr. Eichelberger and his "Paper Cases"

- An introduction by homeopath Luise Kunkle MA


While the late Dr Eichelberger's teaching, which was partly by his publishing paper cases from his own practice, are very well known in German-speaking countries, he seems to be totally unknown in the English speaking world and globally by people that read English as a second language.

Dr. Eichelberger was a M.D. who started out with regular medicine and by the path of complex medicine ended up with using to a very great extent the "classical" approach, with which he remained for decades, right up to his retirement (perhaps - I do not know - his "retirement" coincided with his recent death at age 80+).

The paper cases are rather unique in homeopathic literature for the feature that they are made up in the way of "find the remedy", i.e. the case is presented and then the reader is left to work on the case and choose the remedy s/he thinks the most suitable. In the following part, Dr. Eichelberger tells the remedy that cured, describes the details of that cure and discusses the reason for his own choice. Unique is also that in the four volumes of his book there are around a thousand of those cases.

The cases below are all taken from vol 2.

These paper cases differ from the quizzes and also from cases taken from Nash or any other homoepathic text - and most of all of those taken from seminars.

In all the above, the cases were very much selected for some specific aspect: to highlight a remedy, to show the superiority of small remedies to polycrests, to show keynotes, etc.

The Eichelberger cases were by contrast to a great degree "taken as they came in": before publsihing them in his books they - or most of them - had been presented to his students by circulars. This was something akin to to-day's online courses. He had to fill in those monthly circulars - any of the busy homeopaths on this list and everywhere would agree with the problem of finding a lot - more than 1000 cases - to write up over time. There is no way for all that much selection and they truly are a mixed lot

This is their main weakness and also their main strength. The paper cases presented in seminars and books are so tidy and logical - and we are very surprised when we meet the cases of normal clinic reality.

Eichelberger's cases are much closer to real-life cases, coming into the practice with all their masses and messes of symptoms.


In a telephone conversation Dr. Eichelberger gave me his permission to post his cases. This was shortly before his death, and he was very pleased with the prospect of his work being exposed to international audience - even if only on this small a scale.

I kept postponing that work, but after Eichelberger's death, remembering his pleasure at the idea, I thought I would go through with the project of posting at least those I had already translated. He did me a lot of favour by being able to learn from them in his books, and I thought I would return that favour by doing something he would have liked.

I also think that some of the homeopaths who, for the reason of not being able to read German, have no access to these texts, may derive some benefits from those cases.

And last not least there is alway the hope that some publisher of English language books may read them and find it worth-while to have the books themselves translated and published in English.


Some explanations to start out with:

1
For complicated cases, Eichelberger gives a questionnaire - 32 pages long - for the patient to fill in, in most cases before the first consultation.I.e. he will give or send this questionnaire when the patient makes an appointment or will give it to take home after a first short interview.

The way he explains the questionnaire:
Of the umpty symptoms and signs in one of those questionnaires, only a small percentage will turn out to be of any usefulness and all the others are disregarded. but the patient has lots of time to think while s/he is filling in this quest. and symptoms will be included that otherwise, during the comparatively short interview, may be forgotten.
And it may just be one of these forgotten symptoms that will turn out to be of prime importance.

2
Eichelberger mostly uses LM 18 - he uses it as starter and keeps up with it all through the case.

He gives it in a pre-determined manner: he tells the patient how often to use it- mostly once a day or twice daily. It seems he has no problems with aggravations. He gives it right through amelioriation and also through reactions, aggravations. The latter two, of course, within reason.

I know there is a lot of controversy about this kind of dosing. However, this is the way Hahnemann instructed in his 6th Organon. While some homeopaths read his instructions differently, this is just bending Hahnemann's statements to their own opinions! (Their methods may or may not be better, but they are not based on Hahnemanns instructions in the Organon, 6th edition.That it is the true interpretation of what Hahnemann wrote is borne out by the way Hahnemann himself prescribed in his own praxis - hundreds or thousands of cases to be found in his casebooks bear this out without any doubt (exceptions confirm the rule)

There is also controversy about Eichelberger's starting with LM 18. While Hahnemann himself generally started with LM 1, he did not in the Organon specify to do so. his instructions are merely to use the lowest potency - which probably means "the lowest potency the homeopath is going to use of this remedy in this specific case"; for he repeatedly and strongly insists that the next potency should be higher - he does not say how much higher.

Eichelberger considered himself a Kentian, and the paper cases are all done with Kent's Repertory. (in his last years of practice he also used computer software - but the cases listed below are previous to that).

There may be homeopaths reading those cases who think it preposterous on my part to assert that Eichelberger's method was Kentian or even Hahnemannian.

These cases were originally translated for an online study group. Some of the people asked me about mental symptom - asked one way or other.

Eichelberger quite rarely uses mental symptom - only where they are well-pronounced and srp - or sometimes for confirmation.

For all that he was a died-in-the-wool Kentian and follower of Hahnemann - as he claimed to be.

To those who doubt that I can but give the advice:

1
Get Rima Handley's book "In Search of the Later Hahnemann". Disreagard what people, e.g. David Little and Peter Morrell have said about it, disregard even what Rima Handley said. Instead go to the end where there is a translation of one of Hahnemann's Paris cases in its entity and see for yourself on what symptoms he prescribed - and how. It is quite a typical case. And then in the light of this re-read the Chronic Diseases.

2
Read Kent's "Clinical Cases". The people who have computer software probably can find them right there. For the others you may go to
http://www.homeoint.org/books3/kentclin/index.htm.
There you will find papercases from Kent. Study them and you will - IMO - agree that Kent's statements about mind symptoms and "treating the patient, not the disease" must have been misinterpreted by his followers or by to-day's homeopaths, or he must have spoken "with forked tongue".

But now to his paper cases.

On the format:
My own contributions in the following texts will show up as above.
Eichelbergers text is marked in a different color. This color will in most cases be blue, but it depends on the browser you are using : the color may be anything it likes.
Short remarks (for clarification etc.) by myself will be set off by putting them in square brackets [...]. Round brackets and all other signs are Eichelberger's .
I will often leave out portions of the text - but only where they are not relevant to the case (Eichelberger often intersperses remearks on regular medicine, homeopathic philosophy etc)
In my translation I have tried to catch just a little of the flavor of the way Eichelberger Expressed himself - so any incongruences, as far as English is concerned, may be for this reason.
The "solutions" will be found below the respective case.
(the notation pg ... means the page in the Kent repertory where the symptom can be found)


I will, however, start out with a case that is not one of "find the remedy". It will demonstrate Eichelberger's method.

Case 1

Man, 49 years old, wants a consultation by telephone. He had had trouble with his bladder for 3 weeks. This is ok again now; but now he has some other problem.
Because he had thought that a pain in his groin, which he had since that time, would pass away with the bladder disturbance, he had done nothing about it. So now his question: what could be done about this pain in the groin, which was still present.

On questioning:

To be exact, he had felt this pain already 8 or 10 days before the bladder business, namely after he - being a cabinet maker - had had to move a heavy cabinet. Also - perhaps this could be done at one stroke - he had had for 3 weeks abdominal pain of a kind he had never had before and also a different, diarrhea-like stool and bad appetite. He supposed that he had got cold feet during the moving and disturbed his stomach by that.

I told the man I would do something for his groin to start out with. The remedy was obvious. Because of the cause [causa]:pulled muscle or tendon when moving furniture, Rhus tox had to be tried as the first remedy, only later I was going to give him something for the belly trouble.

The patient got himself Rhus in LM 18 and after 2 to 3 days the pains in the groin were gone. He called, told me this, and now wanted a remedy for his abdomen. Because of the cold feet in the anamnesis I did not make a lot of diddle-daddle and had him get Dulcamara. I thought the causing symptom sufficient, approximately: +abdomen, pain, cold, from taking, page 557+ and I added the rubric +Rectum diarrhea, cold, becoming after, page 611+. I did that sort of routine fashion, for I had a leading symptom and, if this one remedy did not fit, there would always be a next one to give.

So I gave Dulc LM 18 and learned after one week that nothing had changed. But the patient told me on the phone something new: He said he had to correct himself, for he had told me something wrong about his abdomen: He did not think that he had gotten cold, but - and his wife had provided this clue - this trouble he had got exactly at the time that he had taken the remedies for his bladder. He had had the tablets prescribed for it 3 weeks ago, and he had used all 40 of them. The belly had started acting up some days after he started to take the tablets.

Now the starting point was different: but this time also a Causa greatly facilitated finding the remedy. On taking Nux vom the abdomen was ok again after a very short time. The remedy was prescribed in LM 18.

Firstly it is easy to find the fitting remedy when there is a known cause (Rhus-T for the groin as a remedy for "pulls" and Nux v. as remedy for states caused by [allopathic] remedies; both these remedies worked immediately.)

Secondly, there were in this case not only two different kinds of problems, each which each needed its own remedy, it also turned out that the patient did not have the slightest intention to have his belly trouble "suggested" away by the wrong remedy. He very meekly waited for the curing remedy to get better.

But one has to put down the symptoms and signs in a nice sequence - this is no different in the simplest case or in the most complicated one - and one has to take them apart to get the idea of the respective illness.

Our example showed that 3 different factors had to be dug out and be taken into account, if one wanted to treat homeopathically:
a) the pulled groin was to be seperated from the sub-acute bladder problem
b) the abdominal illness had been judged a separate disturbance only because the patient had told me that they were separate (he gave "cold feet" as a cause)
c) without the man remembering the taking of the tablets, this abdominal trouble would not have been taken care of that quickly.

When we experience things like this, we can well imagine that many of our failures have no other reason than the difficulty to get on top of the symptomatology of the respective case, to put the seperate symptoms and signs into their proper place, and to get from the patient everything that is possible to get.

This is different from not or only badly mastering the taking of the case as as such. Because such difficulties come up after a case has been well taken, when all possible symptomes, signs and modalities have already been found by expert methodology and noted down.

But it is not possible wildly to "go hierarchising" after this work. There too, the gods have put sweat before success. We have mindfully to get a full picture of the connections, knot together the mental ribbon, we have to be able and competent to conceive the IDEA of the illness, the way it is necessary for the homeopathic considerations; with one word, do our job "to the laws of the craft" [lege artis].


[Here the "find-the-remedy" cases start.]

Case 2
(in this case a questionnaire was used)

The patient, female, had filled in a questionnaire because of a migraine headache that had been troubling her for the last 15 years, She had come into the clinic in June 1981. She got a remedy potency LM 18, notified me after 6 weeks that she was feeling pretty well . After that there was no further report from her until about a year later, when she wrote to make an appointment for her daughter. At that time she wrote "You have prescribed for my migraine a remedy that has helped me excellently"

The questionnaire yielded the following:

Migraine headaches for the last 15 years. 8 years ago strumectomy [removal of thyroid gland].
The headache on the right or left side - especially on the weekend. Light and noises aggravate. The pain is bursting, stinging-boring etc. Face pale during headache.
Tendency to wandering/moving rheumatic complaints. Little thirst during fever, likes to be uncovered then; stool knotty; a lot of flatulence, fullness, especially after eating; eructations of air. Copious urination during the attacks; lack of vital heat, easily chilled. Ravenously hungry during the headache; desire for outside air; fat and heavy food not well tolerated; often adds salt to food at the table [in the German way of cooking, salt is usually added to the food during preparation]; desire for sweet; unrested after sleep; lunchtime nap not well tolerated; menses every 3 weeks. Tendency to headache towards end of menses; consolation is rejected. Wants things to move all the time.

Since I did not get any further report from the patient herself, I do not know what happened to the other complaints mentioned in the questionnaire, whether they also got better.


Solution and discussion:

This is the moman with the migraine headache of 15 years duration, which was pretty typical.By changing sides, one time on the left, one time on the right, it typified itself, above all however the patient.

The valuable symptom is the never varying consistency of this modality of lateraly - this has been so for more than a dozen years.

The same applies to the rhythm. This periodicity is also remarkable: once every weekend, and this also has been so for a long time.

This symptom by the way is even better than a rhythm coinciding with the menses cycle, which co-rhythm happens very often with the migraine-illness of women.

Light and noise aggravate - this is not unpleasant to us, but much more valuable is: ravenous during attack.

Well, you don't find that in Kent - there is a much milder version: appetite increased, headache with.

The different kinds of pain, also the pale face we can forget - as far as simile is concerned. The "urina spastica" - (spastic urination) on the other hand is a "pretty good" modality.

Now to the other symptom that could be had from the questionnaire: there are the wandering/moving rheumatic pains, a good to very good symptom for in our remedy *LAC CANINUM*, which is prominently part of its symptom picture ; also menses every 3 weeks - which ist just too frequent.

The knotty stool, the flatulency, the eructations of air, the desire for fresh air, the badly tolerated lunchtime nap, the not-being-rested after sleep, the rejection of consolation, the desire for sweets, the non-tolerance of heavy, fat food are not of such quality to make us waver in our selection of the "milk. most of the those latter symptom are e.g. part of almost every questionnaire, they therefore are not typical for the patient.

Desire for salt is a bit more relevant. Easily chilled also is not bad. With these symptom also Lac-c OR Lac vaccinum defloratum - is present. There is not much difference between those two. The IDEA (the mental bond) is "animal milk" - this is the deciding factor. Headache at end of menses - this is also present in this remedy - which shall suffice now.


This was a classical case. The people in the study group had no difficulty with it. By contrast I had had plenty, years before. It was the first of Eichelberger's paper cases I did - and I though it preposterous that he "mixed the 2 milks", at the end. I am still not sure why he should have done so. Nash once said that 3 good symptoms build a stool on which we can firmly sit. Not all symptoms have to be present for a good fit. It just did not seem very straightforward thinking - and as a matter of fact I rather think that Eichelberger selected Lac c. on the 3 prominent symptoms he first mentioned and then, at publication, he threw in the others just for good measurement. This is one thing about his cases - probably not about the ones presented here, but about plenty of others: I am almost certain that in many cases he had prescribed on previous experience with the remedies for certain disturbances and on "intuition" (which may be the same thing). At publication time he tried to find more similarities - and quite often this shows. As I said in my introduction: these cases are not as "smoothed down" as most cases in the homeopathic literature and on seminars.


Case 3

It's a case where E. did not - IMO and his also - cover himself with glory.

He says himself that some other remedy may have done a faster job - I can only agree. More than that - it is not at all certain that there was a remedy action at all - the way the case went it might have run the same course without any remedy at all - in spite of the symptoms being very similar.

This is a good point to be brought out for critical evaluation. Very often amelioriation or cure may have come about the same way without any remedy, at least in acute cases. This has been brought to our attention often enough by the regulars - call it placebo effect or whatever.This also applies to aggravations, however. Aggravations of a condition may not be due to a remedy given - they may mean a progress of the illness, which would have occurred with or without the remedy. It may only show that the remedy did not work - not that it made things worse.

Phone call during the night at 3.30 by a worried father because of his 17 year old daughter's illness:

The girl had collapsed the second time already on the toilet; she had suddenly had started vomiting and diarrhea with this collapsing being an additional feature.
I immediately ask about the food. The man only knows that the patient had eaten some fat ham in the afternoon, of which the other members of the family, however, had also partaken without any adverse effects. However, the daughter could not even think about this ham, for then she would feel revolted. On further questioning: There are abdominal cramps und unbearable headache as well as terrible thirst, cold sweat and deadly pale face.

Which remedy did I tell the father to give her right away?

He had it in the house in 6x potency by coincidence - he is a patient of mine.

I had her take the drops every 10 minutes, and half an hour later I got a phone call. The vomiting and the gagging had got better. At the time no diarrhea; temperature Celsius 39,8, measured in the armpit. At 9 o'clock the next morning the father called again as directed: No furthers incidence of collaps; but still high fever, loose stools and headache "the head is red-hot"
Because of the definite improvement of the entire condition I directed to keep up with taking the drops, 4 times a day.

By no means everything went magically away within hours, instead it took several days until everything was back to order. Even more, 3 days after the beginning there occurred a diarrhea of the bloody-mucous kind; however, all in all, the diarrhea had noticeably lessened. I still gave a high potency of Merc-cor, which did not do anything. The temperature slowly but consistently went down and after one week she felt ok. The patient had lost 6 kilos during that time.

What were the leading symptom in this case, what the remedy??

This is a case where one might think that a "better" simile might have been found. I was not really sure of that and did not dare - except the for the attempt with Merc-c. - to experiment with some other remedy, even though the one chosen did not show a super-quick result. Perhaps it would have worked better using the LM 18, twice daily 5 drops.


Solution and discussion:

First of all it is important to state that it is quite impossible to give, in homeopathic treatment, in a routine fashion a homeopathic "Kreislauf"-remedy ["Kreislauf" is a common German expression, for which I have never found an equivalent English expression - it means more or less a combination of blood circulation, blood pressure] even for the most impressing weakness of "Kreislauf", i.e. loss of consciousness and collapse.

We see this "weakness" within the *total frame* of the respective illness and encompass with the simile the "Kreislauf" in the same manner as e.g. any possible accompanying anxiety or restlessness. Thus, we do not give one remedy for fever, another as circulation-remedy, yet another as remedy for diarrhea. We take all these symptom and signs together and prescibe a remedy that covers the totality of the disturbance.

This weakness of Kreislauf combined with the diarrhea is, of course, for us a leading symptom, inasmuch as we will select one of those remedies that have this kind of weakness in their picture. Thus we have the rubric collapse, to find in the Kent repertory Generalities, collapse, pg 1350, the rubric fainting, pg 1358 and also the rubric weakness pg 1413. This adds up to quite a number of remedies; the remedy needed by this patient has to be one of them.

For selection we need further signs and modalities.

First of all we take a look whether not inside the "Kreislaufschwäche" itself there might exist modalities that are valuable enough for us to think they might indeed give the chance to reduce to a few the many "Kreislauf-remedies.

To do this we should be very much aware of the consequences; for, by choosing the symptom "Kreislaufschwäche" and by the choice of a second symptom (which is supposed to reduce the remedies to a few), we will eliminate a number of remedies, which will then be taken completely away from our consideration for the present illness. Thus the second symptom has to be "extraordinary, peculiar, of high quality" - of such quality, in fact, that we may affirm: only such remedies that also have this 2nd symptom can be right for this case of illness.

This second symptom is the combined vomiting and diarrhea - together with which or caused by which this weakness of "Kreislauf" is happening. We have a rubric on pg. 532, (stomach, vomiting, diarrhea in), which is exactly what we need. Looking at the remedies of the "Kreislaufschwäche" and those of this last rubric together, we shall find some that both those rubrics have in common.

After this reduction there are still quite a few remedies left, which have to be further differentiated to find the most similar.

Of course we have already considered the fact that the daughter had eaten fat ham in the afternoon. All the other members of the family had had no problem with it, but the patient cannot even think of it "without her getting the horrors" This is an interesting symptom or rather way of reacting - but quite uncertain. There are many remedy for "loathing"- pg 504 - stomach, loathing of food, but it cannot be decided at this point whether this "loathing" is there by itself, or whether it was caused by the modality "from too fat or even spoilt food". For the loathing itself there are so many remedy that this sign does not help us with the choice of a remedy.

The patient complains of terrible thirst, an excellent symptom in this case (pg. 429, stomach, thirst, extreme). There are many remedies, ours has to be one of them, but it cannot be found at once by this rubric.

So far we cannot tell the father which remedy to use. We have to use a "shortcut" - but a legitimate kind of one: we know that the weakness, the unconsciousness, the collapse happened in connection with a state of combined "fever, vomiting and diarrhea" and look for a remedy by an abbreviated method. There exists a rubric that expresses exactly what we are looking for: generalities, weakness, diarrhea from (pg. 1416) and even better: pg.1359 faintness, diarrhea after, and, exactly: Mind, unconsciousness, diarrhea after. The only remedy there is Arsenicum album.

Shall we rely on these few rubrics?

We may rely on them, for now all the pieces fall into place: the severity of the symptoms, the cold sweat pg 1296, the onset at night, the terrible thirst, the loathing of food, everything "is" Arsenicum. All at once, everything fits together just as in a puzzle. Arsenicum was the simile, the father had it in the house, it could be given immediately.

Whether or not Ars. prevented further collapse is not the deciding question. The question is whether Ars is the remedy for this illness.

Next morning we find out that the high fever is even higher, that in a way it only really came on after taking the remedy, that the head "glows", the diarrhea is still there, there are abdominal cramps. Yet, Ars. is still "similar", it has the important symptom, it also has the hot head (with cold feet) pg 122, the headache (unbearable, meaning distinct) during fever (pg 140) - the headache would hardly be caused by the diarrhea - the abdominal cramps during diarrhea (pgs. 560, 557)


Case 4

A woman, 56 years old, comes into the clinic because of a skin eruption she has had for a little less than a week. Strangely, she feels quite ill: she is tired and fatigued, no appetite. This cannot be explained by the skin trouble per se, so my nex question is: What happened before the eruption? And promptly the answer is given that 14 days ago she had had "bronchopneumonia", for which the usual sulfonamide drugs had been given.

Whether or not this had actually been a case of pneumonia I did not feel like verifying. To me it was enough that her general health had remained poor since then, and that the skin had become troublesome and the eruption had started, and this quite massively on her entire body, with a nasty itch that only got better when the patient scratched herself to bleeding. "Looking at it that way" the skin trouble got quite a different look than originally shown. Why??

[I never did fathom the meaning of that last sentence with its "why"]

Following the idea of the process of this illness I prescribed a remedy LM 18

I got the telephone report that, starting immediately after, not only the skin started getting better, but also the entire feeling of illness disappeared after a few days and she got back to quite normal.

What was the basic idea of this case and what was the curing remedy?

Solution and discussion:

This case was not taken only because of the week-old skin eruption. An eruption that had existed for only one week may disappear with or without treatment of any kind. It offers no possibility for a critical evaluation of the effectiveness of a remedy.

Strange about this case is the poor general condition of the patient, which cannot be explained by the skin disturbance alone. The question therefore is: "what happened before", in a general way, and not so much in relation to the skin problem itself.

This little trick leads us to the solution right away, also as far as the local trouble is concerned:

2 weeks ago a "Bronchopneumonia" had been diagnosed. As immediate follow-up I asked the question about the therapy for this lung affection. And the answer was- - as was to be expected - that sulfa drugs had been given.

Well, we should not be too critical of that: this is OK as long as there are no reasons to doubt the effectiveness of such treatment without bad side effects. In other words, if the woman gets well and remains so after such an illness, including treatment, the matter is no longer interesting to us. However, if she is not healthy, we take the liberty to diagnose an artificial disease, i.e. we shall have to throw into the pot of the artifacts the troubles coming up after the pneumonia, as there were: bad general condition, loss of appetite, the spontaneously reported feeling of being ill and, in this case, also the skin disturbance.

If we do not do this we miss the idea of this patient's illness and cannot influence it homeopathically in a reasonable and effective manner.

.............

Confirmation for our considerations is the observation of the patient that the skin trouble did not start before the allopathic treatment and even more the fact that she had been told once before that she had a tendency to allergy. Thus, the eruption was a skin reaction to allopathic substances she is allergic to. On top of this, there was this pneumonia that had been attacked with those substances, a pneumonia that had not yet been digested by the patient. To talk even more plainly, we could say: it was a bronchopneumonia too quickly suppressed, because remedies for lowering the fever had been given - and those remedies had, in addition, caused an allergic skin reaction.

Sequelae of "suppressed" pneumonia we find pg 836, the expression "neglected" pneumonia we take as being synonymous. The skin disturbance by a remedy is the 2nd important symptom.

Lastly we have the scratching until it bleeds. There are rubrics pgs 1309, 1311.In those also Sulfur - which was the curing remedy - is listed. This symptom is of much lower value than the other two, however.

Some other remedy to consider might have been Nux. V: But fundamentally it is quite far off the mark, for it does not have the suppression/neglection process, which, after all, was the main symptom in this illness.

As Eichelberger himself says in one of the next cases, he has a preference for Sulphur - a trait he shares with Hahnemann and v. Boenninghausen. The above is one of his typical "Sulphur cases". This why I chose it.

He chooses that remedy above all - and almost exclusively - for the bad effects of suppressed infections. Interesting is his equalizing "suppressed pneumonia" with "neglected pneumonia". This does not seem justified - at least not on first glance. A neglected pneumonia would actually be one where nothing had been done. On reconsideration,however, a pneumonia (or other infection) treated by antibiotics/sulfa drugs might be just that: neglected. The person is by those drugs rushed back to his normal life, with all its strains and stresses - instead of being nursed through it.


Case 5

Woman, 49 years old, for a little less than half a year has been suffering with her legs, as she expresses it. This is the reason for her visit. Both legs burn, especially the part between knees and ancles, it is more like a cold burning. Since then the patient also notices that some scars on her legs - which she has had for years, some since childhood (caused by accidents) are getting "dark red" and "raised".

She also feels a funny kind of heat in both lower extremities, although those feel normal on touch. Because of this heat, she wants to uncover her legs at night. At the end she told me that she cannot keep her feet quiet any more - especially in the evening. The woman has moderate varices.

What were the symptoms, signs and modalities that - by par 153 of the Organon - made me choose my remedy?

The drops were taken in LM 18.

After about 6 months she returned to get the remedy again. She had got rid of her trouble after some days. Lately she had felt this restlessness again and also the burning. The scars had not again got red, - they had even "reduced by half their size"


Solution and discussion:

This kind of illness is quite rare. For this reason, the symptom, signs and modalities are of especially great interest. When do we ever have a patient who comes to us complaining of burning of the legs and unpleasant sensations of heat together with changes of scars that partly have existed since childhood. During the last 6 months they have become "dark red and raised" so the verbal quote. Further details were that the legs had to be uncovered during the nights, because of the heat sensations and that the feet cannot be kept quiet any longer, especially in the evenings.

A reason cannot be found - reason in our sense of cause, "causa"

The leading symptom is the change of the scars - some of them several cms long - on both lower legs, which had never happened before. Becoming red of scars is in Kent pg 1304 (skin, cicatrices, red, become). There are 9 remedy in this rubric. One of them has to be "ours".

The other symptoms serve only to separate this - our - remedy from the others; for this purpose it is not required to search around in the total biography of the woman, IF there are some more valuable symptoms to be found within the recent resp. subacute symptomatology.

And there one has the "heat of the legs" together with the burning and the uncovering of them. This heat has started since the illness; "why" is not the question. We are interested in the phenomena, we do not research "behind" them, but just note them.

We cannot ignore the burning heat. This is a symptom, a shocker, which has to be in our remedy - in its MM. When we now look through Kent for exactly this symptom we do not find anything "exactly exact"

This would be a rubric: Burning heat of the lower legs. This rubric does not exist; we do have something similar: burning lower legs ( extremities, pain, burning, leg - pg 2/625) In this rubric our remedy is not present. But even if it were, it would not mean much, since the symptom is "burning heat" (thus neither the burning nor the heat alone would apply) This may sound somewhat pedantic, but if we are taking the sensation as excluding symptom to differentiate the existing "red-scar-remedies" it simply has to be covered as closely as possible

[it seems that there was an inexact translation of this rubric from English to German - this is why the above may be a little hard to understand. The rubric in German seems to be "burning, lower legs" without reference to pain]

Let's look for pure "heat, lower leg", pg 1012. But this also is not our rubric, no matter whether our remedy is listed or not.

Best covering the "idea of those legs" is to retain the "burning + heat" but - since no rubric exists for the lower legs - use the rubric in the rep that best covers the "idea" of the case [neglecting the exact location], and this is "burning heat, foot (pg 1013). We can be happy with this rubric, since this burning and heat are merely especially at the lower legs, so we cannot exclude the possibility that it also exists at other places on the lower extremities.

Generally speaking, we should not put too much weight on the localization stated by the patient. Much more precise and thus more valuable for us, is her statement about the "hot burning sensation".

In the rubric sensation of burning heat there remains of the remedies "red scars" only Fluor. Acid, which was the curing remedy.

To repeat: Fluoric acid is the only one that has "scars becoming red" AND "sensation of burning heat" The uncovering of the lower legs at night because of this sensation cannot be found in Kent as such, and therefore "easily". One has to browse through the rep and find out whether he offers "similar" rubrics, such that come close enough to the idea of this modality to be acceptable to us.

We find our symptom on pg 1013, burning, sole, foot - uncovers them. This is not exact, since it is not "burning heat" - but will just do, esp. since this symptom is not very high-grade. We still like to see that fluor. acid is in there, thus also has some connection to uncovering the legs.
It's similar with the restlessness of the feet at night. It will do to find fluor acid in the general rubric: restlessness of feet, pg 1188.

We must not forget that all those last symptom and modalities are of relatively low value as far as their individual, extraordinary quality is concerned. If the respective remedy is to be found in those rubrics, we like it, but it not absolutely required that these symptom ALSO have to be covered EXACTLY.

As few as one or two leading symptoms can lead a case, of whatever kind, to the homeopathic remedy. The LESS VALUABLE a symptom is, the less it has to be exactly mirrored in the MM; this is reasonable to assume.

............

The concomitant symptom, i.e. that the patient suffers from varices (pg 1223) does of course fit into the picture of Fluor. Acid, but does not serve as the starting point to it.


Case 6

Female patient, 36 years old, comes to clinic because of "gastric ulcers again and again" as she expresses it. She brings with her a filled-in questionnaire. In the questionnaire the following symptom were given: 1962 appendectomy and tonsilectomy, 1958 gastritis; gastric ulcers 1963, 1970, 1977. Also in between, again and again, gastric and other stomach troubles.

Headache often behind the eyes. She is very sensitive to light, esp. sun light. As a child often ear inflammations and coryza with sore throat. In sun has to sneeze, had adenoids. The tip of her nose is always red - the patient does not know any reason for that.

Tendency to bleeding gums. Has fissured tongue "like mapped tongue" (the patient has some medical background). Sore throat often left. Lying down often a little dyspnoea. Palpitations when excited. Quickly "her back gets tired". Often cold hands and feet. Fingernails often show white spots. Stool also sheep dung like... Patient however believes that this is from the many medication she takes.

Sometimes diarrhea after excitement. Tightness around stomach is not tolerated. The stomach pains mostly come on 2 to 3 hours after eating. Eructations of air during her complaints. The pains are in the stomach and right upper abdomen, now have existed afresh for 3 months. They are burning, often accompanied by nausea and extend to the back. Warm drinks aggravate as does warm food. Sometimes she feels as if stomach would hang down. Wants warmth/heat but head cannot tolerate sun. Is chilly [friert] with any pain and with excitement, is easily chilled in any case. Desire for sweet; thirsty for cold drinks, aversion to fat things. Always has had loathing of milk. When fasting stomach worse. Fear/anxiety [Angst] for others,of being alone, in the dark. A pregnancy was normal.

After the remedy in LM 18 the troubles in stomach, in her back and throat region at first aggravated, the patient was "all tensed up". After 5 days of taking the remedy the stomach ache had disappeared, the stool no longer knotty, but she felt some nausea and light general abdominal pains. Meanwhile I had learned from the woman who had "sent" me the patient that she is doing very well. So I sent her the message to get the remedy again and to go on taking it. What was the remedy? I got further news from the patient after 3 months. She confirmed that she had been very well, that she had lots of energy and that she felt "great" I am convinced that this result will hold. If there should be, after a longish interval, difficulties again, this same remedy, with almost absolute certainty, will help again.

Well - it does not have to be like this all the time; but if a remedy was a very good simile - and this was the case here - then, by experience, it will work again promptly if there ever should be a relapse.

Solution and discussion:

The symptoms, signs and modalities that we learned from the questionnaire, which constitute the raw material from which the "more conspicuous (auffallenderen), peculiar (sonderlichen), unusual (ungewöhnlichen) and characteristic (eigenheitlichen/characteristic)" [in accordance with aphor 153 of the Organon - usually called the SRP symptoms]of them can now be considered. Since the patient furnished in the questionnaire all the symptoms there are, we have the base on which we can select the SRP ones of them and can be certain that those (and only those) furnish the base for the selection of the remedy. That means, we can be sure. as much as possible, allowing for human imperfection, that apart from these there does not exist anything further with regards to this patient that is of any significance for our choice of the remedy.

This, after all, is the pointe of working with a questionnaire. We are sure that, concerning a patient who has carefully filled in this questionnaire, no further surprises will pop up, in the sense that a more or less great number of symptoms and modalities will yet come to our knowledge later, very late or not at all.

We have the questionnaire, we have the entire symptomatology, we are certain that we now "know" everything that we need for the selection of the remedy. Nothing further can happen to us. Inside the symptomatology found by using the questionnaire, whatever their kind and quality may be, we shall move around while searching for the remedy. There is nothing else that we need to be interested in. Exceptions only confirming the rule - as always.

From the appreciable nummer of symptoms and signs listed I consider the following to be the "leading" ones:

Warm food and drinks aggravate the state of the stomach. This is peculiar. Heavy food is badly tolerated - well, that is nothing to bowl us over and thus no sign of any specific quality. But that warm things are not tolerated, that is individual - that is a good symptom!

On pages 513 (stomach, pain, hot drinks aggr)and somewhat 561 (abdomen, pain, warm food, after) we have rubrics that are relevant; also on page 515 (stomach, pain, warm food agg) this is a rubric that is exactly right for us. To this we add rubric pg 1364 (Generalities, food, warm food aggr) and also pg 1363 (Generalities, food, hot, agg). The idea of this modality is that EVERYTHING hot aggravates the condition. And we see that there exist several rubrics, the remedies of which we have to consider together. One of them will be our simile. In order to find it, we shall make possible the differentiation using other good symptoms and signs.

A pretty good local symptom is the pain, which always comes on 2 to 3 hours after eating, and this has been so for years. Here the distinctness of the symptom adds to ist quality - pg 513 (Stomach, pain, eating after, 2 or 3 hours after). Fasting brings on complains we find on pg 513 (Stomach, pain, fasting, while). But this is not all that the case has to offer.

There we have the chronic loathing of milk, why should that be? We do not know why, the patient herself also cannot give us any good reason for this loathing - pg 481 (Stomach, aversion, milk).

The patient is afraid for others, of being alone, in the dark (pages 7, 5, 6). Well, nothing fascinating in that, but also not certainly not bad. Similarly being thirsty for cold drinks - pg 484. That fits pretty well into the pattern that warm things (eating and drinking) are not tolerated. There is desire for sweets - pg 486 and aversion to fat foods - pg 480. This also is not shocking but it helps to facilitate the selection of the remedy: These are by no means leading symptoms, but still just within the range of those worthy to be taken into consideration.

The hanging down sensation of the stomach we also note - pg 499 (Stomach, hanging down, sensation of, relaxed). Our remedy is not there, but that is no catastrophe. This sensation should not be considered trivial, but it is only felt sometimes. And since here the pervasiveness (Penetranz)is lacking, the quality of the symptom is lessened.

There is in addition bleeding gums - page 398 and the spotty fingernails - pages 981, 1191; in the latter rubrics our remedy is not included; just very low grade with red tip of nose, 334 - 3rd grade, however, with red nose -also 334. But this last symptom is quite trivial.

Last not least we look for tired back, which sensation is not trivial at all - page 950, (back, weakness)

Looking at these symptoms and signs, actually freely and easily it comes to mind that Phosphorus is the remedy that corresponds best to the pattern of these signs and modalities. The "Geist" of the disturbance, the idea of the disturbance should be most closely corresponding to Phos.

Her stomach got better, she remains feeling well. Last report one year later "Stomach is wonderful".


Case 7

Patient, female, came to the clinic end of October 1977 because of her chronic rheumatism of joints [Gelenkrheumatismus - PCP??] It had existed for 3 and a half years and had been treated with steroids [Cortisone] for 10 months, dosage between 50 and 5 mgs. 1975 this therapy had been stopped, because a neurologist had advised against it. The patient had instead got "Amuno" [Indometacin] which had been stopped again soon after. One year ago the patient had again been started on the cortisones, at first 60 mgs daily, then stepping down gradually to 10 to 5 mgs. For the last 3 months this latter treatment had again been stopped and Amuno alone had been given, of which daily 7 to 8 tablets were taken at the time of the consultation.

Painful are specially the shoulder joints, the arms, the elbow and wrist joints, the knee joints; and during the night everything is at its worst. She likes to be moving, because then everything is more tolerable. Bad it is in the knees, especially getting up from sitting. Also all of the back hurts and is stiff.

After some consideration I give the woman a questionnaire to take with her, and as a first remedy Rhus tox LM 18, selecting this on the amelioration by moving (Kent pg 1045) and the aggr during the night, (pgs 1047 and 1044) and the agg. in the knee joints rising from sitting (pg 1073).

This choice of symptoms for the selction of the remedy was the result of a symptom picture which was completely impossible to get an overall view of from a homeopathic point - without questionnaire. It was the poor attempts to get at the remedy some way or other, some mixture of "sloppiness" and "helplessness", as happens when, from lack of time and a feeling of being overtaxed with such serious symptomatology, one somehow "spaces out" and simply prescribes some homeopathic remedy that perhaps has an affinity to the rheumatic process more often than others.

"Medium mental deficiency" of course, when something like this happens, but who of us has not in some kind of despair tried his luck on some cheap symptoms and signs? To recall: This illness had been treated for years with the most modern remedies. It had been the target of the strongest medical substances that the establishment medicine has at its disposal, and nothing had worked, on the contrary, it is getting worse and worse, and sooner or later the patient will not be able to tolerate taking all those tablets - no more than she could take the previous hormones. On paper all this looks relatively simple - especially when just scrolling over it. A little rheumatism - that can surely be managed. But with the patient in front of you, experiencing that she is a "little heap of misery", who is tortured by her illness (even more at night than during the day), moreover without any therapeutic success- except for amelioration of pain. In addition the fact that all the other kinds of "therapies", the baths, massage, everything that is done complementarily for those kinds of illness, had done just as little to change anything.

Well, discussing the questionnaire 14 days later,the patient mentioned politely that the drops (Rhus tox) had had quite some good effect, but sorry to say ... We know this. There are patients that try to save the doctor's feelings and tell him what happened in a very refined manner; even when nothing happened they will not say so outright.

Rheumatism since spring 1974; 1968 operation for varicose veins. Earlier often headache above the right eye, which has disappeared after the rheumatic illness started. Blood pressure 140/80. Pain in the back esp. during the night. The pains resemble sore muscle after too much exercise [Muskelkater]. Pain from the shoulder region to the hands. Swellings of the knee joints, swelling of hands in the mornings. Always cold hands.

Scarlet fever 1941 with non-persisting rheumatic complaints, which at that time lasted for 4 weeks. For years tendency to costiveness, especially always constipated while travelling. Irritated bladder when feet are cold. Drafts of air are bad for the rheumatism, warmth feels good and is sought for. At rest complaints get worse. At start of moving first strong complaints. The pains are experienced as drawing, stinging, burning.

Against wool the patient is allergic. Aversion to fatty foods. Feeling of tension in the hollows of the knees when walking. Afraid of thunderstorms ever since childhood. Quickly irritated, contradiction is not tolerated.

Before the rheumatism started, in April 1974, there had been an operation for prolapse of uterus and 1969 a hysterectomy/ovarectomy. That happened at age 47, at a time when the patient's menses were still normal. It seems a myoma had been removed, which had caused too long- lasting bleedings. The patient at that time - and before - had felt quite normal. The illness started about 5 years after this operation.

What is to do?

Looking through the symptomatology of this questionnaire, at first one hardly gets any hint for a simile. On the other hand, the important things are definitely stated in this questionnaire, for this q. directs a sort of searchlight into all nooks and corners of a biography of illness, as much as this can be found out by homeopathic principles.

On top of this, the qestionnaire had been answered very well and carefully by this patient, who could be taken serious - the way it is practically always done if someone has been loaded with this labor because of a chronic or therapy-resistant illness. Exceptions just confirming this rule!

So there was nothing more to be learned concerning this case, and the search for the fitting remedy started. Sepia was prescribed, LM 18, based on some symptom that could have justified this remedy. The woman sometimes during the interview started a sudden fit of weeping, which seemed like a valuable mind symptom. Rhus btw has the same kind of symptom (pg 93). The prolapse of the genital area also points to Sepia (pg 743), less, however, the fibroid tumor [myoma] Surprisingly the Sepia is not active there - in spite of it being such a great "women's remedy". The distinct intolerance of contradiction also speaks for Sepia.

The only problem is: it did not do anything for the patient.

You can take the time and trouble to look things up - and you will find more symptom of this "homeopathic fish" in the symptomatology of the patient. You will succeed - yet, nothing happened.

.....

Since Sepia did not work, not in the least, no reaction in any direction, there has to be something to this case of illness that had been overlooked resp. had been neglected as being of no importance.

For, with the certainty oft the "Amen in the church": Homeopathy will heal this rheumatic process if the simile for it can be found. In spite of cortisone, in spite of year-long massive chemical therapy the good simile will cure this rheumatism, without baths, without massage, without any other kind of therapy; all alone, by the well-directed homeopathic remedy, by the "missing" remedy, this symptomatology will disappear. (Nothing said against baths and massages, medicomechanical therapy etc.)
The homeopathic simile by itself will cure this - and many other kinds of illness.

End of December 1977, thus 8 weeks after starting the therapy, the remedy was given that the woman needed.

In LM 18, once daily 5 drops, after 3 weeks there was the telephone report that these had been the first drops that had "reacted". Right away itching had started, which had lasted until that time, but by then with less severity. I did not at all interrupt the treatment but waited cold-bloodedly for the next report. This came 10 days later and said that the itching was completely gone now and the pain had got a lot better. This could also be inferred by the number of tablets the patient was taking then, which had been reduced from 7 to 3 daily.

To this let me remark that it is hardly possible to take away the tablets from this patient right away. As we saw: Neither Rhus nor Sepia had done anything. Without the painkillers the patient was used to she would have been very much tortured. Those who assert that our remedies can only work when we take away other, especially chemical, medical substances, should speedily - at the relevant occasions - look for a better simile.

Remarks like this are very important, for especially younger doctors, which are only on their way to homeopathy and have even more failures than us experienced ones, will not accept our exhibitions of power. They do not accept that: firstly we find the right simile at once in each and every case and secondly that, with a bad simile, the patient has to make do without his - mostly long-term - therapy (of whatever kind) he has been used to, that there is need for that.

..............

Whoever does not recognize the above facts in their proper proportions proves that he has no idea even of proper homeopathic anamnesis and has a sloppy relationship to homeopathy.

..........................

Well, the cure progressed so well, with the same remedy, always the same doses, LM 18, that after some time the patient did not need any painkillers at all in a routine fashion - only a light one once in a while, where needed. She was practically free from complaints.

Also, she feels a lot better all over and the "energy", which had been existing only minimally before, was back to what it had been before she fell ill.

This remedy thus id not only work on the rheumatic complaints but on the entire condition of the patient. Well, once one knows what it was, this is a matter of course. After a few weeks the drops were stopped, the patient remained well. But there is a note that they should be given again later for a while.

If they can do even more, very well; if they are not needed, because the organism had taken care of matters by itself now, they'll just run on the sidelines . .. They won't benefit any more, but they do not do any harm, they do not "spoil" the patient, they do not stress him - it's as easy as that.

To round this off: if someone should be "itching", the curing remedy was NOT Sulfur, even though this is my staple remedy - where it fits.

Solution and discussion:

This chronic illnes presented some difficulty, not because it was "incurable" but only because the fitting remedy was not found. We experience the searching for the curing remedy, we also experience the mistakes and "mental deficiency symptoms" of ourselves that can happen during these kinds of search. Before discussing the solution, I should like to quote the statement of a collegue - he was informed about the illness, how he would have seen this case.

#####

Feeling of tension in the hollow of the knies when walking is something that people only report when they have actually experienced them. Backache at night also should be something that can be observed with a high degree of certainty. Swelling of the knees is a sure sign. Taking those 3 rubrics together, there are left Merc, Nat-m, Nux-v and Sulf.

Varices are only operated on when they are important, thus also a certain sign. By this Merc is excluded. Adding "Contradiction is not tolerated", only Nux vom ist left!

Nux vom is also present in the rubric pain in the knee worse getting up afterer sitting.
It also has myoma.
Aversion to fat food does not seem relevant to me - this is something that is said often without much thought.
Swelling of hands does not make for differentiation of the above 4 remedies; while in "swelling of hands in the morning" only Nat m is präsent, I think that considering the great number of remedies that have swelling of hands, one should not lean on such single modalities with such a general sign (very likely more remedies, e.g. Nux v, have this swelling more pronounced in the mornings; at the time Kent was compiled this just had not been observed yet)
As far as sensitivity "allergy" goes, Nux v. has the highest grading of the above 4 remedies.
This also applies to intolerance of clothing,
specifically for wool there is only Sulfur listed. Sulphur, however, does not have intolerance of contradiction and also not the aggravation of the knee pains on getting up from sitting.

So I should have given Nux v.

################

So far the complete comments of the collegue.

The remedy I prescribed was NOT Nux v.

Analysing the above considerations and examining the hierarchising of the symptoms, one cannot miss the fact that the LEADING SYMPTOMS of the patient were reduced to 3 symptoms of rheumatism: backache during the night, swelling knees and feeling of swelling in the hollows of knees when walking. The 4 remedies that now appear as THE ONLY ONES, are THEN diffentiated by more or less good symptoms and signs.

With this operation an important part of the anamnesis of this patient is not taken into consideration at all. Firstly, however, it should be said that the selection of leading symptom from the LOCAL symptomatology may very well be possible and sometimes may even be required.

But this can only be justified on the always applicable conditions: That these symptoms should be grave, peculiar, characteristic, individual. And these qualities are totally lacking with the 3 "starting symptoms" taken above. Swelling, knee joints is a triviality for us in this kind of rheumatism, this also applies to the sensation of tension in the hollows of the knee - unless there exists nothing except a local illness of the knee - also the backache at night. These are "cheap" symptoms of rheumatic illness, not even ONE of them has the touch of a personal, a peculiar quality.

I pointed out in my presenting the case that something similar happened to me and that only lack of time can excuse this. A a homeopathic null-version had been produced. No different for the collegue.

Well, then - what was the solution of the riddle:

In the anamnesis of the patient there are not only varices, they probably are the least important.

There was a total hysterectomy/ovarectomy at a time of her life when the menses were till quite normal. And any operation at such a time is problematic for us. No matter whether such an operation was necessary or not, if subsequently - and this does not necessarily mean 4 weeks or 4 months afterwards, it may be much later! - a process of illness manifests itself that never before had been known to exist, i.e. if a Novum appears, something new, completely new, then the OPERATION may have been the reason for it.

One therefore may consider the probability that subsequent illnesses have a direct relationship to this operation. One MAY, it is not a case of must, this is a matter of judgement. However, when we think about it, we have to take as fact that the hysterectomy/ovarectomy with absolute certainty was a "suppression" for this patient, a measure that closed the "ventile down below". No-one may and will argue against this. The only argument could be whether something like this can produce problems later on. A simple course of reasoning will aid in this matter.

If it wasn't the process explained above, then it was pure coincidence that a process of illness that massive and resistant to treatment came up. I should set suppression before coincidence!

The operation for the prolapse itself, immediately after which the entire thing started, surely is not directly responsible, for that was not any suppression. This later operation may possibly have contributed to "finish" the patient - after all, it also happened in the genital area.

All who have observed that often years after comparable measures and artifacts comparable things have happened, will never disregard such connections. The remedy that in this case must be FIRST considered, is Lachesis -

Something like rubric Genitalia, female, menses, suppressed, page 782 - it had its effect. Ex juvantibus one may say, the hypothesis of suppression proved to be true.

Studying Lachesis one will find that it also "has" varices, prolaps, scarlet fever and is also a classical remedy for the climacterium.


I found this case very interesting as far as the idea of time-line goes. I should not have attributed the illness to an operation 4 years before.

I am still not sure whether I do: some homeopaths in the study group found it as one of the remedies to be considered on the symptoms alone.

I find it very impressive that the curing remedy was found following two entirely different trains of thought.

Their analysis of this case showed that the patient was in a possible Lachesis state before the operation.Thus it is after all open to question that the rheumatism resulted from the operation itself, was in fact a suppression.

My own reasoning, when I did this case, was to trace it back even further, i.e. to the scarlet fever. After this illness there had been transitory rheumatic complaints. which was not the case - for 4 long years - after the operation in question.

On the other hand, the big trouble started after the last operation - which Eichelberger discounted. It seem smuch more reasonable to suppose that this last operation was the "last straw that broke the camel's back" - the previous straws having been the scarlet fever, the hysterectomy and probably other provocations.

The fact that Lachesis was the curing remedy does not argue against it, since - as Eichelberger also pointed out - Lachesis is also a remedy for sequelae of scarlet fever.



Reference:

The cases were takenfrom the book:

Otto Eichelberger Klassische Homöopathie Vol. 2 Praxis und Forschung (Clinic and research) Karl F. Haug Verlag, Heidelberg 1982




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