The Lady and the Homoeopath

Queen Victoria – not Lady Ponsonby Blythe…

Lady Gwendolyn Ponsonby-Blythe sat condescendingly in my consulting room. I have never seen anyone sit condescendingly before, but Lady Ponsonby-Blythe’s sitting had an expression all of its own. She looked around and sniffed, clearly unimpressed by my simple chairs, desk and unadorned walls.

I asked how I could help.

“It was the royal wedding, you know,” she confided. I must admit, I was impressed.
“You were invited?” I asked.
“One’s television screen in the main hall of one’s castle is set at the most inconvenient angle,” she continued, ignoring my question as an expression of plebeian ignorance. “Since the royal wedding, one’s neck hurts, every time one turns it, so,” and she turned her head to the left and to the right, wincing with the utmost gentility. I thought for a moment that she was about to wave to imaginary courtiers.
“It’s dreadfully cold in the big hall, impossible to heat, you know, and one cannot stand drafts.”

I asked about other complaints.
“Spring allergies, you know, most people have ‘em,” was the response. “One still suffers from the occasional cough and sneeze,” and she withdrew a small square of cambric and patted her nose.

“And does one – er, do you get neck pain often?”
“Oh yes,” she responded. “Since one was a child, always the drafts, one just can’t abide ’em . One asks Tompkins to draw one a hot bath, that and a small brandy, for medicinal purposes, you know.”
“Does that help?” I asked.
“Of course,” the lady snapped, clearly impatient with so many impertinent questions.

And suddenly, the small square of cambric emerged again as the lofty Lady Gwendolyn Ponsonby-Blythe dissolved into tears. I don’t know which one of us, whether it was “one” or myself, was the most surprised.

I handed her a glass of water and waited.

She sipped the water with a grimace, as if it was not sufficiently well-bred. When she spoke next, her voice was uneven but controlled.
“It was that damned wedding,” she explained. “Obviously Cedric and oneself must have been invited, but without the invitation there would have been a fuss, don’t you know, and one does not like fuss. So common, you know.  So one watched the event on the television – and now this!” she ended, turning her head gently but painfully from side to side.
“It’s just all too much!” The tears threatened again, but were subdued into silence by “one’s” iron will.

I asked some more questions, gave a remedy and instructions, and Lady Ponsonby-Blythe sailed, galleon-like, out of my consultation room into the masses of the great unwashed, cambric handkerchief held gently to her nose for protection.

As others greater and wiser than myself have said of this kind of story – it didn’t happen but it could have done… in a parallel universe or somewhere equally exotic…

What remedy would you give – and why?
How would you dose? And why?
What results would you expect?

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Hepar Sulph, provings, and a rant in a teacup…

winking? or dry eye…

I was recently working with a patient suffering from dry eyes. The patient would wake at night unable to open his eyes, and said the condition was ameliorated by cupping his hands gently over his eyes. Among the symptoms – worse during sleep, worse in artificial light, sensation of dryness and burning in the eye, unable to open the eye at night. I had given Rhus Tox which had helped somewhat but it was stalling. And we homeopaths expect more from our remedies – don’t we now…

I used the rubric worse for uncovering as an expression of the hand-cupping amelioration but based the center of the case on all the other symptoms and modalities where the rubrics were more precise. I reviewed everything again and saw that only two remedies covered all the symptoms – Rhus Tox and Hepar Sulph. I looked closely at the provings of the two remedies, thinking that if Hepar Sulph didn’t look like a better match I’d go up in potency on the Rhus-Tox. The eye symptoms were very well represented in the Hepar proving, but I could not find clear mention of hand-cupping ameliorates.

So I went on an obsessive hunt for the symptom – even though I knew I didn’t really need it. I found it in Kent’s repertory – but no Hepar. The only remedies there were Aur-Mur and Thuja. I went through the books I used many years ago, in the olden pre-TPB days – Phatak, Kent, Clarke, Boger Synoptic and others, and finally tracked down the symptom in Vermeullen’s Prisma given as Eye, pain, better for lightly covering eyes with hand.  But where did it come from?

I looked in Schroyen’s Synthesis, and there I found Eye Pain, covering eyes, hand with, amel with the previous suspects from Kent – Aur mur and Thuj. And then – Eye pain, covering eyes, lightly, amel – Hepar.

Various materia medicas do report that some light covering amel with Hepar. Vermeullen is the only one I found in my search who specifically states the symptom, and the source is unclear. It appears in the Rubrics section of his Prisma, which he writes gives symptoms taken from the Synthesis, and further states that he made corrections and additions in this section where he felt symptoms had been misinterpreted or overlooked. So no certainty there…

And as I was on this hunt which was unnecessary  as I could already see that Hepar was indicated but by this time I couldn’t stop – I realized that this was a kind of reversed engineering of  the way I used to work, a way that has become completely unnatural for me.

I started out on my homoeopathy studies with an impressive (and heavy) hardcopy of Schroyen’s Synthesis, in a scholarly dark red binding with gold lettering. I studied out of town, and this huge book, together with other weighty tomes, were my constant companions and back-straighteners (in a reinforced  backpack for hikers). I would take symptoms, rummage around in the Synthesis to repertorize the case, and hunt through Kent, Phatak, Tyler, Boger, Vermeullen, Sankaran et al to see if I could make a case for a remedy. The work was imprecise and frustrating. There was no certainty, no clear path through all this literature – even though eventual purchases of a laptop and software eased the back pain somewhat but little else…

Which brings me to a conversation I had recently with a colleague (this is the “rant-in-a-teacup” part). I had mentioned that I was thinking of putting together an online course for the study of provings. Wake up, he said, don’t you get it? No-one is interested in provings. And I had to admit he was right. I can see from the interest in various posts on the IHM sites. Readers of our sites really like the articles on vaccinations, and damning materials quoted from other sources.  Scandals in the conventional medical world are a particular favourite. Readers, hopefully many of them homoeopaths, like case presentation and analysis, methodology, posology, repertorization, and even discussion of materia medica, and this is good. IHM rants are quite popular as we can on occasion be quite amusing… But while articles on provings have their devotees (thank you, you know who you are), they garner much less interest in the world of modern homoeopathy.

But then I thought further. If the mass of people in this field are not interested in provings, then they are also not interested in doing homoeopathy properly. Because the principle of like cures like rests on provings, without provings homoeopathy as a scientific medical method would not exist.

Until you’ve read a remedy proving you really know very little about it, about its diversity, potential for healing. You will be forever mired in the prejudices passed from teacher to student, prescribing Pulsatilla for needy, weepy blonde women with blue eyes, and Hepar only where the patient is extremely chilly. Men and children would never be given Sepia. Everything would rest on what was learned from teachers rather than primary sources. And so much would be lost.

And if you start with software, speculative materia medica, and the mass of material from the older homoeopaths which has simply been copied from work to work as can be seen from the exact repeats in wording – it’s a mess. You don’t know what symptoms come from provings, clinical or poisoning. What is central and certain and what is at best confirmatory. You don’t know where to start and where to finish. And in my obsessive sleuthing, when I started with the proving and ended with the synthesis, I realized just how little these materia medica reflect the proving, how disconnected the investigation became.

Since I had started out on this rather senseless quest with Hahnemann’s provings on Hepar and Rhus Tox, and with Boenninghausen’s therapeutic pocketbook which is based on primary sources and not on a cacophonous centuries-long game of Chinese Whispers and creative writing, I recognized that my sleuthing was, for the most part, a waste of time. I was confident that Hepar would help my patient. My process today, for which I am totally grateful to P&W and the IHM, is much easier, and more sure-footed. But it also reminded me of those early days, how literally back-breaking it was to rely on these hefty tomes which just didn’t seem to add wisdom, only to dilute it, to shatter what little knowledge they contained into tiny unrecognizable fragments.

Homoeopaths should be interested in provings. Homoeopaths should want to go to original sources, and to have the ability to do so. But I have come to the point where I feel I have to recognize and accept the reality. Very few (undeniably intelligent) homoeopaths are interested in provings.

Unless I’m wrong? Whether I do an online course on the study of provings or not – I would be delighted to be proven wrong.

LMs – what are the odds (or the evens)…

hardworking horses…

I have recently been asked about changing potencies in LMs, with people mentioning using odd numbers, even numbers, going up in steps of 2 potencies (LM1 – LM3 – LM5) etc.

I came across this issue before I started studying with David Little, from a post he wrote on the Minutus list, sometime around 2005.  He mentioned that while most people do just
fine on a series of ascending potencies (LM1 – LM2 – LM3 etc.)  he had noticed that some seem to do better on odd or even numbers of dilutions or succussions.  He also noted that Hahnemann didn’t always start with LM 1.

There are two issues in play here, in my view.

The first is the risk of putting theory before experience.  The beauty of homoeopathy is that Hahnemann first observed, then developed a way of harnessing the power of the similar stronger artificial disease without harming the patient, and  what he thought was the most probable explanation for what he was observing.  In Aphorism 28 (and elsewhere), Hahnemann sets out the basis for his thinking on experience versus explanations of how something happens:

“As this natural law of cure manifests itself in every pure experiment and every true observation in the world, the fact is consequently established; it matters little what may be the scientific explanation of how it takes place; and I do not attach much importance to the attempts made to explain it.  But the following view seems to commend itself as the most probable one, as it is founded on premises derived from experience.”

The second issue is the sensitivity of the patient, something that is difficult to assess ahead of time.  In Aphorism 278 Hahnemann explains that individual sensitivity can’t be deduced through “fine-spun reasoning” or “specious sophistry.”  In order to learn the appropriate dose, “pure experiment, careful observation of the sensitiveness of each patient and accurate experience can alone determine this in each individual case…”

To my mind it comes down to “specious sophistry” if we adopt a theory of odds and evens, where there is no solid backing for the theory, or to apply it and then say it worked – especially when there is a body of material showing that many patients do well just going up through the potency scale.  On the other hand, some patients do especially well on a particular potency, but we cannot know if it was the potency itself or if the improvement was built up by the work of the previous potencies and only manifested itself with the current one.

And furthermore – although it is natural to look for protocols, for theories which provide rules for action which can be employed in every case, we will then have moved away from the individualization of the patient, and of the patient’s sensitivity.

In my own experience, many patients do very well going up the scale, some seem to advance more with specific potencies in the scale, and if the remedy is going to help it is usually already visible in the patient’s response to LM1.

However, looking for a pattern in the sensitivity of individual patients and developing theories to govern posology rather than drawing on pure experiment, careful observation and accurate experience on an individual case-by-case basis seems to be a case of putting the dazzling cart of theory in front of the plodding hardworking horse of experience.  Specious to say the least.

 

 

Workshop 15th November – and who’s in love with provings…

Earlier this week, I was accused of being in love with provings.  To be a bit more precise, I was told “you’re in love with them – but no-one else is interested.  Wake up and smell the antidoting coffee…” or words to that effect.

But, as I explained to my insistent interlocutor, I’m not in love with provings.  I’m in love with certainty in prescribing.  And one of the best ways to achieve that certainty is through – ta-da! – provings.

Even the best prescribers among us have to deal with some uncertainty – it’s part of what goes on in treatment.  We can’t know the exact level of resilience a patient has, how much he or she can be restored to health.  We can’t always know how sensitive the patient is to remedies at the outset.  And we can’t know what the patient has not told us – the vaccination he was embarrassed to report, the home herbal remedy he was convinced wouldn’t interfere with treatment.

So personally, I take whatever certainty I can get, and knowing how to study and work directly with provings helps me towards the certainty I crave…

A little girl, a newborn, was suffering from a rash.  There wasn’t much to go on and several remedies were indicated.  I went through them looking for the eruption, and Phosphorus turned up trumps, with a description  that fitted my little patient’s rash perfectly.  The remedy also contained several others of the few presenting symptoms in the case.  When I gave the remedy, I had a great degree of certainty that it would help my patient, because I knew for a fact that this substance can cause this symptom in a healthy person.  And that, dear readers, is what homoeopathy is all about.

I’ll be giving a workshop on the study of provings in a couple of weeks.  It will be a hands-on hard work seminar – you’ll come out of it knowing how to study provings and you’ll have a clearer idea of how to work with provings in prescribing.

Where?!  Jerusalem, exact location to be announced.

When?!  on Wednesday 15 November, from 9:45-13:30

How much will it cost?!  NIS 370

Any early bird reduction?!  Of course, NIS 320 for those who pay by Friday 10th November.

To register? Write to me on vera.homeopath@gmail.com.

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I’m considering giving the workshop online at a different time.  Please write to me on vera.homeopath@gmail.com or using the contact form if you’d be interested in such a workshop. 

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Pimples, Pustules and Boenninghausen’s Questions

Pimples Pustules and Boenninghausen’s Questions

I was recently asked about Phosphorous in eruptions. Specifically I was asked why Phosphorous doesn’t appear in the TPB symptom Eruption, pustules (symptom no. 1426 in P&W Synopsis), when the word “pustule” appears twice in Hahnemann’s proving.

In the proving “Pustules” appears in the following contexts:

Preparation of medicinal solutions

I’m often asked about preparation of remedies for dosing, especially in connection with use of LM potencies.  I’ve quoted David Little’s article on Solutions Large and Small below in full.  You can read the original here.  David also describes the experiments he carried out.

 

Solutions Large and Small
Preparation of the Medicinal Solution

The question of how to make a medicinal solution has been raised. Our research group uses the Hahnemannian Standard as discussed in The Chronic Diseases and The 6th Organon of the Healing Arts. The reason for this is twofold.

Dr. Fickel and the high priests of homeopathy

Dr. Alphonse Noack, whistleblower

In January 1836, the appropriately named young Dr. Fickel took up the position of Chief Physician at the Leipsig Homoeopathic Hospital, an institution Hahnemann had scorned due to allopathic influences in its staffing.

What was fickle about Dr. Fickel, you may ask? He had been appointed the Chief Physician in a homoeopathic hospital – without knowing anything about homoeopathy. Dr. Fickel was an allopath who deliberately insinuated himself into the company of homoeopaths to harm the profession, cobbled together books on homoeopathy which he published under pseudonyms, and was offered the position of Chief Physician of the hospital by its governing association without knowing the first thing about homoeopathic treatment. During the 7 months that he held his position, most of the time he relied heavily on his assistant Dr. Seidel for actual prescribing, primarily dispensed sac lac, and left cures to nature.

You can read the whole sordid story in Haehl and in Bradford. It has all the elements of a good thriller, with money changing hands, people lying about their credentials, criminal negligence, unmasking and punishment of the wicked. Or something like that.

Fickel produced three works on homoeopathy, which would probably still be considered part of homoeopathic literature if he hadn’t been exposed at the time. All three were published under pseudonyms.

In the first he pieced together works by Hahnemann and other homoeopaths, and discussed effects of remedies. The book was well received by Stapf’s Archiv.

Fickel then produced a “Cyclopedia of the whole of theoretical and practical homoeopathy,” supposedly authored by a “Union of homoeopaths”. Hartmann, one of Hahnemann’s students and a member of the prover’s union who should have seen through it even if he and Hahnemann did part company, pronounced it to be “the most comprehensive, the most accurate and practical work”.

In 1835 Fickel published his third masterpiece, again under a pseudonym: “Homoeopathic manner of healing in surgical cases, together with the pure medicinal effects of a new and important anti-psoric.” The work was commended by Stapf and Haubold, and Haubold even claimed to have cured a condition of leucorrhea with the new remedy.

Fickel’s masterworks included descriptions of fictitious provings and cures, clearly tailored for his gullible audience, who chose to have blind faith rather than to check references.

Despite stories which were already circulating to the effect that Fickel was not the most plausible or well-intentioned homoeopath, and despite the warnings the appointment board had received, “The priests of homoeopathy opened wide to me the portals of their temple, not so much in confidence as from a blind sense of devotion…” wrote Fickel.

Suspicion continued to grow. Finally in March 1836 after more prodding and criticism of his work by Dr. Alphonse Noack, Fickel owned up to his penmanship and to his ulterior motives. He announced that the “insipid innacurate work” had a definite purpose, “the whole thing was nothing but irony and satire… against the prevailing charlatanry of our time”. In a pamphlet published in June or July 1836 Noack exposed the entire fraud, and Fickel resigned in August.

Several years after Fickel’s unmasking, he went public in attacks on homoeopathy, such as his “Direct Proof of the Futility of Homoeopathy as a System of Healing, for Doctors and Laymen”, published in 1840.

This sordid episode raises so many questions, many of them relevant today. Why did hardly anyone see through Fickel? Why were his works not more severely critiqued? And how on earth could someone who knew nothing of homoeopathy be appointed to one of homoeopathy’s top official positions of the time, as a senior practitioner?

Why relevant today? Because the dangerous mixture of apathy and mindless adulation of the great is alive and well. Because Hahnemann’s Organon is fast becoming an obsolete work – and without reading the original method, would-be practitioners will know nothing of homoeopathy except the regurgitated messes dropped by their teachers into their eager waiting mouths….

Fickel got as far as he did because few had the courage to challenge the “old boys network” of the time, to demand sources complete with chapter and verse for works. Has anything changed?