Sanyal I B
In the January issue 1951, of this magazine, an article, running by the name “some practical hints in therapeutics” written by me, was published, where I cited a case of remittent fever in which Bryonia was prescribed and which proved to be rightly selected medicine.
With regard to this selection of medicine in that particular case, some criticisms have been passed by one of my colleagues, who personally wrote to me, stating his arguments.
I am sorry, I could not give any conclusive reply to him, due to shortage of time. I now take this opportunity to review the article and support my statements made therein.
The case in question, ran thus:-
(1) Remittent type of temperature – 7 days
(2) No stools – 5 days.
(4) Thirst – drinking rather frequently but little at a time.
(6) Dry cough.
In this case, I prescribed Bryonia instead of Ars. Alb. But my colleague is of opinion that Ars. Alb should have been the remedy and not Bryonia. He places in support of his argument article no 153 of Organon. Here in this case, according to him, the thirst with its peculiar characteristic and restlessness were cardinal and more important symptoms. So my selection of Bryonia was directly in contradiction to article no. 153.
There is no doubt “the more prominent, uncommon and peculiar features of the case are especially, and almost conclusively considered and noted”. But it is a matter of great difficulty to judge the relative importance of the different symptoms in a given case, strong power of judgment and extensive experience both being needed indispensibly and in the highest degree.
Individual symptoms, though by themselves are not very characteristics, but when grouped together their summation creates a sumtotal picture which sometimes assumes such a great importance as to justify to neglect some other symptoms which though very characteristics by themselves, yet when put against the sumtotal picture produced by other symptoms are eclipsed, by the latter. A serious consideration will make us able to see that this statement of mine is not in contradiction with article no. 153.
True it is, what the great Hahnemann says “that totality does not mean the numerical value of symptoms, but the uncommon, unusual and the striking symptoms constitute the totality.” But by this he never meant that we should always over – rule the sumtotal effect of a number of symptoms in the face of one or two uncommon symptoms, if the sumtotal effect of those symptoms carry more weight than the uncommon ones.
In fact, cases are seen in which a group of symptoms which individually may be less important weight by weight, than some other one or two more important symptoms but their collective importance is more than the collective importance of the individually more important ones. This statement can be made very clear mathematically:-
10 + 10 = 20. But 7+8+8+ = 23. In a similar way 3 less important symptoms when put together may be more weighty than two more important symptoms; though the reverse may also be sometimes true:- As 10 + 10 is greater than 5+4+8. It is in such cases that we get the actual field for the application of the law given in article No. 153.
Now let us come to our present case:- In the treatment of fever, (1) the type of fever and its cause, as well as, (2) individual symptoms are very important.
Causal Factor:- The factors which cause intermittent fevers are often found to be different from those which cause remittent or continuous fevers, the final manifestations are however somewhat modified by personal constitution. So the type of fever, whether intermittent or remittent or continued or any other type must first be considered because they are produced by different causes and different remedies are given in the repertory under each head. Bryonia, for instance, is one of the principal remedies in remittent and continued fevers.
(2) Then we have to consider the different symptoms associated with fever. The degree of intensity – the permanency that is the duration of different symptoms must be ascertained before giving those symptoms their deserving importance. A symptom which is persisting for a long time and in a pretty severe intensity is certainly much more important than those symptoms which are of shorter duration and of less intensity.
There are seen cases in which symptoms are found to be changing every now and then – those variable symptoms by themselves are of little importance.
In the above case, constipation was very marked and persisting for throughout the whole period of duration of fever. So it was neglected.
The next symptom was that of Headache. It was a symptom for which the patient was particularly troubled and complained very bitterly of. So it was kept in the totality.
Dry cough:- Cough is not associated with each and every case of fever. Moreover, on physical examination there was found no obvious pathological causes, as for instance, pulmonary, tracheo bronchial or laryngeal congestions as to account for the cough. So the symptom of cough could not be neglected. Then comes restlessness. It is not an absolute contraindication to Bryonia, though Bryonia patients, are, as a rule, ameliorated by rest, and aggravated by movements.
In this matter, I would request the reader to refer to knerrs repertory where Bryonia has also been given a place, though of third importance, under the head of restlessness. In fact in my experience, I have found, in some instances particularly in case of fevers, patients demanding for Bryonia, show a peculiar type of restlessness without amelioration.
In this case, the patient came to my chamber personally. He was found to be constantly changing his seat, from this chair to that chair and so forth. Evidently he could not be called restful and so restlessness was taken as one of his symptoms, but this restlessness was not of the type which we find under Ars. Alb. and the patient himself was not at all worried for that symptom.
Thirst:- It is a symptom which is often found to be changing from day to day. Recently I have come across with a case of acute nephritis in which thirst showed utter variability, one day it being unquenchable, again two days after, it being replaced by absolute thirstlessness. In many of my cases, in which Bryonia was the remedy patients showed conspicuous thirstlessness, so I do not put much importance to the symptom of thirst unless it be very prominent and present for a continued period of time.
So the symptom of thirst was neglected. When the symptom itself is neglected, it is useless to retain its modality and character in the totality. In cases of intermittent fevers also. I attach importance to the symptom of thirst only when it maintains its character and intensity in each paroxysm of fever.
I therefore, neglected the character of thirst and restlessness in favour of the sumtotal picture created conjointly by the other symptoms.
Above all, the results which are obtained after the administration of a drug, prove whether the drug has been properly administered or not. In this case the response was obtained as quickly as ever.
On this point, I am sorry to remark that my learned colleague observed that the cure might have been the result of a “Lucky shot.” Perhaps he meant that the cure was only a matter of coincidence. In reply to that I can say that a patient who was suffering for the last 7 days had all round amelioration of all his symptoms directly, after taking the medicine cannot be considered to be influenced by coincidence.