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commentary to aphorism 92

Most important thing in taking a case is to elicit rare peculiar symptoms but what we get is common symptom or some diagnostic terms used by the other doctors. The symptom is of such a character that the patient says of it, " I have always had it and I did not suppose that had anything to do with my disease." When asked, "Why did you not tell me that before? " she says, "I did not think that amounted to anything, it is so insignificant."

The physician often find it difficult to select a remedy. He feels he must make a prescription, but has no sensible grounds for thinking he has found the remedy because the patient's story has been so confusing, and the symptoms that he has obtained are so common and ordinary, such as all remedies possess. With such a basis he cannot have any confidence that he has the remedy, and, although he may have selected  several remedies in the case, the patient comes back uncured, month after month, and year after year. These symptoms that are withheld and seem to be so confused, and so difficult to obtain, are the very ones that the patient thinks do not amount to anything. kent says "What seems to him to be the little symptoms are very ,often characteristic of the disease, and necessary for the choice of the remedy."

A patient comes along with a 

• pallid face, 
• a rather sickly countenance,
• tired and weary, 
• subject to headaches, 
• disorders of the bladder and disturbances of digestion ; and in spite of all your questioning, you fail to get anything that is peculiar. she comes back month after month and give her Sulphur, Lycopodium and a good many medicines.

You can sometimes find out whether she is a chilly or hot-blooded patient, and thus you can get a little closer among the common remedies; but the patient says one day, "Doctor, it seems strange that urine smells so queer, it smells like that of a horse." Now at once you know that is Nitric acid.

"How long have you had this ?"

"Oh, I have always had it, I did not think it amounted to anything."

If you examine the common things belonging to Nitric acid, you will find that it possesses all the features of the case. This is how a guiding symptom can be used.

Nitric acid has a keynote :"urine smelling strong like that of a horse," but if you should give it upon that alone and the general symptoms were not there, you would probably remove the particular symptoms only, and they would come back after a while.

In a busy day you will have several of these cases that you have been working at for months, and the patients have spent a lot of money to no account. You might just as well have given Sac. lac. until you found the right remedy or those who can buy computer can easily repertorise very quickly- the radar is one such computer repertory.

certain question comes up

	why did I not see the remedy before
	why did I not ask her if there was any odor to the urine, and if so, what it was like.

kent says that "I have had this very symptom come out when I have asked a dozen times about the smell of the urine, and they did not know, and yet would say afterwards their urine smelled like a horse's urine, and they knew it all' the time." Kent further added "On the other hand, the patients are so accustomed to their long sufferings that they pay little or no attention to the lesser symptoms which are often characteristic of the disease and decisive in regard to the choice of a remedy."

Our materia medica is written in very very simple language. Uneducated  ignorant people living in villages often present symptoms better than the educated people dwelling in towns and city because uneducated people are      

• simpler 
• they do not camouflage the symptoms  
• they come out and tell the little details in a better way, in a way that  be similar, be in line with to the language of our remedies.
• Our remedies have been recorded in simple language to a great extent, and this simple language is often better observed by the simple-minded, uncultivated people than among the aristocrat.           

Educated people do not know the language of materia medica. such people often camouflage symptoms because people who have plenty of means and much education are more excitable, they have more, fear and they have tried a great many doctors and  any physician who has a reputation is consulted for a chronic disease ; and the patient who has plenty of money goes around amongst the doctors, and finally when he comes to Homoeopath he will  tell his symptoms he tells them in the trivialities of his numerous physicians, so that when he has finished his story nothing has been gained.

EXAMPLE " I have been suffering from migraine doctor "

"my child is suffering from asthma" 

"I have ulcerative colitis for 15 years"

Such are the comments of educated class the patient is satisfied because he was able to name his disease. These do not help any homoeopath doctors. Only gradually can the physician lead him back into a language simple enough to describe the sufferings. They who have been sick long with their chronic ailments, and have become somewhat hypochondriac will go through with this list of their diseases. They have paid lots of money, and have lots of names, and they are loaded with drugs.

The physician must deal very carefully with these type of  people, because if they are irritated they will run off.

Management of person suffering from acute disease who is already suffering from chronic disease

 illustration of  the doctrine of not prescribing for an acute and chronic trouble together.

A chronic patient, for example, may be suffering from an acute disease and the physician on being called may think that it is essential to take the totality of the symptoms; but if he should do that in an acute disease, combining both chronic and acute symptoms together, he will become bewildered and will not find the accurate  remedy.

The two things must be separated.

The group of symptoms that represents the image and appearance of the acute miasm must now be prescribed for.

The chronic symptoms will not, of course, be present when the acute miasm is running, because the latter suppresses or suspends the chronic symptoms, but the physician, not knowing this is so, might wrongly gather together all the symptoms that the patient has had in a life time.

Again, on the other hand, in collecting together the chronic symptoms for a prescription it is adequate to mention merely that the patient has had typhoid or measles or other acute miasms. Such diseases are not a part of the chronic miasm. The symptoms of the acute attack were separate and by themselves. You must realize that the effort to prescribe for two distinct miasms will result in error.

kent has given a good example "If you practice in the western part of this country you will often get confused cases, a sample of which would be about as follows: A patient has been suffering from intermittent fever, and has been treated with medicines, Quinine, Arsenic and low potencies of this and that drug, until the case has been complicated. You learn that the symptoms now are different from what they were in the beginning, that there has been a transformation scene. You prescribe for them, as they are now, regarding it as a species of malaria ; you prescribe for them with a view to antidoting all the drugs that he has had, and your remedy brings about a surprise; it opens out the case in a wonderful manner. The patient up to this time was unable to give you anything descriptive of the original state of his malaria, but he comes back in the course of a week or two and says :

If you examine each one of these states, you will find that the two chills begin in a different place, and the beat of each begins in a different place, and the symptoms of the two attacks are totally different. Such a thing will seem unlikely to one who has never seen it, but one who has lived in the west and practiced accurately will see such things, unknown to those who have practiced what is called Quinine Homoeopathy. A correct prescription will disentangle these two malarial miasms and show that two exist in the body at the same time, each having conditions quite different from the other. These two can co-exist and have their own times and expressions without interfering with each other to any great extent. The big doses of quinine will complicate them and cause a general clouding of things, so helter-skelter and disorderly that nobody can tell anything about it. If in such a case you were to attempt to prescribe a remedy that had both these groups you would fail to cure."

what are points to remember in such a case where person who is already having chronic disease is now suffering from an acute disease?

	Select the worst one, and leave the other one alone, entirely ignoring it.
	It is a bad policy to give one remedy for one and another for the other.
	Single out the worst one and cover it carefully with a remedy, and you will find it vanish and the other one comes on, just as if the patient had not a remedy at all.
	Now do not be in too great a rush about removing the second one. You will find that after one has been removed the patient will improve, and the one that has remained will become more and more manifest from day after day ; then prescribe for it.
	Never prescribe for any two conditions, unless they be complicated. Only chronic diseases can be complicated with each other. The acute is never complicated with the chronic ; the acute suppresses the chronic and they never become complex.

This illustrates the doctrine of not prescribing for an acute and chronic trouble together.

SECRET OF SEQUELAE OF ACUTE DISEASE AND THE HIDDEN MIASM

Of course, the allopaths will tell you about the sequelae of measles, scarlet fever, etc., but they know nothing about it, and their pathology teaches them nothing which is true concerning it. That which comes out after all acute  diseases have run their course is not due to the disease itself ; the sequelae of measles are not due to measles, the sequelae of scarlet fever are not due to scarlet fever, but to a prior state of the patient. A psoric disorder may come after scarlet fever or measles, and must be treated as psora. These sequelae, regardless of the disease which stirs them up, are psoric and crop out at the weakest time, which is the convalescent period.

points to remember regarding sequelae of acute disease

The better the acute disease is treated, the less likely there are to be any sequelae. If measles and scarlet fever are, treated properly we have very little trouble afterwards. Of course, you will find now and then some constitutions extremely psoric ; almost in a condition of advanced decay, and for malignant scarlet fever in such a patient it is difficult to find a proper remedy, and then the very best physician in the world may make a mistake ; yet with good treatment in ordinary cases you should not expect sequelae, such as sore eyes, running ears, etc.

It is of the greatest importance in such cases to be able to classify and distinguish one thing from another, so that you may know what you are prescribing for.

You cannot prescribe an antipsoric in order to prevent sequelae following scarlet fever while the scarlet fever prevails. The points to keep are

	Prescribe first for the acute attack, and the symptoms that belong to it.
	It is well, however, for the physician to know all the symptoms that the patient has of a chronic type, that he may know what to expect, that he may look at the close of the acute attack for the coming out of the old manifestations of psora, although often an entirely new group of symptoms will appear.

When at the close of scarlet fever troubles come about the ears or dropsical conditions come on ; these are not a part of the scarlet fever itself, but of the state of the miasm.

It is a great mistake for anyone to fit remedies for complaints or states. It is a fatal error for the physician to go on the bedside of a patient with the feeling in his mind that he has had cases similar to, this one, and thinking thus :

"In the last case I had I gave so and so, therefore I will give it to this one."

The physician must get such things entirely out of his mind.

It is a common feature among unqualified homoeopaths  who profess to be homoeopaths to say : "I cured such and such a case with such and such a remedy. I will now give this patient the same remedy."