Miasmatic Prescribing
Dr N. Ghatak worked in Calcutta 100 years ago. A great prescriber, he understood the need to address the predominant miasm in a case and bring back old symptoms before a cure could be considered complete. Miasmatic prescribing was his forte.
His wonderful book, Chronic Disease: it’s Cause and Cure, provides plenty of well documented cases as well as a thorough explanation of homeopathic philosophy. Parts of the book were published in the Calcutta journal Homeopathic Gleanings around 1930 and its popularity led Dr P.N. Banerjee to translate Ghatak’s work and publish it as a book.
Here follows one such case as reported by Ghatak.
A Combination of all Three Miasms – Psora, Sycosis and Syphilis
9.2.1916 Mr___, age 31. Lost his character too early in life in the company of some young friends. The dissipation continued unabated for 4 or 5 years. The death of the father, which took place when he was very young, enabled him to inherit a big zemindary and as big an amount of cash. Thus, there was no difficulty in satisfying his vile greed – no want of money and no control in the shape of a guardian. He made it a point to spend most of his time in Calcutta and used to go to his village only very occasionally and that for very short periods of time, in connection with the affairs of his estate.
He spent his days freely in Calcutta surrounded by friends who only helped him to ruin himself. But dissipation is soon bound to be followed by a reaction and when his liver had actually reached a condition too frightening to be ignored, he was advised by Dr N. Sarkar to leave his vile practices and all the attendant objects of his enjoyment. The poor fellow was thus in great difficulty. He could neither give up his enjoyments nor take to a sober life but when he vomited a large quantity of pure blood one morning, he was roused to the reality of the situation.
There was the arrogance so long that he had any amount of money, and money would have brought him cure, but when the spell of blood-vomiting appeared in spite of all the costly treatment he had undergone, he seemed to be alive to the fact that money was not perhaps sufficient for giving cure always. He had already had syphilis and gonorrhea, but as any long course of suffering from these would have interfered with the pleasures of his life, he got each of these removed by injection the quickest. As a matter of fact, he used to declare to his physicians that the more quickly they could cure him, the more handsomely would they be rewarded; and it was actually reported he had paid Rs1,000 to a physician in one day for having kindly brought for him a very powerful injection from Germany by a special indent.
This powerful injection was said to be so powerful as never to allow the gonorrhea and syphilis in the system, ever to make their appearances during the rest of his life. But as ill luck would have it, they made their appearances in all the ugliness of their symptoms, nullifying the assurances of his physician and ignoring the “powerfulness” of the injection. This will be described later on but, in the meantime, he was suffering so badly from dyspepsia that it really grew impossible for him to stay in Calcutta.
His physicians were unanimous in their opinion and declared that Calcutta was to be left at once and a change for some better place was absolutely necessary. He therefore went on a change. By the way, I may say here exactly what the patient said to me about this advice for change: “Whenever these Calcutta physicians find a paying patient, they begin to suck him. Yes, they suck him white, and when he is pretty near death’s door they advise a change of climate with all the characteristic gravity of their learning and profession, and thus free themselves of all responsibilities. They are, however, not slow to point out that they have done their best for the benefit of the patient, though in fact it means a loss to them because, as physicians, they cannot but give their unbiased and disinterested advice. But I do not know if there is another fool like myself…”
Record (an exact translation of the patient’s statement.)
“I am a veritable scoundrel, and there is no sensual pleasure on earth that I have not had. I have now only to depend on your kindness and sympathy.” – Just here I asked him to keep to the subject, and he continued: “I contracted gonorrhea at the age of 21, and syphilis only 5 or 6 months after that. These were removed by injections and external application of ointments of various kinds, but my health broke just here.
I had, therefore, to use all sorts of medicines including patent medicines from that time. Dr Nilratan Sarkar was my chief physician. Of course other reputed physicians also used to treat me at times, however, at the age of 27 I was quite an old man. When 24 years old I spat a large quantity of blood one morning. Of course I grew cautious after this, but as my friends advised that drinking would cure the trouble, I did not give up drinking. It was only after I had become 26 that I actually gave off wine and women. It is about 4 years now that I have not taken part in any kind of amusements, and the reason is the condition of my health.” – I asked him to state his symptoms and suffering and he began.
I have a continuous vertigo and there is a tendency for falling while walking. It is only by extreme carefulness that I avoid an actual fall. Then again, there is an indescribable pain within the head. At times it seems there are innumerable ants within and I feel their bites. This is generally more severe after sleep. I get angry very easily and any contradiction from anybody excites an irresistible impulse for beating him, as I cannot tolerate that there should be any contradiction to my views.
It has become a habit with me to use rough off-hand words against all, and at times I abuse my wife and the servants for nothing. But, again, there is resentence and even weeping, as soon as I become a bit sober after the angry fit. I then seem to think that all will combine and curse me for having abused them.
There is pain in the back and waist and this is comparatively severer at night in bed. There is tendency for frequent urination and after a flow, which is always scanty, there is a severe burning pain in the urinary canal.
No sleep at night. All the history of my earlier misdeeds comes up in the night and keeps me awake. I feel awfully miserable. Towards the morning there is a rumbling in the abdomen and it is then followed by 8 or 10 loose motions. It gradually becomes more and more thin every time and the last motion is as thin as water. The rumbling is awfully severe and it really frightens me.
There is perspiration on every slight exertion. It is fetid smelling and the smell is garlicky. The evacuation also has the same smell. There is a craving for food but no power of digestion. I have often seen undigested solid stool being passed with the watery evacuations.
There is burning on the vertex. I cannot tolerate cold air; it brings on headache and fever. The rumblings and watery motions continue until 9 or 10 in the morning and after that there is no trace of these, and then the appetite is quite like a normal man’s.
I take my food then. I bathe only occasionally and not every day as I do not feel any inclination for it. I am worst in the rainy season, as then I get an accumulation of catarrh in the chest and nose, and this compels asthmatic breathing throughout the whole rainy season. This asthmatic breathing is most severe in the night; I have to sit up in bed and cough and breathe like that during the whole night.
The eyesight is bad and I seem to look through a mist; various colours seem to be floating before my eyes. I have piles too and these are aggravated in the rains and winter. There is severe cutting in the rectum and profuse flow of blood. This is much less in summer.
The most severe troubles at present are about the urine and the stomach. In summer there is a ringworm-like eruption on the abdomen and in the margin of the anus. These exude a highly fetid smelling, thick and sticky discharge. The smell is exactly like that of putrid flesh. There is itching and the itching is followed by pain.
I stopped him just there and said: “A thorough cure of all your troubles is possible only by bringing back the suppressed gonorrhea and syphilis. But in the present condition of your health, such constitutional treatment is not possible, as you have not the vitality to withstand the action of deep acting remedies. For the present, you require an immediate relief from the dyspepsia. When you have been relieved of the troubles in your stomach, and when you have recouped your health to a certain extent by a careful regulation of diet and movements etc., it will be possible to treat you for a thorough cure. Such treatment for a thorough cure will, however, be necessary as otherwise you will never keep well in your life, even for two days at a stretch if the stomach only is corrected. Please therefore, let me know what else about your stomach troubles.”
On this the patient replied: “… Pray, save me from this dyspepsia first of all.”
I then took up the dyspepsia and cured it in 15 or 16 days with Thuja 30 and 1M and then Sulphur 30 and 200. He was then kept on strict dietetic control for full three months, and when he gained some strength, I explained to him the mystery of chronic treatment and began his case on 14th June, after making the following record.
Record (as taken for the second time, i.e. after the cure of dyspepsia)
“All symptoms, except the dyspepsia are still there and I have the following troubles besides: There is a sudden palpitation at times. There is also rheumatism at times. In cold weather and in rains there is a soreness in the body. Memory is totally gone; cannot remember things even a month or two old. Pray, do something to save me from asthmatic troubles that will be coming on in the next rains.”
After a thorough study of the case, I prescribed Medorrhinum and gave the first dose of it in the 1,000th potency on 18.6.1916, with instruction for reporting the result after a fortnight. Sufficient placebo was given for daily use. (Giving a daily dose of placebo is common in India and placebo for one week or two weeks etc. is charged accordingly. Editor)
3.7.16 No gonorrheal discharge yet, but there was running of the nose. Medorrhinum 1,000, another dose with placebo.
11.7.16 The gonorrhea reappeared and the patient sad it was exactly as it was originally, but the prospect of cure had put courage in his mind. Rx placebo twice daily.
27.7.16 The discharge was almost disappearing. Another dose of Medorrhinum 1,000
3.8.16 The discharge was reappearing again but not so profuse this time. Placebo
14.8.16 The discharge had almost ceased – Medorrhinum 10M
27.9.16 No further reappearance of gonorrhoea after the 10M potency but instead there came on a severe fit of asthma. It was most severe from 9 or 10 in the night until about daybreak. Natrum sulph 200, one dose every morning until asthma abated after 5 or 6 days.
16.10.16 Asthma again, at least as severe as the last time: Natrum sulph 500, single dose only. The asthma became very severe on the 18th and 19th, and after that it gradually disappeared, and instead, there came out eczema on the whole body except face and chest. It was an awful sight to see. The whole body was covered and a putrid smelling discharge was rolling down in abundance and the patient was itching, now here, now there.
18.12.16 Psorinum CM, one dose every morning for three days and then globule no. 10 twice daily. (“Globule no.10” is the size of a poppy seed. See aphorism 285, Organon, fifth edition and footnote to aphorism 288, fifth edition. Editor)
7.4.17 The eczema which was drying up increased again; Rx Psorinum MM one dose only and gave more placebo.
11.7.17 The eczema was totally gone and the patient was much improved in the mind too. Gave some placebo as there were no symptoms to prescribe the next dose upon, though syphilis was still hidden in the system. The patient was feeling alright and the few symptoms of fetid night sweats and vertigo, etc. that were still persisting, were not enough for risking a prescription. I therefore waited on, in the expectation that syphilis must come out before long in all its own symptoms.
24.9.17 Some ulceration n the mucous membrane of the nose appeared. This gradually increased. There was pain in the left nostril and some discharge of blood and pus. But as these few symptoms, besides the night sweats and vertigo etc., were not enough, I decided to wait on for another fortnight and gave more placebo.
9.10.17 The ulceration was quite characteristic now and I gave Kali. bich 200 in graduated doses. There was relief after a week.
22.10.17 The ulceration was almost gone. Placebo for a fortnight.
8.11.17 Kali. bich 1M, one dose and placebo for a month.
5.12.17 The ulceration in the nose was totally gone, but the nose was running, and it seemed there were repeated attacks of cold. Merc. sol 10M, one dose. But, though I waited for full three months, the syphilitic chancre did not return and as the patient began to show want of interest and inclination for continuing the course of treatment further, I had to close the case with a dose of Tuberculinum 1M, as called for by the tendency to frequently catching cold. (And probably the night sweats. Editor)
Remarks
(1) While taking up a chronic case, if the patient is found to be suffering any acute symptoms or from an acute exacerbation of the chronic disease, superficially acting remedies should be used at first and the acute condition subdued. Deep acting miasmatic remedies in high potencies should never be used at once in such cases, as that might bring on a severe aggravation and endanger the patient’s life. (Ghatak used the fifth edition of the Organon so was unfamiliar with Hahnemann’s “new improved” method of prescribing gentler fifty millesimal potencies. This, along with Kent’s advice to use a remedy that covers the acute and chronic symptoms, means, possibly, Ghatak could have used deeper acting remedies without fear of a severe aggravation. It’s also fair to ask: was Ghatak too reliant on nosodes? Ghatak obviously learnt a lot from Dr J.T. Kent who said he always cured asthma with Nat. sulph or Thuja. But this was Kent’s experience; would Ghatak’s patient above have responded better to a different remedy during the asthma episode? Editor)
(2) Where there are several miasms in a case, the remedy indicated by the symptoms of the miasm predominant at the time, should be selected, and not the remedy indicated by all the symptoms in the case. If this is done, the miasm thus struck at will be subdued, and one of the other miasms will come out prominently. Then, a fresh selection will be necessary according to the symptoms thereof, and so on until the case is cured.
(3) The curative course in the case where the primary manifestations of a miasm has been suppressed must bring that back and this necessitates the use of high potencies. But the potency in such cases should always be fixed upon with due regard to the patient’s vitality.
(4) Where, however, the miasm is inherited and not acquired, there cannot possibly be any coming back of the primary manifestation, but in such a case too, the reappearance of old symptoms in the reverse order of their coming would give positive indication of a true course of cure.
(5) In the present case all the symptoms of the patient were not eradicated, but this was due entirely to want of patience on the part of the patient.
The book is available from Minerva and Emryss etc