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Introducing homœopathy into general practice
Introducing Homoeopathy into general practice R. A. F. J A C K , M.B., CH.B., M.R.C.G.P., M.F.HOM.
The word "homceopathy" derives from two Greek words, "homoios" meaning "like" and "pathos"--"suffering", and occurs twice in the New Testament where it is translated as "like passions" on both occasions. 1 I t was first used in medicine b y Dr. Samuel Hahnemann, after he had made the remarkable discovery t h a t what a drug could cause, it could cure. Amplified, this means t h a t a substance which, in certain forms and doses, causes disease symptoms, m a y also be used to cure illnesses showing similar symptoms. He propounded the theory "let likes be treated by likes". Accordingly, homceopathic treatment involves matching a "drug picture" with a "disease picture", i.e. choosing a drug which in its toxic effects manifests symptomatology similar to the symptoms of the patients. Such a drug he called the "simillhnum". This in turn requires a detailed knowledge of the toxicology of drugs, which is why the homceopathic materia mediea has greater detail than the average textbook of pharmacology. A classified index of drug symptoms is known as a repertory, and is used as a short-cut to isolating the indicated drug, in the same way that a crossword enthusiast makes use of a dictionary of quotations and a thesaurus. The h r n d t Schulz Law states t h a t the opposite effects of stimulation and depression can be produced by different doses of the same drug. This is well exemplified in alcohol intoxication, where small doses cause hyperactivity, but larger doses depress the nervous system, ttomceopathy utilizes this opposite effect, so t h a t the best homceopathic remedies for diarrhoea are laxatives when used allopathically. The same principle is embodied in modern desensitizing methods, vaccinations and inoculations where a small attenuated dose of an antigen is injected, with a view to stimulating the body's defences to withstand an overwhelming dose of the same antigen. Homceopathy uses a small dose, as this has been found to be sufficient to stimulate the body's vital reaction and recuperative powers. ILLUSTRATIONS
OF
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1 As a historical example, H a h n e m a n n scored a great success with Homceop a t h y in treating cholera. I n 1831 a serious epidemic was spreading west from Eastern Europe. Hahnemann, in Kothen, had never seen a case, but suggested treating the early stages with Camphor, as camphor poisoning produces symptoms clinically indistinguishable from cholera. "The aggregate statistics of results of allopathic treatment of cholera in Europe and America show" a mortality of over 40 per cent; statistics of homceopathic treatment a mortality of less than 9 per cent. ''2 These impressive results helped to establish Homceopathy in the British Isles.
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2 In the days before the phenothiazines, hypomania was controlled by injecting a small dose of hyoscine (0.6 mg). But an overdose of hyoseine produces mania. 3 Strong coffee is a stimulant, used to keep a person awake, and the mind alert. Potentized homceopathically, coffee is an excellent hypnotic, when the cause of the insomnia is overactivity of the mind. 4 Exposure to onion juice produces lachrymation, sneezing and coryza. Red onion (Allium cepa), when given in homceopathic potency, is one of the most effective medicines for hayfever. Homoeopathic medicines are usually prepared as tinctures, tablets, pills, granules or powders. They contain a small amount of medicine which has been "potentized" by repeated dilution, with vigorous shaking (suceussion) at each stage of the dilution. The drugs used are prepared from plants, chemicals, and animal products (snake venom, etc.) and many are mentioned in Martindale's Extra Pharmacopoeia. They can all be prescribed on the National Health Service. They can, in instances, be used in conjunction with ordinary allopathie medicines, although their action may be depressed by these drugs. This is understandable, as the homceopathie medicine works by stimulating the body's natural defenees and vital reaction, and if these are being suppressed by antihistamines, tricyelies or, worst of all, steroids, the action of the homoeopathie drug is curtailed. With increasing experience of Homceopathy, one gives one form of treatment or the other. However, homceopathic medicines can prove a very useful adjuvant to antibiotic therapy, and the two forms of medication apparently don't conflict. Nor do vitamin supplements or analgesics vitiate homoeopathie therapy. Homoeopathic treatment involves taking a history of the case, and a detailed examination of the patient, in the conventional way; but differs from allopathie treatment inasmuch as it uses the principle of treating the whole patient rather than his individual symptoms. An analogy from one of the few examples of allopathic prescribing where this principle is applied will illustrate the point. Consider a case of depressive illness: it is well recognized that this may present with various intractable somatic symptoms such as lassitude, dyspnoea, gastralgia, constipation, amenorrhoea, insomnia, or even severe headaches or muscular pains. The usual palliative treatments, including tranquillizers, fail to help, and it may be months before the florid symptoms of depression emerge. If, however, one suspects early in the illness that there is an underlying depressive reaction, inquiry will elicit feelings of failure and guilt, loss of interest and libido, irritability, anorexia and loss of weight, and the diurnal mood swings with the nadir of mood in the mornings. Using current allopathie therapy, little or no relief will be obtained until the required tricyclie or other anti-depressive agent is prescribed. The patient is predominently concerned about his one particular somatic symptom: you treat his general and mental condition, anticipating a predictable improvement in the next few weeks. Homceopathic nomenclature also uses those three words, "mentals", "generals" and "particulars", in describing symptoms, and attaches importance to them in that order. "Mentals" refers to the mental make-up of the patient, and describes the variations of affect, disposition and attitude. I t is well recognized that certain illnesses (jaundice, with its "melancholia") and certain drugs (gold injections)
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make the patient depressed. Homceopathic provings have shown that most drugs alter the "mentals" of a patient, making him, for example: irritable (Nux vomica) depressed (Aurum (gold)} elated (Cannabis) lachrymose (P~lsatilla) indifferent to loved ones {Sepia) worse for consolation ~Natrum tour.) suspicious (Hyoscyamus) jealous and loquacious (Lachesis Bushmaster snake) restless (Rhus tox. (poison ivy)) fearful (Aconite) afraid of the dark {Phosphorus) hypomanic (Stramonium ) Although only one example of each has been given, the repertory contains a list of drugs, under each of the above headings, that have induced these mental changes in their "provings". Hahnemann tested, or "proved", each drug in a double blind trial, by giving repeated small doses of it to groups of volunteers until significant mental and physical changes were induced, and these he carefully recorded. Some of the drugs had been well documented already, following cases of accidental overdoses, etc. Other drugs affect sleep (even dreams), memory, balance, sight, etc. Others disturb the appetite, causing unusual cravings or aversions, e.g. Ar~entum nitricum makes a person intolerant of heat and impulsive, and produces flatulent dyspepsia with an irresistible craving for sweet things. "Generals." Drugs also affect the patient generally in himself, so that he m a y become intoleraut of the cold {Arsenicum alb.) or the heat (Apis) or damp (Nat. sulph.), or of a north-east wind (Hepar sulph.), etc. Again, they may make the person feel very weak and exhausted, e.g. Kali carb. and other potassium salts (cf. hypokalaemia). "Particulars." These symptoms generally refer to an organ or part of the body. Again, different drugs, in toxic doses, affect different parts of the body. Bryonia selects the serous membranes and pleura, producing synovitis and pleurodynia, and Phosphorus affects the stomach, producing an intense craving for cold drinks which are promptly vomited back again; Copper causes cramps, and Lead poisoning results in colic and wrist-drop. "Modalities" is another term employed in Homceopathy, and is used to qualify symptoms, e.g. "worse for movement" {written " ~ movement"), or "better for pressure" { " ~ pressure"), or "better for applied heat", etc. In the Modalities section of a repertory the aggravations are listed before the ameliorations. So the homceopathic doctor has to assess the whole patient with his mental, general and particular symptoms, and find a corresponding drug picture. Obviously, if he can isolate a unique or peculiarly outstanding symptom that few drugs in toxic doses can produce, his task is made easier. In a police search, if the identikit or description states "walks with a limp", or "tattoo on left forearm", or "ugly scar on right cheek", the hunt for the suspect is made infinitely easier. In the same way, if we find a prominent, unusual symptom, the list of possible remedies is immediately shortened, as only a few drugs will have
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that change in their provings. For example, Arsenicum alb. (white arsenic) in its provings makes a person feel very cold, fearful, weak and restless. He develops an acute gastro-enteritis, with an aggravation of his symptoms about midnight. Furthermore, there is the unusual feature that the vomiting occurs during the diarrhoea. Few other drugs cause this. Thus, in treating a case of gastro-enteritis with such an identikit, the choice of drug is relatively easy. But suppose the patient simply complains of nausea. I t would be profitless to hunt in the repertory among the hundreds of drugs that can cause this. If, however, questioning reveals that the patient has become intensely irritable and unsociable, is easily offended at the least, harmless word (like '% bear with a sore head") and is hypersensitive to noise and smells; but feels unusually chilly and has an unsatisfactory bowel function ("false alarms", ineffectual urging) and is worse in the mornings, then Nux vomica is probably indicated. Here, the choice of drug is made by his mental and general symptoms, rather than his particular one--nausea. This is analagous with the earlier illustration of prescribing tricyc!ics for the bowel symptoms of depression. Homceopathic prescribing further differs from allopathic prescribing in that only a single dose of the drug is given, and is allowed to work until its action is exhausted. The patient has to heal himself the dose but initiates and stimulates that response. The second dose must be given only when benefit from the first has worn off. When a satellite is being put into orbit, the second and third stages of the rocket are fired only when the force of the thrust from the preceding stage has nearly ceased. The third stage usually puts the satellite into orbit. So too in homceopathic prescribing: the secret of success is not to spoil the action of the simillimum by too-frequent repetition of the dose. The benefit of one dose of some deep-acting drugs lasts for four to eight weeks, or longer. I have patients who have found that one dose of Silica in high potency will control their footsweat for six weeks or more. Furthermore, when a homceopathic drug eases a disorder it tends to cure it rather than simply suppress symptoms, with the result that the need for giving further doses becomes progressively less frequent. HOM(EOPATHIC
MEDICINES
HAVE CERTAIN
UNIQUE
QUALITIES:
(a) Acceptability. These medicated sugar pills are universally popular. The most nervous or resistant child will take them, once it has tasted one. The children in my district call them "sweeties" and enjoy visiting the surgery since they know they may be offered one. They are ideal for the occasional child who resolutely refuses every other form of medicament. (b) Convenience. One hundred or more remedies can be carried in a small compartment of a doctor's visiting case. For many years I have carried in my jacket pocket a small case which measures 5" • 4" • ~" and contains twenty-four labelled tubes, each containing a different drug. (c) Shelf-life. Shelf-life is indefinite; homoeopathic medicines in their screw-top bottles keep their strength for decades. However, they must not be contaminated by over-handling or by coming into contact with volatile oils, camphor, embrocations, etc., as these inactivate them. Similarly, homceopathic pills of one medicine must not be put into a bottle that previously contained a different homceopathic medicine. The chemists who supply these medicines usually give detailed instructions about how they should be kept and administered.
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(d) Administration. Homceopathic medicines can often be given orally when an allopathic equivalent would have to be given parenterally; for example, in cases of repeated vomiting, quinsy, syncope, coma and epilepsy, or in sleep. A few medicated granules can be placed, dry, on the tongue or inside the lips. The medicine is rapidly absorbed through the buceal mueosa.
(e) Speed of Action. In many acute conditions or emergencies, the rapidity of action of homceopathic medicines is astonishing. Aconite and Belladonna act as a febrifuge far more quickly than any form of salicylate and will, when indicated, start to bring down the temperatnre in a few minutes. In migraine and hayfever the speed of action is more dramatic still, and relief often starts within half a minute. Similarly, a screaming babe who has been crying for hours with teething pain will become quiet, and even start smiling and gurgling, within about thirty seconds of receiving potentized Chamomilla--when Chamomilla is the inidcated drug. Many years ago, before the days of effective hypotensives, I had a patient who regularly developed attacks of hypertensive encephalopathy. After her first prodromal symptom she had less than one minute before she blacked-out. In these attacks her face became bright red, and her pupils dilated, as though she were suffering from belladonna poisoning, and I gave her a supply of homceopathic Belladonna granules to be kept at hand always. She found that if she could get even one granule on her tongue within thirty seconds of the onset of her warning throbbing headache, she could abort the attack; but failing this she lost consciousness, and I was sent for. In the following eight years I was called to her only once, and that was because she had been in the toilet at the time of her attack, and couldn't get to her medicine in time. She called the granules "pin heads"! (f) Economy. At the time of writing, the average homceopathie prescription costs the NHS less than half the price of an allopathic equivalent. (g) Effectiveness. Brilliant cures have been effected by homceopathie medicines when allopathy had nothing further to offer. In terminal anuria with gross oedema and anasarca, where even parenteral diuretics were ineffective, Apis reel. (honey bee) has produced a brisk diuresis, followed by recovery. Homceopathie Carbo veg. (potentized charcoal) is known as the "corpse reviver", and justifies the title. Hom0eopathic treatment can abort attacks of shingles, cure intractible migraine, life-long eczema, asthma, facial acne, hayfever, tinnitus, hyperhidrosis, and impotence; and resistant allergies and photosensitivity. In chronic diseases, where spontaneous remissions are rare or unlikely, homceopathic medicine can give greater ease or improvement than allopathic medication; e.g. Rhus fox. (poison ivy) is superior to indomethaciu, ibuprofen, phenylbutazone or salicylates in many cases of rheumatoid or advanced osteoarthritis. In fact, I can think of few medical conditions for which Homceopathy cannot offer as much, or more help, than allopathy. Of course, there is still a need for surgery; and for manipulation, which many homceopathic doctors use. (h) Toxicity. Homceopathic medicines are non-toxic and do not produce iatrogenic effects. This is relevant, as the Dunlop Committee recently reported that approximately 12 per cent. of hospital admissions were due to drug-induced illness. I remember visiting a house where a child had emptied four bottles of pills
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into the goldfish tank some days previously, and the goldfish were s~ill swimming about, quite unaffected! Despite this, they do work in illness, when the body needs them. Dr. Alan Birch warns that " a n y drug is potentially dangerous, and you must ask yourself 'what could go wrong if I use it, and, in the event of an untoward reaction, what could I then do?' ,,a. This is perfectly true of allopathic medicines but does not apply to Homceopathy (see Instruction Sheet, Appendix I). Nor, in general, can homceopathic medicines suppress or mask symptoms in any harmful way. (i) Constant and Unvarying. Homceopathy has not fluctuated in the last 170 years, since H a h n e m a n n first taught it; nor can it, because the pharmacology of drugs hasn't altered. In contrast, compare the fashions in the treatment of burns or hypertension, and in oral diuretics, during the last twenty years. Until recently I was receiving information on the thirty or so new drug preparations being issued monthly, m a n y of which are destined to be withdrawn or replaced within a few years. As one GP used to say to the drug company representative who was introducing a new product: " I f it is still in use in a year's time, I will try it." (j) Stimulating. Homceopathy is a most absorbing, interesting and exciting study. You are searching for a drug whose "drug picture" is the same as the "disease picture" of the patient. I t is true this involves learning afresh, and in greater detail, the ~oxicology of m a n y drugs, but this need be done only gradually. I f you spend five minutes rea(ling up one of the commoner remedies, the chances are (in general practice) t h a t within the next day or so you will meet a patient whose symptoms are crying out for t h a t very medicine. Then with confidence you prescribe it, are gratified to see it work, and encouraged to experiment further. You can even write the abbreviated indications for prescribing the drug onto a gummed label, and attach it to the side of the pill bottle. Then each time you use the medicine, you can quickly revise its "chug picture". I f you are unsure or undecided as to whether a remedy is the indicated one, a safe expedient is to give a few doses of the homceopathic medicine, and a prescription for an allopathie alternative, with the instruction to use the pills first, and, if they "are not strong enough", to have the prescription dispensed. I f they do work, it is not likely to be due to suggestion, as the doubt as to the efficacy of the homceopathic pills has been raised in the patient's mind. For the busy GP, a convenient way of introducing Homceopathy into his practice is to utilize a set of Nelson's H o m e Remedies which comprises a basic set of about two dozen of the most commonly used remedies. These labelled bottles not only give the name of the drug, but also the homceopathic indications for using it (Appendix II). This latter is important, because homceopathie prescribing has to be as it were "tailor-made", and you have to prescribe for the whole patient rather than for the disease. This means t h a t four consecutive cases of 'flu might require four different medicines, depending on how each individual patient has reacted to the influenza virus infection. Happily, it usually happens t h a t in any one epidemic most patients display the same symptoms, so t h a t most would benefit from one hom(eopathic medicine. Supplied with such a set of a dozen or so labelled bottles, it isn't difficult for the busy GP to decide which one to use. For the doctor's convenience, the chemists who supply these medicines will also, on request, supply gratis a
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cross-reference list of the remedies (Appendix I I I ) and a copy of all the labels (Appendix II) for easy identification. One can go further, and let the patients have their own small supply of medicines for first-aid or home use. I have done so regularly for the last twenty years. Routinely, every new family t h a t joins the practice is invited to have their own supply of homceopathic medicines. To save a lot of explanation, they are also provided with an Instruction Sheet (Appendix I). The local chemist gets a stock of these labelled bottles of medicines from the manufacturing chemist and so can dispense them over the counter. A convenient way of dispensing a few pills at a time to a patient, is to use "Krystal pockets". These are small paper envelopes, about ~" • ~ lU , which are inexpensive unless one has one's name printed on them (available from: Pharmaceutical Packaging Limited, Kirkstall Hill, Leeds). Alternatively, small sterile glass dispensing tubes are available, which are economic if bought in bulk from Nelsons. Initially, according to the circumstances of each family, I start them with between four and eight bottles from the list, depending on the ages of the children in the family. For example, m y usual initial choice for a young family is "Shock and No. 1 Fever Pills" "No. 2 Fever Pills" "Nausea and No. 1 Cough Pills" " I n j u r y Pills"
(ACONITE) (BELLADONNA) (IPECAC.) (ARNICA)
"Stomach Pills" "Laryngitis and Repeated Vomiting Pills" "Sickness and Diarrhoea Granules" "Frantic Pain Granules"
(NUX VOM.) (PHOSPHORUS) (ARS. ALB.) (CHAMOMILLA)
this last if there is a child under two years old. These are ordered in the ordinary way, in the following abbreviated form, on two prescriptions: R 1. Aconite 2. Belladonna r30th 3. Ipecac. Nelson's Pills 4. Arnica (7g. of each. 1~
1. N u x vom. 2. Phosphorus - - Pills 3. Ars. alb. ~ , 4. C h a m o m i l l a / u r a n u m s
30th. Nelson's 7g. of each
"30th" means the 30th potency, which is the particular degree of dilution and succussion involved in the preparation of the pills, i.e. their strength. "Nelson's" is the name of the manufacturing chemist. I order the bottles of A r s e n i c u m a l b . and C h a m o m i l l a in granule form, for convenience of administration to vomiting or screaming children; although, if preferred, you can order any or all of the medicines as tablets, pills or granules. Although the initial cost to the N H S m a y be high, m y prescribing costs are usually lower than the local, county and national averages, because the bottles last so long. And m y prescribing costs remain low despite the fact that, on average, I order over 1 500 of these "home remedies" annually; in m a n y cases as a repeat prescription, at the patient's request. I n the case of young couples
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"signing on", where there are no children in the family, I usually defer issuing the prescriptions until the wife is pregnant. She is then exempted from paying prescription charges, and the impecunious couple is not faced with an excessive financial outlay which they could ill afford at t h a t time. The result of m y issuing H o m e Remedies has been a noticeable reduction in home visits and night calls. Times without number a mother has brought a child to the morning surgery with the following story: "Last night, in the early hours, he went burning hot, and delirious. We didn't know what to do, and were just going to send for you, when we remembered the set of pills. We looked through them and tried the Fever Pills, and within half-an-hour he was cool and sleeping again. This morning he woke up all right, and has eaten a good breakfast. I thought I had better bring him, just to see what he was going to get." I reply by saying t h a t I don't know what he had been developing, but t h a t when the pills work, they stop an illness at its source, before it becomes established, without having any harmful suppressive effects. I f you peruse the list of available remedies it becomes apparent t h a t they cover most of the emergencies in general practice. Over the years, the patients' confidence in the remedies has grown to such an extent that they will happily accept advice over the phone as to which remedy to use for the emergency, and I ask them to ring back in a few minutes' or hours' time if they h a v e n ' t worked. I n most cases this suffices, or tides over the patient until the next surgery time. I n doing this, the GP is no way abnegating his responsibilities to his patient; nor is there any risk of masking serious symptoms, nor of delaying urgent surgery b y using homceopathic medicines in acute conditions. I f they work at all to ease, they usually work to cure. Routinely, I use Arnica (Injury) instead of morphine for road traffic casualties, and often during one surgery wilt prescribe it to several patients for traumatic conditions. I n croup, Aconite acts more quickly than diazepam (Valium), and can also be given to calm the agitated mother. The paradox is that, occasionally, a patient will inform the Doctor t h a t he finds a certain medicine effective in treating conditions not listed on the label; and on looking up the drug in a repertory the doctor finds it covers t h a t condition. Thus one's knowledge is increased. On rarer occasions, the repertory doesn't contain any relevant information, in which case the patient m a y be a placebo reactor. At any rate, he was helped, and ~he doctor spared extra work! Many of the medicines in the Reference List are for the doctor's use, and will be ordered for the patient only occasionally; e.g. Euphrasia for hayfever where it has been proved to be more effective than an antihistamine. There are several other good hayfever medicines commonly required, as even in hayfever there are individual variations. A necessary caution must be given about treating cystitis with Cantharis (Bladder and Burn Pills). I t is now recognized that in every case of cystitis a mid-stream specimen of urine should be sent for laboratory examination, including culture and sensitivities; and if there is haematuria, full investigation of the renal tract is mandatory. Furthermore, antibiotics should, where possible, be withheld until an M.S.U. has been reported on. I t is during this time t h a t Cantharis can give dramatic symptomatic relief. I t would be most imprudent to prescribe a bottle of Cantharis for a patient's own use, unless he clearly understood this, and was prepared to present himself for appropriate investigations and treatment during each attack of cystitis. The instructions on the labels are precise because homceopathic prescribing
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has to be accurate, and there can be no "blunderbuss" prescribing. When a homceopathic medicine doesn't work, I assume I have not found the correct one, and not that Homceopathy cannot help t h a t person. I n conclusion, Hom0eopathy is a simple, well-proven and reliable form of therapeutics, which fascinates all who study it seriously. I have yet to meet the doctor who, having genuinely inquired into it and taken it up, has discarded it on the grounds t h a t it was either ineffective or inferior to allopathy. Those who use these H o m e Remedies in general practice find their work-load is lightened and the number of home visits reduced. Their patients are convinced the medicines are effective. REFERENCES 1 A c t s 14, v. 15. J a m e s 5, v. 17. 2 B r a d f o r d (1900) Logic of Figures, p. 137. a Birch, A l a n , Medical Emergencies. T a p e - r e c o r d e d lecture. R o y a l College o f G P s Medical R e c o r d i n g Service.
APPENDIX I PLEASE KEEP FOR REFERENCE INSTRUCTION SHEET These pilules are homceopathic, similar to those used in the various homceopathic hospitals in the country. They have the following unique properties: (a) They keep their strength for years without deteriorating or losing their power, if k e p t sealed in their bottles. {b) They can be given to any age of person, adult or child--even to a b a b y if the pill is first crushed into powder. A convenient way to do this is to crush the pill between two folds of clean greaseproof paper or two dessert spoons. I t doesn't matter if a few fragments fly off and arc lost, there is still enough medicine left to work. The powder can then be given dry or melted in water. I f the invalid is feeling sick, it is best to crush and dissolve the pill in water in any case, or the sweet taste of the pill sometimes causes sickness. Ic) They can be given to a child in its sleel>--the child will simply rouse itself sufficiently to chew the pill, without properly waking. Thisis very useful when a child is found to be getting feverish after it has gone to bed. (d) They are not poisonous--a b a b y could eat the contents of a whole bottle at once and wouldn't be h a r m e d - - y e t , for all t h a t they work in sickness. (e) I f in doubt as to which fever pill to use, t r y No. 1, and if after two doses there is no improvement, t r y No. 2. I t is like trying to open a locked door when you have two keys, you t r y the first and if it doesn't fit you use the second. So with the pills--if the first doesn't work you have done no harm but only wasted a pill. I n the rare event of the pills appearing to make the condition worse, stop giving them and wait. Such an aggravation is generally followed b y a marked improvement. I f this improvement wears off, start giving the pills again, but be ready to stop as soon as they begin to act. I t is as if they were working too powerfully, in which case only a few doses will be necessary. This applies chiefly with the cough and cold pills, and catarrh pills. When you are running short of a n y of these medicines (or the bottle gets broken or mislaid) please come for a further supply. I want you always to have them b y you as they so often cut short an illness at its onset.
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List of labels Aconite
SHOCK and No. 1 F E V E R PILLS. When hot, very thirsty, anxious, ?frightened, restless. Also for SHOCK, croup, effects of fright or chills, any EMERGENCY, or numb tingling pains. One L-hourly until relief.
Belladonna
No. 2 F E V E R PILLS. When burning hot, flushed, wide-eyed, excited, ?delirious, (?scarlet rash). Thirsty but won't drink. Also sore throats, colic, throbbing headaches, throbbing boils, severe earache with above symptoms. One L-hourly until relief.
Ipecac.
NAUSEA and No. 1 COUGH PILLS. For persistent NAUSEA, ?vomiting, with clean tongue, much saliva. Onset violent suffocating wheezing bouts coughing. Also nose bleeds, haemorrhages, with nausea. One 2-hourly until relief.
Ant. tart.
No. 2 COUGH PILLS. When touchy, drowsy, very weak. Cold, clammy sweat; pale or bluish face, white-coated tongue. Breathless, gasping, must sit up. Rattling cough, unable expectorate. Worse warmth. One L-hourly until relief.
Phosphorus
LARYNGITIS and REPEATED VOMITING PILLS. When chest tight, hoarse, hurts to talk, ?loss of voice. Dry, tickling, racking cough, worse cold air, worse talking. Craving cold drinks ?vomited immediately. Nervous. One 2-hourly until relief.
Pulsatilla
CATARRH and No. 2 MEASLES PILLS. When thick, coloured catarrh, eyelids, nose. Loss smell. Dry mouth, no thirst. Better open air. Catarrhal cough, worse warm room. MEASLES. Indigestion from fat, rich food. ~Tearful. One 4-hourly until relief.
Chamomilla
FRANTIC PAIN GRANULES. For UNBEARABLE PAINS: earache, toothache; teething, better being picked up, ?one cheek hot. Colic, diarrhoea green motions. Bad tempered, impatient, worse heat, anger. 10 granules approximately, every 5 minutes until relief.
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Ars. alb.
SICKNESS AND DIARRHOEA GRANULES. When sickness and diarrhoea SIMULTANEOUSLY, feeling very cold, exhausted, can't rest. Burning pains stomach. Thirst warm drinks. Can't bear sight, smell food. 10 granules in warm water 88 until relief.
Nux
STOMACH PILLS. When chilly, IRRITABLE, ?quarrelsome. Delayed indigestion, nausea, constipation, frequent ineffectual urging. Itching piles. "Flu", pharyngitis, if chilled when uncovers or drinks. Stuffy colds, raw throat. Infants' snuffles. One 4-hourly until relief.
vom.
Bryonia
PAIN OR HEADACHE PILLS. For bursting headaches, MIGRAINE, arthritis, pleurisy, only when pains worse movement, breathing, warmth, BETTER PRESSURE, KEEPING STILL, cool. Parched, thirst cold drinks. Irritable. Indigestion, stomach tender. One 4-hourly until relief.
Natrum mur.
RECURRENT COLD PILLS. For "sneezy colds", much nasal discharge, ?fever blisters. Feeling cold. WORSE WARM. Cough with tears. Thirsty, irritable, weak. ?weepy. (Blinding headaches, on doctor's advice only.) One 4-hourly until relief.
Camphor
CAMPHOR PILLS When ICY COLD following chill. Onset head cold with chilliness A- sneezing, better warmth. ONSET DIARRHOEA feeling chilly. One everT 5 minutes until warm/relief. KEEP BOTTLE SEPARATE. Camphor vapour inactivates other pills.
Mere. sol.
FEVERISH COLD PILLS. When feeling chilly in cold, hot in warmth, weak, trembling, offensive sweat and breath. Profuse greenish catarrh, salivation, THIRST. DIARRHOEA, straining-{-, slime, ?blood. Worse night. One 2-hourly until relief.
Rhus fox.
RHEUMATISM PILLS. When pains, stiffness, worse wet weather, cold air, in bed, after rest (first movements hurt). BETTER KEEPING MOVING. "FLU", dry cough with above symptoms. Also itching blisters. One 4-hourly until relief.
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Gelsemium
INFLUENZA and "NERVE" PILLS. When hot, flushed, aching, TREMBLING, dizzy, drowsy, "drugged", weak. Headache, eyes heavy. Back chilly. Sneezing, running nose. Sore throat. Difficulty swallowing. No thirst. Also upsets from "nerves". One 2-hourly until relief.
Euphrasia
MEASLES and HAYFEVER PILLS. For onset MEASLES when eyes streaming, tears burn, can't face light. Running nose, sneezing, cough. Throbbing headache. HAYFEVER, as above, worse indoors, warmth, evenings. One 2-hourly until relief.
Sulphur
SULPHUR PILLS. For BURNING itching skin rashes, worse WARMTH, scratching, washing, clothing, BURNING boils, eyelids and piles. Hungry, tires, "flushes", bunting feet. Kicks off bedclothes. Morning diarrhoea. One twice-daily until relief. Maximum 6.
Co]oeynth
COLIC PILLS. For agonizing colic, better doubling up, hard pressure, heat, twisting about. Griping pains causing distension, belching, vomiting, ?diarrhoea. Colic and neuralgia from anger, "getting worked up".
Cantharis
BLADDER and BURN PILLS. Cystitis when urine SCALDS, passed drop by drop. Unbearable urging and frequency. Also BURNS, scalds, better cold applications. Also burning itching busters (erysipelas). GNAT BITES. One 2-hourly until relief.
Ant. erud.
No. 2 STOMACH PILLS. When CROSS, TOUCHY, depressed. Vomits feeds. WHITECOATED tongue, corners mouth cracked. No appetite. Sick headaches from catarrh, alcohol, bathing. Wants sharp drinks. ?pickles. Belching, bloated. One 4-hourly until relief.
Arnica
INJURY PILLS. For bruises, sprains, concussion, or any other injury. Also for aching, fatigued muscles. One 2-hourly until relief of pain or aching.
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III
Cross-reference list
(a)
Aconite ............ Belladonna ........ Ipecac ............. Ant. tart ........... Phosphorus ........ Pulsatilla .......... Chamomilla ........ Ars. alb ........... Nux vom ........... Bryonia ............ Natrum mur ........ Camphor .......... M e r c . sol . . . . . . . . . . . . Rhus tox ........... Gelsemium ......... Euphrasia .......... Sulphur ............ Colocynth .......... Cantharis ........... A n t . c r u d . 9. . . . . . . . Arnica ............
Cross-reference list
SHOCK and No. 1 FEVER PILLS No. 2 FEVER PILLS NAUSEA and No. 1 COUGH PILLS No. 2 COUGH PILLS LARYNGITIS and REPEATED VOMITING CATARRH and No. 2 MEASLES PILLS FRANTIC PAIN GRANULES SICKNESS AND DIARRHOEA GRANULES STOMACH PILLS PAIN OR HEADACHE PILLS RECURRENT COLD PILLS CAMPHOR PILLS FEVERISH COLD PILLS RHEUMATISM PILLS INFLUENZA and "NERVE" PILLS MEASLES and HAYFEVER PILLS SULPHUR PILLS COLIC PILLS BLADDER and BURN PILLS No. 2 STOMACH PILLS INJURY PILLS
PILLS
(b)
SHOCK and No. 1 FEVER PILLS ...................... No. 2 FEVER PILLS .................................. NAUSEA and No. 1 COUGH PILLS .................... No. 2 COUGH PILLS .................................... LARYNGITIS and REPEATED VOMITING PILLS ........ CATARRH and No. 2 MEASLES PILLS .................. FRANTIC PAIN GRANULES ............................ SICKNESS AND DIARRHOEA GRANULES ............... STOMACH PILLS ................. . ................... PAIN OR HEADACHE PILLS .......................... RECURRENT COLD PILLS .............................. CAMPHOR PILLS ...................................... FEVERISH COLD PILLS ................................ RHEUMATISM PILLS .................................. INFLUENZA and "NERVE" PILLS .................... MEASLES and HAYFEVER PILLS ...................... SULPHUR PILLS ...................................... COLIC PILLS .......................................... BLADDER and BURN PILLS .......................... No. 2 STOMACH PILLS ................................ INJURY PILLS ........................................
.
Aconite Belladonna Ipecac. Ant. tart. Phosphorus Pulsatilla Chamomilla A r s . alb. Nux vom. Bryonia Natrum tour. Camphor M e r e . sol. Rhus tox. Gelsemium Euphrasia Sulphur Colocynth Cantharis Ant. crud. Arnica
The word "homceopathy" derives from two Greek words, "homoios" meaning "like" and "pathos"--"suffering", and occurs twice in the New Testament where it is translated as "like passions" on both occasions. 1 I t was first used in medicine b y Dr. Samuel Hahnemann, after he had made the remarkable discovery t h a t what a drug could cause, it could cure. Amplified, this means t h a t a substance which, in certain forms and doses, causes disease symptoms, m a y also be used to cure illnesses showing similar symptoms. He propounded the theory "let likes be treated by likes". Accordingly, homceopathic treatment involves matching a "drug picture" with a "disease picture", i.e. choosing a drug which in its toxic effects manifests symptomatology similar to the symptoms of the patients. Such a drug he called the "simillhnum". This in turn requires a detailed knowledge of the toxicology of drugs, which is why the homceopathic materia mediea has greater detail than the average textbook of pharmacology. A classified index of drug symptoms is known as a repertory, and is used as a short-cut to isolating the indicated drug, in the same way that a crossword enthusiast makes use of a dictionary of quotations and a thesaurus. The h r n d t Schulz Law states t h a t the opposite effects of stimulation and depression can be produced by different doses of the same drug. This is well exemplified in alcohol intoxication, where small doses cause hyperactivity, but larger doses depress the nervous system, ttomceopathy utilizes this opposite effect, so t h a t the best homceopathic remedies for diarrhoea are laxatives when used allopathically. The same principle is embodied in modern desensitizing methods, vaccinations and inoculations where a small attenuated dose of an antigen is injected, with a view to stimulating the body's defences to withstand an overwhelming dose of the same antigen. Homceopathy uses a small dose, as this has been found to be sufficient to stimulate the body's vital reaction and recuperative powers. ILLUSTRATIONS
OF
THE
PRINCIPLE
OF
HOM(EOPATHY
1 As a historical example, H a h n e m a n n scored a great success with Homceop a t h y in treating cholera. I n 1831 a serious epidemic was spreading west from Eastern Europe. Hahnemann, in Kothen, had never seen a case, but suggested treating the early stages with Camphor, as camphor poisoning produces symptoms clinically indistinguishable from cholera. "The aggregate statistics of results of allopathic treatment of cholera in Europe and America show" a mortality of over 40 per cent; statistics of homceopathic treatment a mortality of less than 9 per cent. ''2 These impressive results helped to establish Homceopathy in the British Isles.
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2 In the days before the phenothiazines, hypomania was controlled by injecting a small dose of hyoscine (0.6 mg). But an overdose of hyoseine produces mania. 3 Strong coffee is a stimulant, used to keep a person awake, and the mind alert. Potentized homceopathically, coffee is an excellent hypnotic, when the cause of the insomnia is overactivity of the mind. 4 Exposure to onion juice produces lachrymation, sneezing and coryza. Red onion (Allium cepa), when given in homceopathic potency, is one of the most effective medicines for hayfever. Homoeopathic medicines are usually prepared as tinctures, tablets, pills, granules or powders. They contain a small amount of medicine which has been "potentized" by repeated dilution, with vigorous shaking (suceussion) at each stage of the dilution. The drugs used are prepared from plants, chemicals, and animal products (snake venom, etc.) and many are mentioned in Martindale's Extra Pharmacopoeia. They can all be prescribed on the National Health Service. They can, in instances, be used in conjunction with ordinary allopathie medicines, although their action may be depressed by these drugs. This is understandable, as the homceopathie medicine works by stimulating the body's natural defenees and vital reaction, and if these are being suppressed by antihistamines, tricyelies or, worst of all, steroids, the action of the homoeopathie drug is curtailed. With increasing experience of Homceopathy, one gives one form of treatment or the other. However, homceopathic medicines can prove a very useful adjuvant to antibiotic therapy, and the two forms of medication apparently don't conflict. Nor do vitamin supplements or analgesics vitiate homoeopathie therapy. Homoeopathic treatment involves taking a history of the case, and a detailed examination of the patient, in the conventional way; but differs from allopathie treatment inasmuch as it uses the principle of treating the whole patient rather than his individual symptoms. An analogy from one of the few examples of allopathic prescribing where this principle is applied will illustrate the point. Consider a case of depressive illness: it is well recognized that this may present with various intractable somatic symptoms such as lassitude, dyspnoea, gastralgia, constipation, amenorrhoea, insomnia, or even severe headaches or muscular pains. The usual palliative treatments, including tranquillizers, fail to help, and it may be months before the florid symptoms of depression emerge. If, however, one suspects early in the illness that there is an underlying depressive reaction, inquiry will elicit feelings of failure and guilt, loss of interest and libido, irritability, anorexia and loss of weight, and the diurnal mood swings with the nadir of mood in the mornings. Using current allopathie therapy, little or no relief will be obtained until the required tricyclie or other anti-depressive agent is prescribed. The patient is predominently concerned about his one particular somatic symptom: you treat his general and mental condition, anticipating a predictable improvement in the next few weeks. Homceopathic nomenclature also uses those three words, "mentals", "generals" and "particulars", in describing symptoms, and attaches importance to them in that order. "Mentals" refers to the mental make-up of the patient, and describes the variations of affect, disposition and attitude. I t is well recognized that certain illnesses (jaundice, with its "melancholia") and certain drugs (gold injections)
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make the patient depressed. Homceopathic provings have shown that most drugs alter the "mentals" of a patient, making him, for example: irritable (Nux vomica) depressed (Aurum (gold)} elated (Cannabis) lachrymose (P~lsatilla) indifferent to loved ones {Sepia) worse for consolation ~Natrum tour.) suspicious (Hyoscyamus) jealous and loquacious (Lachesis Bushmaster snake) restless (Rhus tox. (poison ivy)) fearful (Aconite) afraid of the dark {Phosphorus) hypomanic (Stramonium ) Although only one example of each has been given, the repertory contains a list of drugs, under each of the above headings, that have induced these mental changes in their "provings". Hahnemann tested, or "proved", each drug in a double blind trial, by giving repeated small doses of it to groups of volunteers until significant mental and physical changes were induced, and these he carefully recorded. Some of the drugs had been well documented already, following cases of accidental overdoses, etc. Other drugs affect sleep (even dreams), memory, balance, sight, etc. Others disturb the appetite, causing unusual cravings or aversions, e.g. Ar~entum nitricum makes a person intolerant of heat and impulsive, and produces flatulent dyspepsia with an irresistible craving for sweet things. "Generals." Drugs also affect the patient generally in himself, so that he m a y become intoleraut of the cold {Arsenicum alb.) or the heat (Apis) or damp (Nat. sulph.), or of a north-east wind (Hepar sulph.), etc. Again, they may make the person feel very weak and exhausted, e.g. Kali carb. and other potassium salts (cf. hypokalaemia). "Particulars." These symptoms generally refer to an organ or part of the body. Again, different drugs, in toxic doses, affect different parts of the body. Bryonia selects the serous membranes and pleura, producing synovitis and pleurodynia, and Phosphorus affects the stomach, producing an intense craving for cold drinks which are promptly vomited back again; Copper causes cramps, and Lead poisoning results in colic and wrist-drop. "Modalities" is another term employed in Homceopathy, and is used to qualify symptoms, e.g. "worse for movement" {written " ~ movement"), or "better for pressure" { " ~ pressure"), or "better for applied heat", etc. In the Modalities section of a repertory the aggravations are listed before the ameliorations. So the homceopathic doctor has to assess the whole patient with his mental, general and particular symptoms, and find a corresponding drug picture. Obviously, if he can isolate a unique or peculiarly outstanding symptom that few drugs in toxic doses can produce, his task is made easier. In a police search, if the identikit or description states "walks with a limp", or "tattoo on left forearm", or "ugly scar on right cheek", the hunt for the suspect is made infinitely easier. In the same way, if we find a prominent, unusual symptom, the list of possible remedies is immediately shortened, as only a few drugs will have
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that change in their provings. For example, Arsenicum alb. (white arsenic) in its provings makes a person feel very cold, fearful, weak and restless. He develops an acute gastro-enteritis, with an aggravation of his symptoms about midnight. Furthermore, there is the unusual feature that the vomiting occurs during the diarrhoea. Few other drugs cause this. Thus, in treating a case of gastro-enteritis with such an identikit, the choice of drug is relatively easy. But suppose the patient simply complains of nausea. I t would be profitless to hunt in the repertory among the hundreds of drugs that can cause this. If, however, questioning reveals that the patient has become intensely irritable and unsociable, is easily offended at the least, harmless word (like '% bear with a sore head") and is hypersensitive to noise and smells; but feels unusually chilly and has an unsatisfactory bowel function ("false alarms", ineffectual urging) and is worse in the mornings, then Nux vomica is probably indicated. Here, the choice of drug is made by his mental and general symptoms, rather than his particular one--nausea. This is analagous with the earlier illustration of prescribing tricyc!ics for the bowel symptoms of depression. Homceopathic prescribing further differs from allopathic prescribing in that only a single dose of the drug is given, and is allowed to work until its action is exhausted. The patient has to heal himself the dose but initiates and stimulates that response. The second dose must be given only when benefit from the first has worn off. When a satellite is being put into orbit, the second and third stages of the rocket are fired only when the force of the thrust from the preceding stage has nearly ceased. The third stage usually puts the satellite into orbit. So too in homceopathic prescribing: the secret of success is not to spoil the action of the simillimum by too-frequent repetition of the dose. The benefit of one dose of some deep-acting drugs lasts for four to eight weeks, or longer. I have patients who have found that one dose of Silica in high potency will control their footsweat for six weeks or more. Furthermore, when a homceopathic drug eases a disorder it tends to cure it rather than simply suppress symptoms, with the result that the need for giving further doses becomes progressively less frequent. HOM(EOPATHIC
MEDICINES
HAVE CERTAIN
UNIQUE
QUALITIES:
(a) Acceptability. These medicated sugar pills are universally popular. The most nervous or resistant child will take them, once it has tasted one. The children in my district call them "sweeties" and enjoy visiting the surgery since they know they may be offered one. They are ideal for the occasional child who resolutely refuses every other form of medicament. (b) Convenience. One hundred or more remedies can be carried in a small compartment of a doctor's visiting case. For many years I have carried in my jacket pocket a small case which measures 5" • 4" • ~" and contains twenty-four labelled tubes, each containing a different drug. (c) Shelf-life. Shelf-life is indefinite; homoeopathic medicines in their screw-top bottles keep their strength for decades. However, they must not be contaminated by over-handling or by coming into contact with volatile oils, camphor, embrocations, etc., as these inactivate them. Similarly, homceopathic pills of one medicine must not be put into a bottle that previously contained a different homceopathic medicine. The chemists who supply these medicines usually give detailed instructions about how they should be kept and administered.
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(d) Administration. Homceopathic medicines can often be given orally when an allopathic equivalent would have to be given parenterally; for example, in cases of repeated vomiting, quinsy, syncope, coma and epilepsy, or in sleep. A few medicated granules can be placed, dry, on the tongue or inside the lips. The medicine is rapidly absorbed through the buceal mueosa.
(e) Speed of Action. In many acute conditions or emergencies, the rapidity of action of homceopathic medicines is astonishing. Aconite and Belladonna act as a febrifuge far more quickly than any form of salicylate and will, when indicated, start to bring down the temperatnre in a few minutes. In migraine and hayfever the speed of action is more dramatic still, and relief often starts within half a minute. Similarly, a screaming babe who has been crying for hours with teething pain will become quiet, and even start smiling and gurgling, within about thirty seconds of receiving potentized Chamomilla--when Chamomilla is the inidcated drug. Many years ago, before the days of effective hypotensives, I had a patient who regularly developed attacks of hypertensive encephalopathy. After her first prodromal symptom she had less than one minute before she blacked-out. In these attacks her face became bright red, and her pupils dilated, as though she were suffering from belladonna poisoning, and I gave her a supply of homceopathic Belladonna granules to be kept at hand always. She found that if she could get even one granule on her tongue within thirty seconds of the onset of her warning throbbing headache, she could abort the attack; but failing this she lost consciousness, and I was sent for. In the following eight years I was called to her only once, and that was because she had been in the toilet at the time of her attack, and couldn't get to her medicine in time. She called the granules "pin heads"! (f) Economy. At the time of writing, the average homceopathie prescription costs the NHS less than half the price of an allopathic equivalent. (g) Effectiveness. Brilliant cures have been effected by homceopathie medicines when allopathy had nothing further to offer. In terminal anuria with gross oedema and anasarca, where even parenteral diuretics were ineffective, Apis reel. (honey bee) has produced a brisk diuresis, followed by recovery. Homceopathie Carbo veg. (potentized charcoal) is known as the "corpse reviver", and justifies the title. Hom0eopathic treatment can abort attacks of shingles, cure intractible migraine, life-long eczema, asthma, facial acne, hayfever, tinnitus, hyperhidrosis, and impotence; and resistant allergies and photosensitivity. In chronic diseases, where spontaneous remissions are rare or unlikely, homceopathic medicine can give greater ease or improvement than allopathic medication; e.g. Rhus fox. (poison ivy) is superior to indomethaciu, ibuprofen, phenylbutazone or salicylates in many cases of rheumatoid or advanced osteoarthritis. In fact, I can think of few medical conditions for which Homceopathy cannot offer as much, or more help, than allopathy. Of course, there is still a need for surgery; and for manipulation, which many homceopathic doctors use. (h) Toxicity. Homceopathic medicines are non-toxic and do not produce iatrogenic effects. This is relevant, as the Dunlop Committee recently reported that approximately 12 per cent. of hospital admissions were due to drug-induced illness. I remember visiting a house where a child had emptied four bottles of pills
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into the goldfish tank some days previously, and the goldfish were s~ill swimming about, quite unaffected! Despite this, they do work in illness, when the body needs them. Dr. Alan Birch warns that " a n y drug is potentially dangerous, and you must ask yourself 'what could go wrong if I use it, and, in the event of an untoward reaction, what could I then do?' ,,a. This is perfectly true of allopathic medicines but does not apply to Homceopathy (see Instruction Sheet, Appendix I). Nor, in general, can homceopathic medicines suppress or mask symptoms in any harmful way. (i) Constant and Unvarying. Homceopathy has not fluctuated in the last 170 years, since H a h n e m a n n first taught it; nor can it, because the pharmacology of drugs hasn't altered. In contrast, compare the fashions in the treatment of burns or hypertension, and in oral diuretics, during the last twenty years. Until recently I was receiving information on the thirty or so new drug preparations being issued monthly, m a n y of which are destined to be withdrawn or replaced within a few years. As one GP used to say to the drug company representative who was introducing a new product: " I f it is still in use in a year's time, I will try it." (j) Stimulating. Homceopathy is a most absorbing, interesting and exciting study. You are searching for a drug whose "drug picture" is the same as the "disease picture" of the patient. I t is true this involves learning afresh, and in greater detail, the ~oxicology of m a n y drugs, but this need be done only gradually. I f you spend five minutes rea(ling up one of the commoner remedies, the chances are (in general practice) t h a t within the next day or so you will meet a patient whose symptoms are crying out for t h a t very medicine. Then with confidence you prescribe it, are gratified to see it work, and encouraged to experiment further. You can even write the abbreviated indications for prescribing the drug onto a gummed label, and attach it to the side of the pill bottle. Then each time you use the medicine, you can quickly revise its "chug picture". I f you are unsure or undecided as to whether a remedy is the indicated one, a safe expedient is to give a few doses of the homceopathic medicine, and a prescription for an allopathie alternative, with the instruction to use the pills first, and, if they "are not strong enough", to have the prescription dispensed. I f they do work, it is not likely to be due to suggestion, as the doubt as to the efficacy of the homceopathic pills has been raised in the patient's mind. For the busy GP, a convenient way of introducing Homceopathy into his practice is to utilize a set of Nelson's H o m e Remedies which comprises a basic set of about two dozen of the most commonly used remedies. These labelled bottles not only give the name of the drug, but also the homceopathic indications for using it (Appendix II). This latter is important, because homceopathie prescribing has to be as it were "tailor-made", and you have to prescribe for the whole patient rather than for the disease. This means t h a t four consecutive cases of 'flu might require four different medicines, depending on how each individual patient has reacted to the influenza virus infection. Happily, it usually happens t h a t in any one epidemic most patients display the same symptoms, so t h a t most would benefit from one hom(eopathic medicine. Supplied with such a set of a dozen or so labelled bottles, it isn't difficult for the busy GP to decide which one to use. For the doctor's convenience, the chemists who supply these medicines will also, on request, supply gratis a
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cross-reference list of the remedies (Appendix I I I ) and a copy of all the labels (Appendix II) for easy identification. One can go further, and let the patients have their own small supply of medicines for first-aid or home use. I have done so regularly for the last twenty years. Routinely, every new family t h a t joins the practice is invited to have their own supply of homceopathic medicines. To save a lot of explanation, they are also provided with an Instruction Sheet (Appendix I). The local chemist gets a stock of these labelled bottles of medicines from the manufacturing chemist and so can dispense them over the counter. A convenient way of dispensing a few pills at a time to a patient, is to use "Krystal pockets". These are small paper envelopes, about ~" • ~ lU , which are inexpensive unless one has one's name printed on them (available from: Pharmaceutical Packaging Limited, Kirkstall Hill, Leeds). Alternatively, small sterile glass dispensing tubes are available, which are economic if bought in bulk from Nelsons. Initially, according to the circumstances of each family, I start them with between four and eight bottles from the list, depending on the ages of the children in the family. For example, m y usual initial choice for a young family is "Shock and No. 1 Fever Pills" "No. 2 Fever Pills" "Nausea and No. 1 Cough Pills" " I n j u r y Pills"
(ACONITE) (BELLADONNA) (IPECAC.) (ARNICA)
"Stomach Pills" "Laryngitis and Repeated Vomiting Pills" "Sickness and Diarrhoea Granules" "Frantic Pain Granules"
(NUX VOM.) (PHOSPHORUS) (ARS. ALB.) (CHAMOMILLA)
this last if there is a child under two years old. These are ordered in the ordinary way, in the following abbreviated form, on two prescriptions: R 1. Aconite 2. Belladonna r30th 3. Ipecac. Nelson's Pills 4. Arnica (7g. of each. 1~
1. N u x vom. 2. Phosphorus - - Pills 3. Ars. alb. ~ , 4. C h a m o m i l l a / u r a n u m s
30th. Nelson's 7g. of each
"30th" means the 30th potency, which is the particular degree of dilution and succussion involved in the preparation of the pills, i.e. their strength. "Nelson's" is the name of the manufacturing chemist. I order the bottles of A r s e n i c u m a l b . and C h a m o m i l l a in granule form, for convenience of administration to vomiting or screaming children; although, if preferred, you can order any or all of the medicines as tablets, pills or granules. Although the initial cost to the N H S m a y be high, m y prescribing costs are usually lower than the local, county and national averages, because the bottles last so long. And m y prescribing costs remain low despite the fact that, on average, I order over 1 500 of these "home remedies" annually; in m a n y cases as a repeat prescription, at the patient's request. I n the case of young couples
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"signing on", where there are no children in the family, I usually defer issuing the prescriptions until the wife is pregnant. She is then exempted from paying prescription charges, and the impecunious couple is not faced with an excessive financial outlay which they could ill afford at t h a t time. The result of m y issuing H o m e Remedies has been a noticeable reduction in home visits and night calls. Times without number a mother has brought a child to the morning surgery with the following story: "Last night, in the early hours, he went burning hot, and delirious. We didn't know what to do, and were just going to send for you, when we remembered the set of pills. We looked through them and tried the Fever Pills, and within half-an-hour he was cool and sleeping again. This morning he woke up all right, and has eaten a good breakfast. I thought I had better bring him, just to see what he was going to get." I reply by saying t h a t I don't know what he had been developing, but t h a t when the pills work, they stop an illness at its source, before it becomes established, without having any harmful suppressive effects. I f you peruse the list of available remedies it becomes apparent t h a t they cover most of the emergencies in general practice. Over the years, the patients' confidence in the remedies has grown to such an extent that they will happily accept advice over the phone as to which remedy to use for the emergency, and I ask them to ring back in a few minutes' or hours' time if they h a v e n ' t worked. I n most cases this suffices, or tides over the patient until the next surgery time. I n doing this, the GP is no way abnegating his responsibilities to his patient; nor is there any risk of masking serious symptoms, nor of delaying urgent surgery b y using homceopathic medicines in acute conditions. I f they work at all to ease, they usually work to cure. Routinely, I use Arnica (Injury) instead of morphine for road traffic casualties, and often during one surgery wilt prescribe it to several patients for traumatic conditions. I n croup, Aconite acts more quickly than diazepam (Valium), and can also be given to calm the agitated mother. The paradox is that, occasionally, a patient will inform the Doctor t h a t he finds a certain medicine effective in treating conditions not listed on the label; and on looking up the drug in a repertory the doctor finds it covers t h a t condition. Thus one's knowledge is increased. On rarer occasions, the repertory doesn't contain any relevant information, in which case the patient m a y be a placebo reactor. At any rate, he was helped, and ~he doctor spared extra work! Many of the medicines in the Reference List are for the doctor's use, and will be ordered for the patient only occasionally; e.g. Euphrasia for hayfever where it has been proved to be more effective than an antihistamine. There are several other good hayfever medicines commonly required, as even in hayfever there are individual variations. A necessary caution must be given about treating cystitis with Cantharis (Bladder and Burn Pills). I t is now recognized that in every case of cystitis a mid-stream specimen of urine should be sent for laboratory examination, including culture and sensitivities; and if there is haematuria, full investigation of the renal tract is mandatory. Furthermore, antibiotics should, where possible, be withheld until an M.S.U. has been reported on. I t is during this time t h a t Cantharis can give dramatic symptomatic relief. I t would be most imprudent to prescribe a bottle of Cantharis for a patient's own use, unless he clearly understood this, and was prepared to present himself for appropriate investigations and treatment during each attack of cystitis. The instructions on the labels are precise because homceopathic prescribing
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has to be accurate, and there can be no "blunderbuss" prescribing. When a homceopathic medicine doesn't work, I assume I have not found the correct one, and not that Homceopathy cannot help t h a t person. I n conclusion, Hom0eopathy is a simple, well-proven and reliable form of therapeutics, which fascinates all who study it seriously. I have yet to meet the doctor who, having genuinely inquired into it and taken it up, has discarded it on the grounds t h a t it was either ineffective or inferior to allopathy. Those who use these H o m e Remedies in general practice find their work-load is lightened and the number of home visits reduced. Their patients are convinced the medicines are effective. REFERENCES 1 A c t s 14, v. 15. J a m e s 5, v. 17. 2 B r a d f o r d (1900) Logic of Figures, p. 137. a Birch, A l a n , Medical Emergencies. T a p e - r e c o r d e d lecture. R o y a l College o f G P s Medical R e c o r d i n g Service.
APPENDIX I PLEASE KEEP FOR REFERENCE INSTRUCTION SHEET These pilules are homceopathic, similar to those used in the various homceopathic hospitals in the country. They have the following unique properties: (a) They keep their strength for years without deteriorating or losing their power, if k e p t sealed in their bottles. {b) They can be given to any age of person, adult or child--even to a b a b y if the pill is first crushed into powder. A convenient way to do this is to crush the pill between two folds of clean greaseproof paper or two dessert spoons. I t doesn't matter if a few fragments fly off and arc lost, there is still enough medicine left to work. The powder can then be given dry or melted in water. I f the invalid is feeling sick, it is best to crush and dissolve the pill in water in any case, or the sweet taste of the pill sometimes causes sickness. Ic) They can be given to a child in its sleel>--the child will simply rouse itself sufficiently to chew the pill, without properly waking. Thisis very useful when a child is found to be getting feverish after it has gone to bed. (d) They are not poisonous--a b a b y could eat the contents of a whole bottle at once and wouldn't be h a r m e d - - y e t , for all t h a t they work in sickness. (e) I f in doubt as to which fever pill to use, t r y No. 1, and if after two doses there is no improvement, t r y No. 2. I t is like trying to open a locked door when you have two keys, you t r y the first and if it doesn't fit you use the second. So with the pills--if the first doesn't work you have done no harm but only wasted a pill. I n the rare event of the pills appearing to make the condition worse, stop giving them and wait. Such an aggravation is generally followed b y a marked improvement. I f this improvement wears off, start giving the pills again, but be ready to stop as soon as they begin to act. I t is as if they were working too powerfully, in which case only a few doses will be necessary. This applies chiefly with the cough and cold pills, and catarrh pills. When you are running short of a n y of these medicines (or the bottle gets broken or mislaid) please come for a further supply. I want you always to have them b y you as they so often cut short an illness at its onset.
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List of labels Aconite
SHOCK and No. 1 F E V E R PILLS. When hot, very thirsty, anxious, ?frightened, restless. Also for SHOCK, croup, effects of fright or chills, any EMERGENCY, or numb tingling pains. One L-hourly until relief.
Belladonna
No. 2 F E V E R PILLS. When burning hot, flushed, wide-eyed, excited, ?delirious, (?scarlet rash). Thirsty but won't drink. Also sore throats, colic, throbbing headaches, throbbing boils, severe earache with above symptoms. One L-hourly until relief.
Ipecac.
NAUSEA and No. 1 COUGH PILLS. For persistent NAUSEA, ?vomiting, with clean tongue, much saliva. Onset violent suffocating wheezing bouts coughing. Also nose bleeds, haemorrhages, with nausea. One 2-hourly until relief.
Ant. tart.
No. 2 COUGH PILLS. When touchy, drowsy, very weak. Cold, clammy sweat; pale or bluish face, white-coated tongue. Breathless, gasping, must sit up. Rattling cough, unable expectorate. Worse warmth. One L-hourly until relief.
Phosphorus
LARYNGITIS and REPEATED VOMITING PILLS. When chest tight, hoarse, hurts to talk, ?loss of voice. Dry, tickling, racking cough, worse cold air, worse talking. Craving cold drinks ?vomited immediately. Nervous. One 2-hourly until relief.
Pulsatilla
CATARRH and No. 2 MEASLES PILLS. When thick, coloured catarrh, eyelids, nose. Loss smell. Dry mouth, no thirst. Better open air. Catarrhal cough, worse warm room. MEASLES. Indigestion from fat, rich food. ~Tearful. One 4-hourly until relief.
Chamomilla
FRANTIC PAIN GRANULES. For UNBEARABLE PAINS: earache, toothache; teething, better being picked up, ?one cheek hot. Colic, diarrhoea green motions. Bad tempered, impatient, worse heat, anger. 10 granules approximately, every 5 minutes until relief.
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Ars. alb.
SICKNESS AND DIARRHOEA GRANULES. When sickness and diarrhoea SIMULTANEOUSLY, feeling very cold, exhausted, can't rest. Burning pains stomach. Thirst warm drinks. Can't bear sight, smell food. 10 granules in warm water 88 until relief.
Nux
STOMACH PILLS. When chilly, IRRITABLE, ?quarrelsome. Delayed indigestion, nausea, constipation, frequent ineffectual urging. Itching piles. "Flu", pharyngitis, if chilled when uncovers or drinks. Stuffy colds, raw throat. Infants' snuffles. One 4-hourly until relief.
vom.
Bryonia
PAIN OR HEADACHE PILLS. For bursting headaches, MIGRAINE, arthritis, pleurisy, only when pains worse movement, breathing, warmth, BETTER PRESSURE, KEEPING STILL, cool. Parched, thirst cold drinks. Irritable. Indigestion, stomach tender. One 4-hourly until relief.
Natrum mur.
RECURRENT COLD PILLS. For "sneezy colds", much nasal discharge, ?fever blisters. Feeling cold. WORSE WARM. Cough with tears. Thirsty, irritable, weak. ?weepy. (Blinding headaches, on doctor's advice only.) One 4-hourly until relief.
Camphor
CAMPHOR PILLS When ICY COLD following chill. Onset head cold with chilliness A- sneezing, better warmth. ONSET DIARRHOEA feeling chilly. One everT 5 minutes until warm/relief. KEEP BOTTLE SEPARATE. Camphor vapour inactivates other pills.
Mere. sol.
FEVERISH COLD PILLS. When feeling chilly in cold, hot in warmth, weak, trembling, offensive sweat and breath. Profuse greenish catarrh, salivation, THIRST. DIARRHOEA, straining-{-, slime, ?blood. Worse night. One 2-hourly until relief.
Rhus fox.
RHEUMATISM PILLS. When pains, stiffness, worse wet weather, cold air, in bed, after rest (first movements hurt). BETTER KEEPING MOVING. "FLU", dry cough with above symptoms. Also itching blisters. One 4-hourly until relief.
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Gelsemium
INFLUENZA and "NERVE" PILLS. When hot, flushed, aching, TREMBLING, dizzy, drowsy, "drugged", weak. Headache, eyes heavy. Back chilly. Sneezing, running nose. Sore throat. Difficulty swallowing. No thirst. Also upsets from "nerves". One 2-hourly until relief.
Euphrasia
MEASLES and HAYFEVER PILLS. For onset MEASLES when eyes streaming, tears burn, can't face light. Running nose, sneezing, cough. Throbbing headache. HAYFEVER, as above, worse indoors, warmth, evenings. One 2-hourly until relief.
Sulphur
SULPHUR PILLS. For BURNING itching skin rashes, worse WARMTH, scratching, washing, clothing, BURNING boils, eyelids and piles. Hungry, tires, "flushes", bunting feet. Kicks off bedclothes. Morning diarrhoea. One twice-daily until relief. Maximum 6.
Co]oeynth
COLIC PILLS. For agonizing colic, better doubling up, hard pressure, heat, twisting about. Griping pains causing distension, belching, vomiting, ?diarrhoea. Colic and neuralgia from anger, "getting worked up".
Cantharis
BLADDER and BURN PILLS. Cystitis when urine SCALDS, passed drop by drop. Unbearable urging and frequency. Also BURNS, scalds, better cold applications. Also burning itching busters (erysipelas). GNAT BITES. One 2-hourly until relief.
Ant. erud.
No. 2 STOMACH PILLS. When CROSS, TOUCHY, depressed. Vomits feeds. WHITECOATED tongue, corners mouth cracked. No appetite. Sick headaches from catarrh, alcohol, bathing. Wants sharp drinks. ?pickles. Belching, bloated. One 4-hourly until relief.
Arnica
INJURY PILLS. For bruises, sprains, concussion, or any other injury. Also for aching, fatigued muscles. One 2-hourly until relief of pain or aching.
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III
Cross-reference list
(a)
Aconite ............ Belladonna ........ Ipecac ............. Ant. tart ........... Phosphorus ........ Pulsatilla .......... Chamomilla ........ Ars. alb ........... Nux vom ........... Bryonia ............ Natrum mur ........ Camphor .......... M e r c . sol . . . . . . . . . . . . Rhus tox ........... Gelsemium ......... Euphrasia .......... Sulphur ............ Colocynth .......... Cantharis ........... A n t . c r u d . 9. . . . . . . . Arnica ............
Cross-reference list
SHOCK and No. 1 FEVER PILLS No. 2 FEVER PILLS NAUSEA and No. 1 COUGH PILLS No. 2 COUGH PILLS LARYNGITIS and REPEATED VOMITING CATARRH and No. 2 MEASLES PILLS FRANTIC PAIN GRANULES SICKNESS AND DIARRHOEA GRANULES STOMACH PILLS PAIN OR HEADACHE PILLS RECURRENT COLD PILLS CAMPHOR PILLS FEVERISH COLD PILLS RHEUMATISM PILLS INFLUENZA and "NERVE" PILLS MEASLES and HAYFEVER PILLS SULPHUR PILLS COLIC PILLS BLADDER and BURN PILLS No. 2 STOMACH PILLS INJURY PILLS
PILLS
(b)
SHOCK and No. 1 FEVER PILLS ...................... No. 2 FEVER PILLS .................................. NAUSEA and No. 1 COUGH PILLS .................... No. 2 COUGH PILLS .................................... LARYNGITIS and REPEATED VOMITING PILLS ........ CATARRH and No. 2 MEASLES PILLS .................. FRANTIC PAIN GRANULES ............................ SICKNESS AND DIARRHOEA GRANULES ............... STOMACH PILLS ................. . ................... PAIN OR HEADACHE PILLS .......................... RECURRENT COLD PILLS .............................. CAMPHOR PILLS ...................................... FEVERISH COLD PILLS ................................ RHEUMATISM PILLS .................................. INFLUENZA and "NERVE" PILLS .................... MEASLES and HAYFEVER PILLS ...................... SULPHUR PILLS ...................................... COLIC PILLS .......................................... BLADDER and BURN PILLS .......................... No. 2 STOMACH PILLS ................................ INJURY PILLS ........................................
.
Aconite Belladonna Ipecac. Ant. tart. Phosphorus Pulsatilla Chamomilla A r s . alb. Nux vom. Bryonia Natrum tour. Camphor M e r e . sol. Rhus tox. Gelsemium Euphrasia Sulphur Colocynth Cantharis Ant. crud. Arnica