The logic of case taking.

Deafness Cured by Mezereum, with Remarks
From  Homeopathy the  Science of Therapeutics
By Dr.  Carroll Dunham

       G.W.W.  (17),   small but well proportioned and of good constitution, healthy since his ninth year,  has been deaf  since he was four years old.  When three years of age, he had an eruptive disease of  the whole scalp, which, after resisting for a year all the milder methods of allopathic treatment, was finally caused to disappear in the following manner: A tar-cap was placed upon the head, and when firmly adherent to the scabs, was violently torn off; the scabs came with it, leaving the whole scalp raw. This raw surface was moistened with a saturated solution of nitrate of silver. The eruption did not reappear; but from that time the child was deaf.
The condition of the youth now excites the earnest solicitude of his friends. His inability to move in society, or to get a situation in business, on account of his deafness, has produced a morbid state of mind. He broods over his infirmity, and secludes  himself even from his own family.
Under these circumstances, he applied to me to be cured of his deafness.  His present condition is as follows: He is quite unable to hear ordinary conversation, and has never heard a sermon in his life. A loud-ticking lever watch can be heard at a distance of three and a half inches from either ear. On application of  the watch to his forehead, or to his teeth, he hears it distinctly. Occasional buzzing noises in front of the ears. A physical examination of his ears reveals the following conditions: The external meatus is abundantly supplied with soft, normal wax. The membrana  tympani is white, opaque, and evidently thickened. When the patient attempts to inflate the middle ear (which he accomplishes with great difficulty, by closing both mouth and nose and making a forcible expiration) the membrane tympani becomes but very slightly convex, and it is impossible to distinguish its distended blood vessels. There has evidently been a deposit in the substance of the membrane. On examination of the throat, it appears that the orifice of the eustachian tube is free.
Feb. 3rd, 1857. Patient received a powder containing three globules of Mezereum 30, to be taken on retiring.
Feb. 24th. Thinks he hears better — “every sound seems much louder than before.” Hears my watch at a distance of four and a half inches from the right ear, and four and a quarter from the left ear. (No medicine.)
March 1st. Has not improved during the last week. Mezereum 30, three globules.
March 27th. Hears my watch, with the right ear, six and a half inches, and with the left, seven inches. (No medicine.)
April 20th. Hears my watch, with the right ear, at a distance of ten inches, and with the left, at a distance of fourteen inches. Hears ordinary conversation easily, with attention. (No medicine.)
Sept. 28th. Has been steadily improving until three weeks ago, when he became more deaf again,  without apparent cause. Mezereum 30, three globules, on retiring.
Jan. 26th, 1858. Hears my watch at a distance of fourteen inches from the right ear, and twenty-four inches from the left ear. Deafness returns when he takes cold, but disappears with the cold. Mezereum 30, three globules on retiring.
March 19th. To his surprise, on going to church, although seated at the extreme end of a very large building, he distinctly heard the whole sermon — for the first time in his life. On physical examination, the opacity of the membrana tympani is found to have disappeared, and its elasticity to have sensibly increased.
May 24th. Patient writes me that he has obtained, without difficulty, a situation in a store, and that he is no longer conscious of being deaf. His sole difficulty is that, as he has the reputation of being deaf, everybody shouts at him. His father writes that the son’s hearing is “perfectly restored.”

Remarks. The success of the treatment resorted to in this instance warrants a few remarks upon  its rationale. Here was a case which presented to the practitioner apparently nothing on which to base a prescription. There was a thickened membrana tympani  — nothing more. The work of thickening had probably been accomplished years ago. Here was a pathologico-anatomical condition, but no pathological process and, consequently, there were no abnormally performed functions — or in other words, no symptoms of disease — from which to draw indications for the treatment. The pathological-anatomical condition threw no certain light on the pathological process which had produced it — just as a knowledge of the town at which a traveller has arrived, gives no certain clue to the road by which he reached it.
Daphne mezereum "Foxglove"   …the history of a case is often of the utmost importance in determining the treatment. In the  case before us the coincidence between the violent removal of the tinea capitis by nitrate of silver, and the appearance of the deafness, was too marked to escape notice. It could not fail to occur to the practitioner that the scalp disease… disturbed in its localization upon the scalp, had transferred itself to the tissues of the ear. It further occurred to me that, since in this latter localization there were no sufficient indications for a prescription, I might find such indications in the phenomena of the former localization upon the scalp. I accordingly addressed myself to the task of getting a complete picture of this affliction, which had disappeared thirteen years before. By good fortune the mother of the patient was possessed of a good memory, and of very excellent powers of description, and from her I learnt that “thick, whitish scabs, hard and almost horny, covered the whole scalp. There were fissures in the scales, through which, on pressure, there exuded a thick, yellowish pus, often very offensive. There was great itching, and a disposition to tear off the scabs with the finger-nails — especially troublesome at night.
The remedy, which corresponds most closely, in its pathogenesis with the above group of symptoms is undoubtedly Mezereum…. The resemblance between these groups of symptoms was so striking that Mezereum was at once selected as the remedy for this case of deafness, just as if the scalp affliction had still been in its original form, and had been the immediate object of the prescription.

3 responses to “The logic of case taking.

  1. I found that no matter what combination I used from the sxs of this case I couldn’t get Mezereum to come up high enough in the repertorization where i would even consider it for comparison, if I didn’t know the remedy beforehand. My knowledge of the remedies is feeble I admit, but still shouldn’t one be able to get the remedy to come up near the top 6 at least? I find this problem in this paper case as well as many in Hoynes’ Clinical Therapeutics. It often seems impossible to see how they chose the remedy by using the repertory.

  2. Pingback: A question | Institute for Homoeopathic Medicine

  3. Pingback: Case review of | Institute for Homoeopathic Medicine

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