Index of All Installments

Installment 6 of a series on case analysis

© Will Taylor, MD 2001 (bio)

Specificity of Seat -
James Compton Burnett
and the Generalization of Locality

Section 2

Sections: 1 | 2

James Tyler Kent speaks to this in his 1912 article, Remedies Related to Pathological Tissue Changes. Disease may exist, and remedies may act, on the dynamic plane; but there are clearly observable patterns in which these dynamic disharmonies manifest and eventuate in the tissues. The medicinal disease of Lycopodium, and those natural diseases bearing similitude to Lycopodium, exist in the dynamis, and not really in the gut, the liver, or the right side of the body; yet these dynamic diseases preferentially manifest in these tissues. It would be difficult to describe Lycopodium without referring to its specificity of seat in the gut, the biliary tree and the right side of the body; and it would be difficult to prescribe this remedy in a case where disharmony was not expressed in these localities.

Where does Locality come in as a characterizing dimension of disease or of remedial action?

In the study of remedies, there is often a clear display of "seat" in a remedy. The figures below display the number of references to several remedies in each region-of-body section of the Repertory. The first figure (below, left) is for Ledum, Rhododendron, and Kalmia, three members of the botanical family Ericaceae. These remedies display a strong specificity of seat for rheumatic affections of the joints, synovial tissues and connective tissues of the body, seen in the prominence of symptoms in the Head Pain, Back, Extremities and Extremities Pain sections of the repertory. The second figure (below, right) is for Uva-ursi, Oxydendron, Epigea and Chimaphilla, four other members of the botanical family Ericaceae. For these remedies, a strong specificity of seat is demonstrated for the urinary tract, with a preponderance of symptoms in the Bladder, Kidney, Prostate, Urethra and Urine sections of the Repertory.

This is not to suggest that these remedies act directly on or through those tissues - but rather, that the disharmonies with which these remedies are associated manifest preferentially in these localities. And this allows us to have a purely homoeopathic perspective on Burnett's "organ remedies" - Chelidonium is not really a remedy that acts on the body through the liver, but a remedy whose dynamic disharmony expresses preferentially in (whose specificity of seat is in) the liver and biliary tree. Burnett suggested so much himself, when in his Diseases of the Spleen, he wrote:

"I am not maintaining that treating an organ affection by an organ remedy after the manner of Hohenheim, Rademacher and their respective co-doctrinaires, will stand as a medical system in itself, but that it is eminently workable, and is largely of the nature of elementary homoeopathy, is, in fact, specificity of seat…

"Rademacher's organopathy (that an otherwise able modern writer appropriates with child-like naivete) is no more and no less than the homoeopathic specificity of seat, with just a dash of a mystic psychic something in the several organs; if we set aside this little particular soul for each organ, it is only local affinity, or elective affinity. And it is quite true in nature, and the mind that cannot, or will not, recognize it, is wanting in catholicity of perception; and in practice will often go a mile when three paces would have reached the goal. Whatever else Cantharis may be, it is first and foremost a kidney medicine; whatever else Digitalis may be, it is primarily a heart medicine; and let Belladonna be what it may, it is before all things an artery medicine, and just in this sense Ceanothus Americanus is a spleen medicine."

In this manner, Burnett characterized groups of remedies he considered to bear "specificity of seat" in a variety of organs and tissues in the body. His "liver remedies" included Chelidonium, Carduus mariae, Leptandra virginica, Cholesterinum, Myrica cerifera, Chelone glabra, Quassia, Crocus sativus and Podophyllum. "Spleen remedies" included Ceanothus americanus, Squilla maritima, Quercus, Juniperus communis, Oleum succinum, Conium maculatum, Magnesium tartaricum, Rubia tinctorum and Urtica urens.

The significance of this emphasis on Locality, is that the similliumum needs to cover the pathology of the case, not merely superficially match the superficial symptom-expression. This is not at variance with Hahnemann's aphorism 7 ("... it must be the symptoms alone by which the disease demands and can point to the appropriate medicine for its relief ..."). Rather, it merely demands that we be fully observant of the signs and symptoms of disease in the case at hand. In Burnett's words,

"Homoeopathy may be said to be based upon organopathy, for a drug to cure the heart of its disease specifically must necessarily affect the heart in some manner. But the homoeopath specializes, and says further: The drug that is to cure the heart must affect the heart, certainly - that is one of the foundations of our whole therapeutic edifice, but that is not enough; the nosological organopathy and the therapeutic organopathy must be and are similar. And inasmuch as we can know disease only by its subjective and objective symptoms (its language), it follows that the two organopathies must be symptomatically alike ...

"but to be curative the natural disease of the organ (noso-logical organopathy) must be like in expression to the therapeutic organopathy or drug-action." (Burnett, Diseases of the Spleen)

"Experience teaches me that if we are to avoid false issues in treatment we must start with diagnosing, if possible, where the malady is primarily located. At any rate, I find this the shortest way to curing. If this be neglected we not infrequently cover and cure the symptoms, leaving the malady itself more or less untouched." (Burnett, Diseases of the Liver)

A case from Burnett's Diseases of the Spleen provides an excellent illustration:

... I was at the house of a patient in London, the wife of a general officer and the conversation fell upon the general's heart affection, and also upon that of their char-woman. I learned that the lady of the house took a certain interest in her charwoman because she had seen better days and had an invalid husband depending on her labor more or less.

This charwoman was, it was said, suffering from an incurable disease of the heart, causing her terrible distress; on rising in the morning she would have to fight for her breath, so that it would take her often three-quarters of an hour to get dressed, having to pause and rest from the dyspnoea and its effects, nevertheless she persisted in thus getting up and dressing, and did as much charing as she could get. Her pride would not allow her to beg of her friends. Such was the story, and I really felt curious to see the charwoman, and promised to do what I could, though from the account given me by the general's wife, I certainly thought it quite a hopeless case.

Calling a few days later, I saw the lady and the charwoman, and having duly examined the latter, I promised to cure her! She was to come to my city rooms, and report herself every fortnight. On returning from the bedroom to the drawing room, the general's wife accused me of cruelty in thus raising the poor old woman's hopes "when," exclaimed she, "you must know it is impossible."

I tried to explain that it was a case of enlarged spleen, and not the heart disease at all, that the charwoman was suffering from, and that the palpitations and fightings for breath were the mechanical sequels of the splenic engorgement, but my patient evidently did not believe it, for she wound up by saying, '.As you will treat her for nothing, I hope you may succeed, and it is very kind of you, but you must know that the poor woman has been under various doctors, and all have declared it incurable heart disease, and I merely wanted you to tell me of something to relieve and ease the poor old thing."

This was towards the middle of October. A careful physical examination. showed that the heart-sounds were normal, but there was much beating visible in the neck, arid the heart's action was labored. In the left hypochondrium there was a mass corresponding to the position of the spleen, and a dull percussion note was elicited not only in the left hypochondrium, but also in the right, and all across the epigastrium, or pit of the stomach, from side to side.

The following notes were put down at the time: "Heart-sounds, normal; apex beat, exaggerated; splenetic dullness extending up to the left mamma; the whole region very tender, so much so that she cannot bear her clothes or any other pressure." The prescription was: Ceanothus Americanus 1x 3ij, five drops in water three times a day.

November 14.
Has been taking the Ceanothus five weeks today, and has taken altogether three bottles of it, viz., 3vj. It has nearly stopped the pain in the left side, which had lasted for quite twenty-five years. This pain came on suddenly, especially if she drank anything cold. She would get an indescribable pain under the left ribs, and she would have to fight for breath, and the dyspnoea would be so severe that it could be heard in the next room, frightening everybody. She had ague thirty years ago in Northamptonshire. Repeat.

November 29.
Not much pain left; the cold feeling still there, but nothing as it was. Repeat.

December 20.
Has the pain in the left side, but very little; has not had any of those attacks of fighting for breath; she can walk better, and the side is. much smaller, which she knows from her dress. In her own opinion she is less in the waist by two inches. Before taking the medicine, for very many years she was compelled to pause in the morning when dressing, and lie down on account of the beating of the heart, but this has all gone; on examining by palpation and percussion I find the dullness diminished by four inches in the perpendicular, and by about the same from side to side.

However, there is still some tenderness on pressure, and the swelled spleen can still be felt towards the median line and inferiorly. She can now do her work (charing) very much better. R. Tr. Ceanoth-Am. 1, four drops in water three times a day.

January 10.
The pain is gone; has now no pain in walking, and she is a great deal stronger and better. The coldness in the pit of the stomach has gone. Repeat.

February 7.
In the left hypochondrium there is now nothing abnormal; the old ague-cake has disappeared, there being no dull percussion note. Her own conception of the size of that portion of the enlarged spleen that used to stretch across the pit of the stomach to the liver is thus expressed by her: "I used to say it was as big as a half-quartern loaf." Not only is the lump gone, but she is much stronger; she now wears stays again, and fastens her clothes with comfort. She again gets some cold feeling in the pit of the stomach, but not much.

Her Liver seems considerably enlarged, and there is still too much beating of the blood-vessels (Veins) in the neck. In my opinion the condition of the blood-vessels calls for Ferrum 6, which I now -prescribe, and when that has done its duty-as it surely will - the liver will call for attention. But what I wanted to bring out was the specific affinity of Ceanothus Americanus for the spleen, and its consequent brilliant effects, as the simile only grounded on the homoeopathic specificity of seat, which some say has no existence.

This poor woman thus took Ceanothus during about four months in small appreciable doses: at first the 1x and then the 1 centesimal. The existence of the hypertrophy was ascertained by percussion and palpation; and subsequently I ascertained by the same means that it had ceased to exist. Although patient took the drug for four months I could not find that it affected any other organ-liver, kidney, bowel - save and except the spleen.

The dyspnoea and palpitation were cured certainly, but these arose, I submit, from the engorged condition of the spleen itself.

As far as I could ascertain, the secretions and excretions were not affected in the least degree; the remedial action must, therefore, be considered specific. My conception of the cure is simply this, that the specific Ceanothus stimulus persistently applied restored the spleen tissue to the normal. This homoeopathic specificity of seat suffices only in simple local disturbances; it is only a simile, not a simillimum. The latter would, I apprehend, have affected the liver also and the right heart, and I should then not have needed further detail treatment.

This charwoman continued to attend at my rooms for some months, and Ceanothus Americanus and other indicated remedies cured her of her "incurable heart disease;" and I saw no more of her for some time, when one day she was ushered into my consulting room. She came up to where I was sitting, told me she was perfectly well, could do any work with ease, and-then occurred one of the sweetest things in my whole professional life - the old lady (and what a lady!) put a tiny packet on my desk, tried to say something, burst into tears, and rushed out!

I never saw her again, and have often since wished I had kept that particular sovereign and had it set in diamonds.

In this case, the apparently peculiar symptoms originally attributed to heart disease are fully explainable as merely resulting from mammoth splenomegaly. As such, these symptoms lose their aphorism 153 status as characterizing symptoms, and the only symptoms of genuine note remaining in the case are "massive splenomegaly" and "splenic pain worse pressure (of clothes, etc.)".

The rubric {ABDOMEN - ENLARGED - Spleen} lists 61 remedies in the Quantum view of the Synthesis Repertory (Kent listed 51), with Ceanothus, China and Iodium in boldtype.

{{ABDOMEN - PAIN - pressing - Spleen - pressure agg.} lists only Ceanothus and Zincum.
{{ABDOMEN - PAIN - Spleen - lying on left side, while} lists Agar, Cean, Cocc and Colch.

James Compton Burnett case

We find in Hering, for Ceanothus, "Enlarged spleen, extending to within an inch of crest of ilium, with severe pain in side." - the only remedy in our materia medica described for such massive enlargement of the spleen, and one of our remedies with a primary "specificity of seat" for the spleen.

Here an "organopathic" remedy is indicated - not because Burnett made a decision to abandon Hahnemann and resort to organopathy, but because the focal involvement of a particular tissue - a locality - was overwhelmingly the most characterizing feature of the case.

Sections: 1 | 2

Next Installment
Index of All Installments