Desktop Companion to Physical Pathology

Recensie

This book review is reprinted from The Homoeopath with permission from Nick Churchill of The Society of Homoeopaths.

Reviewed by Francis Treuherz

Here it is, the long awaited Desktop Companion to Physical Pathology, the companion volume to Roger Morrison's Desktop Guide to Materia Medica. Morrison states like Clarke and others before him that he wanted this information all in one place and the only way to have it was to write it down himself. He covers a wide range of conditions loosely grouped into six chapters, Head and Neck, Chest, Digestions, Urogenital, Peripheral Organs and Systemic Conditions.

In his introduction the author writes that a main concern is that its purpose and the information contained in the book would be misconstrued and misused. Homoeopathy is an art and a science which must always aim to cure the patient on the deepest level. in this aim often it is the deepest inner conflicts and frustrations of our patients which lead us to the correct remedy. The practitioner must always consider the whole person.

Yet we all know that there are times when in person and on the telephone, (and lately by email!) we are confronted with a partial case. Or we need some minute clue from the pathology in order to discover a suitable remedy which will fit the rest of the case. Or we just wish to study some area of pathology and see what remedies are common. Until now we had mainly 19th century volumes like Lilienthal.

Roger Morrison has done us all a great service. Not only has he been to Greece and learned the language in order to study with Vithoulkas and Ghegas. Not only has he worked for twenty years in California. He has written up the fruits of his clinical experience in many areas. Each section has a lengthy introduction with an account from the homoeopathic coal face about patient management, coping with allopathic medication - the medicines are often listed as a hierarchy of allopathic medication - and a myriad therapeutic lips. These are as useful as the materia medica summaries, as whether in private or NHS work most of our patients will be taking or have taken recently some conventional medical drugs and want to take less of them.

There are also some naturopathic tips. These are very useful but not a primary or comprehensive resource. May I suggest Murray and Pizzorno's large paperback The Encyclopaedia of Natural Medicine.

Some of us were educated to be arrogant about the role of the GP and conventional services. We may have a different philosophy of healing but our puny single-handed service for usually ambulant patients has its limitations, sometimes in the severity of pathology brought to us at a late stage in the illness by a fearful patient, some times in the severity of the medication, and other reasons. In this area, the possible need for referral to conventional services, Roger Morrison is cautious. But if he, as an experienced medical doctor in the USA, has to watch his back against quackbusters, litigants, and allopathic colleagues, let us learn from him and apply his advice according to our local practicalities with humility, rather than condemn him for his caution.

As far as I can see all that is missing is the index to the main subjects, which I have made myself for readers to copy, and an index to remedies, which is desirable but would take me far too long as he covers many remedies. For example Nitric acid has a summary in seventeen different sections. A remedy index should be made and posted on our networks.

Abdominal Pain 243, Allergy 43, Arrhythmia 172, Arthritis Acute 324, Arthritis Chronic (Degenerative) 347, Arthritis Rheumatoid 333, Asthma 145, Back pain & Sciatica 356, Bell's Palsy 583, Cellulitis 468, Concussion 402, Conjunctivitis 27, Convulsive 591, Cough 99, Cough Croup 123, Cough Pertussis 126, Cough Uncomplicated 108, Diarrhoea 227, Fever 519, Heart 171, Heart Angina 181, Heart Arrhythmia 172, Heart Degeneration 190, Hemorrhoids 271, Influenza 509, Injuries Bruises 369, Injuries Burns 381, Injuries Fractures 379, Injuries Sprains 375, Injuries Sunstroke 296, Injuries Wounds 385, Injury Spinal 399, Kidney Stones 295, Liver Disorders 255, Multiple Sclerosis 572, Otitis Media 31, Parkinson's 603, Pharyngitis 71, Pneumonia 133, Prostate Conditions 303, Sinusitis 53, Skin Abscess 477, Skin Acne 471, Skin Cracking 427, Skin Eczema 407, Skin Fungal 465, Skin Herpes-Genital 453, Skin Herpes-Simple 446, Skin Herpes-Zoster 441, Skin Impetigo 460, Skin Poison Oak 435, Skin Psoriasis 41 6, Skin Urticaria 429, Skin Vitiligo 491, Skin Warts 486, Stomach Pain 21 7, Surgical Trauma 391, Tendonitis 331, Thyroid Conditions 83, Tics Cramps Twitches 586, Tonsillitis 71, Tooth Pain 61, Urinary Tract Infections 281, Uterine Haemorrhage 311, Vertigo 495.

A particularly useful part of each section are rubrics to look for in the repertory. They are more accessible than Eizayaga's Repertory Algorithms, a publication not much studied in the UK. They point the neophyte in the right direction. Although not cited I think they must be from Roger van Zandvoort's Complete Repertory.

Of course in the brief time I have had this volume I have not read all 605 pages. But I have had it by me for a week and used it frequently. I have found it in the main reliable, and where I am familiar with the area, it confirms my own experience. I have learned from it. I have noted some remedies omitted in some sections. The thyroid section places remedies for hypo- and hyper- together, and there are other small points which could be improved. This book does not cover the whole of human ills, for example gynaecology is largely missing. But this does not detract from it. I look forward to a second volume and to a computer version as soon as possible. This is indeed a companion for all our desktops.

The Homoeopath - Number 71
Autumn 1998

This book review is reprinted with the permission of the National Center for Homeopathy
801 North Fairfax Street, Suite 306
Alexandria, VA 22314

Reviewed by Richard Moskowitz, MD, DHt

This is a book that took some courage to write and badly needed to be written. Although wholly contemporary in feeling and style, it speaks to the dilemma of busy homeopathic physicians in every time and place: how to keep doing good quality work under pressure of time, reputation, and ever more difficult and demanding cases to come up with creditable prescriptions without delay.

It is perhaps a measure of the extent to which our own practices have grown and prospered in recent years that homeopaths today are seeing more and more patients with serious organic pathology, many of them chronically dependent on powerful allopathic drugs, who need and want and can in fact make use of the unique kind of help we can offer. Now as then, overworked GP's in the trenches have always had recourse to compilations that summarize our collective experience with different pathological entities, including practical "tips" on the remedies most frequently indicated for each and how to differentiate them.

In addition to manuals of first aid and self-care, such as Hering's Domestic Physician or Panos and Heimlich's Homeopathic Medicine at Home, and specialized monographs on particular organs and organ systems, like Roberts' Rheumatic Remedies or Guernsey's Obstetrics, our literature has always included general texts of therapeutics for the busy professional. Jahr's For Years' Practice, Dewey's Practical Homeopathic Therapeutics, and Lilienthal's Homeopathic Therapeutics come to mind as classics of the genre that I myself have sampled more often than I might care to admit at a fancy case conference.

Dr. Morrison's book is clearly of this lineage and will surely gladden the hearts of practicing homeopaths both new and old. Like all the other titles I have mentioned, it also should and probably will revive legitimate questions about the classical method per se that were already raised by the master himself and have thus generated controversy from the very beginning. With everyone from Hahnemann on down insisting that we treat the individual patient rather than the approximate pathological diagnosis or category, the intelligent student can hardly fail to wonder why it is necessary or useful to talk about "diseases" at all.

Speaking from my own experience, I can think of four good reasons why a pathological orientation that applies generically to large groupings of individuals is still relevant to homeopaths of all persuasions. First, I would cite the accumulated experience of untrained laypeople using remedies for first aid and self-care, a technique of proven worth for over hundred and fifty years. Both to examine the validity of self-care as a concept, and to appraise its scope and limitations in a classical framework, it is necessary to draw on that experience.

Second, within the realm of more serious conditions usually seen by a professional, conventional diagnostic categories like pneumonia, breast cancer, or multiple sclerosis offer our collective experience with their average, approximate, or expected course as points of reference against which the remedies most often effective in these conditions may be compiled and measured. My own experience with Belladonna, Bryonia, and Phytolacca in acute mastitis, for example, has simplified the process of choosing a remedy in such cases, by providing familiar standards against which more unusual possibilities are quickly suspected and identified.

Such approximations are particularly valuable in epidemic diseases such as measles, scarlet fever, or cholera, where the main features of any given outbreak impose themselves somewhat uniformly on almost every patient, so that the remedy most closely resembling it can be offered preventively to incipient cases, definite or suspected contacts, and others at high risk. Indeed, with Belladonna for scarlet fever, Pulsatilla for measles, Bryonia for pleurisy, Sepia for morning sickness, Arnica for blunt injury to soft tissues, ignatia for acute grief, and the like, the pathogenesis of the condition corresponds so closely to the essence of the remedy that each illuminates the other. Under these circumstances, the remedy may appropriately be thought of as "specific" for the condition, and given out in early cases or even preventively to those at high risk of developing it or with a history of having benefited from the remedy for it in the past.

Unfortunately, there is no simple rule or formula for the untrained or inexperienced to distinguish these wholly legitimate practices from the short-cuts of those merely impatient with the discipline of the totality of symptoms. Matching common remedies with lists of remedies for treating them and adding a few easy indications for each to differentiate one from the other, texts like those of Jahr, Dewey, or Lilienthal make it possible for a busy or lazy practitioner to forego the labor and discipline of interviewing patients, grading symptoms, or studying remedies at all. Another reason for studying pathology is thus simply to help navigate a path through this minefield.

Third, the central features of many ailments, like the remedies best suited to healing them, are limited in scope to a relatively specialized area of functioning. In otherwise healthy patients bothered by headache, constipation, neuralgia, menstrual cramps, or vaginitis, for example, the narrow focus of the problem may itself provide the first and best clue to the indicated remedy. Clearly recognized and considered at length by Hahnemann himself, these seemingly one-sided or "local" ailments are shown in fact to represent latent chronic diseases of a more generalized character, which are apt to break out in full force if suppressed with conventional drugs.

In some cases, with few underlying constitutional symptoms that patients tend to ignore out of familiarity the picture remains circumscribed even after skillful casetaking, and the indicated remedy must also reflect that pattern. Many remedies both famous and obscure are known primarily for limited applications of this type, though more detailed provings may well reveal their "constitutional" features in the future.

Fourth, as all these examples illustrate, the practice of homeopathic medicine culminates in the riddle of chronic disease, a problem to which Hahnemann devoted himself throughout the final decades of his life, revealing broad patterns of symptomatology that underlie the myriad of individual differences and are traceable even across the generations. To this pioneering work, still controversial among homeopaths today, we owe the major nosodes, prepared from actual disease products, and an integrated schema of animal, vegetable, and mineral remedies based on them, both of which have greatly deepened and enriched clinical practice and thus stood the test of time.

For all of these reasons, books like Morrison's that are organized by diseases will continue to serve a valid and useful purpose, as they have always done, however liable to misuse. I regard them as simply another way to classify materia medica information, and as such another possible conduit to the best available remedy in addition to prescribing by keynote, repertory "essence" information, miasmatic analysis, and various mixed strategies, no one of which is sufficient, but all of which are helpful at times. These issues are addressed by Morrison himself in his brief Introduction:

"The purpose of this book is threefold: It is meant first as an aid to be used at the time of the interview to cue the practitioner toward likely remedies for a particular condition. The second ... is as a study guide, bringing the main points of the remedies into focus. And finally, [the third is] to give advice about treatment based on the experience of myself and my colleagues at our center."

Yet another way to think of the book is as the companion piece and logical extension of his earlier Desktop Guide to Keynotes and Confirmatory Symptoms, which presents some of the same information organized by remedies, a condensed materia medica for the same busy professional I mentioned at the beginning. As he says, both were written "because I wanted [them] for my own practice." Taken together, these two volumes are thus rather like an updated version of Boericke's Materia Medica and Therapeutics, intended for the same eminently practical purpose and for much the same audience.

Furthermore, the book is organized in an equally practical and user-friendly way, and also incorporates several novel features that are found nowhere else. Thus for every specific ailment a brief introductory discussion concludes with a "Management" subsection where homeopathic and conventional perspectives are combined. The next section, entitled "Therapeutic Tips," is divided into homeopathic, naturopathic, and allopathic varieties, and is equally helpful and convenient to use.

Yet another thoughtful innovation, extracted from MacRepertory and ReferenceWorks, is the listing of useful rubrics in our Repertory language, to show the possible connections that have been made so far, and thereby to eliminate the necessity of rediscovering them anew each time, an incredibly useful service to student and practitioner alike. Only then, at the very end, do we come to what is found in all the other books, the remedies he has found most often useful in the condition, with a few characteristic features for distinguishing them.

Even here, at the point where it closely resembles the earlier texts, it is clear why books like Morrison's will have to be written and updated continually, because both the definition of pathology and the number of possible diagnoses have expanded in all directions and will very likely do so even more in the decades to come. Indeed, it is in his selection, most especially in the diagnoses he chose to leave out, that the limitations of the present volume are most apparent, presumably reflecting 1) the relatively limited experience with them at his clinic, and 2) the increased medicolegal risk incurred by even the most experienced homeopath in treating them at present.

It is noteworthy, for example, that most of the conditions listed in his table of contents, and even most of the subheadings found in the text, were familiar to Dewey and Boericke and even to Jahr and Lilienthal, while diseases more recently discovered, like chronic fatigue syndrome, fibromyalgia, or multiple chemical Sensitivity (or environmental illness), are omitted, as are some infections (gonorrhea, Lyme disease, mono, PID).

For much the same reasons, serious or potentially life-threatening ailments (AIDS, serious blood dyscrasias, cancer, etc.) are avoided, as are myocardial infarction (which is combined with "Angina Pectoris" because the appropriate rubrics for them are indistinguishable), and hypertension, hypercholesterolemia, osteoporosis, and the like, which represent purely technical or laboratory diagnoses, typically or often without symptoms or rubrics at all.

In his Introduction Morrison speaks to this issue as well, likewise from the eminently practical standpoint of physicians the world over:

"My conviction is that our main duty is to the safety and health of our patients, not to our homeopathic ideals. This sometimes means that we need to resort to allopathic treatment for the short run. Furthermore, the safety of the practitioner is significant. We should never jeopardize our licenses or our reputations in the community. This is especially true in the United States, where homeopathy is still vulnerable to attack from medical authorities. A balanced and conservative approach is our best chance for longterm gains in spreading our beloved therapy."

These bracing and sensible truths should never be far from the thoughts of any practicing homeopath. Yet as a tentative First Edition of a classic text that hopefully will be updated over the years, I have no doubt that subsequent versions will phase in some of these other more controversial diseases as further experience becomes available, and the integration of homeopathy into the medical profession continues as at present. The book as it stands is splendid and unequalled elsewhere. It could well become an important achievement for the society at large in the future.

HOMEOPATHY TODAY
APRIL 1999

This book review is reprinted with the permission of the International Foundation for Homeopathy

Reviewed by Asa Hershoff, N.D., D.C.

Homeopathic clinical literature comes in basically three flavors: materia medica, repertory, and clinical guides. This last category has a long and solid tradition. From Boenninghausen through Clarke, Dewey and Tyler, there are literally scores of excellent guides that outline the most useful remedies in the treatment of specific diseases. Morrison's Desktop Companion to Physical Pathology follows in this tradition, and indeed may help reverse a trend of some modern homeopaths to downplay or overlook the physical complaints of the patient.

Thus it is that Dr. Morrison, a well-respected pioneer of the modern wave of homeopathy, is obliged to state in his preface that, "in many such circumstances, the physical pathology supplies the necessary clue to the prescription." No such apology is necessary and in fact one wishes that the introduction would have described more fully the criteria, references, and methods used in creating this useful text, since all clinical guides are a reflection of the clinician's own experience and predilections.

The first thing that strikes you about the Desktop Companion is that it is a handsome book. Unlike Morrison's previous best-seller, the cloth-bound Desktop Guide, the new book is leather bound and gold stamped; the paper and binding are highest quality. The layout and typeface are extremely clear, attractive, and readable, making the book a durable and useful clinical tool. It is clearly designed to have a look consistent with its companion volume. Inside, 66 disorders or clinical syndromes are discussed. Each condition has an introductory section, followed by sections called "Management" (homeopathic, naturopathic, and allopathic), including "Therapeutic Tips" (again for these three categories), "Repertory" (rubrics for the condition), and then "Remedies" (materia medica listings).

The management and therapeutic tips section is the most personal part of the book and has exciting information, "based on my own and my colleagues I experience in a general homeopathic practice." Again, references here would be useful. In a direct way, the author shares his clinical experiences and insights, basically telling us what works and what doesn't work for each condition. Particularly useful are the prognosis and therapeutic expectations of homeopathic treatment and the effects of simultaneous treatment with typical medical drugs.

The naturopathic tips are an excellent addition, though naturally (in the short space available) by no means complete or comprehensive from a nutritional or herbal perspective. But in a refreshing way it opens up any restrictive approach to homeopathy that may overlook both Hahnemann's approach to hygiene and homeopathy's place in the context of fullspectrum holistic medicine.

The Repertory section shows the typical rubrics where one might find the symptoms of the disease. This approach is very useful, particularly Morrison's occasional comments and clinical tips on repertorizing specific conditions. Some of the rubric lists are quite brief, while others are summaries of an entire chapter (for example "Head Pain" and "Respiration"), but reorganized in innovative clinical categories. Listing the number of remedies in each rubric would have been helpful, since there are single remedy rubrics alongside 100-remedy rubrics. Additionally, the author never tells us if the repertory used is strictly Kent, or if there are additions of rubrics from the Complete Repertory or the Synthetic.

The heart of the book is the Remedies section, which is divided into main remedies, followed by an alphabetical listing of other important remedies. The number of remedies in each section is variable depending on the condition, often totaling 40 or 50. The choice of main and "other important" is based on the author's experience. Not everyone might agree, for example, that Sepia is the most common remedy for psoriasis, but these opinions are what make the book so rich and useful, pulling the practitioner out of therapeutic ruts. Naturally the descriptions are brief keynotes and essential clinical symptoms. A therapeutic guide is always a companion to more extensive materia medica, and a copy of Morrison's Desktop Guide, Vermeulen's Concordant, or Synoptic I & II, are essential companions-as is a repertory.

So far so good. As Morrison states in his preface, the book is designed to "create a concise yet thorough differential for each of the main pathologies encountered in homeopathic practice." Yet it is in this regard that the Desktop Companion seems incomplete. Though many conditions seen in daily practice are outlined (otitis media, cystitis, headache, back pain, etc.), the omissions are also significant. Of the 66 disease states discussed, 15 are skin disorders and nine are in the injury and trauma section, while in the key area of women's health, there is only uterine hemorrhage. Dysmenorrhea, PMS, menopause, vaginitis, etc., are omitted. Conditions like insomnia, fibromyalgia, exhaustion, eating disorders, and enuresis are not discussed, while more serious, rare conditions such as Parkinson's and multiple sclerosis are included, leaving out senility. One might argue that some of these are deep constitutional conditions, but the same is true for skin problems, headaches, arthritis, and so on.

The other point is that the organization of the book is highly unconventional. The conditions are not alphabetical, organized by organ systems, or according to traditional homeopathic materia medica. The book somewhat follows regional anatomy, but has a section called "Peripheral Organs" that lists musculoskeletal disorders, injury and trauma, and skin diseases. There is also a "Systemic Conditions" heading that lists vertigo, influenza, and neurological disorders.

Oddly, the conditions in any one system are not alphabetical, but arranged arbitrarily. For example, under "Skin" there is eczema, psoriasis, cracking skin, urticaria, etc., in that order. The lack of an index makes navigation difficult, and random flipping to a section is out of the question. With less than 70 conditions, however, the reader will soon get used to where things are, even if the logic of it escapes them.

Part of these problems are inherent in self-publishing. No professional editor would allow a book of over 600 pages to hit the presses without an index and cross-reference of the conditions and medicines discussed, or a more logical organization of the material.

The insights, therapeutic hints, and materia medica pointers make this book a solid hit, but if future editions (or volumes?) went further into commonly seen conditions, added an introductory section, index, and bibliography, and rearranged the conditions into a more user-friendly system, this book could be a perfect ten.

Asa Hershoff, D.C, N.D., Santa Monica, CA, has been practicing homeopathy for 25 years. He was a founder of the Canadian College of Naturopathic Medicine in 1978 and teaches and consults internationally. He is the author of Homeopathy for Musculoskeletal Healing. (reviewed in this issue) and is writing the Homeopathy Handbook for Avery Publisbing as well as theforth coming volumes: Healing Plant Families and The Umbelliferae- Healing and Meaning in the Hemlock Plant Family.

RESONANCE - September/October 1998