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Cinchona Caselet

Mrs. Dr. Keese was attacked with a severe inflammatory rheumatism of the knee. The swelling was very red and painful. There was high temperature, quick pulse, great restlessness and exceeding sensitiveness to the pain. Aconite brought very little if any relief, and Bryonia next on account of the < on movement and great thirst suffered like defeat. Now (said the patient) why don't you help me? I know you can if you have a mind to. That was flattering, and I naturally wanted to "make good." I turned down the bedclothes to view the situation. As I put out my hand to feel of the knee, she exclaimed in terror, Oh! don't touch it. The least touch is unbearable and brings on the pain for hours. I said you hold still, and put my hand carefully on the inflamed knee and gradually increased the pressure until I pressed it hard and firm. The patient looked astonished and ashamed as she said why, doctor, that don't hurt me, but I tell you that the least touch has put me in agony before. I took off the pressure as gradually as I had put it on, and the usual severe < did not follow. She then got China 200th, and when I visited her twenty-four hours later she exclaimed, there, I knew you could help me if you wanted to. No other remedy was needed.

(from EB Nash, Testimony of the Clinic ; c.1911)

Analysis of the case by Will Taylor , MD:

The characterizing features of this case can be found in the following “keynote” symptoms of Cinchona, from HC Allen, Keynotes and Characteristics with Comparisons ; c1898:

Pains are < by slightest touch, but >> by hard pressure

A seemingly paradoxical situation, which is reflected in the following rubrics from the Synthesis Repertory:

It is in these striking modalities , in the context of locality (synovial tissue) that similitude is identified in this case.

I love it that Nash gave Aconite and Bryonia first, without effect. Kinda takes the heat off the rest of us to get the Simillimum on the first go-around.

It's not difficult to understand Nash's choice of Bryonia, with its strong “specificity of seat” for the synovial tissues, and its striking aggravation from slightest motion. A search of our literature for the key phrases “synovial” and “slight motion” demonstrates the prominence of Bryonia in this complex of locality/modality.

Note though how well Cinchona ( China ) does in this search (11 th position in the chart); underscored for our case by the proving symptom (in Hahnemann's Materia Medica Pura ), “Pain in the knee on the slightest motion, as if bruised ”.

The initial symptoms of the case also make a reasonable case for Aconite:

Note though that neither of these analyses adequately differentiates between leading remedies. It was the Striking, Exceptional, Unusual, Odd (SEOU) juxtaposition of <<touch, >hard pressure that brought Nash to China , and the patient to a cure.