David Little Interview 1-2

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Leela: In India, it is a motto for every practicing doctor to give a part of their services free (I think it is part of the Hippocratic Oath). I think homeopaths are expected to do so to a greater degree. Especially as in India, homeopathic remedies being cheap; it is the medicine of the poor.

You mentioned once about how your sons helped you in your clinical work. What part has your family played in your homeopathic practice?

David: I met my wife, Jill, in India in 1978. She is British and traveled overland through Turkey, Iran, Afghanistan and Pakistan before entering Northern India at Amritsar, in the Punjab. She has always helped me with my work. We have three children, two sons (24 and 21) and a daughter (11). Our two sons grew up speaking perfect Hindi and from a young age acted as translators in the clinic. They understand the hill dialects as well as pure Hindi and are good linguists. In the free clinic days, one son worked with my wife and received the patients and the other stayed with me and acted as the compounder and explained how to take the remedies.

My wife and oldest son would start the case history and my youngest son would make up the remedies. With this four-person team we faced the masses on a day-to-day basis for many years. I could not have accomplished what I have done without my family. My daughter is excelling in the sciences and has a great knowledge of anatomy and physiology for her age. She already has a good idea of how Homoeopathy works. My children have watched patients come and go since they were infants. This was the first phase of their training. Later they worked next to me in the clinic. What they do in the future will be their own choice but they will always know how to take care of themselves, their families and those around them.

Leela: That’s a wonderful and perfect introduction into homeopathy for your children! It is what makes great homeopaths of the future. A living homeopathic legacy.

David: In the last few years I have moved to a new area and reduced the number of patients I am seeing in an effort to finish my written works. Now the same team is working to complete my literary projects, which includes a 6 volume 3000 page textbook on Homoeopathy. My eldest son, David Jr., takes care of all the household and business duties and also helps takes cases. My younger son, Adam, runs the computers and is in charge of the book project as well as helping on cases. Both sons have a good knowledge of Homoeopathy as well as several other aspects of the healing arts. My wife acts as the editor and heads the proof reading team, etc. Once again it is a family affair.

Leela: Yes isn’t that great? I consider it truly a blessing from God to have your family committed to your work with homeopathy. I can imagine how fulfilling it is to work in supportive partnerships that have a similar mindset and thinking in homeopathy.

Could you tell us a little more about your book?

David: I hope my work, The Homoeopathic Compendium, Volume 1 through 6, will be available next year. It has taken me 12 years to put together this material and our whole team has been working on it for the last five years. I have gone to original sources for my material and drawn heavily on the data found in the Paris casebooks to demonstrate different methodologies used by Hahnemann. I have done my best to bring all this material up to date for practice in our times. Volume 1 and 2 includes history, philosophy, case taking, posology, and case management and teaches the clinical methods of Hahnemann, Boenninghausen, Hering, Jahr, Kent and Boger. These volumes cover all the areas raised in the Organon.

Volume 3 and 4 offers the largest study of the chronic miasms ever presented and reviews little known areas found in the classic literature as well as new data never before published. In this work I take up the subject of old and new miasms and predict what is to come in the future. These volumes cover all the area raised in the Chronic Diseases.

Leela: That is something we certainly need!

David: Volumes 5 and 6 are a study of constitution and temperament as well as psychology and metaphysics. Volume 5, Constitution, Temperament and Maps of Consciousness, is a fully illustrated work that will act as textbook on psychology and Homoeopathy. This volume reviews the ancient teachings found in the Mappa Mundi and Greek classics as well as traditional Freudian, Reichian and Jungian psychology.

Leela: Now this is something I know very little about, though I have read Jung with great interest. I think he has the most homeopathic outlook towards psychology and management of a psychological case than any other school of psychology today. He made some very interesting observations about synchronicity as well.

David: One of the reasons Jungian Psychology dovetails so well with Homoeopathy is that it has its roots in the same schools of philosophy. Jung based his work on the Greek classics, the works of Kant, Swedenborg, Schopenhauer, Nietzsche, and Goethe, as well as the best of the Oriental traditions. His presentation of the fivefold human psyche and the Self are greatly influenced by India. Jung’s term the “Self” as that which initiates individuation is based on the Vedanta teachings on the Atman. His work is an attempt to fuse the best of the Occident with the best of the Orient as well as the best of the old with the best of the new.

Jung introduced many concepts into modern language including the terms introvert and extrovert, the collective unconscious and archetypes. Unlike the Freudian psychiatrists, Jung integrated mythology and metaphysics into psychology as a part of the human mind that cannot be ignored. I would suggest that Homeopaths take advantage of the large volume in material available on Jungian psychology and go to the original sources. His works offer a map of the Unconscious that shape to the formless psyche. This can be very helpful in taking cases and understanding remedies.

Leela: We will. I don’t think I’ve fully grasped his explanations on archetypes, etc., and I look forward to reading what you’ve written. From the little I have read though, homeopathic concepts of disease and its cure largely concur with Jungian psychology. What about your final volume?

David: Volume 6 is a special 200 remedy materia medica that emphasizes mental illness, personality disorders, neurosis, psychosis, schizophrenia, autism, hyperactivity, archetypal complexes, etc. and their physical concomitants. In Part 5 Constitution, Temperament and Maps of Consciousness, I review the history of philosophy and psychology beginning with the ancients to the advent of homoeopathy and ending with modern psychiatry. I explain the terms of psychology in such a manner that I hope it provides a roadmap of the psyche that will be easy to follow in case taking. Volume 6 is a special 200 remedy materia medica that emphasizes mental illness, the 12 personality disorders, 5 forms of neurosis, psychosis, schizophrenia, autism, hyperactivity, archetypal complexes, etc. and their physical concomitants.

Volume 6 allows for the practical application of the volume 5 and put all the material in a clinical perspective. These two volumes represent around 1000 pages of original material on these subjects. I hope that it helps to provide a foundation for the skillful application of Homoeopathy and psychology in contemporary practice.

Leela: I’m sure it will!

I am also aware that you did a lot of reading and study on the use of various potencies and their effects. How did all this come about?

David: Yes, I was intrigued about why potency selection continued to remain an arbitrary choice among homeopaths today.  The first books I studied deeply were Kent’s Repertory, Lectures on Homeopathic Philosophy and Lectures on Materia Medica. I also began to read the 6th Organon of the Healing Art and the Chronic Diseases by Samuel Hahnemann. I immediately related to Organon passages on the vital force and the general philosophical structure of the work but I was totally confused by the posology and case management procedures. This was because I was reading about the LM potency of which I had no knowledge and no one I knew ever used.

I was taught the single dry dose wait and watch method with an emphasis on high potency centesimal remedies. Most of what Hahnemann was really saying went right over my head and I must confess I did not understand what he was talking about most of the time. As the Organon gathered dust on my book shelves, I went on to study the works of C. Boenninghausen, C. Hering, T. F, Allen, H. C. Allen, J. H. Allen, H. A. Roberts, Nash and others.  I was using Kent’s Repertory, and although I had a copy of Boenninghausen’s Therapeutic Pocketbook, I did not truly understand its construction or usage.

The second time I read the Organon it shocked me because I began to realize that I did not really understand the basics of Homoeopathy yet I was treating the ill! What troubled me the most was that I was taught the Kentian idea that the size of the dose, the number of pills, and the delivery system made no difference in the action of a remedy on the patient. Hahnemann, however, was clearly stating that the size of the dose was critical in the action of the remedy and became more crucial as one used higher potencies! He pointed out that the size of the dose, subtle changes in potency and the delivery system were very important factors in posology and central to case management.

Leela: So what you’re saying here is that we really need to take the clinical responses of our sensitive patients seriously and extrapolate that into every choice of potency, dose and repetition we make. How in your experience, does this affect the choices between dry doses and liquid doses?

David: I realized that Hahnemann no longer even used the dry dose because he thought it was too limited and imposed too many unwarranted restrictions on the use of homeopathic remedies. Hahnemann replaced the dry pills with the medicinal solution and the exclusive single dose with split-doses if and when necessary to speed the cure. He also clearly stated that this method could reduce the number and strength of aggravations and prevent accessory symptoms and antagonistic counter actions of the vital force. This all took me by surprise as neither I, nor anyone I knew was paying any attention to all this additional information.

As I researched the source material deeper I came to realize that there were great differences between the 4th, 5th and 6th edition of the Organon and what I was actually practicing was most similar to the 4th Organon.  Why was this I wondered? Why are we only studying the methods Hahnemann practiced up to 1828 -1829 and ignoring everything he introduced between 1832 and 1843? How come I knew so little about the methods of the 5th and 6th edition? This was not true only in the USA but it was the same in Europe and India. At this time, I decided I should do an extensive clinical trial in which I would use the methods of the 5th Organon (1833), the Paris edition Chronic Diseases (1837) and the 6th Organon (c. 1842-43) and compare them with the methods of the 4th Organon (1829) and first edition of the Chronic Diseases (1828).

Leela: Right at this poignant point we’ll stop and wait for the results of your clinical trials in the second interview to follow, next month. There is so much to learn from you and about your work we wouldn’t be getting enough ….. I can already hear the cry “We want more!” out there!

We will also discuss your perspective on contemporary clinical approaches in a different context. I remember on one of the Online Lists, you explained with great clarity what was required in clinical homeopathy today. I agreed with what you said: Homeopaths need to have the flexibility of adapting case analysis to the type of case presentation.

What has your homeopathic practice been like all these years? Could you tell us again about the different clinical approaches you have used?

David: My homeopathic practice has been quite varied over the years. First of all, our family ran a free clinic with a volume practice in the villages for many, many years. At the same time, I did a free private practice for other individuals who sought my help from different parts of India. I also treat many Westerners who come to India as they also seek me out because of my knowledge of local conditions. My patients vary from the poorest of the poor to the families of Ministers, the Home Secretary, the Secretary of Police, Army officers and Members of Parliament. I have never charged anyone any money whether they were beggars, leading industrialists, well-known politicians or former kings. In this way, I maintain my complete independence and perform selfless service to humanity. Sometimes, I travel to the USA and treat patients there although it has been 7 years since I have left India this time around. So you might say I have seen “everything” and “everybody” over the years.

I try to mould myself to the patient and their circumstances rather than fit the individual into one specific type of case taking method. To apply this method properly one must understand all the major methods of case taking including Hahnemann’s, Boenninghausen’s, Hering, Jahr, Kent’s and Boger’s.

Leela: We’d like to get a glimpse of how you incorporated this clinically.

David: The foundation of case taking, of course, is Hahnemann’s method, which is based on causation, symptoms and their attending circumstances. Hahnemann taught that one should study the complete case history and assess the exciting and fundamental causes as well as coincidental bafflements where the cause is unknown.

On this basis, Hahnemann suggests collecting the totality of the signs and symptoms of the body and soul and their attendant circumstances such as the condition of the physical constitution, the character of the intellect and emotional disposition, habit, lifestyle, occupational talents, domestic and social relationships, age, sexuality, etc. All of this information forms the only conceivable Gestalt of the disease and leads to the true simillimum. Without this essential foundation no case taking method is complete. On this basis, the choice of the remedy is made by those symptoms that are the most striking, extraordinary, uncommon and oddly characteristic of the disease case.

Next, comes the methods of Baron von Boenninghausen, which were developed directly under the tutelage of Samuel Hahnemann. Hahnemann was the first to view symptoms in terms of locations, sensations, modifications and concomitants, but Boenninghausen clarified these ideas and brought them to further heights. The Baron pointed out that a rubric should have all these component parts to become a complete characteristic symptom. This means that our complete rubrics are constructed from symptom segments that can be arranged in different combinations depending on the time and circumstances. This idea became the basis of the Baron’s classic repertory, The Therapeutic Pocketbook.

In this repertory the Baron generalized the most important characteristic symptoms of the 125 remedies found in the Materia Medica Pura and Chronic Diseases and indexed them alphabetically in a repertory format. Boenninghausen suggests building the totality of the symptoms up by locations, sensations, modalities and concomitants and tended to use the mental symptoms as confirmatory signs.

The idea is to construct the symptoms part-by-part according to the locations, sensations, modalities, and times as found in the patient. The method of viewing the symptoms as segments or bits of information that can be broken up and recombined in various ways greatly expanded the role of the repertory beyond acting only as an index to symptoms already found in the materia medica. The Baron’s contribution offers the best method for understanding the essential elements that make up a complete characteristic symptom and the complete case. This work, however, presents very few mental symptoms and is weak in this department.

Kent’s contribution to the repertory and materia medica is quite vast. He integrated most of Boenninghausen’s generalization in his general section and greatly expanded the chapter containing mental symptoms. Kent also included a great number of sub-rubrics that offer further particularization of the themes found in the main generalized rubrics. He emphasized the important of the mental symptoms and suggests that they can be used as primary elimination symptoms. This idea is associated with the hierarchy of the symptoms from the mental generals to the physical generals to the regional particulars. In this way, the symptoms can be constructed from the top downward starting with the mental symptoms and ending with the regional particulars.

The grand contributions of C. M. Boger’s include his Boenninghausen’s Characteristics and Repertory, the Synoptic Key of the Materia Medica and General Analysis with its index card repertory. Cyrus was sensitive to the criticism by Hering, Kent and others that the Therapeutic Pocketbook was not complete. Some were concerned about the over generalization of some of the symptoms and others complained about the dearth of sub-rubrics containing further particularizations. Others worried that the Baron had broken up too many of the complete characteristic symptoms found in the materia medica in such a manner they were lost. In Boger’s Boenninghausen’s Repertory, Boger preserved the Baron’s generalization but also reintroduced amble sub-rubrics with further particulars as well as unique concomitant symptoms.

Boger emphasized the importance of the general symptoms as the middle path between the mental symptoms and the regional particulars. He felt that even the pathological general symptoms could be utilized if they were filled out with sensations, modalities and concomitant symptoms. He acknowledged the importance of the mental symptoms but pointed out that they were really only useful when they were well marked and peculiar. He also noted that the regional locations were useful but did not represent a complete case unless balanced by the general symptoms.

Boger felt the mental symptoms were often too subjective while the regional particulars only represented the physical body. The general symptoms, however,were vital in nature and related the reactions of the entire mind-body complex to its internal and external environment. On this basis, he published his General Analysis and card repertory in which he stressed the role of the general symptoms. This work does not include all the regional particulars, and like the Therapeutic Pocketbook, this work contains few sub-rubrics. It was Boger’s intention that further particularizations could be studied in his Boenninghausen’s Repertory, the Synoptic Key, or Kent’s Repertory. Phatak based his repertory and materia medica on the works of Boger. This method may be called the central general method.

Leela: That’s very interesting information on Boger’s work. I had not realised that Phatak based his work on Boger’s Synoptic key, though I have used his repetory very sucessfully many a time. It is so simple and direct!

David: Yes, it is a useful method. From this review, one can see that on the basis of Hahnemann’s case taking methods there are three primary repertory methods, Boenninghausen’s, Kent’s and Boger’s. Their three methods may be referred to as the “below to above method”, the “above to below method” and the “central general method”. In Boenninghausen’s method the symptoms are built up from the location, sensation, modification and concomitants to the mental symptoms. In Kent’s method the symptoms are constructed from the mental and general symptoms to the regional particulars. In Boger’s method the case is constructed by first finding the most dependable general symptoms and the adding the particular and mental symptoms around those generals. What all these methods have in common is making one final decision on the materia medica and what Hahnemann called the striking, extraordinary, uncommon and odd characteristics. This idea was sacrosanct to all and the meeting point of all repertory methods.
Leela: Understanding these differences in approach to analysing characteristic symptoms must be the foundation to using each one appropriately in the clinical case presentation. Could you give us a couple of case examples?
David: I will. Many times the patient presents a well known constitutional portrait as presented in the materia medica and its commentaries. Sometimes, one notices immediately that the expression on the patient’s face is careworn and full of grief; their skin is shiny, pale, waxy and greasy; and they are emaciated around the neck and collar bones while they are rather plumb or edematous around the abdomen, hips and legs. This has one already thinking in terms of remedy portraits.

It does not take long before the symptoms of inappropriate relations, unrequited love, professional disappointments, prolonged grief, and fastidious control issues with emotional repression become obvious. Then comes a litany of physical symptoms like violent thirst, salt cravings, splitting headaches, scanty or delay menses, etc. One often knows “who” such patients are when they walk in the room and the Natrum Muriaticum is prescribed and they recover their health. When the symptoms are present as abundant mental and general symptoms in clear constitutional pictures it is often best to use Kent’s Repertory and synthetic repertories based on its format. That is because such cases suit the “above to below” method.

Unfortunately, not all cases are presented in such a complete manner. Many times, the cause of the sickness is unknown and the case is presented in fragmented incomplete symptoms. In such cases one has to collect the fragments of the symptoms from different regions and make up characteristic symptoms on the spot that fit the case. Here the ideas presented in the Therapeutic Pocketbook often come to one’s rescue. The patient complains of one-sided joint problems but offers no defining sensations or modalities of the complaint and just says it hurts “all the time”. No matter what one ask it always comes back to the same limited answers.
Leela: Haven’t we all had those cases?! In our initial practice, many of us make the mistake of digging for symptoms… and drive the patient away!

David: Right! When actually that itself is a characteristic expression. An example is of a case, when under persistent questioning there is some dryness here, some stitching sensations there, and they don’t like to move around yet no one symptoms is complete in itself. It also has become apparent that they cannot or do not wish to get any deeper into the details. It seem that they are rather fixed and rigid in their understanding of their disease state. The only way to sum up the general and mental situation is “rigid and unmovable”. In such a case, the joints may my taken as the location, the dryness and stitching as sensations and < motion as the modality with a rigidity and fixed nature as concomitants even though they all appear in different regions.

Suddenly a fragmented one-sided case that presents no complete symptoms in the materia medica begins to demonstrate well known characteristic symptoms of a remedy like Bryonia. One has to see if the remedy studied in the materia medica has the potential to produce the symptoms found in the patient. One has to look at the various regions and collect the symptom fragments and combine them in such manner that fits the case. One has to generalize the symptom threads according to the strength and number times they are found in the patient and materia medica. In this way one can “read between the lines” and find remedies where others may not see anything. I have cured many such one sided, fragmented cases in this manner. Such situations suit the “below to above method” because one must construct the symptoms segment by segment until a fuller image of the characteristic symptoms appear and generals are collected that are confirmed by the mental symptoms.

In some cases the etiological rubrics are very important. While writing this interview I just saw a patient who was presented in terrible agony with pains in the stomach that made him lie down and moan with great suffering. The patient’s face looked emotionally distressed and I wondered what caused this state. He seemed dark, morose and melancholic. He made himself vomit because he thought it would make him feel better but it did not. He did feel a bit better after passing a stool, but his pains returned. He had not taken any unusual food or drink nor ate anything outside the home. I was pondering what to do when a friend of his told me that the patient had became very, very angry the day before, almost to the point of hitting a person and had to be restrained. The next day he awoke with the terrible pains.

A quick look at the rubric “ailments after anger” showed that Nux Vomica would be the best remedy when compared with the concomitants like thinking he would feel > if he could vomit and pains > by stool. He was given a single dose of the 30c in medicinal solution and he immediately fell asleep for several hours. When he woke up he was much, much better. A second dose was given the next day for a few lingering symptoms and he was then totally well.

Some cases present themselves in terms of the group characteristics of the chronic miasms. Sometimes a review of the case history will show that the patient had a miasmic infection that was suppressed. One may find that the patient had a serious skin infection that was suppressed, gonorrhea, the removal of genital warts, an old treated TB infection, or even a syphilitic chancre. In other cases there may be an inherited miasm that can be traced by a study of the maternal and paternal lineages. In this case the patient is suffering from a disease of miasmic cause which produces similar symptoms that affect a homogenous group. This is the time when one needs to assess the symptoms in terms of potential anti-miasmic remedies and nosodes, and treat the chronic miasm first.

One must also understand that not all cases can be treated by the constitutional method because it is too late for such a technique. This is most common in conditions with one-sided pathology in the vital organs like the heart, kidneys, or lungs, when the organs of elimination are completely compromised. These are cases where Kent said, “Don’t give them that constitutional remedy they needed 20 years ago.” Why? Because the unproductive aggravations such a remedy may cause will speed the death of the patient rather than the cure! In such cases one must think in terms of locations, systems, tissues and organs the disease has compromised, and use remedies that are known to act on such conditions and diseases. In such cases the pathological generals are to be highlighted by their locations, sensation, modifications and concomitants. Under such conditions Boenninghausen’s and Boger’s methods are more suitable than Kent’s.

About the author

Leela D'Souza

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at www.homeopathy2health.com for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website : http://www.homeopathy2health.com/member.htm
and her at: [email protected]

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