The following four cases, in addition to showing some of the keynotes of Phosphorus and its scope of action, illustrates a method of studying chronic conditions.

A physician, aged 63, fair skin and hair, weight over 250 pounds, complained of throbbing pain in the mid-chest front and back, with shortness of breath induced by any emotion or exertion. He had swelling of the feet and ankles. Puls 96. Apex four inches to the left in the fifth space; heart sounds indistinct and weak. This patient represents that class of cases so aptly described by Mackenzie as “the beginning of heart- failure,” due, undoubtedly, in his case, to a fatty heart.

His pains first occurred as a throbbing in the lumbar region if he retained his urine too long or strained at stool or when urinating; later, this pain worked up to the chest with the aggravations as described.

Diagnostically, these symptoms referable to the heart are of first importance; but, in studying for the homoeopathic remedy, we allow them temporarily to slip into the background and regard the symptoms which characterize the constitution as the most important.

This man was mentally active and keen but physically sluggish, this sluggishness being due partly to inclination and partly to old un-united fracture of the femur. He was buoyant if all went well but easily depressed by adverse conditions. If awakened after going to bed, he remained wakeful and disturbed for the remainder of the night. He was good-natured, but very susceptible to emotional disturbances. Mental exertion caused occipital headache toward the the end of the day.

He was neurasthenic and apprehensive, and for two years had been developing a few phobias. He perspired easily; experienced general aggravation before a storm and in wet weather. He had five to eight painless stools daily, the first always waking him at 4:20, after which he did not sleep. All acid fruits passed undigested. He had never been as well since an operation for anal fistula a few years before.

Two prominent characteristics in this patients case were general aggravation from emotional disturbances and easy perspiration. Repertorially, the most prominent remedies under these two symptoms are: Calc. carb., Cocc., Gels., Nat. mur., and Phos.

Mental keenness, susceptibility to weather changes, and chronic painless diarrhoea are all keynotes for Phosphorus. This remedy was given in high potency, doses not being repeated as long as improvement continued. All symptoms improved and now, fifteen months later, the anginoid symptoms are gone, there are only two stools a day, and he can do a normal days work without headache or other distress.

The second case was a man sixty-two years old, stout, blond, taller than average, who for ten years had had periods of exhaustion with shortness of breath, and, for the last three years, had had irregular pulse with occasional extra systoles. For one years there had been angionoid symptoms, sudden pain in the heart extending down the left arm like the twanging of a taut string. Every few weeks, stoppage of the urine necessitated catheterization. Glycosuria for many years.

He had spells of mental depression. Constitutionally he took cold easily and these colds always affected the chest. He was a large eater and felt that eating braced him up; was always much refreshed by a nap; better from heat than from cold; perspired easily and felt better from perspiring; was worse in a close room. He was far more active mentally than physically.

This patients pulse was 84 when he was seated; apex in fifth space four inches to the left of the sternum, second aortic accentuated, heart-sounds indistinct. This complex of symptoms also belongs to Phosphorus, and this remedy, given as it was given in the case just cited, has corrected all the heart and other symptoms.

The next case is a man of 31, tall, dark, slender, aquiline features, long fingers. Harvard graduate. This patient had had three attacks of manic-depressive insanity; the first in 1914, the second in 1915, and the last in 1917 when he was for five months in a hospital, from which he was discharged with a bad prognosis. These attacks began with excited mental state which gradually increased until he became exalted and then maniacal; after a few weeks of this it was succeeded by depression that lasted for several months. He was always subject to alternate periods of elation and despondency.

I first saw this man in December, 1917, three months after his dismissal from the hospital. His constitutional symptoms were: Inability to concentrate because thinking made him restless and uneasy. Sensitiveness to cold and easily induced fatigue. Perspiration of hands and feet, that from the feet being offensive. Difficulty in falling asleep. Ravenous appetite during the outbreaks. General relief from eating. General aggravation in the afternoon. Occasional headache, better in the open air and worse from stooping or any motion. Depression during cloudy weather. Susceptibility to taking cold. General desire for and alleviation from being in the open air.

Repertorially, considering the local perspiration of hand and feet and the relief in the open air, Fluor. acid., Phosphorus, Sepia, and Sulphur, present themselves for comparison. Phosphorus covers the entire case and it was given in the same way as in the two previous cases. All the symptoms gradually cleared up including his lack of mental control, and he obtained employment in a bank where he has had several promotions during the past three and a half years.

Kent reported a case of dementia praecox which he cured with Phosphorus, where he discovered the keynote in the fact that the patient wanted all food and drink cold. Apropos of dementia praecox, that remarkable man, the late Joseph Fraenkel, stated in one of his endocrinological clinics that, before he became interested in homoeopathy, he had considered dementia praecox incurable but that since practising homoeopathy, he had cured seven cases.

The last of this series of Phosphorus cases was a man of 32, suffering from psychasthenia; medium height, fair complexion and hari, face round but drawn, worried expression. His teeth had been treated for pyorrhoea two years before and he had, as he put it, never felt right since. Two months before I met him, he had had a nervous spell of which he had but a hazy recollection, had “talked peculiarly,” he said, and ever since had felt strange and everything had seemed to him strange.

He had constant apprehension; feared insanity; wondered how he came to be here; everything in the world was wrong; he kept getting in a panic, it seemed, and had been unable to go to his office. This man was in the insurance business.

He feared to be near a knife lest he should commit suicide, yet he was afraid of death; afraid to be alone. He often got impulses to smash things.

Constitutionally, he was always worse from 5 p.m. until bedtime; fell asleep late; had general aggravation on a gloomy day. Often took cold. Highly sensitive to noise. Fidgety. Restless. Sensation of internal trembling. Teeth sensitive to cold.

Repertorially taking into account the three fears, viz., fear of being alone, of death, and of insanity, the following remedies suggest themselves for comparison: Phosphorus and Pulsatilla highest, with Arsenic, Calc. carb., Kali car., Lyc., Nux vom., and Sepia in lower degree. Phosphorus covered the case and it was given as in the other three cases. This patient was better in a week, went back to work the second week, and, in six weeks, reported “well”.

Epitomizing the method of studying chronic cases: First, take the history with especial reference to constitutional symptoms.

Second, compare in the repertory two or three of the most characteristic constitutional symptoms.

Third, study in the materia medica the residual symptoms in connection with the remedies brought out in the second step. New York, N.Y.