James Compton Burnett (1840-1901) frequently wrote that at times, covering the totality of symptoms will not result in cure and that it may be necessary to treat behind the symptoms. His reasons for this were varied and manifold such as miasmatic, vaccinosis, good old fashioned organopathy and the much less routinely mentioned “Synorganopathy”.
You may ask “What is synorganopathy?” And I will reply “Shame on you for not reading ALL of Burnett’s books, then you would know!” But relax, prepare a hot (or cold if you prefer) beverage, sit down and read the following case that nicely illustrates Burnett’s prescribing strategy that he termed synorganopathy.
In the autumn of 1993 a forty year old woman came to me for the treatment of heavy menstrual flow. This had been occurring for one year and left her weak, tired and irritable. Her cycle was regular, 28 days, and her flow was very heavy for 3 days and then lighter for 5 more days.
Patient medical history:
As a young child she suffered from repeated tonsillitis and inflammation of the adenoids. At age 12 her tonsils, adenoids and also a nasal polyp was removed.
All through her life she has been prone to constipation. At times not passing a stool for 7 days or more. The pattern now is that most days she will pass a stool but at least three times a month will be constipated. At age 16 a vaginal cyst was removed.
At age 26 ovarian a cyst was removed on her left side. She contracted a sexually transmitted disease (std) in her 20’s.Also during her 20’s she used the oral contraceptive pill and she states that this predisposed her to cystitis. At 39, whilst travelling in Asia she caught an infection resulting in fevers, pale stools and mild jaundice.
Mornings are her worst time of day, and it takes her up to 45 minutes to become fully awake. Inclined to oedema of hands and feet. < heat. < alcohol.
Generally better in the mountains and at the sea side.
Food desires: Sweets, salt, spice. Aversions: slimy foods eg. oysters.
Strong thirst especially for fresh orange juice and fizzy water.
Good sleeper. Position is on the abdomen. Dreams of water, sex and falling. (not all at the same time!)
Confidence has been low in the past but ok now.
Describes herself as a “control freak”. Controls her anger and very rarely loses her temper. Would not like to be observed whilst being “angry and confused”.
Controls her environment and is particularly tidy. Very fastidious. Very clean. Fears germs. Has financial worries and is scared she will die from starvation.
Our patient is a strongly built lady with a robust skeleton. She delivers her symptoms clearly with understanding and is dressed very smartly.
Three remedies present themselves for this case.
Medorrhinum may be considered due to the history of nasal polyp, left sided ovarian cyst (Med being principally a left sided remedy with a fantastic track record for treating left sided sciatica cases), history of std, > sea side, aversion to slimy foods, desires orange juice, sleeps on the abdomen and an affinity for the uterus.
Arsenicum album is also a thought because of the marked fastidious symptoms, fears germs, financial worries.
Calc carb very much covers her presenting complaint of heavy menses, the history of tonsillitis, polyps, the tendency to constipation, fears loss of control and especially the symptom of being observed whilst confused. Her build suits the classic description of the remedy Calc carb.
Rx – Calc carb 200c weekly doses.
First follow up:
After one month of treatment she shows only minor improvements on the remedy.
A small amelioration of the menses but now has an increase in watery leucorrhoea.
Stools much easier to pass and now regular, passing a stool once or twice a day.
In the last week she has been waking at 3am, had thick mucus in the mornings and noticed an increase in oedema of her hands after alcohol.
Calc was partially similar to the case. Has improved the bowel symptoms but little else. The symptoms waking 3am, increased mucus and oedema of the hands all indicate Medorr so this was the next prescription.
Rx – Medorrhinum 200c weekly doses.
Second follow up:
Patient reports “No change”. Menses still as heavy and exhausting. Very slow to wake in morning. However leucorrhoea much improved, not waking at 3am and mucus much less.
Patient states that she is much thirstier.
I had high hopes for Med but it has not really helped apart from taking out the symptoms that the Calc brought forth. My next choice was to give Ars alb.
Rx – Arsenicum album 200c weekly doses.
Third follow up:
Like a good Arsenicum patient this lady phoned to say no amelioration occurred during her menses and she wanted to cancel her next appointment to save money! I offered to treat her one last time, for free! She agreed (what Arsenicum album patient could possibly refuse!)
Since the phone call I had re-read some of my Burnett books for guidance with this case. One thing that struck me whilst reading was his tendency to focus on past disease episodes and prescribe upon them and their results. Looking back over the notes it is quite clear that her heavy menses started soon after the infection in Asia. The symptoms of pale stools and jaundice added to the symptoms < alcohol and slow to wake in the morning all point towards the liver.
Rx Carduus marianus 3x bd.
This remedy resulted in complete amelioration of the menses. The flow re-established itself to 5 days and much less heavy. Waking in the morning became 50-75% improved and she also reported that her sclera became much clearer and less “dirty looking”, which I had not observed or been told about.
This was a case that Burnett would describe as “Synorganopathic”. This is when you have a disease state in one organ, the primary organ, and then the symptoms are expressed through a secondary organ. In this patient the primary organ was the liver, but the symptoms were expressed through a secondary organ, her uterus. Treating the secondary organ in such cases rarely improves the picture. Treatment must be “first come, first served” as Burnett stated.
Primary organ ➤ Secondary organ = symptoms.
Liver ➤ Uterus = symptoms of heavy menses.
Now I do think that both the Calc and also the Med helped, but only partially and not the presenting complaint – heavy menstrual flow. Covering the totality of characteristic symptoms did not cure this case.
What is certain is that the Carduus marianus did help. And the cure has held ever since. And that the path to this prescription was Burnett’s strategy “Synorganopat