Domenick J Masiello, DO, DHt
It is not difficult to imagine that shortly after the discovery of the homeopathic principle by Samuel Hahnemann in 1796 and the production of the first several medicines, a case or cabinet used to house these remedies was made.
Initially used as a method of storing and organizing the ever-increasing number of remedies used by physicians, later these cases were downsized to kits convenient for making house calls. Julian Winston, in his delightful book, The Faces of Homeopathy1, pictures such a physician's case manufactured by the Leipzig Homeopathic Pharmacy, circa 1840.
As for domestic kits for use by the public, we know that such a kit must have existed in the United States by the year 1835. This was the year that Constantine Hering's "The Homeopathic Domestic Physician" was published. This book listed sixty-six remedies, presumably in potency, and five tinctures for external use. As homeopathic physicians were few and far between even in 1835, this book and available kits provided the only access most of the public had to homeopathic medicine. Winston2 documents the sale of a "Family Medicine Chest" by the Sears Roebuck catalogue in 1900 indicating the continued expansion of homeopathic manufacturing and distribution for the retail market into the early part of the twentieth century.
There is one other type of kit that is of more than just historical interest and the reason for this article - a kit for patients of homeopathic physicians. Again, it is difficult to know precisely when this practice began but my guess is that it started with the common use of the telephone. Having his or her patients purchase a kit was a way for a busy homeopathic physician to manage acute cases by phone until the patient could be seen at the office. The individual vials were labeled by number and not name. The physician merely told the patient to take several pellets from the numbered vial. One or more of the vials contained placebo. Julian Winston came across the codes for several physician kits when he was clearing out the Boericke and Tafel site in Philadelphia in 1991.3 There he found index cards listing the constituents of kits for patients of Elizabeth Wright Hubbard (1896-1967), James Hawley Stephenson (1919-1885) and Edward C. Whitmont (1912-1998), all New York City homeopaths. Hubbard's was a kit containing 60 remedies, most in the 200C potency. Stephenson's was a 21-remedy kit in the 30X potency. Whitmont's was a 53- remedy kit, most in the 200C potency. His number 52 was placebo. When I read the list of remedies in Hubbard's kit, I didn't need Julian's explanation for vial number 23 - "Cubana". Whitmont, my homeopathic mentor, had suggested to me in the early years of my practice, to use the label, "Cubana" if I ever needed to dispense placebo. He explained that since sugar cane was grown in Cuba, it was a useful way to prescribe placebo. He obviously inherited it from his teacher and physician, Elizabeth Wright Hubbard!
These days federal law prevents the sale of unlabeled kits so we can't use placebo for phone cases but we are still designing kits for our patients. Every homeopath has preferences based on his or her experience or that of their teacher. It is my distinct pleasure to share with you my take on the homeopathic kit for your patients.
As to the number of remedies, historically most kits had 25-60 remedies. More than fifty remedies will seem too expensive to today's patients. It is surprising how many patients will pay over $100 for a 10 day course of a new anti-biotic for an infection but refuse to pay as much for a remedy kit that will last decades! So with that range in mind, where does one start? I find it best to think about the kinds of calls you are currently getting from patients and the most frequently needed remedies for those conditions.
Trauma is a frequent reason for a phone consult, so one immediately thinks of the vulneraries: Arnica, Hypericum, Ledum, Ruta, and Sympytum.
Thinking of digestive disturbances leads one to: Bryonia, Ipecac, China, Lycopodium
Nux Vomica, and Carbo Veg.
Upper respiratory infection is a huge category and MUST include Arsenicum Album and Kali Bichromicum. Statistically, these remedies are the most frequently used in my practice for URIs. Seventy-five percent of all acute sinusitis in my practice is cured with several doses of Kali Bichromicum. It is also the most frequently needed remedy for viral laryngitis/pharyngitis.
There is an overlap of upper respiratory remedies and influenza remedies and the list should include in addition to Arsenicum Album as the chief remedy, the following: Belladonna, Bryonia, Gelsemium, and Rhus Tox. Once every several years I have used Eupatorium Perfoliatum for influenza especially when pain with eye motion was a keynote symptom. However, if your kit is a 25 or 36 -remedy kit you should use that slot for another remedy.
So far with three major disease categories 15 remedies are covered. If you treat children, then you'll want to have the ABCs covered: that's Aconite, Belladonna and Chamomile so often needed in pediatric practice for a variety of conditions.
Adding seasonal and other allergies to the list will yield: Allium Cepa, Apis, Euphrasia,
Gelsemium, Natrum Muriaticum (the most commonly needed) and Nux Vomica.
Urinary tract infections? - add Cantharis, Pulsatilla, and Staphysagria.
PMS? - consider Lachesis, Pulsatilla, Sepia, and Natrum Muriaticum.
And no kit would be complete without acute otitis media remedies, some of which have already been mentioned: Aconite, Belladonna (most likely right sided), Calcarea Carbonica, Chamomile, Ferrum Phosphoricum (most likely left sided), Hepar Sulph, and Mercurius Sol (or Merc Viv).Of course homeopathic remedies are not prescribed based on the name of the disease condition but on a repertorization of the symptoms as experienced by the patient. Thinking of disease categories is just a useful way to put together a kit. You might also add remedies such as Phosphorous, Sulphur, Silicea and maybe Spongia. Ignatia, the preeminent grief remedy should be in your kit as well. Please note that if you add nosodes such as Tuberculinum, Psorinum or Influenzinum to your kit, it will become a prescription item under current federal law. This is not a problem if you sell the kit from your office, however, if a homeopathic pharmacy is selling it to your patients, they will need to have a prescription on file.
I sell my kits for the recommended retail price and I include my own package insert. In it I explain that each of the vials has an indication printed on it as required by federal law but that it is not the only indication for the remedy. This helps avoid needless phone calls in the middle of the night. I also include instructions about seeking help at an emergency room for severe conditions and general guidelines for case taking. I sell the kit with a homeopathic home-prescribing guide because I encourage my patients to care for themselves and their families. Most can easily learn how to prescribe for simple acute conditions but if their remedy selection hasn't worked, I will take their acute case over the phone. My secretary has been trained to elicit symptoms and modalities and will leave that message with the patient's chart. If I need clarification, I will call the patient and further discuss their concerns. Most likely the remedy they need is in the kit. If not, they will be able to purchase it at one of several pharmacies in New York City. I charge a modest fee for phone consultation, however, should my prescription not work, the patient is asked to come for an office visit and the phone consultation fee is deducted from the office visit fee. When I first went into practice in 1987, I used a 30C kit with 200C trauma remedies. Over time I noticed that 30C remedies required more frequent repetition for acutes and that resolution was slower. In 1992, I switch to an all 200C kit and found the results much more satisfying.
Rarely a few patients will continue to call for phone consultations in place of regular office visits for chronic conditions and they are simply told that they need to come to the office. For the most part, however, I have found the domestic kit to be a practice builder and a great way to spread the word about homeopathy. Besides, I love being part of a medical tradition that goes way back to the 18th century.
1 Julian Winston, The Faces of Homeopathy: An Illustrated History of the First Two Hundred Years (Tawa, New Zealand: Great Auk Publishing, 1999) 29.
2 Winston 84
3 Winston 508
Dr. Domenick Masiello, D.O. is board certified in Family Practice (C-FP), Osteopathic Manipulation (C-SPOMM) and Homeopathy (D.Ht.). Dr. Masiello is published in many peer reviewed journals and continues to practice in New York City. He graduated in 1985 from the New York College of Osteopathic Medicine and completed his internship at Kennedy Memorial Hospital in New Jersey. You can read more about Dr. Masiello here, and contact him for appointments at 212-688-4818.