RANKING OF SYMPTOMS
And now reluctantly leaving the subject of Grouping of Symptoms, as I feel much more could and should be profitably said upon it, let us take up the Ranking of Symptoms.
At first let me repeat what I have often said and written, viz., that the real totality is not necessarily the numerical totality, e. g., in a case presenting fifteen symptoms, twelve of Nux vomica, and three of Bryonia, the totality may be found in Bryonia.
How? As you know, most authors rank the symptoms 1,2,3,4,5, so that three symptoms of Bryonia with rank of 5 each would total 15, while twelve of the Nux with rank of 1 would total 12.
How do we arrive at the different rank of a symptoms? Authors differ. I will again take Chionanthus to illustrate my method. If five out of seven provers wrote depressed, listless or bum I would rank that symptom 5. If six out of seven would write yellow, bilious, watery stools, make that symptoms 4. If three out of six had bile in the urine I would make that symptom 4, because in the third case, it is more difficult to produce bile in the urine than a bilious, watery stool. Had four our of seven reported casts or cells in the urine, I would have ranked the findings 5, because it takes a more powerful drug to produce a functional change in the liver than in the kidneys; and it takes a still more powerful remedy to produce a structural change in any tissue or organ it does to produce a functional.
Let us now study our Chionanthus chart (Wheel) from another viewpoint, viz., that of sequence of symptoms, and we find that we first had hepatalgia then hepatitis, then functional disturbance. From the last we would expect yellowness of the sclera, then of the skin, and with the yellowness of the skin we would except itching of the skin. Our common sense aided by our study of the science of medicine would teach us to expect such a group of symptoms.
Now as per contrast, let us suppose we have yellowness of the sclera and skin but no itching, no bilious, watery stool, no bile in the urine, no depression, but marked apprehension, rapid emaciation and loss of strength. What rank should we give the yellowness in that group? My old partner and warmest friend had that group. The post mortem showed carcinoma of the liver, a structural change and the symptom, yellowness, etc., was called cachexia and ranked 5 instead of 3. But some of you may say that the yellowness in the functional case and that in the structural varied. Yes, and as I stated at Montreal, it is the ability to detect and rank this shade of difference which makes the difference between the tyro and the eminently successful homoeopathic prescriber.
How do you, personally, divide symptoms for the purpose of ranking them?
I have answered that question many times, but its importance may justify a repetition here an now. Hitherto in one class, I have divided them into subjective, objective, mixed and reasonable. Recently I have added pathological.
But there is no more than one exception to this rule. At the close of some one days work I think the third should be first, but the next day it is different. You see a mixed symptom is combination of subjective (mental) and objective. To illustrate : A patient says, My face feels hot, my tooth and throat feel dry and hot, my heart pounds so I can feel it, not only in my head, but through my whole body.
You can see (objective) what the patient feels (subjective) and so are more positive about the rank. Again, pure mental symptoms are rarely found. Brain symptoms are very frequently found in combination with those of some other tissue or organ. In such cases the complicating symptom is usually objective, e. g., one may be depressed from some functional stomach disturbance. But on the whole I still cling to the order first given.
