The selection of a curative remedy in this case, therefore, was governed by two symptoms of no known pathological value, and of seemingly trifling character. Yet these two symptoms were what gave the case its individuality. and unerringly pointed out the curative remedy.
This case is a beautiful example of the kind of work for which Dr. Lippe was famous. It illustrates the necessity of being familiar with the natural history, symptomatology and diagnosis of disease. Dr. Lippe could not have decided that these two symptoms were peculiar and characteristic if he head been unfamiliar with the symptoms of cholera. Neither could he have selected these two symptoms as peculiar if he had not had the rest of the symptoms before him for comparison. The mistake of arbitrarily picking out some “freak” symptom, and giving a remedy which has a corresponding symptom, should be avoided. Dr. Guernsey did not teach prescribing on a single symptom.
In the preface to the first edition of his great work on obstetrics Dr. Guernsey presents the subject of “keynote prescribing” in another way. He says: “The plan of treatment may seem to some rather novel, and perhaps on its first view, objectionable, *inasmuch as it may seem like prescribing for single symptoms, whereas such is not the fact. It is only meant to state some strong characteristic symptom, which will often be found the governing symptom, and on referring to the Symptomen Codex or Materia Medica all the others will be there if this one
is.
“There must be a head to everything; so in symptomatology; if the most interior or peculiar symptom, or keynote, is discernible, it will (usually) be found that all the other symptoms of the case will be also found under that remedy which produces this peculiar one, if the remedy be well proven. It will be necessary, in order to prescribe efficiently, to discover in every case that which characterizes one remedy above another in every combination of symptoms that exist. There is certainly that in every case of illness which pre-eminently characterizes that case, or causes it to differ from every other. So in the remedy to be selected, there is and must be a peculiar *combination of symptoms, a characteristic or keynote. Strike that and all the others are easily touched, attuned or sounded. There is only one keynote to any piece of music, however complicated, and that note governs all the others in the various parts, no matter how many variations, trills, accompaniments, etc.”
If it is understood that the “keynote” to a case may and often does exist in, or consist of, a “peculiar combination,” as Dr. Guernsey puts it, and that is it not merely some peculiar, single, possibly incomplete symptom which the tyro is always mistakenly looking for, the subject is cleared of part of its obscurity. Dr. Guernsey might have summed up the whole matter in one word – Generalization, which has been discussed at length in the chapters on the logic of homoeopathy.
Dr. Lippe, discussing characteristic symptoms, wrote as follows: “When medicines are submitted to provings upon the healthy they develop a variety of symptoms in a variety of provers. Each prover has his own peculiar, characteristic individuality affected by the medicine in a peculiar manner; other differently constituted individuals experience different, yet similar, peculiar symptoms from the same medicine. There is a similarity and a difference evident upon close comparison. In like manner diseases and all other external influences affect different individualities differently, yet similarly. The physiological school and its followers accept in disease only what is general (common) to all those affected by it; in medicinal provings in the same manner they accept only that which has been experienced alike by many. In both cases they simply (sic) generalize. The homoeopathic school reverses this order. Accepting all the symptoms experienced by the differently constituted provers, they consider as peculiarly characteristic the individual symptoms of the patient; those *not generally experienced by others suffering from a similar form of disease.”
This is individualizing with a vengeance! In aspersing the process of what he calls generalizing Dr. Lippe traduces the very instrument he is apparently unconsciously using, but misusing the word. One is the traditional pathological – diagnostic method based upon an arbitrary and artificial classification of only the common or gross phenomena of disease; the other is the homoeopathic natural or inductive method of modern science, based upon *all the phenomena of the case, but paying particular attention to the *uncommon and peculiar features, never forgetting that we always have an *individual patient to treat and cure.
Dr. P.P. Wells says: “Characteristic symptoms are *those which individualize both the disease and the drug. That which distinguishes the individual case of disease to be treated from other members of its class is to find its resemblance among those effects of the drug which distinguish it from other drugs. This is what we mean when we say that with these the law of the cure has chiefly to do. When we say “like cures like” this is the ‘like’ we mean.”
Characteristics may sometimes be symptoms observed only as a result of the closet scrutiny, like the apparently trifling clues in a mysterious murder case which the ordinary detective overlooks or ignores, but which a Sherlock Holmes pounces upon and utilizes with amazing logical acumen to clear up what is otherwise impossible of solution. Their value depends upon who is using them. An Agassiz or a Leidy, placed in possession of a fragment of bone, or the scale of a fish, found in the remains of some pre-glacial geologic period, will reconstruct for us not only the animal or fish from which it came, but unfold a whole chapter of natural history, picture the scene and repeople a forgotten period of earth’s history before our delighted eyes.
Dr. Charles G. Raue pointed out that scarcely one of the “keynotes” or characteristic symptoms belongs exclusively to a single remedy, and cautioned us not to diagnose a remedy on one symptom only, be it ever so characteristic. “While in some cases,” he says, “it may point exactly to the remedy, it cannot do so in every case, as it is not rational to suppose that the whole sphere of action of a remedy, which is often extensive and complex, should find its unerring expression and indication in one symptom. But such characteristics are of great aid in the selection of the remedy, as they define the circle of remedies out of which we must select.”
Dr. Hering, in his quaint fashion, years before the “keynote system” was ever heard of, said: “Every stool must have at least three legs, if it is to stand alone.” He advised selecting at least three characteristic symptoms as the basis of prescribing.
A milking stool will stand upon one leg-*if you sit on it and thus provide your own two legs as the other necessary props; but even then, as every farmer’s boy knows by bitter experience, a vicious kick, or a “corkscrew swat” from the old cow’s tail may upset the youthful milker and his pail of milk and bring him to grief.
So it is wise to always give the symptomatic milk-stool as broad a base and as many legs as possible. The youthful prescriber will get many a vicious kick from refractory cases. He may be knocked sprawling and lose his pail of milk a few times, but he will be able to avoid this when he has learned the peculiarities of his patient as well as I learned the peculiarities of my bovine kicker when I was a boy.
The Totality is an ideal not always to be realized. As a matter of fact, in practical experience, it is often impossible to complete every symptom, or even a large part of the symptoms. Patients have not observed, or cannot state all these points. They will give fragments; the location of a sensation which they cannot describe, or a sensation which they cannot locate; or they will give a sensation, properly located, but without being able, through ignorance, stupidity, failure to observe or forgetfulness, to state the conditions of time and circumstances under which it appeared. Sometimes no amount of questioning will succeed in bringing out the missing elements of some of the symptoms.
What is to be done under such circumstances? Make a guess at the remedy? Give two or three remedies, in alternation? Give a combination tablet? Or “dope” the patient with quinine or morphine? Rather than do any of these things, follow the advice of my old preceptor, Dr. P.P. Wells. Sometimes, when I approached him with a difficult case, he would assume a quizzical expression and ask, “Don’t you know what to do?” On being answered in the negative he would say, “If you don’t know what to do, do *nothing- until you do know;” emphasizing the injunction with a characteristic downward stroke of his right forefinger. Then he would go over the case and show what should be done and how to do
it.
It was he who taught me Boenninghausen’s method of dealing with such cases. And I thought the more of it because he had known Boenninghausen and had received instruction and treatment from the Grand Old Man personally, while travelling in Europe.
Dr. Close was born November 24, 1860 and came to study homeopathy after the death of his father in 1879. His mother remarried a homoeopathic physician who turned Close's interests from law to medicine.
His stepfather helped him study the Organon and he attended medical school in California for two years. Finishing his studies at New York Homeopathic College he graduated in 1885. Completing his homeopathic education. Close preceptored with B. Fincke and P. P. Wells.
Setting up practice in Brooklyn, Dr. Close went on to found the Brooklyn Homoeopathic Union in 1897. This group devoted itself to the study of pure Hahnemannian homeopathy.
In 1905 Dr. Close was elected president of the International Hahnemannian Association. He was also the editor of the Department of Homeopathic Philosophy for the Homeopathic Recorder. Dr. Close taught homeopathic philosophy at New York Homeopathic Medical College from 1909-1913.
Dr. Close's lectures at New York Homeopathic were first published in the Homeopathic Recorder and later formed the basis for his masterpiece on homeopathic philosophy, The Genius of Homeopathy.
Dr. Close passed away on June 26, 1929 after a full and productive career in homeopathy.