Theory & Practice

Borland published this piece in The British Homoeopathic Journal. In this h enumerates how to decide the correct symptoms after case taking. How to evaluate symptoms, especially mental symptoms….

It is interesting to look at the history of medicine from the earliest days of which we have any knowledge. This shows that there has been a constant endeavour by the physicians to correlate their practice to the prevailing philosophical beliefs or scientific pronouncements of their days. In the early days the accepted beliefs consisted almost entirely of philosophical speculations. Since the dawn of scientific investigation the accepted beliefs of the day have tended more and more to be tested by the evidence to proved fact. Throughout the centuries the endeavour of the physician has been to adapt his practice to the prevailing dogma of the scientist or philosopher. This has, to a large extent, accounted for the ever changing practice of medicine, and accounts, very largely, for the constant changes which we see taking place in medical practice to-day. One has but to consider how, in the dawn of medicine, medical practice was founded on the philosopher;s dicta about the influence of the liver and spleen on the various disturbances from which the patient suffered to realize how the treatment by the physician endeavoured to follow the teaching of his philosophical mentor. In the middle ages one sees the heroic measures adopted to clear the theoretically poisoned fluids of the body, which again were postulated in theory.

Later one sees the dawn of morbid pathology, and the dawn of operative surgery in the endeavour to eliminate the diseased organ. And later still one sees the discovery of the microbic infection and the steps taken by the physician to correlate his practice to this new discovery. The microbic theory of disease is, of course, still the accepted belief, but one sees less and less stress being placed on the infecting organism and more and more recognition being given to the infected host, with corresponding modifications in treatment. Latterly one has watched the discovery and exploitation of the existence of vitamins and the influence that they exercise in human health, and again one sees medical practice modified to conform to this least discovery. A short time ago the place of vitamins was taken by the ductless glands with their endless internal secretions, and these two influence are still fighting for first place in scientific medicine of to-day. Recently some of the American workers have been advancing the theory that vitamin deficiencies in the patients are due not to the lack of intake of vitamins but to constitutional failure of the patient to b able to utilize such vitamins as are necessary for his well being. Theories are endless as fresh facts are discovered, and practice endeavours to keep up to date. Only by the discovery of the homoeopathic principle was it possible, for the first time, to enunciate a theory of practice which was applicable to any and every disease. This rule of practice was based on accurate observation and has been verified endlessly over the last hundred and fifty years.

It is in no way dependent on the varying beliefs or fashions of the day but it remains constant and governs the treatment undertaken by every homoeopathic physician. Just as through the centuries the physician has endeavoured to make his practice conform to the theory of the day, so the homoeopath tries to make his prescribing conform to the homoeopathic rule. The difficulty for the orthodox throughout the ages has been to make art correspond with theory. The difficulty for the homoeopath is to make his art conform to homoeopathic law. What I should like to examine is how the homoeopath can most easily and most accurately make his practice conform to the homoeopathic principle.

Before one can master the art of homoeopathic prescribing one must first accept Hahnemann’s dictum that all illness is recognizable by the signs and symptoms which it produces, and which can be reported by the patient or observed by the physician, in other words, that a diseased state is recognizable not by a label, or in modern phraseology a diagnosis, but only by the signs and symptoms to which it gives rise. Hahnemann has discarded theory and confined himself to the observation of definite facts. It follows from this that in order to employ the Homoeopathic art, or make a homoeopathic prescription, one must first obtain a complete and accurate record of the signs and symptoms of which the patient is complaining. Over the years definite advance has been made in the art of getting such a record, and this technique is now commonly known as the art of Case Taking. To That I will return in a moment.

The next point which has to be grasped is that from the point of view of the homoeopathic physician all the symptoms and signs produced by a patient, as indicating his departure from complete health, are not of equal degree of importance when one is deciding upon the most appropriate remedy to use in the treatment of the particular case. This has given rise to what one terms for convenience the Relative Value of Symptoms from the point of view of homoeopathic prescribing.

Having obtained the complete and satisfactory record, and having decided which of the symptoms in the case are of the maximum importance, one has to decide which drug in the homoeopathic Materia Medica most accurately corresponds in symptomatology to the record obtained from the patient. This inevitably necessitates facility in handling a complete Repertory of the Materia Medica.

Finally, one has to decide in what form the remedy chosen will best suit the individual case which one is attempting to cure.

Just as, when one is approaching any case with the object of making a diagnosis, there are certain signs and symptoms which, when present, will inevitably clinch the diagnosis and make it certain, so in approaching a case from the point of view of making a homoeopathic prescription there are again certain signs and symptoms which, when present, will clinch the selection of the correct remedy. One was taught what were the cardinal points must be present in order to make an accurate diagnosis, one also has to learn what are the important differentiating features in making a homoeopathic prescription.

The first thing that one always has to remember is that in homoeopathic prescribing one is endeavouring to discover the manner in which the patient when ill has departed from his normal. Having that idea clearly in mind one then has to consider which of the signs of departure from normal one is to take as determining the medicine to be prescribed, in other words, what is the relative value of the different symptoms presented by the patient.

From this point of view, the most valuable symptoms one can get are the symptoms of any deviation from the patient’s mental normal.

These mental symptoms fall into several groups. From our point of view the most important and most valuable are any symptoms indicating departure from the patient’s normal equilibrium, that is to say, any alternation in what one would describe as the patient’s character. For example, if one had a normally placid patient who since the onset of his illness had become nervous, fidgety and irascible, one would consider that that fact was one of the greatest possible importance in deciding what medicine caught to be administered.

There is a point which arises here which has caused not a little difficulty, namely, how much weight should one attach to a report on the patient’s normal character as opposed to a change of character coincident with the onset of his illness.

In the treatment of a chronic case, where one comes across mental characteristics which are so marked as to make the patient appear to be abnormal compared with the average then such abnormality would have to be taken into consideration in prescribing for his case, although there is no departure from what is accepted as his own individual normal state. Where you are dealing with subacute or acute conditions it is much more importance to confine one’s attention to departure from the patient’s normal rather than departure from the average of humanity. Where mental symptoms of this type are encountered these are the most valuable from a prescribing point of view and they must be covered by the drug which is selected for the treatment of the case.

The next large group of mental symptoms which are of maximum importance are what one classifies under the headings of disturbances of the Primary Instincts. First of all there are disturbances of the instinct of self preservation. For instance, if a patient suddenly develops a loathing of life, or a desire for self destruction, that is a disturbance which one considers must be of fundamental importance and so must be covered by the remedial agent. Coupled with the primary instinct of self preservation one groups any phobias which the patient may have. These are fundamentally dependent on the same instinct and are classified as of the same degree of importance. In the same class, although of slightly lesser importance, one places any symptoms which refer to disturbances of the Social Instinct, that is to say, anything that has to do with racial preservation, such as, for example, disturbance of the affections, alternation of family relationships, lack of the normal desire for company or sympathy, in fact anything that shows a departure from the ordinary social instincts.

Douglas Borland
Douglas Borland M.D. was a leading British homeopath in the early 1900s. In 1908, he studied with Kent in Chicago, and was known to be one of those from England who brought Kentian homeopathy back to his motherland.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.