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.

There is a third class of mental symptoms which one has to take into consideration and which one can, for convenience, call disturbances of the Understanding or Intellect. Under this heading one would consider disturbances such as illusions or delusions, or symptoms occurring in delirium. Also under the same heading one tends to place constantly recurring dreams.

Lastly under the mental section one gives consideration to symptoms indicative of general mental capacity, such as power of concentration, capacity for work, difficulty in finding the appropriate words or phrases, and disturbances of memory.

Mental symptoms as a whole, when found, are the deciding factors in the choice of the appropriate remedy, and under the heading of mental symptoms the degrees of importance are first the character, second the disturbance of the primary instincts, third disturbances of the under-standing or intellect, and lastly disturbances of general mental capacity and memory.

Passing now to the physical symptoms complained of by the patient, from the prescribing point of view one again grades them as of different degrees of importance. One considers that the most important physical symptoms are those which refer to the patient as a whole, as opposed to symptoms referring to one or other organ or part. These one considers the Physical Generals, meaning to imply that the patient generally, or as a whole, is better or worse under certain circumstances, or that he has a general feeling as opposed to a sensation felt in some particular part.

In practice if has been found that these general symptoms are again not all of equal value, with the result that there has been a tendency over the years to group them under different headings according to their degree of importance, Looked at from the point of view, one considers that the general symptoms which express physical desires and aversions are of the greatest importance. By physical desires and aversions one tires to express first of all any sexual disturbances, and secondly any aversions to or cravings for any particular articles of food or drink.

Of second degree of importance one considers the patients reactions as a whole to external stimuli, that is to say, their response to heat and cold, fresh air or stuffiness, wet or dry, thunder or snow, and so on. In addition to that one brings under this heading any tendency to periodicity in their complaints. And finally one places under this heading any foods which disagree and any marked allergic manifestations.

There is a third group of general symptoms which are most easily described as the General Sensations or Reactions of the patient in response to specific action, or in response to definite physiological states, for example, whether the patient is better when in motion or at rest, whether he is better or worse from sleep, better or worse when fasting or after eating, always provided these reactions are general and expressed by the patient’s saying that he himself feels better or worse. Under the heading of physiological stares one places the feeling of well being or illness in such conditions as after stool, during menstruation, after sexual intercourse, in other words the response to any normal physical activity.

There are some other general symptoms which one places as of the same degree of importance, although not quiet covered by the heading that I have already given you. These consist of symptoms which are general to the patient, for instance, if all the pains are of the same character, no matter where felt, one considers that there is a general governing factor and that weight must be given to this point when prescribing. Again, if a patient is suffering from a painful condition and the pains tend to develop or depart in the same manner on all occasions, that one considers a matter of general importance. Or again, if all the patient’s complaints tend to be entirely, or predominantly, confined to one side of the body, that one-sidedness one considered to be of great importance.

Next one takes into account anything in the patient’s past medical history which may have a bearing on the present disturbance, and one gives the same degree of weight to that in deciding on the remedial measures to be taken. Under this heading one finally places anything in the family history which may indicate a family tendency or a hereditary dyscrasia.

Of less importance, but what one considers still as general in character, are the symptoms referring to haemorrhages and discharges, provided the haemorrhages and discharged, no matter from what part of the anatomy, are constant in character.

The foregoing embraces all the general symptoms, and the degrees of value from a drug selection point of view are in the following order, first disturbances of the physical appetites, second general responses to external stimuli, third general reactions in response to physical activity or physiological states, coupled with pains of a general character, past personal history and family history, and of least importance haemorrhages and discharges.

Finally, one takes up symptoms which are-referred to one or other organ or system, in other words, the symptoms of which the patient usually complains in the first instance. Again, from the prescribing point of view, one does not consider all these symptoms as of the same degree of importance. One considers that where a symptom refers to a vital organ it is of more importance than where it refers to a superficial organ or the skin. Symptoms referring to a superficial organ or the skin. Symptoms referring to the heart, lungs, digestive tract and central nervous system and considers of the greatest importance. Symptoms referring to the subcutaneous tissue or the skin one considers of least importance of all.

In a small proportion of cases one comes across instances where the symptoms, or a particular symptoms, complained of by the patient strike one as peculiar. The peculiarity may be dependent on the fact that in one’s experience of the disease form which the patient is suffering one would expect that the patient’s complaint would be the opposite of what it is. For instance, where one has an obviously red, inflamed joint one’s experience is that joint is sensitive to pressure and to movement; if however, one comes across a case in which the opposite occurs, that is to say, the affected joint is relieved by manipulation and pressure, one considers that peculiarity must be taken into account in the choice of the appropriate medicine. Another type of oddity which one sometimes comes across is the case in which a perfectly ordinary and common symptoms appears only under peculiar and restricted circumstances. For instance, it is quite common to meet with patient suffering from diarrhoea, but where that diarrhoea is brought on by anticipation of any unusual activity that fact has to be taken into account. Or, for instance the opposite, constipation, is all to common these days, but where one comes across a case in which the patient is unable to defecate in the presence of the nurse in attendance that, again, is a symptoms of which one would have to take note. Or there is the more common instance still in which difficulty of micturition is felt only when there is someone in the immediate vicinity. Where one comes across these odd symptoms they should always be carefully noted and an endeavour made to cover them by the medicine which is administered. In many cases it is possible to be led direct to the most appropriate remedy by a consideration of these odd symptoms alone, but great care has to be taken in this as the record of the production of these odd symptoms is by no means complete, and further, where the mental or well-marked general symptoms produce by the drug are at variance with the mental or well-marked general symptoms of the individual patient exhibiting these odd peculiar symptoms no curative result will follow the administration of the apparently indicated medicine.

In other words, these peculiar symptoms, although sometimes of the greatest possible help when there are no contra- indications cannot be held to override all other considerations.

Having a clear picture of the relative values of the symptoms from the point of view of homoeopathic prescribing, one has then to approach the problem of how one cab be certain of obtaining of obtaining all the necessary information about any particular case. One finds that, taking a case from the ordinary medical standpoint, one will have a record of all the relevant features which enable one to make a diagnosis. In many cases, however, the diagnosis will not help in the choice of a remedy. This will be determined almost entirely by the symptoms which the patient gives indicating that he is out of health, in other words, that he has departed from his normal.

The whole of one’s success in the art of homoeopathic prescribing depends on one’s power of individualizing every case which one has to treat. With this object in view, what one is always endeavouring to do is to find in what way any symptom of which the patient complains is modified by any external circumstance, or any action on the part of the patient, or is in any way influenced by time. For instance, it is a common experience that a patient will come along with some indefinite rheumatic symptoms, consisting of a certain amount of stiffness, pain, difficulty in movement. These symptoms will help in no way in the selection of your drug as they might well be covered by a hundred or more different remedies.

What one endeavours to do is to find out from the patient exactly what circumstances in any way modify the complaint, that is to say, is it influenced by any action of the patient such as movement or rest, is it affected by weather changes, or does it tend to be worst at any definite hour of the twenty-four hours. From the ordinary diagnostic point of view these facts may be of little or no importance; from the homoeopathic prescribing point of view they are the determining factors in the case.

The next point which emerges in one’s consideration of this problem is that from the homoeopathic standpoint one takes note of many factors which from a diagnostic point of view one may listen to with patients but does not consider worth while to record. For instance, from a diagnostic point of view it is of very little importance that a patient has become very irritable and trying. That he has no longer been interested in his wife and family since the onset of his particular complaint. From the homoeopathic point of view, on the other hand, this is of cardinal importance. There is another practical point which one always has to bear in mind, namely, that the patient will come complaining of some definite disability and is very unlikely to volunteer any statement about any of the concomitant disturbances which have appeared at the same time as, or since, the start of his illness. For example, the patient with the rheumatic complaint is unlikely to tell you that since the onset of this he has developed some strange aversion to particular articles of food, or that he has had digestive disturbances or a skin eruption. These are not the things for which he wants help and so they tend to be ignored, and yet from the point of view of the homoeopathic prescriber they have got to be discovered.

For these, or similar, reasons it has been necessary to evolve a systematic scheme of case taking in order that all the relevant facts will be on record and that nothing which is of value has been over-looked. Various case-taking schemes have been elaborated, but all have the same object in view. When one looks at nay of them one is appalled by the seeming impossibility of applying them rapidly. As a matter of fact, in practice the use of such a scheme saves one endless time and labor, and ensures that one’s case is adequately recorded.

The plan on which I personally work is somewhat as follows. First of all make a note of the patient’s story, dealing first of all the local conditions, then a careful, accurate description of the sensations of which he complains, with any circumstances which individualize these sensations, then the situation of the disturbance, and then any facts that he has noted which tend in any way to modify the complaint. Next anything which he can report as to the cause, duration method of onset, and can report as to the cause, duration method of onset, and progress of the complaint. Then his past personal history and his family history. That, one will see practically case-taking as it is ordinarily learned in medicine.

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.