Symptom study


The best way to study the materia medica is to take a drug or remedy yourself and carefully note in writing all the symptoms it will produce on or remove from you….


A good way study a symptom or a drug is to read, study, think; study, read; over the records of provers as found in the Encyclopaedia of Drug Pathogenesy, T.F. Allen’s Encyclopaedia of Materia Medica, J.H. Clarke’s Dictionary of Materia Medica, and also in some of our Journals which have been published since the above were published.

A better way is to superintend the provings on one or more provers and assemble and rank the symptoms thus obtained.

The best way is to take a drug or remedy yourself and carefully note in writing all the symptoms it will produce on or remove from you. By the last method (way) one learns by both experiment and experience, the latter of which is by far the most important, a verification of August Bier’s statement made to us of the European trip, as his Vienna Clinic.

Definition. We can all agree that a symptom is a manifestation of disease. Let us further agree that by disease is understood an abnormal condition of some tissue or combination of tissues, i.e., an organ. Let us still further agree that there are four abnormalities of tissue or organ, viz., irritation, inflammation, functional changes, and structural changes. Having agreed upon the above, we are now prepared to inquire into the component parts or essential elements of a symptom. These I am going to give as location, sensation and modalities. Although this is unnecessary to most of you, I will pause long enough to define the three words.

By location we mean the tissue involved and not a part of or section of the body. To illustrate: If we take the left nipple as a point and go through the chest to the back in a normal individual, we will find a large number of different tissues and two organs, the heart and lungs. Therefore, to refer to that section of the body as the left chest would be meaningless and useless for our purpose.

The word sensations is much less liable to lead to misunderstanding. However, it may greatly assist in determining which of the tissues of the left chest in involved and whether the involvement be an irritation, inflammation, etc. Again to illustrate: A sharp shooting pain from the spine over the ribs to the sternum says an irritation of the nerve; while a friction murmur, with sharp, shooting pains says inflammation of the pleura; an intermittent heart best says functional change and a mitral regurgitation says structural change.

By modality is understood anything like change of position, of weather, of temperature, eating, drinking, voiding urine, passing of faeces, of faeces, etc., etc., which makes the sensations better or worse. Most of these modalities are readily explained- especially those which refer to the circulation of the blood, e.g., the Belladonna headache which is better from cold application to the head and having the head high or some irritant to the feet to draw the blood from the head.

Having decided what a symptom is, let us consider the divisions of a symptom. The first is into objective and subjective.

The second I make is mixed, rational, physiological and pathological.

An objective symptom is one which not only the patient but others can determine by any of the five senses.

A pure subjective symptom is one which the patient alone can feel and express, one which the doctor can neither see, hear etc.

A mixed symptom is one which the patient and physician both can feel, see, etc., e.g., the patient can feel the throbbing of the radial artery and see it, so also can the physician.

The second of these four symptoms, the subjective, is of much greater value than the first because by it the patient expresses himself in his own words, giving us his own thoughts. Or, as Dorsey would say: “The cerebrum of each individual has analyzed and passed judgment upon the sensations which through the nerves are carried to the part of the brain.”

Sometimes the third is the most valuable because the physician is enabled to add his judgment to that of the patient in either confirming or refuting the statement of the patient. When confirmed, the symptom may become a verified, mixed symptom.

Mental (psychological) and physical (physiological) are two adjectives often added to the word symptom.

What a patient fancies or fears, desires or dreads, is often of inestimable worth in fixing the value of a symptom.

The pathological symptom is one which, of late, has received a good deal of attention; much more than was given it fifteen or even ten years ago. Those of you who are familiar with my “Homoeopathic Therapy of Diseases of the Brain and Nerves” probably realize that the pathological is given a very high rank in it. You remember that the book has four chapters based upon four conditions of tissues and organs. The four conditions are Algia, Itis, Functional Change, and Structural Change. A moment’s reflection will convince you that pathology bears a very important relation to three of the above terms. If you now adopt my method and ask the question, “What do I want to do, what can I do for my patient with the indicated remedy?” you will realize that a pathological symptom may and should hold a very high rank in the particular group of your indicated remedy. For as I have, many times stated, there are some remedies which are incapable of producing a structural change in any tissue or organ, and it would be useless, yes, even detrimental, to administer such a remedy. It would mean a loss of time at least.

For further study of the division and definition of symptoms as related to the ranking of them, you may profitably red my article: “The Subjective Symptom,” found in the April, 1928, Clinique, and: The Determining of Symptom fro Prescribing According to the Law of Similia and Its Corollaries,” as is found in the Hahnemannian Monthly of September, 1929; also Prof. T.H. McGravack’s article in the January, 1929, Journal of the A.I.H.

For me it is absolutely impossible to study a symptom without recognizing the importance of the pathology of the condition.

There is also another word which is receiving more attention and study recently, viz., our word Individuality, or Individualize. The endocrine-therapy men, the osteopaths and even some of the dominant school, are realizing more and more the significance of individualizing each case of a class of patients, whether it be a colitis or pneumonia or without. Prof. Luger’s statement on that point was as emphatic as was his other statement on finding the source and removing the cause. To me the above facts show that the more enlightened, conscientious of all schools of medicines are becoming more tolerant and are uniting in every effort to relieve all of suffering humanity by relieving each personally.

There are two other words, which have become easier for some Homoeopathists to use within the past ten years, viz., Diagnosis and Prognosis. I remember very distinctly how shocked a good brother was when I asked, “What have you told the patient about diagnosis and prognosis?” The doctor replied: “I never that diseases. I treat patients.” A little later the patient asked, “What is the with me? Am I going to get well?” I immensely enjoyed his physician’s predicament and the way he crawled out of

it.

When the patient turned to me with the same question, I replied that he would be better, but never as well as he had been.

As the doctor was taking me to my train, I asked him what his statement to the patient was if not diagnosis and prognosis? He replied that the two words put together spelled “disease” to him, and he had no use for the word in his practice. When the word “condition” was suggested as a substitute for “disease,” he was satisfied.

To me the word diagnosis means the tissue or organ affected and how affected, whether irritated, inflamed, changed functionally or structurally. Making a diagnosis is putting your knowledge of pathology to practical use.

When it comes to ascertaining the comparative value of two or more symptoms different writers and speakers have used some of the following words to express themselves, viz., common and uncommon, basic, keynote, characteristic, peculiar, striking, leaders or leading, generals, ranking, verified, and the latest, determining. To the uneducated, on this point, the above statements are a revelation; to the uninitiated, a mystery.

All the above are still used and have been helpful to me, except the characteristic which by some has been defined as a symptom which can be found only under one remedy; a symptom which is to a remedy what a pathognomonic symptom is to a disease, e.g., “cough relieved by a sip cold water” or “the more the patient coughs the greater the tendency to cough.” The former claimed to be characteristic of Causticum, the latter of Ignatia. Both are found under other remedies.

From the above we should understand that symptoms vary in value or have a different rank in the “totality of symptoms.” How is this rank to be ascertained or determined? This question has also been answered differently by different authorities. I have always taught that a verified mental symptom should be given the highest possible rank. Although I do not intend to discuss the totality of symptoms at this time, I wish to pause long enough to say that the actual “totality” is not necessarily the numerical totality. Most of our leading writers like Boenninghausen, Hering, the Allen and others have ranked the symptoms 1,2,3,4,5. By this method we may readily understand that if the list of symptoms presented three of rank 5 of nux vom., and twelve of rank I of Ignatia, that Nux would have the greater totality.

George Royal
George Royal M. D, born July 15, 1853, graduated New York Homœopathic Medical College 1882, served as president of the American Institute of Homœopathy, professor of materia medica and therapeutics, and also dean of the College of Homœopathic Medicine of the State University of Iowa.