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
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.
What is meant by a verified symptom? My answer has always been that when a drug has taken by a healthy person or number of persons and has repeatedly produced a certain symptom upon the one prover or upon a majority of a class of provers and then that remedy has been given to a patient presenting that symptom and caused it to disappear, that that symptom was a verified symptom, e.g., the dryness of the mucous membrane and dilated pupils of Belladonna. I have seen provers, to whom Belladonna had been given, fight like demons, and I have also seen patients who were fighting like demons (delirious) quickly quieted by the administration of Belladonna. The delirium of Belladonna ranks much higher than the dryness of the mucous membrane of that remedy because it is a mental symptom.
To me, however, the relation of a symptom to the others of the group in which it is found most accurately gives the rank of the individual symptom. To put it in other words, the knowledge of the tissue or organ involved and how involved, should determined the rank of the symptoms, i.e., we should know the source of the cause of the symptom.
Let us devote the remainder of our time to the study of vertigo for the purpose of demonstrating my method of studying a symptom. First let us get together on the word vertigo.
Definition: Hitzig says: “The perceptions of disturbances of normal ideas as to our bodily relation to space.” Dr. Palen, in Bartlett’s Practice, says: “Vertigo is a subjective sensation as a result of which one is unable to judge correctly of one’s position in space.” In Curschmann’s Clinical Neurology we read: “It is a specific, unpleasant feeling on the basis of conscious or feared disturbance of bodily equilibrium.”
The three words most frequently used as synonyms are dizzy, dizziness and giddiness
Ralph W. Leptwich, M.D., in his Index of Symptoms, page 84, gives over forty diseases (which I call groups of symptoms), in which vertigo may be and is a symptom. The tissue or organs include in these forty diseases are: blood and vessels, including the heart; brain, including the nerves; ear; eye; larynx; lungs; stomach; liver; kidneys; pancreas, and sexual organs.
Dr. Palen, in the third volume of Bartlett’s’ Practice, states that “Equilibrium, body balance, is preserved by three factors: (1) The ears; (2) vision; (3) the muscles, tendons, viscera.”
Again speaking of the source of vertigo, he says, “It may arise from (1) organic diseases of the central nervous system; (2) disease of the circulatory apparatus; (3) epilepsy; (4) hysteria; (5) peripheral irritation; (6) disease of the special senses; (7) toxaemia, and (8) from conditions which in the present state of medical knowledge are undiscoverable.”
I have nothing to add to the above it we include under toxaemia such conditions as malarial, remittent, and other fevers in which an extremely high temperature may be present.
The conditions found in the above-named tissues or organs vary from a simple irritation to the most profound structural change.
The number of remedies given in the index of our books on materia medica vary from five, as given by Wm. Boericke in his Materia Medica, to over a hundred and fifty, as found in Gentry’s Concordance.
Most writers on materia medica who use the schema from put vertigo under the section, head. This is a mistake. The word head is just as unscientific and unreliable for locating a tissue or organ as we have shown the word chest to be.
Keeping in mind our definition of a symptom, our classification of symptoms, especially that which we used to determine the rank of a symptom, and the source or cause of symptoms, let us now make a clinical application of the above given knowledge, using patients for whom Gelsemium was the indicated remedy, patients whose entrance complaint was vertigo, i.e., who come to us for relief from vertigo.
Case I. A healthy, well-built, light-haired attorney, aged 42, walked into my office and said: “Dr., I want you to cure me of my `dizzy’ spells. They began six months ago following a severe attack of Flu which was of the nervous form. You know I was down South on a hard case which nearly used me up, and on the day I was ready to start for home I was taken with chills up and down my back, a flushed face and aching in every part of my anatomy.
“There was no homoeopath in the place so I accepted the physician of the hotel at which I was stopping. I think he gave me quinine, in capsules, every three hours, after a good think of whiskey in a glass of hot water, and hot bottles were put about me to make me sweat; but I didn’t sweat. Yes, reading makes the spells worse, also a long heavy sleep, and I have many of them. Another queer thing about my reading, or my eyes, is that I see double. I cannot think as clearly as before the Flu. My legs tremble, all over. All other functions of the body are O.K.” Gelsemium 6th cleared up the paralysis of the recti muscle of the eye, cured him of his vertigo in four days and of his weakness, trembling and sluggish mind a little over four weeks.
Case II. A young woman, aged 22-sister of a woman whom I had cured of epileptiform convulsions coming at the menstrual period, came to my office and said: “My sister sent me to my you to have you cure my dizziness. It troubles me only at the time of my menses, at which time I have some sharp pain in the pelvis, a dull pain in the back of my head and up over the head; the head feels very full and large. Sometimes I feel faint when the dizziness is worse. I am afraid I’ll fall in the school room or that my pupils will think I am intoxicated.” Worse or better? Always worse if the menses are late or the flow scanty. Gelsemium 30th, five drops four times daily before the date of the menses cured her after the third period. The condition had existed for over six years.
Case III. Male, are 50. In the fall of 1883 a man was picked up on the streets of Des Moines as intoxicated and taken to what was then used as a hospital, after it was proven by his breath that he was not drunk. As I was the one who had last registered in the city the case was turned over to me. At 6 P.M. the temperature was 105.6; the pulse slow, full and soft; face a dark purple, besotted; the eyes closed; completely unconscious. The nurse said that he had both voided and defaecated involuntarily since being brought in two hours before. He was given Gelsemium 3rd, five drops every hour.
The next morning at 8.30 I was surprised to find not only that he was alive, but sitting up; rational, with temperature 100.3, face yellow, lids heavy.
He admitted he was a tramp who had come from southern Louisiana. He also said he had been in a hospital in the south and treated for remittent fever. Gelsemium was continued every three hours. He continued to improve and the next morning was normal, except that he was “dizzy” when he attempted to walk. He also “trembled in every part of my body.” Temperature 100. Because of the vertigo he was permitted to remain in the hospital. At 4 that P.M. I was recalled, and found the same conditions which existed at my first visit, except that the temperature was only 105.1. The nurse reported that she had heard a noise and on going to his room had found his unconscious on the floor, between his chair and bed. The Gelsemium was resumed every hour. It was ten days before the patient was normal and the vertigo was the last symptom to disappear.
Case IV. Male: teacher in high school, family and personal history good; said: “Doctor, you know I’m prohibitionist and never drank an ounce of liquor in my life, but I’ve been so dizzy for the past three days I can hardly walk.” Other symptoms? “Had a heavy catarrhal cold three weeks ago. It began in nose with sneezing and worked down; tongue coated heavy yellow; some nausea; to vomiting; no thirst, dark yellow mucous stools, diarrhoea; painless. The only pain or ache I have is a dull feeling over my liver.”
Examination showed an enlarged liver, yellow sclera of eyes and a slight tingling of the skin. Gelsemium 3rd, five drops every three hours promptly cleared up the case.
Case V. An old tabetic patient walked in one day, led by his son with “Doctor, you know I could not walk or even stand with my eyes shut! Well! Today I can hardly stand and cannot walk with my eyes either open or shut because I am so dizzy. On! In other respects there is no change, except that I have lost control of both bladder and bowels.” Fifteen minutes’ quizzing failed to make him say that he knew any cause for the condition. Finally the son motioned me into another room and told me that, three days before, his brother (the patient’s son) had been arrested, found guilty and sentenced to prison for ten years. The news had caused such a shock that his father had gone “to pieces.”
Gelsemium 30th, three doses of five drops, daily, checked the “vertigo with eyes open or shut” and the abnormal stools. This in 48 hours, but it did not help the “vertigo with eyes closed.”
Numerous other cases could be cited in which “vertigo” was the center of different groups of symptoms, but these five are sufficient to illustrate my method of studying a symptom. Therefore, let us close by reviewing these five cases.
In the first and fifth case the tissues affected were the brain and nervous system. The cause in the first case was flu; in the second case was flu; in the second case, emotion-stock. Vision was affected in both cases. In the first there was general trembling and weakness of all muscles in addition to weakness of the recti muscles.
However, there was no disturbance of the sphincters in his case, as was found in case five. Case one was a healthy man, normal except overworked, when he contracted the flu. Case five was a tabetic, the shock only produced an aggravation of the paresis. Because of the paretic condition, Gelsemium only relieved the patient of the effect of the shock. It did not cure him of his incurable condition.
The location in Case II was the seal organs. The vertigo was reflex from a curable condition of those organs and Gelsemium permanently cured the patient.
The blood was the location in Case III, also a curable condition. The source or cause in case four was the liver- catarrhal congestions-which readily yielding to Gelsemium Let us now sum up the above in four statements to guide us in the study of a symptom.
1st. Make the patient’s entrance complaint the ranking, or as Prof. Garth Boericke calls it, the determining symptom, which in the illustrative cases was Vertigo. This word instantly brings to mind from thirty to forty drugs from which to select our remedy.
2nd. First our which tissue or organ of the body is affected. To ascertain this is nearly as important as to get the symptom correctly.
3rd. Ascertain how the implicated tissue or organ is affected, i.e., whether irritated, inflamed, functionally changed or structurally changed.
4th. Get the best possible conception of the modalities.
By the above method we get a very fair idea of not only a symptom, but of the group of symptoms of which the one under consideration is a part-the most important part.