Symptom study

Symptoms are the language of the disease. in accordance with Hahnemann’s instructions, we include under the term “symptoms’ every phenomenon presented by the patient which is a deviation from, or an addition to, his condition when in average health….

In my “Lectures on Materia Medica” I endeavored to define the scope, nature and limits of the science of therapeutics, and to show that homoeopathy constitutes this Science tried to explain to you how it is that by analysis every natural science may be reduced to two series of phenomena, connected by a law or formula which expresses the relation of these two series of phenomena to each other and how the practical problem which the science enables us to solve is this: Given one series of phenomena and the law of relation to find the other series of phenomena: and that in this problem lies test of the soundness of whatever claims to be a natural science, viz., that it furnishes as a means of prevision or foreseeing and predicting that which is to be observed or discovered, points which I illustrated by a reference to the history and structure of the simplest and most complete of the natural sciences, astronomy or celestial mechanics.

Finally I explained that the two series of phenomena which are the subject of a natural science, must each be capable of independent and indefinite expansion and development as a separate department of natural history; and that no expansion of either must destroy the applicability of the law of relation. I then showed you that in the science of therapeutics or homoeopathy (as if is more familiarly called) the two series of phenomena are the phenomena of the patient on the one hand, and the phenomena produced by the drug upon the healthy, living human being on the other hand; while the formula which expresses the relation between these series of phenomena is the well-known therapeutic law, “Similia similibus curantur”, “Let likes be cured by likes.”

I showed in the book that, in our practical application of he science of therapeutics, the constant problem before us is that which is the problem in every natural science viz: Given one series. Given the phenomena of the patient and law, to find the phenomena of the drug which bear to the phenomena of the patient and the law, to find the phenomena of the drug which bear to the phenomena of the patient the relation expressed by the law.

Or of we are studying a drug, and have the phenomena which it produces in the healthy, living human being, then having the law, to find the series of phenomena in the sick which, bearing a certain relation to the phenomena of the drug, will be cancelled by the latter in the terms of the law. In the words, our constant problem is : Given the symptoms of a case, what drug known to us will cure according to the law, or what must be effects of such a drug, not yet known to us, as will cure such a case, or conversely: Given or never yet met with will that drug cure?

Such prevision as this homoeopathy has again and again in notable cases enabled us to exercise; and by this test the has justified her claim to be entitled the science of therapeutics.

After this general view and analysis of the subject, if remains for us to study in detail the elements of which the science is composed, viz: the two series of phenomena respectively and the law.

I shall therefore ask your attention now to the first series of phenomena, those of the patient; or briefly to the subject of “symptoms,” or how to take the case.

And there, at the very beginning of the subject. let me say that much unnecessary confusion exists in the minds of our own school, and of our opponents, because we have not agreed upon the meaning we shall attach to the word symptom.

By the old school and by some homoeopathists who have gone astray after the “strange gods” of the physiological school of medicine, a very restricted meaning is given to the word symptom; and this being done it is made reproach o homoeopathists that they take not only of symptoms, as though we disregarded some important phenomena presented by the patient. Assuming that homoeopathists understand by symptoms only the subjective phenomena or sensations which the patient experiences and describes. “How, then,” exclaims Prof. Bock, “can they prescribe for a typhoid patient who neither hears, sees, tastes, smells nor feels, and who could not express his sensations if he were conscious of them, but lies in a passive apathy, as indifferent as a log?”Well, the fact that he lies there and cannot express his sensations, if he have any, and that the avenues of communication between his brain and the world about him, his special senses and the general sense mainly, are closed, constitutes a most important series of symptoms.

For, gentlemen, in accordance with Hahnemann’s instructions, no less than with the common sense of the matter. we include under the term “symptoms’ every phenomenon presented by the patient which is a deviation from, or an addition to, his condition when in average health.

Whatever we can ourselves observe by careful scrutiny of the patient, bringing to our aid every instrument of observation which he ingenuity of man has contrived whatever the patient can tell us as the result of his observation of himself or of his sensations;whatever his friends and attendants have noticed concerning his appearances, actions, speech and condition, physical or mental, which differs from his condition and actions when in health-all these phenomena together constitute what we call the symptoms of the patient.

I conceive that it would be a waste of time to examine the alleged distinction between symptoms and “the disease.” Sincere have made the term symptom cover every phenomenon, whether it be felt by the patient, or observed, seen handled or heard by the physician, it is manifest that we can know nothing of any disease except by the presence of symptoms; that its presence is announced by the manifestation of symptoms; that when the symptoms have all disappeared we cannot know that any disease exists, and that therefore by us, for all practical purposes, the totality of the symptoms must be regarded as equivalent to, and identical with, “the disease”, Let then the bugbear of a disease as distinct from the totality of the symptoms nevermore haunt your path-way in practical medicine.

Hahnemann directs us to acquaint ourselves with every deviation from the patients normal, healthy condition which we can observe; to gather from the patients and attendants all of a similar character that they have observed; to listen to the patient’s statement of everything of the kind which he has noticed, and if all unusual sensations and pains which he has experienced, and all unusual phenomena of which he has been conscious, whether body or mind.

You will perceive that here are two classes of phenomena referred to, viz. : such as may be observed by the physician or attendants and friends, and such as are perceived and can be stated only by the patient himself.

The former, which may be the objects of study and observation by the physician, are called objective symptoms. The latter are the subjects of the patient’s own consciousness, and are styled subjective symptoms. We may notice and study the spasmodic twitching of the facial muscles, the alternate flushings and pallor in a case official neuralgia, but the patient alone can make us aware of the sensation which he experiences simultaneously with those twitching and flushes. In a case of pleurisy we may detect a friction sound denoting dryness or roughness of the pleura, or the dullness denoting effusion; we may observe the deviation from the natural symmetry of the thorax; the labored and hurried breathing, the short, dry cough and the expression of suffering which accompanies it, but the patient alone can tell us that he suffers from a stitch in the side, where it is, what direction it takes, what provokes and aggravates and what relieves it.

The physician and attendants may notice and observe the accelerated yet unsustained pulse, the dulled preceptions and sluggish or perverted intellection, the red, or dry, or cracked and trembling tongue, the elevated and uniformly fluctuating temperature of body, the tympanitic abdomen, the tenderness about the caecum caput coli and the enlarged spleen which characterize a typhoid fever; but only the patient could have made known to us the failing strength of body, mind and will, the peculiar headache and the desolate sense of illness which, perhaps many days preceding the commencement of the doctors attendance, began to take possession of him.

We meet with few cases which do not present throughout their course, or at least in some portion of it, both subjective symptoms. If there be an exception, it is that of some chronic affections, consisting exclusively, so far as our observations enable us to speak of pains and abnormal sensations. I say far as our observations enable us to speak, for I can hardly conceive of an abnormal sensation except as coincident with some structural change of tissue, although this be so fine as to elude our present means of research.

On the other hand, we meet cases presenting at fist view only objective symptoms, as for example, chronic cutaneous affections and heterologous formations. and yetI believe that in every such case, if we take a broad enough view of it, including the history of the case, we shall find a tradition of subjective symptoms. However this may be and whatever maybe their relative number, and what comparative importance we may be disposed to attach to them, these are the two varieties of symptoms which patients present to us.

Now we may study symptoms under to views, with two different objects: First, we may study the science of symptoms as branch of medical science, as a department of the science of biology- much as we study physiology, which is the other department of biology-without any view to a practical application of the results of our study, without any reference to a purposed application of the therapeutic are, without considering how we seal remove the symptoms by interposing the action of a drug; and second, we may study symptoms with reference to the practical application of our knowledge in bringing drug action to bear upon the patient’s symptoms.

Let us first consider the study of symptoms as an independent department of science. It is one, let me say, which has not received the attention to which its great importance entitles it.

The patient is before us-the object of our observation and inquiry, just as the healthy human being is before us when we study his constituent tissues and organs and their respective functions in pursuing the science of anatomy and physiology. We observe his objective symptoms and learn from him his subjective symptoms.

A fact of prime importance for us to remember at the outset of our inquiry is this: that as a nature there are no accidents, so there can be no symptom which is not directly the result of some immediate cause operating in the organism of the patient; no abnormal appearance or condition of any tissue or organ which does not proceed from a modification of its cell structure, its nutrition, or of the normal proportion of the tissues which compose it; not abnormal sensation experienced by the patient which is not he result of some change, either appreciable in some tissues of the body, or assumed to exist therein, or referred to the indefinite realm of dynamics, the convenient habitat of functional derangement for which we have not as yet discovered any structural substratum.

No symptom then is to be passed over as unimportant. We know not how important that which now seems most trivial may tomorrow prove to be. This we know that everything in the human organism, as in the universe, moves and occurs in obedience to LAW; and when we observe the phenomena of nature we fail of the reverent spirit of the true and faithful student if we pass over any phenomenon assuming it to be of no account, just because our faculties are so little developed that we cannot see that has any significance. If it be true, as the Lord of Glory tells us, that not one falls to the ground without our heavenly Father, that the very hairs of our head are numbered, how can it be that changes of tissue abnormal sensations should be experienced save in accordance with some law of the organism? The noble sentiment of the Latin poet, “I am a man: Nothing that is human can be alien to me, “is true in a physical sense no less than in a moral sense.

It is our object to observe everything that is a deviation from the healthy condition. We must then keep up, during our observation a constant recollection of the condition of organs and tissues and the performance of function in the healthy subject; and our observation will be a sort of running comparison.

Our object is to note every deviation. We must necessarily follow some method in our investigation, otherwise among such multitude of objects some would surely escape us. If it be necessary for a dog in hunting to scour a field according to a certain method of lines and angles, surely method must be needful when we are beating up this complicated field of the human organism, and that too in search of a game which does not start up at our approach.

We may adopt the regional method and survey the whole body, passing from region to region in anatomical order. This is valuable method and indispensable to a certain extent. It fails, however, to give us sufficient information respecting organs and tissues which, from their situation, are entirely removed from our physical examination or exploration, as for example, the kidneys and the ovaries. the anatomical method of investigation must be supplemented by what I may call for a moment, somewhat incorrectly, the physiological method. By this we seek to arrive at the condition of an organ or its tissue, or of the parts of an apparatus by examining how it performs its functions. thus, by examining how it performs its functions. Thus, by examining the excretions of the kidney we form some conclusion respecting the condition of that organ. If we find albumen and certain microscopic objects in it, we may be certain that a portion of the kidney has become changed in a very definite way which, however, we could not otherwise recognize during the life of the patient. The same is true of may other organs. This knowledge has been obtained by accumulated observations of the symptoms of diseases, and of he results of diseases as noticed after death. But so difficult is the art of observation, and so hard is it o obtain from patients all of their subjective symptoms, for the reason that patients have not been trained to the observation o natural phenomena, and are not good observers even of themselves, that we should hardly succeed in getting all the symptoms of a case if we did not add to the regional and the physiological another mode of observation.

The history of disease has taught us that when certain symptoms are present in some one organ or apparatus of the body, there are almost sure to be present certain other symptoms, objective or subjective in other organs often anatomically quite remote, and of which the patient probably is hardly aware until his attention is called to them by the physician.

I may cite as examples the fact that certain pains in the head persistently experienced by the patient are found by observation of a great many patients to coexist with certain uterine affections, of the existence of which the patient was hardly aware; and the immediate symptoms of which would probably have been overlooked in the recital. Another noteworthy instance, a recent discovery, is the coincidence of a certain morbid condition of the retina with a form of Bright’s disease of the kidney, to which attention may thus be called at an earlier stage than that at which the kidney symptoms would have revealed it.

To recapitulate then: we observe the changes in form and structure which are open to our senses, we use whatever methods we possess to discover others; we illuminate the interior of the eye, the rim of the glottis, the canal of the urethra, the meatus of the external ear. We sound the thorax and the abdomen by the methods percussion and auscultation; we analyze the secretions and excretions, and reason from the results-through our knowledge of the history of disease-to a conclusion respecting the condition of organs and tissues hidden from our observation. thus we obtain our complete series of objective phenomena.

We then address ourselves of the task of taking the subjective symptoms of the case. Availing ourselves of the regional method which investigates in topographical order one region of the body after another; the physiological method which traces sensations from one organ to another, and leads us to look for sensations or even objective symptoms in some part of the body because we know them to exist when certain others are present; and finally, employing our knowledge of the history of disease to trace symptoms, both subjective and objective, from one organ and apparatus to another, we make up our series of subjective phenomena.

Now, it may occur to some of you that when I speak of the modifications of tissues and organs found in the patient, and of the necessity of exactly observing and studying them,. I am advocating the study of pathological anatomy; and that in showing how a study of the connection, of symptoms in the patients may great facilitate the discovery of symptoms by showing their mutual connection dependence and succession, just as the study of physiology enables us to grasp the phenomena of the healthy organism.

I am defending the study of pathology. And so I am. for just here we have the province of pathology and pathological anatomy, which are indispensable instruments in the study of symptoms. Let us not be frightened from their legitimate use for the reason that they have been put to a false use.

If we disregard these auxiliary sciences, our collections of symptoms must be for us incomplete lists of unmethodized and unarranged observations. How can we imagine that any department of medical science can exist and be pursued which would not be a useful auxiliary to the physician?

Let us turn now from this glance at the independent study of symptoms as a science, to theory study as the means to a practical end. As practitioners of medicine what is our object in collecting and studying symptoms?

If we regard our duties to our patient in the order in which they were stated in my last lecture, that we are ascertain for him where and what ails him, whether and how soon he can recover, and finally what will cure or help him, se study symptoms, first of all, to form our diagnosis.

Viewed with this object, the symptoms we have obtained from the patient at once classify themselves in our minds. Certain symptoms take front rank as indicating the organ which is chiefly affected and the kind of deviation from a healthy sate which exists in it. such a symptom is called pathognomonic, and is entitled to that epithet if it be found only when a certain diseased condition exists, and always when that condition exists. We cannot pronounce a symptom to be pathognomonic, not recognize it as such, unless we are acquainted with the history of disease. Then we require have a knowledge of the history and course of disease, that we may recognize any symptoms which indicate a lesion so extensive that recovery is unusual or impossible. We most know, likewise, the history of disease, as its course is capable of being modified by medical treatment, and by different varieties of medical treatment.

Third:Our object in the study of symptoms is to get into position to ascertain what drug shall be applied to cancel the symptoms and effect a cure. This is the practical end.

The homoeopathist obtains his series of symptoms, and then, in accordance with the law similia similibus, he administers to the patient the drug which has produced in the healthy the most similar series of symptoms.

Now, in speaking of the independent study of symptoms as a science by itself, I have urged the necessity of eliciting all of the symptoms, both objective, bringing every auxillary science to aid in he search for symptoms. But when we come to the practical applications of the law, Similia similibus curantur, when we come to place side by side the two series of symptoms those the patient and those of the drug respectively, i is manifest that those of the drug respectively it is manifest that those of the patient to which we find nothing corresponding in the symptomatology of the drug, are of no use in the way of comparison. Practically, them, unless the observation of symptoms as produced by drugs in our provings is developed pari passu with that of symptoms as observed in sickness, there will be much of which practically we can make no use. And you will find this view to explain much that is said in disparagement of the study of pathology and pathological anatomy, and of the any aid which they may afford to the practitioner.

The difficulty resides in the present imperfection. respectively, of the sciences of pathology, symptomatology and pathogenesy.

Carroll Dunham
Dr. Carroll Dunham M.D. (1828-1877)
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.