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.
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'.