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.
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'.