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.
Of the symptoms which we have obtained from our patients, the question of their relative value must occur to you. I have mentioned pathognomonic symptoms and their supreme value as determining the diagnosis. Are they as valuable when we are in search of the right remedy. To answer, let us see what we are doing. We are seeking that drug of which the symptoms are most similar to those of the patient. We may have seen in our lives a hundred cases of pneumonia. Every one of these presented the symptom which is pathognomonic of pneumonia. and yet the totality o the symptoms of each patient was different, in some respects, from that of every other phenomena patient. And this must necessarily be so, because he diseased condition of each patient is the result of two factors,. the morbific cause, assumed to be the same for all, and the susceptibility may be assumed to be different for each and resultant drug must be different for each.
We must look, then, for the symptom which shall determine our prescription in some other symptom than the pathognomonic, in some symptom from the diagnostic point of of view is far less important, in some subjective symptoms, or in a condition which individualizes.
Is it essential that the pathognomonic symptom of the case should be resent among the symptoms of the drug? Theoretically, it certainly is. Practically, even in the present rudimentary condition of our provings, it is not. We attain a brilliant success of not a certain one, where it has never been observed; although I think we are bound to assume, and are justified in assuming, that were our provings pushed far enough it would be produced. This subject will come up again hereafter.
Recalling now the practical division made of symptoms into objective and subjective, the question presents itself: Do we, in the practical use of our symptom series, make use of objective symptoms as in the independent study of symptoms? Unquestionably wherever the character of our provings has made this possible, and indeed wherever clinical observation has supplemented the provings.
In the skin diseases, wherever we meet the well defined, smooth erysipelas of Belladonna, or the vesicular erysipelas of Rhus, or the bullae of Euphorbium, or the cracks of Graphites, or the lichen of Clematis, or the intertrigo of Lycopodium, or the hard scabbed ulcers of Mezereum, from the edges of which thick pus exudes on pressure, do not these symptoms almost determine our election of these remedies? Or the white tongue of Pulsatilla, the red-tipped, dry tongue of Rhus, the moist trembling tongue of Phosphoric acid, the broad, pale, puffed and tooth-indented tongue of Mercurius solubilis, the yellow coat at the base of the tongue of Mercurius proto iodatus, or the patchy tongue of Taraxacum- do we not recognize these symptoms as most important indications for these remedies respectively? Shall I further mention the objective symptoms-sandy grains deposited in the urine, or a red deposit which adheres to the vessel, or the various peculiarities of feculent excretion and of sputa, which are well-known and universally admitted indications of certain remedies, or the radial pulse, or the heart rhythm?
It appears, then that objective symptoms are valuable indications for of the remedy, just in proportion as they have been observed in proving drugs, so as to afford a ground of comparison; and just in proportion as the observation has been precise and definite, enabling us to distinguish one case from another, or, as we term it, to individualize the case.
Such is the value of objective symptoms. But our object being to individualize the case, it frequently, indeed generally happens that the distinctive symptoms are subjective.
How now shall we examine the patient to get his symptoms? Do you say that his is an easy mater? gentlemen, it is the most difficult pat or your duty. To select the remedy after a masterly examination and record of the case is comparatively easy,. But to take the case requires great knowledge of human nature, of the history of disease, and as we shall see, of the materia medica.
We see the patient for the first time. If the case be an acute one, it may be that at a glance and by a ouch we shall observe certain objective symptoms which at least help us to form our diagnosis, and constitute the basis of the picture which leads us to the choice of our remedy.
Further examination reveals other objective symptoms. For others, as well as for subjective symptoms, we must depend on the testimony of the patient and his attendants. We have then to listen o testimony, to elicit more testimony by questioning and cross-questioning the patient and his fiends, and to form conclusions from their evidence. We have to weigh evidence, and here we encounter a task which is similar to that of the lawyer in examining a witness, and success in which requires of us obedience to the rules for the collection and estimate of evidence. We must study our witness, the patient. Is he of sound understanding? May we depend on his answers being true and rational? He may be naturally stupid or idiotic, he may be insane, he may be delirious under the effect of the present illness. Or, putting out of view these extreme suppositions, is the patient disposed to aid us by communicating freely his observations of himself, or is he inclined to be reticent? You will be surprised at the differences in patients in this regard. some meet you frankly, conscious that by replying fully and by stating their case carefully, they are aiding you o help them. Others act as if they felt that in meeting the doctor they have come to an encounter of wits, in which they are determined that their cunning shall baffle his shrewdness. Others again are morbidly desirous of making themselves our very sick, and will unconsciously wrap their statement of their symptoms so as to justify their preconceived notion of their case;and it you question them, however you may frame your question, they will reply as they think will make out the case you seem to apprehend. Others, on the contrary, so dread to give testimony which, they fear, may make it certain that they have some apprehended disease, hat they cannot bring themselves to state facts as they are, but twist and misstate them as they fail to have them.
I might pass without mention the case of those who deliberately conceal o deny he existence of symptoms which would betray the presence of disease of which, with abundant reason, they are ashamed because, I take it, you will be minded to have no dealings with those who refuse to their physician their unlimited confidence.
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'.