Holding this truth well in mind, we must early learn to distinguish the inevitable or diagnostic elements of each sickness from the more subtle but exceedingly essential symptoms which invariably guide us in the direction of the truly curative medicine; nor can we hope to do good work without the latter. A very practical point arises right here. Long continued case records show that there are comparatively few cases of chronic disease that have not needed a course of Sulfur, especially toward the close of the treatment. But the greatest of antipsorics may also be given too early – an old house can not be taken down safely by removing the foundations first.
We will often accomplish later with it much of what might have been made incurable by giving it too early. A careful scrutiny of each clinical picture will reveal the peculiar or crucial symptom around which all the others revolve or to which they are fixedly attached like the wires leading into a central telephone exchange. Sometimes this key-symptom can only be obtained by welding the most diverse manifestations into one, and then regarding it as such, after which all the others will fall into place of themselves and complete the picture.
This essential symptom is not peculiar to any special organ, condition or place. It extends the left hand to diagnosis but offers the right to the individuality of the sickness of which it must constitute a more or less concrete expression. It is not the product of numbers, but rather stands out from, while yet remaining the peculiar part of the whole colour scheme.
The psychic expression of which every symptom is the attempted exposition should be studied most carefully in its inner phraseology, only thus will we see the difference between a rigid literalism and reading the spirit of the text between the lines.
This difference is very easily discovered in the use of repertories which nearly all compel a more or less artificial assembling of the bare elements and conditions of symptoms. By a process of exclusion they endeavour to sift out the most fitting remedy. A symptom which is related, even remotely, to the desired one may often be thus found with comparative ease, but the next step which traces its ramifications through other remedies, is however only begun, although we have at present the great satisfaction of following it rather quickly by means of the Concordances of Boenninghausen. The whole case resolves itself into this: Shall we pick the key-symptom and quickly run it down by the aid of the Concordances, or shall we depend upon a greater or less approximation thereto by means of throwing aggregated groups (rubrics) into comparative juxtaposition? All who use these helps know full well that the finding of the correspondence which exists between the animus of the sickness and the genius of the similimum is not fully accomplished by this method.
DISCUSSION
E. A. Taylor: This paper strikes me as much like some of the other papers that we have heard here —so complete and correct that it leaves little to say. It points out a number of important features to apply in practice. I want to emphasize one point made by the paper, and that is that partial knowledge imperils the welfare of the homeopathic school. We are hampered in our efforts and the full sway of the school is hampered by partial knowledge; partial knowledge of the remedy, partial knowledge of disease, and by the use of keynotes. Keynotes are good enough as far as they go, but it greatly hampers one’s powers to depend upon them exclusively. Yet many follow them entirely and want our voluminous materia medica cut down to a small book. In order to do that you have to cut out a great part of the materia medica and a part that may prove as useful as that which they have selected as the basis of their practice.
They leave out equally valuable things as the keynotes. The first important thing is to determine what are the characteristic symptoms of the patient, obtain this information without any reference to the remedy. In doing this, do not be influenced by any predilection for a remedy or remedies. Then, when you have got all the symptoms, find the remedy indicated by them. If we go at the problem in the other way, trying to make a few characteristics fit all cases, you will be like a tailor trying to fit very few suits on all his customers, and you will fail.
Those individuals whom the coats happen to fit are all right, but when a fellow comes along twice the ordinary size and build, he must try to make one of the coats in his meager stock fit him and the result is failure. That is what happens when one tries to practice Homoeopathy with a few keynotes in his head and is content with his scanty or partial knowledge. He tries to make a few characteristics of a few remedies take the place and do the work that requires our whole vast materia medica. It results in a few almost accidental cures and in a great many failures. Get all the symptoms and then boil them down until you get the distinctive ones, those that distinguish one remedy from another and one patient from another.
The doctor in his paper does not try to force symptoms and how often we see this done. How often do we see a doctor ask leading questions so that the patient is led right into the remedies that he has in his mind. That is wrong; it should never be resorted to. Disease shows itself plainly enough if only we know enough to rightly apprehend it. The point about a misplaced symptom or sensation is well enough, but, after all, it simply brings us back to the uncommon or distinctive symptoms. If you fee1 as if your thought was in your head, it is common, but if you feel as if the thought came from your stomach, it is a misplaced sensation and thereby becomes uncommon or distinctive.
Caroryn E. Putnam: In regard to teaching guiding symptoms or keynotes to students much has been said for and against. Keynotes certainly have their place in teaching students the huge mass of materia medica, which they must of necessity know. If students are given the Hering materia medica cards and they study them, this usually makes a good foundation for farther advancement in the subject. Most of the good prescribers that I have known began with the Hering cards, and I have frequently been sorry that those cards are out of print. I would like to use them with the students early in the course while their memories are fresh. But I would always give them the Organon first or as an accompaniment. The cards interest the students and many can not learn much about the subject without them.
President: I agree with Dr. Putnam in regard to the keynotes. Their use as a means of teaching is a most practica1 one. Suppose you tell the student that the way is to learn one thing at a time and ask him to master Belladonna first; an inexperienced student is not going to learn much that way. The keynote system of learning as it seems to me, has a legitimate place in our classes. The man who has taken the pains to learn the keynotes of a good many remedies very soon wants to know more.
Richard Blackmore: The keynotes may be a good way of teaching, but they are a poor way of prescribing. I remember a clinical lecture on materia medica; the then professor went over the symptoms of the patient with the anxious endeavour to make China fit the case. One of the symptoms was a sensation of something alive in the abdomen. I knew perfectly well that China was in the professor’s mind and when he turned to me and asked, “What is the remedy?” I rep1ied China, but that China was not the only remedy that had that symptom. To which remark no attention was paid.
President: As I understand keynotes, a great many remedies may have one keynote; one more perfectly or plainly than another. Through the recognition of a keynote characteristic we are led to the study of the similar to find the similimum. We have to begin somewhere and that will do for a starter. Hering reminds us in his preface to the first volume of the Guiding Symptoms, that the definition of a characteristic being “a symptom not found under more than one remedy” is quite erroneous.
C. M. Boger: The trouble in teaching materia medica is fundamental and originates in our general methods of education; it not only applies to medicine, but to all branches of modern school work. We endeavour to press all minds into one form and method. You cannot get good results in that way with materia medica or anything else. I never saw Hering’s cards. We should try to get the whole case and out of our knowledge of it as a whole, pick the characteristic and peculiar symptoms and try to learn their relation to the other symptoms.
Born in Western Pennsylvania, he graduated from the Philadelphia College of Pharmacy and subsequently Hahnemann Medical College of Philadelphia. He moved to Parkersburg, W. Va., in 1888, practicing there, but also consulting worldwide. He gave lectures at the Pulte Medical College in Cincinnati and taught philosophy, materia medica, and repertory at the American Foundation for Homoeopathy Postgraduate School. Boger brought BÅ“nninghausen's Characteristics and Repertory into the English Language in 1905. His publications include :
Boenninghausen's Characteristics and Repertory
Boenninghausen's Antipsorics
Boger's Diphtheria, (The Homoeopathic Therapeutics of)
A Synoptic Key of the Materia Medica, 1915
General Analysis with Card Index, 1931
Samarskite-A Proving
The Times Which Characterize the Appearance and Aggravation of the Symptoms and their Remedies