as Present Unfavorable View & Prognosis
The difference between a symptom complex and a symptom image is partly a question of knowing from training and partly from experience. To one who knows the totality as written out it may mean a clear symptom image and a sure index to a remedy the patient needs, which generally goes with a prediction of speedy recovery. To one who lacks training and experience the totality as written out is a complex of symptoms that means chaos. As one gains knowledge by training, reading, and experience, the symptom complex is less common until he is capable almost at a glance of saying of some cases ever so carefully taken that the whole case has the stamp of complexity. Yet some of these after much study will reveal the image in the totality, and it can be seen what is the remedy, but it must be known of any case that so long as it is chaos, just so long a favorable prognosis is to be withheld.
In this great question there is ample room for artistic perception and judgment to manifest themselves, but there are scientific rules to be followed which constitute the foundation of art and experience. The beginner who has been properly taught may soon be able to judge of the relative magnitude of a given record of symptoms and know to which class it belongs.
There is more to be learned about diagnosis and prognosis by studying the complex of symptoms than by any form of physical examination, but both and all methods of investigation should be used, as they core each other, and often where one is defective the other is strong and helpful.
To know symptoms in cause, beginning, purport, direction, and ending is only that acquaintance with sickness so often urged by Hahnemann. To distinguish the symptoms that are natural or common to fixed morbid states should be the earliest acquirement of the physician in order that he may learn to discover what is queer and unaccountable.
To distinguish an incongruous symptom complex can scarcely be expected until one is able to say what is required in any symptom totality to constitute it harmonious.
Experienced homoeopathic observers know very well that the burning, stinging, enlarged glands, infiltration, hardness of the part, weakness, loss of flesh, in a scirrhus of a mamma will not lead to a remedy that will act curatively; also that oedema of extremities, weakness, albumen in urine and heart symptoms, dyspnoea and anxiety furnish no basis for a remedy for the patient. All know that remedies given on such symptoms are only expected to comfort, and will not restrain the progress of disease nor very much prolong life.
All know that the above manifestations are the representatives of the sickness that ultimated upon the patient, but do not signify or show forth the signs and symptoms of the patient. The particulars of the disease are there, which are the common symptoms, but the generals and particulars of the patient are left out. Now it matters not whether these generals and particulars are masked, suppressed by previous drugging or never existed, except in the ancestry of the patient. They must be discovered in any case or a favorable prognosis cannot be declared. It simply sums up by distinguishing from well settled evidence what is order from what is disorder.
It is not to be doubted that sickness may appear in order or disorder. Many or most sicknesses will appear in an orderly form if permitted to do so. The acute sicknesses all have order so that we are able to declare their course and termination. Many chronic sicknesses present a form of order which is well known to observers. The order so far as knowable is a guide to distinguish that which represents the disease from, that which represents the patient. The hysterical patient presents an incongruous symptom complex that always deceives the neophyte. It seems natural to gather all those queer, incongruous fluctuations, imaginations and sensations and prescribe for them. Who has not done just this thing? Who has not had his lingering cases over which he has toiled for months, while the patient improved in no manner, and the friends wondered if the doctor was ever to be of any use? When one has learned the nature of the hysteria he sees that he has been trying to fit the remedy to the hysteria and not to the patient. The writer has been asked to prescribe for such cases many times when the symptomatology was beautifully presented, where the hysteria was there in all of its richest neurological& exaggeration, but not an idea could be drawn from it to portray the state of the patient. Such a case remains incurable until the symptoms that stand for the patient are also known. These generally are found, if they are discovered to be changes of desires and aversions, loves and hates. These are most difficult to secure, as every hysterical patient conceals her real loves and hates, and relates such as are not true of her; hence it requires the skill, and power of an experienced strong mind, which cannot be deceived, to question her when she has lost her guard. This case is incurable until the case can be taken in a manner to present what is true of the patient. It is always true that what is predicted of the disease is easy to secure, but what, is predicted of the patient comes out under difficulties by cross-examination or by accident and prolonged observation.
Let it not be supposed that the symptoms that are predicted of the disease are to be ignored or considered valueless in selecting the remedy, but they are to be considered subsequently to the symptoms that are predicted of the patient; and it has often occurred that a remedy has made brilliant cures when it suited the patient, even though it was not known to possess a strong likeness of the disease; but let the likeness be first to the patient and last to the disease. The patient is first and the disease is last. It is like initiation, direction and termination.
In the prospective phthisical patient we see a patient with few symptoms of the patient himself, but weakness, loss of flesh, anaemia, coldness, tired from all exertion, bad reaction, easily disturbed by eating, drinking, exposure, loss of sleep and weather changes. These states are common to so many remedies that it will at once be seen that the patient is not represented and no promise can be made, though there is no sign of tubercles. A favorable prognosis must be withheld until a series of carefully selected remedies has been used and the symptoms that represent the patient begin to appear, such as mental symptoms and other generals too well known to need description. There is enough to be told about this subject to convince any one who thinks with his head that a knowledge of diagnosis and prognosis is not limited to the traditional doctor, as is claimed. Indeed the most of these quasi-learned class investigate with their heels, like the mule, instead of with their heads; i. e., they go about things to kick them into pieces and not to know them. They do not love truth for the sake of truth.
There are three conclusions to be put into axioms:
First. When there are tissue changes with no symptoms to represent the state of disorder in the economy.
Second. When there is a complex confusion of particulars and no generals.
Third. It does not follow that the patient must die because the symptoms are such as to persuade the physician to withhold a favorable prognosis. It may only mean a lingering sickness.