Dr. Robert’s comments on case analysis. Advise on what is necessary to take to complete the totality….

*** IN analysis of the case, the value of symptoms must be taken into consideration on several points. First, the personality, the individuality of the patient, must stand out pre-eminently in the picture. This can be illustrated by likening the whole symptomatology to a complete picture of the whole individual;, a whole personality. This embraces not only his physical characteristics, but the expiration of his mental and emotional characteristics as well.

While the generals rank the highest in evolution the case, and without generals we cannot expect to find the *simillimum, the mental and emotional characteristics have a high value, since these are the true reflections of his personality, the man himself. Because the subjective symptoms are the registration of his physical or other difficulties as expressed upon his own personality, these are also of great value. The objective symptoms are less differentiative, yet their value lies in the fact that they cannot be distorted by the design of the patient; the little realizes that he is manifesting these objective symptoms and therefore they picture accurately certain phases of the case.

Objective symptoms, those that are seen by the careful observer, have more importance in child life than in adult life, because through them we see the expression of the child’s disposition and desires. Therefore, many of the seemingly objective symptoms may be translated into a subjective form. It is for us to interpret the symptoms according to our understanding of its proper value. While they may be presented to yes in child life almost entirely as objective symptoms, yet they may have their counterpart subjectively in the province.

Now in taking a case was must take into consideration the nature of the disease and its peculiar types. We must know disease accurately before we can give effective relief. Occasional cures take place without such knowledge, but it is almost by accident. that is, we must know it peculiar manifestations in each individual case, taking into consideration its complete symptom totality. the complete knowledge of the case is associated with another important item. We must know and possess the means by which we are able to relieve. Without this latter knowledge any knowledge of symptoms is of no avail.

There has been a great knowledge of disease attained from investigators from the earliest times methods have been improved whereby diagnostic symptoms have been correlated, and all praise is due to these investigators along this line. The only difficulty is that diseases have come to be treated by names of the diseases instead of by individual symptoms; the disease has been treated rather than the patient. It is only upon the totality of the symptoms that we can base our prescription, and so we require many individual symptoms as showing the characteristics and personality of the patient; so these diagnostic symptoms are of very little use to the homoeopathic prescriber in selecting the remedy. In fact, the *simillimum is practical never found among the diagnostic symptoms. In considering the diagnostic symptoms in the selection of the remedy, its only practical value is the excluding those remedies from consideration which do not correspond to the genius of the disease, but act chiefly on other parts of the organism.

If we allow ourselves to become influenced by the diagnosis in making our remedy selection, we are very apt to become confused and fail to help our patient. We may be faced with a diagnosis of some grave condition such as some form of deep abscess, a grave pneumonia condition, an internal haemorrhage, or any one of a host of conditions. Selection of the remedy on the basis of the diagnosis may, and probably will, fail completely. However, the symptoms of the patient are an infallible guide, and the more serious the condition, the clearer cut are the inductions for the remedy. If we allow ourselves to be guided by these symptoms, we shall probably save the patient, *even though the remedy selected on the basis of the symptom totality may never have been used under like diagnostic conditions before.

The symptoms of location frequently furnish quite characteristic symptoms, and they deserve particular attention, since every remedy acts more, and more decidedly, on certain parts of the organism. These differences enter into the consideration for certain local manifestations, like tuberculosis, but it also enters into those types of disease that localize in certain parts, like gout in the great toe, and yet are of systemic origin. These symptoms all have their bearing and should be considered as to location; and they are particularly valuable to us as pertaining to localization in the right or left side or the body, or of certain organs of the body. They are particularly valuable in noticing the location, as in the base or apices or middle lobe of the lungs. They are particularly to be noticed as to direction on which side the trouble starts and in which direction the symptoms move and where they localize, as, for instance, throat troubles going from the left side to the right, or the right side to the left, or continuous alternation of sides.

All these finer shadings have much to do with Homoeopathy, and have every little to do with ordinary medicine. Even the nurses wonder when we ask regarding the localization of symptoms. However, these things do enter in and make considerable difference in our ability to select the correct homoeopathic remedy. The localization of symptoms and the direction of symptoms will often appear as marked symptoms before pathological change have manifested themselves, as for instance, in the beginning of the syndrome which we call tonsillitis, or in the beginning of a similar syndrome in pneumonic conditions where, if the remedy is given an early opportunity to exhibit its power, the pathological condition will not arise. In such states the localization and direction for symptoms become of considerable moment to the Homoeopathic physician.

The chief aim of the Homoeopathic physician consists in ascertaining the remedy that most completely and fully covers each individual case. In other words, the totality of the symptoms. We hear so much of the totality of the symptoms that sometimes it behaves us to stop and think what this means. The Homoeopathic physician may be likened to an artist painting a portrait. He fills in all those features pertaining to the likeness which he is paining, and those features which may be found on all faces, eyes ears. nose, mouth, lips. In this way all individuals are similar, but each individual has peculiarities of his own, and in order to make the picture complete the artist must present the individualities in the portrait, but not accentuate over and above the other features the normal position, shape, and size, as it appears in the individual himself. In taking a likeness, how strange the finished picture would be were we to draw or paint only the peculiar things Just a nose or just an eye, and nothing by which we could distinguish the one whom the picture was intended to represent. On the other hand, if we painted the classic features only there would be no distinguishing characteristics in the finished product.

It is in this relationship that we must gain a knowledge of the concomitant symptoms of we would prescribe homoeopathically. In drawing the picture we must present the rare, the striking, the peculiar symptoms which present themselves, not out of keeping but associated with the other symptoms which form a background upon which the peculiar, rare, and characteristic symptoms must be presented as determining the individuality, the personality, of the man for whom we are prescribing. It is not the common symptoms, common to all disease syndromes, that are of value, but the rare, the peculiar, the unusual, that stand out by themselves. It must necessarily follow that these concomitant symptoms have a wide variety and are widely distribute throughout the organism.

It is almost impossible to name all the peculiarities in all the case that we might find, but their are certain ones that stand out. First of all, those symptoms that are common and found in almost all diseases may be left out of our count unless they manifest themselves in a striking manner. The same may be true of those ailments and symptoms that usually appear in the disease under consideration, unless they should be distinguished by some rare peculiarity, and in this way offer something particularly characteristic, like thirstless fever, or chill with desire to uncover. On the other hand, all the attendant symptoms should be carefully noted:

(*a) Those symptoms which rarely appear in connection with the leading disease, and therefore are found rare, among the provings

(*b) Those which belong to another sphere of disease than the principal ailment.

(*c) Those which have more or less characteristic signs of the medicine even though they have not before been noticed in the present relationship or diagnostic group.

H.A. Roberts
Dr. H.A.Roberts (1868-1950) attended New York Homoeopathic Medical College and set up practrice in Brattleboro of Vermont (U.S.). He eventually moved to Connecticut where he practiced almost 50 years. Elected president of the Connecticut Homoeopathic Medical Society and subsequently President of The International Hahnemannian Association. His writings include Sensation As If and The Principles and Art of Cure by Homoeopathy.