THE CHIEF COMPLAINT AND THE AUXILIARY SYMPTOMS IN THEIR RELATION TO THE CASE


Dr. Robert’s guide on which symptoms should be taken during case taking….


*** ALMOST every case that comes to the attention of the physician presents two distinct phases, two separate pars, as it were: the part comprising the symptoms of which the patient complains, those which are most annoying to him and most outstanding in his recognition; and secondly, those symptoms which he does not recognize as symptoms or which he does not consider worth reporting or does not consider as having any relationship to the case.

The chief complaint has a psychological value out of all proportion to its value in homoeopathic prescribing: it brings the patient to the physician, and if the physician responds and by careful questioning draws out the history of other symptoms, the patient feels as satisfaction and confidence that the physician is not treating his case as of no consequence.

Now the chief complaint is a very necessary part of every case; some of our colleges are giving the chief complaint of every case much consideration. The young physician places much dependence upon this part of the case; it is close to his training along diagnostic lines. The older prescriber, while giving due weight to the chief symptoms, feels that in prescribing he must consider the totality of the symptoms and in order to do so he must give more weight to the other part, probably unexpressed without some encouragement on the part of the physician, which is an even more necessary part of the case than the chief complaint, because it is that part which manifests more clearly the individuality of the patient and indicates most clearly the individuality of the remedy to cover the case -the totality of the symptoms, if you prefer.

The chief complaint, as presented by the patient, may be altogether different in value from the symptoms discovered and illuminated by the physician’s analysis of the case. The chief complaint is often a pathological state, or an approach toward a pathological state, in the functional sphere.

The chief complaint, or the leading symptoms, may be defined as those symptoms for which there is clear pathological foundation or the symptoms that are most prominent and clearly recognizable; or the symptoms which first attract the attention of the patient or physician; or which cause the most suffering or which indicate definitely the seat and nature of the morbid process; which form the “:warp of the fabric”, as if has been expressed.

The auxiliary or concomitant symptom or group of symptoms seldom has any definite relationship to the leading symptoms from the standpoint of theoretical pathology these are the symptoms which the pathologist would exclude as accidental and meaningless, but they have actually a definite relationship to the case, because they occur in the same patient, and at the same time or in definite relationship of time, as the other symptoms which are considered the chief complaint. If they do not fit into the theories of pathology, they have an even greater individual value in the case; those symptoms which can be explained are of little help in selecting the homoeopathic remedy, but it is this group of auxiliary or concomitant symptoms which limit the choice of the *simillimum.

That group of which the patient complaints most, almost without exception cannot be relied upon for the definite selection of the remedy; it is the concomitant group of symptoms which, taken in conjunction with the major group of symptoms, makes possible the definite selection of the remedy by greatly reducing the number of remedies indicated in such conditions, and upon a closer analysis we can pick the *simillimum unerringly from this small group.

For instance, when we find a case where the patient gives as her chief complaint ovarian pain, we cannot instantly pick the remedy from consideration of this symptom alone; the homoeopathic materia medica has over fifty remedies that have this symptom. Cerebral congestion may be met with any of 150 or more remedies; and so with many single symptom pictures. We might numerous complaints where the chief complaint would lead us into a morass of remedies, any one of which *might give relief to the patient, but only one of which would cure.

At times the chief complaint seems contradictory to the auxiliary group of symptoms brought out by the physician’s questioning; the patient may have, within the course of a day, an exceedingly dry mouth, and then complain of its excessive moisture. The patient may complain of diarrhoea, but a careful taking of the case may reveal an alternation of diarrhoea and constipation. Or there may be a complete alternation of symptoms at different seasons of the year, as rheumatic conditions at one time, and gastric disturbances at another time; rheumatic pains in the limbs during one attack, and perhaps rheumatic iritis at another time. The physician will find many such alternating symptom groups, any one of which may be the chief complaint. Only the thoughtless physician will tell the patient that the present symptoms group is the one to be considered at the present time, a nd when the other symptom group appears it will be plenty of time to consider that group. Such an attitude in the part of the physician may seem logical, but the thoughtful student of homoeopathy realizes that many remedies in our material medica have alternating group symptoms, and he cannot ignore any symptoms which the patient may recite.

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.