Among the Generals, the symptoms of the first grade are if well marked, the MENTAL SYMPTOMS. These take the highest rank: and a strongly-marked mental symptom will always rule out any number of poorly-marked symptoms of lesser grade. (For these may never have appeared in the drug-pathogenesis-perhaps for lack of a sufficiently drastic proving; and yet, time and again, the drug will clear them up.) The Mental symptom’s always provided that they are very definite and well-marked, are the most important symptoms of the case.
But for the mental symptoms particularly, it is well to go constantly through the Repertory (Mind-section), and to master all that it presents; and to make cross references; and to be sure that you get the correct rubric; and often combine two rubrics that practically amount to the same thing, and yet do not give quite the same list of drugs. As, for instance, aversion to company and better alone may not be quite the same thing; and yet it is often difficult to sort them. Again, worse in the dark, and fear of darkness are difficult to fix correctly in many cases, while the elements fear of robbers, fear of ghosts-of apparitions, etc., may come in: so here you have at least four rubrics which you may have to combine on pain of missing something. Many of the rubrics must be considered in company, and all with intelligence and some elasticity, or there is great danger of eliminating the very drug you are in search of. And-the better you know your Repertory, the more rapid your work will be, and the better your results. Never grudge turning its pages!
Second in grade, after the mental symptoms, and his reactions to mental environment, come if well marked, such general symptoms of the patient as his reactions, as a whole, to bodily environment:-to times and seasons, to heat and cold, to damp and dry, to storm and tempest, to position, pressure, motion, jar, touch, etc. But they have got to be in capitals or in italics in the patient as well as in the Repertory, to take this rank; or to be safely used, some of them, as eliminating symptoms. (“Some of them”, because there are perhaps only half-a- dozen symptoms which it is at all safe to use in this way; and then only, of course, if strongly marked.)
And, once again, be sure that you have your very rubric; and if necessary combine two rubrics that work out practically as synonyms, and yet do not present quite the same list of drugs. A doctor was driven to despair over a case of melancholia by using better for open air instead of desire for open air. The symptom was so intensely marked that it was used without hesitation as an eliminating symptom, ruling out Sulphur (which has desires for open air in capitals, but hardly appears in the rubric better for air), but which had every other big symptom of the case in capitals and which promptly cured. You have got to know your Repertory from cover to cover, if you are to have the best results: and you have got to use it with brains and imagination.
The third-grade General symptoms are the CRAVINGS AND AVERSIONS. BUt to be elevated to such rank, they must not be mere likes and dislikes, but longings and loathings: in big types in the Repertory and in the patient-in corresponding types, anyhow!
In corresponding types everywhere and all through; and this is most important. As, for instance, if your patient is only a little restless, Arsenicum and Rhus., superlatively restless remedies, will, of course, be rather contra-indicated. Big types in the Repertory will never help you, unless the symptoms are big type in the patient too. In first taking the case, it is well to vary the type as you set down the symptoms; to put those poorly marked in brackets, and to underline the intensely marked symptoms: for that will help you to match them correctly.
Then next in importance comes, in women, the MENSTRUAL STATE, i.e., general aggravation of symptoms before during and after the menses. Of lower rank comes the question of menses early, late, and excessive and this last course only where there is nothing such as polypus fibroid, menopause, to account for it.
And now, at last, you come to the PARTICULARS-the symptoms that bulk so largely for the patient, and for which he is, as a matter of fact, actually consulting you. You will have taken them down first, with the utmost care and detail, listening to his story and, interrupting as little as possible; but you will consider them last: for these symptoms are really of minor importance from your point of view (certainly in chronic cases) because they are not general to the patient as a living whole, but only particulars to some part of him. In a great railway system, for instance, a strike that raises the price of fuel for a few weeks, an accident on the line that means compensation to the injured, and replacement of rolling stock, and repair of a few yards of permanent way, are less vital to the Company than the brain quality of its General Manager, or the force, competence and activity of the Chairman and Board of Directors.
Make the executive of the Company efficient, and it will deal in the best way with details. In like manner, put your patient, as a whole, in order, and he will straighten out the disorder of his parts. You have got to get at him; and you can only get at him through his general and mental symptoms. Start for the Particulars, and see where they land you! In the body politic, where the executive is not sound, you deal with lax discipline here, with peculation there, with incompetence, and disorder, and slackness, and inefficiency. There is rottenness at the core; and you will find that as fast as you clear up one mess, the system breaks down at a new part. Go for the management; put that right; and let it act. So with your work:-start treating an eczema, per se, and “cure” it, to find yourself confronted with-say asthma; prescribe for that, and the wretched patient comes back presently with a brand-new disease-Rheumatism: tinker with that-and the heart gives out.
Go for the executive-for the patient himself; – the patient who was all along capable of eczema-asthma- rheumatism: go for the patient as a live entity, revealed by his general and mental symptoms in chief; deal with him according to the Law of Similars and he will do the rest. Always provided that the thing has not gone too far, that the tissue changes are not too gross, he will even undo the rest, step by step backwards, to the reproduction of the initial lesion on the skin. The whole is greater than its part. Never juggle with “Particulars” at the expense of the life of the whole.
But, in their right position of secondary importance, you must go into the Particulars all the same, and with great care (if only to confirm your choice of the drug); and it will amaze you to find how they fall into line, when the choice is correct. More than when the drug has been chosen on general grounds, the patient will return and tell you, not only “I am better”, and that the trouble for which he consulted you is better: but he will volunteer, “My knees are better too, all the swelling has gone”; and referring to your notes you discover that you had never heard of his knees before! and he will go on and tell you that his back (Of which you hear now for the first time) is much less painful: and the constipation, which he had not previously mentioned, is a thing of the past. (This was a Nitric acid case!)
Among the PARTICULARS, your first-grade symptoms will always be anything peculiar, or unusual, or unexpected, or unaccountable. You now want to know not only how your patient, as a whole reacts to environment, but how his head, his stomach, his lungs, his muscles and joints stand heat and cold, damp weather and dry, react to stuffy atmosphere or draughts, desire or resent movement and jar. You will find one headache being banged against the wall; while another has to be nursed with such extreme care that the sufferer dare not move a finger, and would swear, if the movement of his lips were not agony, when you clumsily lurch against his bed. Or another headache will demand a bolt-upright position; while for a fourth the only thing is to kneel up, while it is pressed low into the pillow, or against the floor.
Now, to get the terms clearly… A GENERAL SYMPTOM, OR A GENERAL, IS ONE THAT REFERS TO THE PATIENT HIMSELF, AS A WHOLE, AND OF WHICH HE CAN SAY “I”, INSTEAD OF “MY”. “I feel the cold frightfully.” “I dare not move hand or foot in a thunderstorm; and I simply couldn’t be alone.” “This heat is knocking me all to pieces-I just can’t stand it!” -these are Generals. In these the patient expresses himself. Remember, he is the sum of many lives, building up many tissues, and organs of diverse function. Though the Generals the Dweller-in-the-House speaks-through the Mentals and Generals:-the Life which is the sum of all the lives, and something beyond that:-the LIfe “in which they live and move and have their being”; and with whom, whatever their individual life and vigour, they perish. Truly the whole is greater than its part. Surely it is scientific to deal with the whole first, as a Whole?
But where your patient says “My” instead of “I”, there you have a Particular. “My headache is awful in the house: the only thing for it is to go out and walk about. It often drives me out of bed at 2 or 3 a.m., to walk the Common for hours.” (These are not exaggerated statements: we are giving you, all through, actual words of actual patients; and the magic drug for the last was Pulsatilla)
But the Generals and the Particulars may not only be quite different, but they may be flatly contradictory in the same patient: so you see how imperative it is to get them clearly, and to know what value to give to each. Arsenicum is worse from cold: Arsenicum stands in the list of “predominantly cold remedies” in capitals. And yet the `headache of Arsenicum is better from cold. Arsenicum has been described as only comfortable when “rolled in blankets up to his chin, with his head out of the window.” Lycopodium is a warm remedy in the main, and often cannot stand heat: yet his stomach symptoms, which are a great feature of the drug are ameliorated by hot food and drinks. Of these the patient says not “I”, but “My”, therefore they are Particulars. He may say, “I cannot stand heat” (a General of the highest importance, and one of the most safe and useful of eliminating symptoms-if strongly marked!)-“I cannot stand heat, but my indigestion” (a Particular of the greatest importance to the patient, and on which he lays the greatest stress) “is better for hot food and drinks. Cold things always disagree with me” (meaning his stomach). Again, Phosphorus stands in capitals as a very cold person-
If you are to be a good prescriber, by the way, your drugs have got to be people for you, with whims, fancies and terrors; with tempers and idiosyncrasies and characteristics: you have got to see them stalking about the world speaking and moving and halting, with the bodies-minds-souls of men. You have got to travel with them in tram or train, and they will betray themselves, buttoned up and shrinking together, or loose and jolly and open; fidgety, restless, fearful; dull and inert; quarrelling for an open window, growing at the draught with windows closed. You have got to dine with them, and they will reveal themselves in their relation to food and drink, and in the mental revelations such convivial moments of relaxation call forth. You may spot them, standing for preference, or sinking always into the nearest seat; stoop shouldered and drooping, or erect and full of “go”, depressed and querulous; restless and anxious, as their deeply lined faces testify; smooth and smug; dirty complexioned and careless of appearance; chalky faced and flabby of superlative tissue: compact and hard as nails; fault- finding-affectionate and mild-responsive to every wave of sentiment and emotion-dull and indifferent. Look for them everywhere, and learn them, and they will betray themselves at every turn; and you will often save yourselves hours of solid work, by spotting them as they enter your consulting room.
So, to hark back, Phosphorus is a very cold person, but his stomach is better for cold drinks. When that is sick he craves for cold water, which is vomited, however, so soon as it gets warm in the stomach. This is a particular, true, but a priceless one, because it is peculiar to Phosphorus. And here we have a new term-a “PECULIAR” symptom, strongly diagnostic of one drug. These peculiar symptoms are especially useful in acute diseases where you are more likely to meet them, and where they often provide a brilliant short-cut to the drug, saving time and toil. And see how these peculiar unaccountable, contradictory symptoms help you-how unexpected they are, and how diagnostic! Here you have the superlatively chilly Phosphorus: and yet his pains are often of the most intensely-burning description: and though, as a whole, he cannot tolerate cold, yet his sick stomach craves for icy drinks, which it cannot even retain when they get warm! Take your Generals and Particulars mixed-up and awry and just-anyhow, and you might land in giving such a patient Lycopodium: for both are worse for heat, and worse for cold: only the Generals and Particulars are exactly reversed! For Lycopodium is in the main, intolerant of heat, which his stomach craves; while Phosphorus detests the cold which his sick stomach demands with vehemence. See how all-important it is to get your Generals and Particulars right! This is where we fail, and blame Homoeopathy.
Then, besides Kent’s Generals and Particulars, you have COMMON SYMPTOMS. A symptom may be common to all cases of a certain disease, and therefore of no great use in picking out the individual remedy for a particular case of that disease; or it may be common to a very great number of drugs, and therefore indicate one of a large group of remedies only; and so of very little use in repertorising. Take thirst, a general symptom of the patient, though in the Repertory relegated to the section “Stomach’:-“I am terribly thirsty.” If there is nothing to account for the thirst, it may be an important symptom; though common to a great number of drugs! But if the patient is running a high temperature, or suffering from diabetes, or if his work keeps him in the heat of a bakehouse or an engine-room, or if the weather is suddenly and unusually hot, the symptom becomes a Common symptom, and almost valueless. Don’t waste life in writing down that awful list of remedies “Thirsty”. Absence of thirst under conditions where you would expect it, on the contrary, becomes a very important symptom; as absence of thirst with a very high temperature-kent has a rubric for that. Remember!-THE MORE UNCOMMON A SYMPTOM IS, THE MORE VALUABLE: THE LESS YOU CAN ACCOUNT FOR A SYMPTOM AND THE MORE INTENSELY PERSONAL IT IS, THE MORE IMPORTANT. In inflammation, for instance, worse from pressure is what one would expect, and of little value-so many drugs and most inflammations have it! But better from pressure, under these circumstances, is priceless, and leads you to a small groups of drugs, such as Bryonia. Frequent micturition with a fibroid impacted in the pelvis is not a symptom that will help you in working out your case; it is a Common symptom and amply accounted for… and this leads one to insist on the absolute necessity for correct diagnosis before you even open your Repertory. Remember, the priceless symptoms for success are the strange, the rare, the unaccountable ones; those that flatly contradict preconceived ideas, and head off straight for a limited number of drugs.