Distressing symptoms appearing during the course of chronic disease often demand particular attention. To find their counterpart within the scope of some pathogenesis, which will also correspond to the rest of the symptom picture is not always easy, and may well be impossible. It is a dilemma too often met with narcotics or mere symptom covering.
Unfortunately the former soon undermines the morale of the sufferer while the latter make for confusion and and intractability by the suppressing of salient factors out of semblance to any one remedy. The successful management of the sick demands an unhampered evolution of the symptoms. Distortion of this process mostly spells defeat. If we twist nature’s language out of its original meaning by our ineptness, disaster must follow; it is far better to do nothing than the wrong thing, especially by being in too great a hurry or not taking enough time for reflection.
It is in the nature of things that we should attach too much importance to this or that feature of a particular illness, without taking into account the meaning of the whole vital disturbance, an regarding it as but another expression or a fresh outbreak of an already disturbed dynamis, whose every departure from normal should be noted in its totality if we would do the most for out patients.
All of which means that a minute life history is needful in order to complete the symptom image of any one individual sickness. This is the main reason why different prescribers look at clinical cases from different angles, hence prescribe different remedies. It is also the reason why the family physician occupies a more commanding position in the handling of his patients. Published case reports are useful in proportion as they bring out the generals with the particular superadded for definitive reasons.
Histories which do not reveal the constitutional bias or leaning are badly deficient, even if at times this feature may be unobtainable. Cases may even be worked out in the reverse, but it is dangerous and uncertain process, in spite of keynote prescribing. The active practitioners is faced with many a critical situation in which there is nothing left to do but prescribe for it exclusively. His mind must be active enough to see the needed remedy in collapse after placenta praevia, in active hemoptysis in cholerine, diphtheritic croup etc. etc., if he would justify his belief. Here the fitting of the remedy to the presenting totality is just as important as elsewhere, and it will constitute part and parcel of all the factors when the whole life history comes up for consideration later.
The main features of some remedies greatly resemble the broad outlines of certain diseases, as Belladonna and scarlet fever, Lachesis and chorea major, Lachesis and typhus fever, Phosphorous and pneumonia, Antimonium tart and capillary bronchitis, etc., etc. This similarity lies at root of the idea of specific, but even so, instances are constantly occurring in which some outstanding indication takes the clinical case entirely out of the specific class. Both instances tend to show how loosely physical diagnosis and remedy choice are bound together, although admittedly certain groups of drugs are more frequently called for than others in particular diseases. The ultimate reason however lies much deeper, in that the symptoms belonging to particular constitutional states already foreshadow the remedy which later and most likely acute attacks of diseases will show forth more fully; this is clearly proven by the fact that homoeopathic treatment of acute disease attacks gradually renders the recipient less and less liable to acute disease. All things considered the drug which produces the basic systemic symptoms plus those of the later sickness, is the most suitable remedy for the patient.
The fact that the latest manifestations hold the highest rank has misled man prescribers to using them almost exclusively in making a selection. This mistake is especially apparent in the treatment of recurrent colds, where the commonly given drug will relieve promptly for some time, and then gradually fail altogether, because it has not been deep acting enough. Such a course then makes the real simillimum harder to find, because then picture has been shorn of one of its main expressions., Theoretically mathematics is an exact science, but every engineer will tell you of the allowances he makes when it comes to cutting his figures into practice. Medicine is a self styled science striving toward a wished for certitude; how limpingly she advances we all know only too well. Having partly freed herself of an obfuscating multiplicity of procedure, some of her adherents shout themselves hoarse over the most dubious of victories. So much for general medicine. Now comes homoeopathy proposing to cast aside all of these flummeries and treat disease by its nearest similar, necessarily a unit of action, i.e., a single remedy, but its advocates cannot agree upon what is like more like or most like the evidence at hand. Allowance for poorly collected evidence and still worse interpretation is not made. Fortunately the law of similars does not exact the finding of the simillimum in order to get results, but very evidently looseness of application is directly related to the kind or results obtained.
All of which means that it takes time, careful thought and consideration to obtain the highest type of results; results that will hold for long periods of time.
The spirit of the clinical symptom picture is best obtained by asking the patient to tell his own story, whenever this is possible. This account is then amplified and more accurately defined by the questioner, who should, first try to elicit the evident cause and course of the sickness down to the latest symptom, to which he will especially add all the things which now seem to interfere with the sufferer’s comfort. Especially should the natural modifiers of sickness-the modalities-be very definitely ascertained. The following are the most vitally important of such influences, Time, Temperature, Open Air, Posture, Being Alone, Motion, Sleep, eating and Drinking, Touch, Pressure, Discharges, etc.
A consideration of the mental state comes next in order of importance. Here the presence of Irritability, Sadness or Fear is the ruling factor.
The third step concerns the estimate to be put upon the patient’s own description of his sensations. This is a very vital point and in order not to be misled it is always well to ascertain whether any of the following primary sensations are present. Burning, Cramping, Cutting, Brushing, Soreness, Throbbing and Thirst. There may be many others, but the presence of any one of these often overshadows them, especially such as may be due to the play of the imagination; which feature is in itself often of more importance than the particular thing imagined.
Next in order comes the entire objective aspect or expression of the sickness: This should especially include the Facial Expression, Demeanor, Nervous Excitability, Sensibility, Restlessness, or Torpor, State of the Secretions and any abnormal coloring that may be present.
Lastly the part affected must be determined; which also brings the investigations in touch with diagnosis.
By going over the above rubrics in the order named the contour of the disease picture will be pretty clearly outlined and will point fairly well toward the simillimum and the prescriber has only to keep in mind the fact that the actual differentiating factor may belong to any rubric.
What often make a cure hard is the laying of too much stress upon some particular factor at the expense of the disease picture as a whole, thus destroying its symmetry and forming a distorted conception of the natural image of the sickness. This does not however mean that all symptoms stand on the same level, for certain effects must be more prominent than others, yet be part and parcel of them. This is the sense in which we must learn to know our remedies, just as we do our friends, by their air or personality; an ever changing, composite effect, but always reflecting the same motive.
Whenever the chosen remedy excites little or no reaction, the selection has either been faulty, or what is just as likely, one of the fundamental miasms which calls for either Psorinum, Sulfur, Medorrhinum or Syphilinum, is present.
Whenever the general benefit derived from a single dose lags, the remedy should be repeated in the next higher potency instead of looking upon the new symptoms as indicators for some other drug; for only the most inveterately rooted dyscrasia can, by varying its expression, resist the whole scale of an indicated remedy. Sometimes we can advantageously change to another potency scale of the same remedy, before attempting o scrutinize the remaining picture for those new developments which must point toward our next choice, nor should this successor be chosen until the new symptom picture-disease phase- takes on a fairly definite or settled form.