It is a common experience to find cases reported in our journals, presenting large and complex masses of symptoms, to which, as a whole, no remedy in the materia medica corresponds, no reason being given why the remedy that proved curative was selected in preference to many other competing ones. We can learn little or nothing from these cases. Even when we study some of the model cases reported by masters in homoeopathic prescribing, we are often utterly at a loss to understand the rules that led them to give a preference to certain symptoms and to relegate others to a very secondary place.
Hahnemann advises us to base the selection of the remedy upon the totality of the symptoms presented by the patient, as they are the outwardly reflected image of the internal and invisible disease, and the means by which we can truly apprehend this internal distunement of the bodily forces.
I do not at this point propose to go into the observations and arguments that led Hahnemann to advise that the choice of the remedy should depend almost entirely upon the symptoms, to the practical exclusion of pathology. If these symptoms are to be our guides, what do we include in this term ?.
Every deviation from perfect health experienced by the patient, or observed by others, including all disturbances of functions and sensations, all alterations in the external appearance of the patient, and also all probable causative conditions.
As rule, in acute disease there is little difficulty in determining the totality of the symptoms, for the deviation from health is usually sharp and well defined. As an acute, supervening disease never forms a complex with a chronic one the latter being suppressed until the former has run its course care must be taken, when ascertaining the symptoms of the acute disease, to exclude from consideration the symptoms of the now latent chronic disease. According to Kent, at times some symptoms of the chronic disease may persist, and be active during the acute disease. Such symptoms are peculiar, because they have not disappeared, and are not often guiding in the choice of the remedy for the acute disease.
But when we come to deal with chronic diseases, the problem is more complicated, for we have to take into account not only the present symptoms, which often show only a very partial picture of the disease, but must also include many former symptoms that are not now active; for even in those patients that have suffered for very long periods, and from many apparently diverse troubles, there always is method and order running through all their illnesses if we can find the clue.
While, theoretically, we should consider all the symptoms experienced by the patient since his birth, excluding those due to acute disease, yet the task is a very difficult one both for patient and physician, and we can only make very cautions use of these bygone symptoms. Even if we could tryst to the accuracy of the memory of our patient, or his friends, these old symptoms can be used only with the greatest care, for so many of them may have arisen from faulty environment, the abuse of drugs, or the acquisition of some other miasm, that they would not truly indicate the course and progress of the disease.
This is also very often the case when no such question of old, bygone symptoms is involved; and those who are guided in the selection of their remedies mainly by the symptoms are in special danger of overlooking such causes, and have to be perpetually on guard lest they fail into the error of ascribing to disease what is really due to other causes.
Dunham, in The Science of Therapeutics gives many instances where such mistakes have been made, and only a wide knowledge of drugs, of the habits of the people, and the special conditions under which many occupations are carried on, will enable us to avoid these errors.
Such, for example, was the case of a young lady who, for a very considerable time presented a perfect picture of the classical symptoms of Sulphur, and upon whom that remedy, in all potencies ( to say nothing of other remedies), failed to produce the slightest effect. It was finally discovered that she was in the habit of using sulphur to cleanse her teeth and upon this being stopped the symptoms at once ceased.
A maker of crucibles for casting steel ignots, who had suffered for seven years with all the symptoms of Graphites gastralgia; for him that remedy did no good, until it dawned upon me that I had somewhere read that plumbago was now being used for making these moulds.
When we have excluded all symptoms due to such causes, there is the vast number remaining which can be ascribed only to disease proper, and it is with these in particular I wish to deal tonight.
SELECTION IN CHRONIC CASES.
Theoretically, we endeavor to find a remedy whose symptoms correspond exactly as regards both character and intensity to those experienced by the patient. This can rarely, if ever, be done; and in chronic cases, at any rate, we have, as a rule, to make a selection from amongst the mass of symptoms, and to base the selection of the remedy mainly upon these.
If it were necessary always to select a remedy that correspond perfectly to every one of the symptoms, our already vast materia medica would be utterly inadequate, and we should require at least 10,000 more fully proven drugs. Who would care to undertake the task of searching for simillimum in such a labyrinth? It is quite bad enough as matters are at present, but we must think of our remedies as complex tools, capable of doing many very different pieces of work, which to the uninitiated would seem to require many diversely shaped ones.
Who have made finer cures than the old masters in homoeopathy, with their very limited number of fully proved remedies ? But they knew each one through and through, in a way that few of us do nowadays, and in their hands a comparatively few medicines were, in the majority of cases, sufficient for all their work.
It was because they were able to comprehend not only the spirit of each remedy, but also those symptoms that characterized the patient. Following in their footsteps, we also must endeavour to learn to grade the symptoms according to their respective values, and not to act as mere symptom-covered, an opprobrious name that has at times been only too well deserved.
In every case of disease there are always two classes of symptoms:.
First, those that pertain to the disease that is, the common or pathognomonic ones; and.
Second, those that pertain to the patient;.
And in all advanced cases, a third class that pertains to the ultimates or results of disease.
To attempt to select the remedy in accordance with the first and last of these alone is simply to court failure in the majority of cases; for so many remedies will be found to correspond more or less closely to the first, at any rate, that unless we have some other means of individualizing, we shall be quite unable except by good luck to select the correct remedy. Still less can we hope to find a sure basis if we depend upon the pathological condition; foe very few drugs have had their provings pushed forward enough to elicit such effects, and consequently we should have to depend mainly upon such cases of accidental poisonings as happened to be available.
Dunham, writing upon this subject, points out that the drugs varying according to the size of the dose may produce three sets of symptoms, viz:.
(1) The chemical.
(2) The mechanical, or revolutionary, consisting chiefly in violent efforts on the part of the organism to eject from its cavities the offending substance; and. (3) The dynamic, contingent on the vitality, or resulting from the relation of the peculiar properties of the drug to the susceptibility of the living healthy organs.
He still further subdivides the dynamic ones into the generic or those common to all members of a certain class of drugs and the specific.
As an example of the former, Arsenic, in certain doses produces vomiting, diarrhoea cold perspiration, cramps limbs; but Cuprum, Veratrum, Antimonium tartaricum, which belong to the same group, produce identical symptoms.
The specific ones are those that are peculiar to one remedy and serve to distinguish it from its relatives.
In the vast majority of poisonings, little else is produced than the first two classes viz., the chemical and mechanical; and the symptoms obtained therefrom are of little value in the large majority of cases we are called upon to treat. Our main reliance must ever be placed upon the symptoms that signify the patient; and Hahnemann directs that we should be particularly and almost exclusively attentive to those symptoms that are peculiar to, or characteristic of, the patient, and not to those that are common to the disease. Kent, after many years experience, states that he regards this advice of Hahnemanns to be the strongest thing that the master ever wrote. Organon S.153.
In acute disease, there is not much difficulty, as a rule, in recognizing the symptoms that are peculiar to the patient; for the symptoms usually appear in an ordinary manner, and the common or pathognomonic ones are well known. When we deal with chronic diseases, our difficulties are largely increased, fore they are often so complex in nature that it is not easy to separate the symptoms that are peculiar to the patient from those that are common to the disease. Organon, S.S., 82, 152.
In many old-standing chronic cases, especially those that have been long under allopathic treatment, these peculiar and characteristic symptoms have so completely disappeared, or have been so utterly forgotten, that our difficulties are thereby increased. Nay, it is even the case at times that the characteristic symptoms may never have existed except in the patients ancestors, and under these circumstances cure is practically impossible.
It is as if, during the exploration of some old city, a coin were discovered, by which, if we could determine the year of the king during whose reign it was issued, we should be in a position to fix an important date. If the coin was well preserved, any skilled numismatist would promptly furnish us with all the information we desired; but, if it were much worn and eroded, while we might, from the shape or composition of the metal, be able to determine the dynasty under which it had been issued, it would be utterly out of his power to state the individual king, to say nothing of the year of his reign.
Let us take a few examples of the symptoms that are peculiar to the patient, as distinguished from those that are common to the disease.
The common or pathognomonic symptoms of dysentery are bloody mucous stools, pain, and tenesmus. From these alone we can determine the group of remedies that correspond in general to this disease, and in J.B. Bells classical monograph on this subject over fifty remedies are mentioned; yet, from these alone it would be impossible to discover the individual remedy for the case under treatment. If, however the patient has.
Much thirst, and. Every time he drinks he shivers, and.
Each drink is followed by a loose stool.
These symptoms, being unusual in the disease, and consequently peculiar to the patient, would guide to Capsicum as the remedy.
Dyspnoea, oedema, palpitation of the heart and albuminuria are the common symptoms of many kidney troubles, and from them alone we cannot determine the curative remedy; but if we find in addition that there is.
A strong craving for fat,.
Urine intensely strong, and.
A sensation as if the urine were cold when passed,.
Then these would be peculiar to the patient, and point to Nitric acid as the remedy.
Let us turn to characteristic modalities. In a case of spasmodic asthma, an aggravation from lying down is so common as to be valueless in the individualizing of the remedy; but, if we find there is much relief from lying down, as in Psorinum, or from assuming the knee-elbow position, as in Medorrhinum, then these, being peculiar and characteristic, will be invaluable.
In hysteria we have an illustration of the danger of prescribing for the symptoms that are common to the disease, and hence not peculiar to the patient. It seems the most natural thing to gather up all the incongruous and peculiar symptoms that characterize this disease, and to prescribe for them.
But when we realize that this incongruity is the very essence of the disease in other words, is pathognomonic of it — we then perceive that we have been prescribing for the symptoms that represent the disease, and not for those that characterise the patient. In such cases, the true guides to cure, if discoverable, are to be found in the changes of desire, the aversions, the loves and the hates; and these are particularly difficult top find, for the hysterical patient conceals her real hates and loves and relates what is not true.
In the foregoing, stress has been laid on the supreme importance of paying the greatest attention to the symptoms that are peculiar to the patient, but it would be foolish to ignore the symptoms that signify the disease. They must, indeed, be taken into consideration; but as subsequent to, and of much less value than, those that are predicated of the patient.
In a very large number of cases, no one remedy corresponds to all the peculiar symptoms, but three or four seem to have equal numbers of them, and of approximately the same value. In such a state of affairs, the remedy that has also the common symptom best marked must prevail.
It must ever be kept in mind that there must be a general correspondence between all the symptoms of the patient and those of the remedy, and that, however helpful the peculiar symptoms may be in calling attention to certain remedies, yet they are not the sole guides; for after all, it is the totality of the symptoms that determines the choice.
It is true that at times a brilliant cure has been made by a remedy that correspond only to those symptoms that were peculiar to the patient, and was not known to possess any strong resemblance to the common symptoms of the disease; but even in such a case, it is almost absolutely certain that further provings will reveal that the remedy has the common symptoms also.
RANK OF SYMPTOMS.
When using these peculiar and characteristic symptoms as the main guides in the selection of the remedy, it is important to bear in mind that they must be equally well marked in patient and in remedy. In other words, no difference how peculiar and outstanding a symptom may be, either in the patient or in the remedy, unless it be of equal grade in both, we must pay little heed to it.
For example, if a patient experiences occasional and slight heat in the soles of the feet at night in bed, this symptom would not be of much importance in selecting Sulphur as the remedy, because in that drug this symptom appears in such a vigorous and outstanding way that the provers declare that their feet burn at night as if they had been on fire.
Take a case of rheumatism, markedly aggravated in dry weather and better in damp. In such a case, the selection of Phosphorus as the remedy could not be based upon this modality, for while Phosphorus has it, it is only in the lowest degree.
Even in a case, with, let us say, ten peculiar and characteristic symptoms, of which one remedy has eight, but of a very low rank, while another has only five, but of high rank and corresponding to the rank of the symptoms as experienced by the patient, in such a case it is very improbable that the first medicine will prove to be the curative one. The second is much more likely to be so.
It is this question of rank of symptoms that is the chief objection to the numerical method of selecting the remedy. It seems to have fascinated some minds, for while it is laborious in the highest degree, it seems to promise certain and exact results; but medicine even homoeopathic is not yet an exact science, and it is extremely improbable it ever will be, even when we have perfected our armamentarium. Consequently, all such mechanical methods are to end in failure, for quality will ever be of infinitely more importance than mere quantity.
In opposition to this numerical method, some physicians have gone to the other extreme, and have been content to be guided in the selection of the remedy by one or two peculiar and outstanding symptoms, practically ignoring all the others, because they have overlooked the fact that, unless there be a general correspondence between the symptoms of the patient and those of the remedy, it is not reasonable to expect a cure.
This so-called “keynote” system of prescribing is very attractive, as it seems so easy, and saves all the laborious comparison of competing drugs that is involved in the numerical method and also because by means of it many brilliant cures have been made; but it is, from its very nature, a wrong method, and in a large majority of cases is doomed to failure, because it ranks one or two symptoms very high and practically ignores the others.
Having discussed the difference in value, so far as the selection of the remedy is concerned, between the symptoms that signify the patient and those that signify the disease, we would turn to the other great division of symptoms viz.: the generals and the particulars.
The general symptoms are those that affect, the patient as a whole, and, because of this very fact, they are naturally of higher value than the particulars, which affect only a given organ.
What the patient predicates of himself is usually general, as when he says, “I am thirsty,” I am sleepy” thereby indicating that his whole being is so affected, and not merely one or two particular organs. So much higher may a general symptom rank that, if it be a strong and well-marked one, it can overrule any number of even strong particulars.
Let us take a case of gastric catarrh, with.
Roaring in the ears.
Aversion to fat and butter which aggravate greatly.
Fullness and pressure of the stomach after eating.
Vomiting of the food.
So far Pulsatilla and Cyclamen compete equally. If we have in addition.
Diarrhoea only at night.
Nausea from hot not from cold drinks.
Palpitation when lying on the left side.
Then the balance will turn towards Puls.
If we find that–.
The patient has the greatest aversion to the cold open air,. It is always aggravated by the least cold.
Then this one strong, general symptom would overrule the marked particulars that Puls. alone had, and declare plainly that Puls. could not be the remedy, notwithstanding the fact that it alone had the three strong particulars.
On the other hand, a number of strong particulars must not be neglected on account of one or even more weak generals.
Let us take another case of gastric catarrh, with.
Severe pain over the right eye.
Pain in the stomach.
Worse from cold, and better from the drinks.
One cold and one hot food.
So far Lycopodium and Chelidonium correspond about equally to the case. If there is in addition–.
Constant pain under the inferior angle of right scapula.
A yellow -coated tongue with indented margins.
Clay-coloured tongue with indented margins.
No one would hesitate to give the preference to Chel. If, on further examining the case we find that.
The patient always feels worse all over– though not in a very marked degree after eating.
That he feels better moving about than when sitting.
These generals would be against Chel. and in favour of Lyc. but they are only weak and not strongly marked generals, and consequently should not be allowed to overrule the strong particulars that indicate Chel.
1. Amongst general symptoms is to be included the mental state, which, reflecting the condition of the inmost part of man, is bound to be of the utmost importance, and as Hahnemann so strongly insists must always, if well marked, take the highest rank in the selection of the remedy. These symptoms are naturally the most difficult to elicit, for people, as a rule,shrink from revealing their inmost thoughts and motives, their hatreds and yearnings, their evil tendencies, and their delusions, etc., and it requires the greatest tact and a full knowledge of human nature to win the confidence of our patient, and so understand his deepest thoughts.
Of course, we are all aware of the value of the more common mental states, and these influence us, consciously or unconsciously, in the choice of our remedies.
We all recognize, for example, the fastidiousness of Arsenic, ” the gentleman with the gold-headed cane”; the irritability of Bryonia, Chamomilla, and Nux vomica; the gentle, yielding, lachrymose Puls.; the ever varying moods of Ignatia; the hauteur of Platina; the lack of self-confidence of Silicea; but there are many less apparent conditions which have to be deeply probed for, though when found are invaluable.