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.