VALUE OF SYMPTOMS IN THE SELECTION OF THE REMEDY



Such are the presentiment of death of Apis; the lack of natural affection of Sepia and Phosphorus; the strange impulses to kill those dearest to them of Mercurius and Nux; the suicidal promptings of China not open and obvious like those of Natrum sulph., but hidden, shamefaced, and mixed with fear. These latter, in the early stages, few patients care to allude to, yet their value to us in inexpressible. Even amongst the mental symptoms there are various ranks and consequently they vary greatly in their value.

All symptoms of the will and affections, including desires and aversions, are the most important, as they relate to the inmost in man. Of less value are those relating to the intellect, while those of memory are to be ranked lowest of this group.

2. Amongst our other generals are the effects of sleep and dreams such as the aggravation after sleep of Lachesis, and Sulphur; the aggravation from loss of sleep of Cocculus; and the great relief from sleep of Phos. and Sepia.

Again, how often has the study of the dreams revealed the hidden key to the remedy ! For in sleep man is off his guard, and his subconscious self can assert itself, and under such circumstances the veil is often lifted a little, so that we are able to apprehend in some degree the deep and hidden mysteries of that disordered life we call disease. Of course, such dreams must be regular and persistent to make them of value, and great care must be taken to eliminate the effect of all external influence.

I recall a case of aortic aneurism, giving rise to much pain and many other pressure symptoms. The patient had not the slightest idea what his disease was, yet he dreamed night after night, of pools and seas of blood, and so distressing was this that sleep was one wild nightmare. The other symptoms were valueless so far as the selection of the remedy was concerned; but, taking the dreams as my guide I gave Solanum tuberosum oegrotans, which completely removed the dreams, and so relieved the pains that he went down to his grave in peace.

3. But one grand general, viz., the effect of different temperatures upon the patient as a whole is often of the greatest service in calling our attention to special groups of remedies and excluding other groups, so that the labour of selection is thereby greatly lessened. It is by no means always an easy general to use in fact, I am more careful in questioning patients with regard to this than with regard to anything else.

How often, in response to our question as to how they are affected by heat and cold, they will reply: “Oh ! I cant stand heat!” But, on inquiry, you discover they hate cold, but cannot stand close, stuffy place; or perhaps they may say so because they are worse in summer which is not necessarily the same as aggravation from heat, for summer, in this climate at any rate, means more than heat.

Another frequent source of error is the tendency to mistake any undue readiness to perspire as an indication that heat aggravates. On the other hand, many confuse an undue tendency to catch cold with aggravation from cold, but when we have eliminated these errors and find the patient markedly aggravated as a whole by heat or cold, we are greatly aided in our choice of remedy.

The question of temperature is often very valuable when the body as a whole is markedly affected by one temperature, and some special organ by the opposite;for example, we find a general shrinking from cold under Ammonium carb. and Carbo vegetabilis, yet their respiration is relieved by cold air. Cycl. has the same aggravation, except for its cough and some headache; China, except for its stomach symptoms; Phosphorus, except for its headache and stomach symptoms; as a patient suffering from headache and general rheumatism of the body remarked, if he could only have his body in a bath and his head in an ice-tub, he would be supremely happy.

Conversely, the general aggravation of heat of Lyc., except for its stomach and some rheumatic symptoms; of Secale, except for some headaches and neuralgias, illustrates the value of this general. The exquisite sensitiveness of the mercurial condition to both extremes of temperature, finding comfort only at a medium temperature, is doubtless known to all of us, and must often have served us in good stead when the other mercurial symptoms were absent.

5. There is little need to call attention to the general effect of the various weathers, but many a valuable hint is obtainable from them, not only in a positive but also in a negative way. In many conditions such as rheumatism, where we expect as a rule to have an aggravation from weather changes, the absence of such an aggravation becomes peculiar and characteristic, and enables us to throw out of consideration whole groups of remedies.

For example, where change of weather does not influences a rheumatism, we can safely exclude Dulcamara, Nux moschata, Phos, Ranunculus bulbosus, Rhododendron, Rhus., Sil., Tuberc.; if wet weather does not affect, we can eliminate Calc., Merc., Natrum carb., Natrum sulph., and Ruta. Such negative conditions are not sufficiently used.

While the mere absence of particular symptoms that strongly that characteristic a remedy cannot be relied on as excluding that medicine, yet when strong generals that characterize the remedy are absent we can, with a fair degree of confidence, exclude that remedy, simply because each drug is a unity, and such characteristic generals are their very web and woof.

5. Amongst the generals must be indicated the influence of the various positions, such as the strong aggravation of most symptoms by standing, of Sulphur and Valerian; the aggravation of lying on the right side, of Merc.; the peculiar aggravation of Phos., when lying on the left, yet aggravation of the head symptoms when lying on the right. To be of any value as general symptom, the patient as a whole must be markedly influenced by these, and if only one organ is so affected they take only low rank, being particulars.

6. The tendency of disease to affect particular parts of the body is often well marked, and may be a general of considerable value. Such, for example, is the semi-lateral nature of many illness that require Alumina, Kali carb., Phos. acid.; or, if the right side is mainly affected, Apis, Bell. and Lyc.; or, if left-sided, Argentum nit. Lach. and Phos. Again, how often has the oblique appearance of symptoms led to the choice of Agaricus or Asclepias tuberosa as the remedy, and even more frequently the appearance of symptoms on alternate sides has led to a cure by Lac caninum.

7. Let us consider how profoundly time influences our diseases, and how common it is to find the symptoms aggravated regularly at particular hours. Here, indeed, is a valuable and great general whose proper use will enable us many a time to decide which is the true remedy. It may be the morning aggravation of chel., Natrum mur. or Nux. or the evening one of Bry., Bell. or Puls. perhaps coupled in the latter remedy with the exceptional aggravation of the stomach symptoms in the morning.

Or, if we find the cases characterised by periodic return of the symptoms whether it be daily, as in Aranea; or on alternate days, as in Chininum sulph on Lyco.; or every two weeks, as in Ars. or Lach. we here, again, have a general of the greatest value. It is worthy of note that the less the disease, that happens to be under consideration, is itself normally characterized by periodicity, the more does this periodic return of symptoms indicate special remedies which have this characteristic in a marked degree.

This is well exemplified in the case of ague, which is normally characterized by the periodic return of paroxysms at fixed intervals, due as we are all now aware to the segmentation of each variety of the parasite at definite times. The mere fact that this periodicity is common to the disease, and hence not peculiar to the individual patient, had led the most successful prescribers for this disease to base their prescription on other factors that are present, rather than on the periodicity, though of course, by no means excluding it from consideration.

8. The various cravings for, and aversions to, various substances are as a rule general symptoms, for they depend upon some deep need in the body as a whole, and, of outstanding and definite, must always take high rank. It is easy to understand many of these, such as the aversion to fat of Puls., for it also disagrees, or perhaps, also, the craving for salt of Natrum mur.; but the reason for many others is utterly beyond our ken at present.

For example, an intense craving for pork in a case of rheumatoid arthritis, which presented no symptoms beyond those common to this disease, put me upon the tract of Crotalus and led to the cure of the case, thought the patient had been bed-ridden for over six months.

9. One more of these general symptoms I would allude to viz.; the influence of eating. Of course, so far as it affects the stomach directly, it is only a particular, and we do not, as a rule, find it to be of much help in the selection of the remedy; but when the man as a whole is thereby influenced, and states that he feels better, or worse, all over, by eating, then it becomes a general of high rank. Especially is this the case when symptoms in parts far distant from the stomach are so influenced, such as aggravation of pains in the limbs of Indigo, or the amelioration of Natrum carb., or Kali bichromicum.

The effect of special foods is at times general, affecting the man as a whole; but as a rule, they affect only the digestive organs and in that case are merely particulars. It is through forgetting this distinction that all of us at times rank their influence too high, and are disappointed when remedies, selected more or less in accordance with them, fail to cure the case.

10. The special senses are often so closely related to the whole man that many of their symptoms are general. For example, when the patient states that the smell of food sickens him, this is a general, but if he only experiences a subjective, offensive smell in the nose, this would merely relate to the one organ and consequently would be only a particular, and of comparatively low rank.

11. General symptoms are not always recognized at once to be so, but examining a series of particular organs we find that a symptom or modality runs so strongly through them all that it may be predicated of the patient himself. Here we have general made up of a series of particulars.

For example, if we take a case in which, wherever the pain happens to be felt, whether in chest, or head, or limbs, there is relief from being on the painful side this becomes so common as to characterize the patient as a whole; or, if we find that in all organs and tissues affected the pains are boring from within outwards, as we find under Asafoetida, then this symptom can be raised from being an ordinary particular to a general of low rank; or, if the pains, wherever they may chance to be located, are always associated with numbness, as in cases requiring Plat, or Cham., then this may also be regarded as general, though, of course, of a comparatively low rank.

But there is a real danger in over doing this dependence on generals in the selection of the remedy, and a glaring example of this is seen in Boenninghausens Pocket Book. In this he overdid the generals, for he generalized many rubrics that were only particulars.

For example, writing is a rubric of particulars and in no instance is the patient himself worse from writing; but in some cases it is the eyes, from looking; in others the hand, from exertion; or in others, the back from sitting bent. If we are searching for the remedy for a headache aggravated by writing, a rubric composed after this manner would be useless. But the rubric, ” aggravation from motion” is on quite a different footing; for, if we have a case requiring, say, Bryonia, we find so many particulars aggravated by motion that it appears that the very patient himself is worse from motion, and consequently in this case motion is a general.

12. There is one other general — the greatest of them all — which I must not omit, for it is created by the blending of all the generals and particulars into one harmonious whole. For lack of a better work, we speak of, let us say, the “Sepia” constitution, meaning thereby that special diseases condition of the mind and body for which that remedy has so often proved itself curative, that we come to look upon it almost as an entity. At times it is plainly discernible by all, and capable of being described in words-such as the leucophlegmatic constitution of Calc; the tall, thin narrow-chested one of Phosphorus; or “the lean stooping, ragged philosopher,” as Hering called the Sulphur patient. Far oftener it is something much more subtle, such as that of Arg. nit., with its fears and anxieties and hidden, irrational motives for all it does.

To very few of us is it given to penetrate into these secrets, and to understand that almost indefinite something which often lies behind the mere symptoms, modifying and characterizing them all, and so becoming the governing element in the whole case. The masters in our art are those who have had power to understand this great general, and we stand amazed at their skill in penetrating right into the heart of the most complex cases and evolving order and consequent cure out of seeming chaos.

PARTICULARS.

While the general symptoms are of the highest rank, as a rule, simply because they relate to the man as a whole, we must on no account undervalue the particulars. In fact, many cases seem to be composed only of particulars, and have few or no generals of any importance. In such a case, where no one remedy corresponds to the case as a whole, we must base our selection upon those particulars that are most characteristic and peculiar; for it must be borne in mind that both generals and particulars may be either characteristic and peculiar with, say, a vague aggravation from cold and damp, an indefinite depression of spirits, or an irritability without any qualifying conditions, or not of much intensity then the characteristic particulars muse lead.

1. There is one matter in connection with prescribing for the particulars that may give rise to a difficulty in selection of the remedy. In alternating complaints, such as of eye and stomach, we may find that, say, Euphrasia is more sharply related to the eye- symptoms than the deep acting remedy that best fits the whole case, and that Puls. corresponds to the stomach ones better than the deep-acting one does. We must ever remember that there is one deep-acting remedy that is more similar to the whole patient than these special remedies, because it corresponds better to the general symptoms.

I have previously quoted Hahnemann and Kent with regard to the importance of paying heed mainly to the symptoms that are peculiar, but this is only aspect of the truth; for the highest rank of all belongs to those symptoms that only are peculiar, but are also general.

A very good example of this is a case with very high fever, let us say, of 105 degrees, yet without the least thirst. Here we have without doubt a very peculiar symptom, for the absence of thirst with such a temperature is a most unusual thing, and this thirstlessness is a general, for it is the whole man that is thirstless. Of course, if we had only temperature of, say 101 degrees, this symptom would not be specially characteristic, and consequently of comparatively low rank.

2. Before we pass from the consideration of particulars, I would call attention to the fact that common particulars may in certain circumstances assume a comparatively high rank. Two common symptoms which, if they appeared alone, would be of little importance, when associated, at once become of considerable value the coryza with polyuria of Calc. is a good example of this. In this connection it is worth noting that a remedy can cure groups of symptoms, even where they did not appear as concomitants in the proving; and this is the case even when the components of the group were observed by quite separate provers. Kent, in his great repertory, has left out the majority of concomitants, and has retained only those few that abundant clinical experience has demonstrated to be frequently associated.

Other examples of this raising of the rank of common symptom are:-.

Where the common symptom is associated with a peculiar modality, such as the chilliness of Puls., worse near the fire.

Or a special localization may emphasize a quite common symptom, such as the aching pain at the inferior angle of the right scapula of Chel.

Or finally, the mere intensity of a common symptom, such as the overwhelming sleepiness of Nux m., gives it a value that otherwise it would not possess.

OTHER IMPORTANT CLASSES.

1. Ranking close behind, or even at times taking precedence of the peculiar and general symptoms, must be placed the last- appearing symptoms of a case. These symptoms, to be of any real importance, must, of course, be outstanding and definite, and if so they are always of the first importance in the choice of the remedy. So much is this is the case that, where no remedy can be discovered that corresponds to the case as a whole, it is at times necessary to be guided almost exclusively by them. When so prescribing, it is not to be expected that the remedy will influence the case very deeply, or cause the markedly curative results; but it will modify the symptoms and open up the way for other remedies.

The foregoing refers to the symptoms that have been the last to appear, before homoeopathic treatment was instituted; but even when the appropriate homoeopathic remedy has been given and modified the case, and new symptoms have appeared, the same law holds good. Hering, however, cautions us to note that these new symptoms will generally be found amongst the symptoms of the last-given remedy, but only of low rank, and not guiding in the choice of the second remedy.

These new, or last appearing, symptoms may be old ones which had disappeared many years ago, and have now returned through the action of the first remedy. Accordingly, before using them as guides in the selection of the second remedy, we must have patience and make sure that their return is permanent, and not merely a temporary reappearance while on the way to final extinction.

2. Another very important rule of Herings, the observance of which will often prevent many mistakes and save much study, is: that the second remedy must bear a complementary relation to the first; and hence the last remedy that has acted, either homoeopathic, or allopathic, forms one of the most important guides in the selection of the second. The knowledge of this rule is a great time and trouble-saver, for in the majority of cases, a reference to the tables of related medicine would enable us to select with ease the remedy that is follow.

3. Toward the beginning of this lecture, I made passing mention of the value of old symptoms which had long ago disappeared, pointing out that, for many reasons, they are often of very uncertain value. While it is seldom advisable to give them any very high rank in the selection of the remedy, yet they are of the utmost value in confirming the choice of remedy, or in differentiating between competing remedies selected in accordance with the now active symptoms.

As an example of this, Kent mentions the case of a man who had long suffered from neuritis of the limbs, whose present symptoms did not point decisively to any one of five or six competing remedies. It was discovered that in infancy he had been affected by eczema capitis, very similar to that caused by Mezereum, one of the competing remedies, and on examination of the pains in the limbs produced by that remedy it was found that they closely resembled those now experienced by the patient. This remedy curative and reproduced the original eruption.

Dunhams well-known cure of deafness by the same remedy is another example of this use of old symptoms.

4. In the cases just mentioned, the diseases cured were not characterized by any marked pathological changes, but in cases where these changes have become quite definite it is useless, in the majority of cases, to prescribe upon the symptoms that now present themselves. We must here also seek to discover the primitive symptoms that the patient experienced long before any definite pathological change took place; and though the task, as I stated, is difficult, yet we can often obtain enough data upon which to base our prescription.

5. I need hardly say that no one, even when he was been able to obtain the fullest and most accurate description of these old symptoms, expects to be able to cure diseases that have advanced so far as to lead to practical destruction of organs and tissues. It is only the beginnings of such processes that are amenable to medicines, so far positive cure is concerned.

Robert Gibson-Miller
He was born in 1862, and was educated at Blair Lodge and the University of Glasgow, where he graduated in medicine in 1884. Early in his career he was attracted to the study of Homoeopathy, and with the object of testing the claims made for this system of medicine he undertook a visit to America. As a result of his investigations there Dr. Miller was convinced of the soundness of the homoeopathic theory. Dr. Miller did not write much, but we owe him also his Synopsis of Homoeopathic Philosophy and his small book, always at hand for reference, on Relation ship of Remedies.