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.
