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.
Even in comparatively recent and uncomplicated cases of chronic diseases, when the symptoms have been suppressed and the whole character of the disease changed, the symptoms that now present themselves must, in the great majority of cases, be our guides, though at times it may be necessary to select from amongst the competing remedies one that is known to have an antidotal relation to the suppressing drug. That is not, however, invariably the case, and it is at times necessary to give the original symptoms the higher rank ad to be guided by them, to the exclusion of those now present.
As an example of this, an otherwise healthy young man, who had suffered for over a year from sciatica, presented himself with stitching, cutting pains in the calf, worse at night, better from heat, worse in motion, relieved by flexing the limb, Coloc. and other drugs failed to give relief. It was found that the disease, which was originally located in the upper part of the nerve, had been vigorously treated by external applications, with the result that not only was the situation of the pain altered but its character and modalities had been completely changed. The original pain was of a tearing nature, and was greatly aggravated by sitting not quite so severely felt while walking and there was almost complete complete relief when lying down. Ammon mur., selected in accordance with these old symptoms, promptly cured.
7. Tonight I can make only passing reference to the so-called primary and secondary effects of drugs, to which some good prescribed have assigned different values in the selection of the remedy. So far as my experience goes, it does not seem to matter in what order the symptoms may appear in a proving if the remedy can produce them, it will also cure them, irrespective of their position in the disease, and, consequently, so far as rank is concerned we cannot differentiate between them.
PATHOLOGY.
I stated at the beginning of this lecture that Hahnemann insisted that we must be guided in the choice of the remedy almost exclusively by the symptoms, to the practical exclusion of pathology; but I think there is a good deal of confusion with regard to this matter. So far as I can see, Hahnemann did not object to the use of the pathological changes as guides for theoretical reasons, but only for practical ones.
It is true that to a limited extent it is practical to use pathology as our guide, and we all do so use it. Whenever we have to prescribe for eruptions or ulcers which are, after all, pathological changes we do not hesitate to be governed by anything that is peculiar or characteristic about them, such as their colour, shape and position, because by means of these peculiarities we can differentiate. But, when we come to deal with gross pathological changes in the deeper organs we meet with two difficulties.
In the first place, we are unable in the living patient to determine those minute differences, though doubtless they do exist, which, if discernible, would enables us to differentiate.
And, in the second place, very few of our remedies have had their provings pushed far enough to cause corresponding pathological changes.
These, I take it, are the practical reasons that led Hahnemann to ignore pathology; and, though our knowledge of this subject has enormously advanced since his day, his reasons still hold good.
But we cannot, even in the selection of the remedy, to say nothing of its absolute necessity in all questions of diagnosis and prognosis ignore pathology, for without it we cannot understand the true course and progress of a disease. Only by means of it can we know the symptoms that are common to the disease, and hence those that are peculiar to the patient. We also thereby know, at certain stages of some diseases, no matter how similar the symptoms produced by certain remedies may appear to those of the patient, yet that, owing to the superficial character of their action, it is not possible for them to prove curative.
For example, in pneumonia, in the stage of exudation, while the symptoms may apparently call for Acon., we know that this remedy, owing to the superficial nature of its action, cannot produce such a condition, and closer examination will reveal that some deeper-acting remedy, such as Sulphur or Lyc. needed.
Pathology enables us to decide, when new symptoms arise, whether they are due to the natural progress of the disease or to the action of the remedy. We must clearly understand that it is the patient that is curable, and not the disease, and without a proper understanding of pathology we are liable to err.
