The late Dr. Stuart Close defined a symptom as “any evidence of disease of change from a state of health”. This definition, while apparently all inclusive, gives no clue whatever as to be value of symptoms or to these use that can be made of them either from a diagnostic or therapeutic standpoint.
If a symptom is any evidence, then all the symptoms must constitute all the evidence of the totality of the case. Such a totality should reveal the diagnosis or nature of the disease and should also lead the physician to the indicated remedy.
If this means the numerical totality we may well feel dismayed for we have in the complicated chronic case assayed a well-nigh hopeless task were we have elicited,written down and recording all the symptoms. Imagine the job of eliciting and versatile hysteric. While the exactly indicated Homoeopathic remedy will doubtless many times cover the numerical totality of symptoms in a case, we nevertheless seldom need such a totality on which to base our prescription.
Let us for a moment compare a photograph with a portrait. The photograph includes all the lines, curves and particulars,defects and all that are exposed to the lens of the camera,in short,the numerical totality , The portrait,in the other hand, includes the,essential generals but omits numerous particulars. Nevertheless,the portrait if well done by an accomplished artists, will just as truly represent and identify the person as the photograph,. The portrait, therefore , is the artistic totality. If is this and not the numerical totality of symptoms that requires stressing in Homoeopathic practice.
Learn to know remedies as you know your friends and acquaintances. By pains taking work, close study and observation, you will more and more acquire the ability to see the image of the remedy in the symptom ensemble of the patient. Only by persistent work and effort does the novice finally becomes the artist.
Before going further let us make sure that we understand what a symptom is-what it includes. To quote Dr.Close once more, “A single symptom is more than a single act; it is a fact with its history, its origin, its location, its progress or direction and its conditions”. In other words,a mere symptom with nothing as to its nature, location,conditions and modalities is of little or no use to the physician if he is a true of follower of Hahnemann,and homoeopathy.
To illustrate; Suppose a patient comes in and says, “Doctor, cant you do something for me? I have a pain”. If he said no more and did not reveal the location of the pain, how much valuable information have you gained? Well, you could give him a hypodermic or a Placebo, but perhaps you want to help him. He may be in need of constructive relief,not mere palliation.
Generally,the patient will graphically locate the site of the pain without any special inducement. suppose it is in the upper right chest. You ask what kind of pain it is. “WHy, doctor, its like a burning”. See how we are getting out pain symptoms built up-we now have burning pain in the upper right chest.” when is the pain most severe”? “Well,I have it all the time, but it seems to get worse every night around twelve or one o,c;lock”. What relieves the pain”? “A hot water bottle”. Burning pain in upper right chest, aggravated around and after midnight, and relieved by heat. Right away we have our eye on Arsenicum, but dont reach for the remedy case too quickly.”
How does the pain affect you” Do you want to lie quiet, or what position is most comfortable for you”? “Oh, it makes me awfully nervous and restless and I cannot seem t get any peace with it. The only thing that seems to help me is the hot water bottle”. Restlessness,amelioration from, still Arsenicum,, and so you work it out. Something its easy, sometimes very difficult, but it can be done in the vast majority of cases. Now, if instead of a burning pain in the upper right chest, we had a case with stitching pains in lower right chest, with aggravation from two to live a.m. it would lead us to consider Kali carb.
Another stumbling block for man is the matter of “general symptoms” which, as Kent says, can often rule out non-agreeing particulars. A general symptoms is one affecting the patient as a whole, as coldness in general-the entire patient is cold, in merely his hands, keen or feet, If, since the onset of the illness, the patient is more chilly than he used to be, craves the heat, is better from warmth and worse from cold, you have pretty definitely excluded from your consideration all the warm and over-heated remedies in the material medica. Many times a general symptom can be synthetically constructed from a group of particulars carrying the same characteristics.
To revert again to the symptom “burning pain with amelioration from heat.”.
Burning pain in upper right chest ameliorated from heat applied.
Burning pain in stomach ameliorated by hot drinks.
Burning pain along the spine ameliorated by hot baths.
Burning of skin relieved by applied heat.
The sum of these particular burning pains and their ameliorated warrant as in assuming that this symptom isnt merely local but general and therefore of high selective value in our search for the remedy.
But suppose the same patient should have all these burning and yet a violent boring pain in the forehead, which is relieved by bathing the head in cold water. Now we could proceed on the principle that a strong general will rule out non-agreeing particulars and this methods technically correct, but in passing it will do no harm to call your attention to the fact that the complains of the body, under Arsenicum are relieved by heat, while those of the head are relieved by cold.
A further illustration: Suppose in going over a chronic case with pages of symptoms, we find, in studying over the record, and scattered throughout, the following: “Pain in right temple, stiffness of right arm, fullness and stitching in region of liver, tenderness in appendiceal region, stiffness of right knee. The vast preponderance of symptoms on the right side of he body, constitutes a general and we must select a remedy having a special affinity for the tight side.
Looking at symptoms from the standpoint of evident of clues to a case, we will realize that nothing must go unnoticed. the emergency call in the dead of night-note well the time-it may help in the selection of Arsenicum,. Kali Carb., Nux vomica or other remedies which are commonly worse after midnight. It may assist in arriving at the diagnosis. In original cases, a knowledge of the exact time the physician was called may prove of value in working out in chronology of the case.
Many physicians are exceedingly unobservant in noting objective symptoms. Possibly this is due to the stressing of laboratory findings in modern practice. The five senses are marvelous instruments of precision. They should be employed more effectively and more painstakingly than is customary with most medical men of the present day. In the sick room the objective symptoms are not necessarily all to be found by gazing at the patient. Look around the room, notice the dish of cracked ice on the stand beside the patients bed. It makes you think of Medorrhinum and Phosphorus.
Why are all the windows open on such a cold night-who wants the fresh air,the patient or the nurse? Open windows on a hot night might have little significance, but on a cold night in winter this objective symptoms means something. Perhaps its Pulsatilla? Why the fan lying on the chair beside the bed? Why doe the patient want to be fanned because he feels too warm of because he wants the air moving so that he can breathe better? If the later, it is strongly suggestive of Carbo veg. Why such a dim shaded light? Why do the members of the family tiptoe so softly around the room? Is this patient hypersensitive to light and noise, and thus easily aggravated and irritated?.
Bump against the bed and jar the patient-you will doubtless hear from him if he needs Arnica, Belladonna, Bryonia, or Nux vomica (Other remedies have the same aggravation). Listen! You can hear the breathing all other the room-coarse rattling as if the chest were full of bubbling mucus. In a young child or a real old person think of Ant. tart., especially if the nostrils are story and it is difficulty and it is difficult or impossible to raise the mucus.
Perhaps on entering the room a strong putrid or decayed odor has greeted you-Arsenicum,, Pyrogen and Psorinum have such characteristic odors, but further investigation is necessary before coming to any decision. Ask the nurse to let you see the chart. Note the temperature curve. If the patient has fever every afternoon from four oclock on to eight or nine, ask when the worst time in general seems to be. If she says four to eight o,clock or thereabouts, it brings Lycopodium to mind. If there is a very septic temperature curve with no relation between pulse rate and temperature curve with no relation between pulse rate and temperature think of Pyrogen, Particularly if the putrid or carrion-like odor is present in the room.
Another point of utmost importance-when a patient says, “Doctor, I have never been well since. ” let your ears be wide open to catch the next words of the patient, for his whole condition may have come on following the death of a loved one (look up ailments from grief in the repertory).”.
Doctor, I have never been well since. . . . ” when completed, this sentence has been the key that has unlocked many a chronic case. Why should this be so? For the reason that the determining and directional morbid impetus was associated with the grief, the fright, the vaccination, the cold ocean bathing, or whatever set the ball rolling.
If we always know the determining cause and the remedy exactly homoeopathic to the cause, many more brilliant results would be achieved.
The more accurately all these symptoms which are easily found endure the various rubrics, are reflected by the case under treatment, the more assured we may feel of the property of the choice of the remedy we have made, and the more confidently may we expect a happy result-BOENNINGHAUSEN.